NHS England has published guidance on a technique known as active listening, which can improve communication and outcomes in healthcare.

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What is active listening and when should nurses use it?

British Association for Counselling and Psychotherapy (BACP) governor Ewan Irvine says: ‘Active listening is much more than hearing the words spoken by someone – it’s the art of understanding the meaning behind the words. It’s about creating the environment where the speaker feels heard, seen and understood.’

This is achieved using techniques such as summarising what the person has said and repeating back to them, employing open body language and asking open-ended questions.

Registered mental health nurse Lucy Webb, who wrote about active listening in the book Nursing: Communication Skills in Practice, describes it as ‘an interactive performance that uses verbal and vocal behaviour and non-verbal cues’.

Dr Webb, who is reader in psychosocial health at Manchester Metropolitan University, says: ‘This encourages the other person to engage, be reflective or simply give more information.

‘There is no time when a nurse should not be using active listening. Not using it gives the message that the nurse is not interested or does not value the other person.’

Five tips to improve your active listening skills

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UK Council for Psychotherapy spokesperson Julia Arnold’s five tips to improve active listening practice:

• » Ensure you have undisturbed, confidential time to be with the patient

• » Be fully present Practise focusing and not being distracted by your own thoughts and reactions, or by noises and other people around you

• » Look at the patient and listen to what they are saying

• » Be aware of non-verbal communication– for example, signs that may suggest confusion or anxiety. Then check with the patient to see if that is what they are feeling

• » Ensure you have clinical supervision to support you when working with patients experiencing trauma – and use it to develop your skills

What skills help in the practice of active listening?

Dr Webb advises using open body language and open-ended questions, or repeating what the person said to check you have understood them correctly and to show that you are listening.

‘Positioning is also important – getting down to the same level as the person and not sitting behind a desk,’ she says. ‘Match the pace of speech or thinking of the patient. Older people and those with impairments can take longer to process information. This is something newer nurses may forget.’

Mr Irvine adds: ‘Summarise what a patient has said back to them. Even if we summarise wrongly, it allows the person to clarify and this often results in them giving more information.

‘Active listening also involves giving the other person time to explore their thoughts – moments of silence can often be important.’

Why is active listening important for nurses?

‘Active listening is the most important strategy for building a nurse-patient relationship,’ says Dr Webb. ‘The best clinical skills become less relevant if the nurse cannot relate positively to people.

‘When a nurse uses active listening, the patient feels they are listened to, can say something they may be reluctant to disclose and ask questions, and feel valued. We cannot deliver good care if we don’t know what that care should be.’

What are some of the challenges nurses may face when trying to listen actively?

‘The hospital environment and our need to get work done are major barriers to active listening,’ says Dr Webb.

‘Sometimes nurses also need to make an extra effort to reduce patient-generated barriers, such as anger and anxiety or mistrust and depression, which can slow thinking and delay responses. There are also physical barriers, such as talking on the phone, when you aren’t able to see the person’s body language.

‘Two techniques to deal with challenging situations are eye contact and waiting. Look the person in the eye with an expression of interest as they talk to you, and give them time to think and answer. Be comfortable sitting with them in silence even when you are on the phone.’

What advice is there for active listening if English is not your first language, or your patient’s?

‘I go back to matching the pace of the other person – slowing down and clarifying that you have understood what they mean and that they have understood you,’ says Dr Webb. ‘Ask them to say in their own words what you have just said.

‘Most importantly, you cannot be in a hurry. Even if you try to sit still and listen, if you feel hurried in your own mind, it will show in your body language. If the nurse gives themselves the time to listen, they will be able to give the person the time to speak.’