Annex A: Communication & Relationship Skills

A patient with dementia becomes distressed and keeps asking where their (deceased) husband is. What communication approach is most appropriate?

• AIgnore the question and carry on with the task in hand, since answering it only encourages the confusion and prolongs the distress
• BRespond to the feeling behind the question with reassurance and gentle redirection, rather than correcting them repeatedly✓
• CTell them their husband is on his way and will be here soon, so that they calm down and the ward stays quiet for the other patients
• DTell them plainly and clearly each time that their husband died some years ago, so that they understand the truth and stop asking

Answer: Repeated reorientation to a painful loss causes fresh grief each time; validation and redirection meet the emotional need without lying. Ignoring the person or fabricating a comforting story are both poor practice.

A patient who does not speak English needs to give consent for a procedure. What is the correct way to communicate?

• AUse a professional interpreter, and check the patient's understanding through them✓
• BSpeak slowly and loudly in English and use gestures until the patient nods
• CUse an online translation app on your phone to explain the procedure
• DUse the patient's teenage child to interpret, since they are fluent in both languages

Answer: Consent requires genuine understanding, which needs a professional interpreter; family members, and especially children, should not interpret for clinical decisions. Gestures and phone apps are not reliable enough for consent.

What is meant by 'active listening' in a clinical conversation?

• ANodding regularly so that the patient feels they have been heard
• BGiving full attention, reflecting back what has been said, and checking understanding before responding✓
• CListening while completing documentation so that time is used efficiently
• DInterrupting to correct inaccuracies as soon as they arise

Answer: Active listening is a skill: attention, reflection and clarification show the person they have been understood and reveal what they actually mean. Multitasking, interrupting and nodding without engagement are its opposites.

A nursing associate needs to break the news to a patient that their planned operation has been cancelled for the second time. Which approach is best?

• AAsk the ward clerk to telephone the patient's family to pass on the news, since relatives are better placed to break it gently at the bedside
• BTell them face to face as soon as possible, acknowledge their frustration, explain what will happen next, and record the conversation✓
• CLeave a written note on the bedside table explaining the cancellation, so that the patient finds out in private without an awkward conversation
• DWait until the new date has been confirmed by the surgical team before saying anything at all to the patient about the cancellation

Answer: Bad news is delivered in person, promptly and honestly, with acknowledgement of its impact and clarity about the next step. Notes, delegation to non-clinical staff, and delay all treat the patient as a problem to be managed.

Which of these is an example of a closed question?

• AWhat makes your pain better or worse?
• BTell me about your pain.
• CHave you had any pain today?✓
• DHow has your pain been today?

Answer: A closed question invites a yes-or-no answer, which is useful for specific checks. Open questions ('How', 'Tell me', 'What') invite the person to describe their experience in their own words.

A patient who is deaf and uses British Sign Language attends for a wound check. The nursing associate does not sign. What is the best approach?

• AAsk the patient's friend who came with them to sign the conversation
• BBook a BSL interpreter, and in the meantime use written notes and check the patient's preferred way of communicating✓
• CSpeak clearly and slowly, facing the patient so that they can lip-read, since most deaf people manage well that way
• DUse gestures and pointing, since a wound check does not need much discussion and an interpreter would take days to book

Answer: The Accessible Information Standard requires providers to meet the communication needs of people with sensory loss. Many deaf people do not lip-read reliably, friends are not appropriate interpreters for clinical matters, and gestures cannot convey wound care advice.

A patient becomes angry and raises their voice about a delay in their care. Which de-escalation technique is most appropriate first?

• ATell them firmly that shouting will not get them seen any sooner
• BWalk away immediately and return only when they have calmed down
• CStay calm, keep a non-threatening posture, acknowledge their frustration and listen to the concern✓
• DMatch their volume so that they understand you are taking them seriously

Answer: De-escalation starts with calm body language, acknowledgement and listening, which usually reduces anger. Matching aggression, abrupt withdrawal, or confrontation tend to escalate the situation.

A nursing associate is documenting a conversation in which a patient disclosed a safeguarding concern. What should the record contain?

• AOnly the fact that a disclosure was made, since the details are confidential
• BA summary in the nursing associate's words with any distressing details left out
• CThe patient's own words as far as possible, the date and time, who was present, and the actions taken✓
• DThe nursing associate's interpretation of whether the allegation is likely to be true, based on their knowledge of the family

Answer: Safeguarding records must be factual, contemporaneous and verbatim where possible, because they may be relied on in an investigation. Paraphrasing, omitting detail, or adding personal judgements about credibility all weaken the record.