Reassurance in nursing

The aim of this study is to identify the ways in which nurses can be effective in helping anxious patients to feel calmer or more secure. This subject is important to all nurses who work in close day-to-day contact with people under stress. The study uses the Inferential Model of Communication as its main theoretical foundation, emphasising the value of identifying the intentions of the communicator and the inferences made by the respondent. It establishes a Nursing definition of the verb "to reassure" as "an attempt by nurses to communicate with patients who are anxious, worried or distressed with the intention of inducing them to predict that they are safe or safer than they presently believe or fear".

The literature review reveals few research-based studies which explicitly refer to "reassurance", but many experimental studies of interventions designed to calm anxious patients. The inferential model helps to highlight the theoretical inadequacies of interventions based on "information-giving", and demonstrates the importance of the distinction between prediction and control in aversive situations.

Grounded Theory methods were used to collect and analyse a total of 351 Critical Incidents reported in writing by 202 nurses, and in tape-recorded interviews by a further fifty-one nurses and fifty-one patients. The incidents were drawn from the experience of nurses and patients in a wide variety of clinical settings, including general hospital, community, psychiatric and mental handicap settings. A set of descriptive categories was developed from this database to code all the incidents collected. The classification scheme was tested for inter-rater coding reliability, yielding agreement levels of ninety per cent or higher in most categories.

The results show that the nurses used five helping strategies - prediction, support, patient control, distraction and direct action. Of these, only the first two are always forms of "reassurance" as defined above. It appears that rational choice of a helping strategy requires nurses to compare their views of the aversiveness of patients' situations with the views of the patients themselves. Out of this comparative assessment, the study suggests that it is possible to predict which helping strategies are most likely to be effective in inducing patients to feel calmer, and which ones may have undesirable side-effects.

The study concludes by offering some suggestions for further research, arguing that the inferential model of communication has demonstrated its potential as a powerful tool for the analysis of nurse-patient communication.