It's common sense and professional, still in our busy schedules many of us forget to include our patients in the most basic aspects of their care.  In doing so, we lose an opportunity to build trust and confidence regarding our care.  Yes, it takes a few minutes, but if those few minutes mean the difference between an angry patient or family and a subsequent lousy work day.  If it keeps us from being named in a law suit, if it allows us to do our jobs better, then shouldn't it be worth the extra minute?

The flip-side of this is allowing our patient to feel they can ask questions.  It's easy to forget that the nurse is supposed to be the patient advocate when we feel they are questioning our care, but in reality it is their health and their body on the line.  They should make sure they're comfortable with our care and we should make sure that assurance is present without the patient having to ask for it.

In a recent study, the patient's comfort level addressing their healthcare providers with questions was assessed.  Its results confirmed what many nurses all ready know: patients who are undereducated or financially challenged are very reluctant to direct even the simplest question to their physicians.  Male patients especially will often go without basic knowledge and answers simply because it exposes their fears or feelings of inadequacy in front of those they perceive as having "control" over their health.  In reality, do we invite or shun a patient's questions and concerns?  How many times have you had a patient tell you, "I'm sorry for asking," or "I'm sorry for bothering you," or even "I can tell you're busy, I can wait."  A patient should never have to apologize for their presence or needs.

The minute we walk into a patient's space, they should have our undivided attention and they should always feel safe in our presence.  Consider how carefully you are providing answers to these basic questions with your patients.  Consider how you, yourself, would feel if you had to ask these same questions of someone taking care of you.

• Who am I?  Everyone appreciates being called by name, this is especially important for those who trust you to treat them appropriately.  Call them by name, ask for identifying information, check name bands before any medication or procedure.
• Who are you?  Always identify yourself when first entering a room and keep your identification visible.
• What do you need?  Every procedure or approach to a patient should be done with permission.  State clearly what your purpose in their room is and as much as possible honor their wishes.
• Can you tell me again?  Establishing informed consent is the duty of every medical professional.  Make sure the patient clearly understands what will be happening.
• Will it hurt?  In conjunction with informed consent is honesty.  If it's going to hurt, tell them honestly the extent and type.
• Did you wash your hands?  Before approaching make sure the patient can see you cleaning your hands and community equipment, such as stethoscopes, for their safety.
• What are you doing/giving to me?  Even after the initial explanation, if the process is extensive, keep them informed of what each step entails.  Identify all medications by name and function.
• What should I expect to happen next?  Give the patient an idea of expected outcomes, when they should see these changes and what you are looking for.
• When will you be back?  Never leave a patient's room without giving some sort of general time frame for when they should expect you next.  If you'll be back in 15 minutes, tell them.  If you're trying to minimize interruptions so they can sleep, tell them.
• Where have you been?  If you are unable to honor the agreements you have made with the patient, take the time to apologize.
• Can I ask a question?  This is the most basic of all; did you invite each patient to ask questions or voice concerns.

The next time you walk into a patient's room, think about the kinds of questions they might have and answer them before the patient asks.  It takes just a little thought, consideration and an extra minute to keep our patients feeling informed and safe within our care.  No one faults the careful nurse who clearly shows she is trying to follow rules and respect their patients.

References
Davis, R. E., Koutantji, M., Vincent, C. A. How willing are patients to question healthcare staff on issues related to the quality and safety of their healthcare? An exploratory study. Quality and Safety in Health Care, BMJ Publishing Group Ltd. 17:90-96, 2008.

Parker-Pope, T. Doctor, Did You Wash Your Hands? Well. April 3, 2008.

Copyright 2008- American Society of Registered Nurses (ASRN.ORG)-All Rights