Describe a Situation from Your Practice Related to Communication Between Nurse and Patient

The purpose of this essay is to describe a situation from practice related to communication between nurse and patient. The Department of Health (2003) defines communication as ‘a process that involves a meaningful exchange between at least two people to convey facts, needs, opinions, thoughts, feelings and other information through both verbal and non-verbal means. ’ Communication occurs when a person (the source) sends a message via a particular medium (the channel) so it is received by a recipient (the receiver) (Roper, Logan and Tierney, 2002).Since communication is such an integral part of everyday life, it is hardly surprising that it is emphasized as a central component in the delivery of care (LeMay, 2004). The healthcare professional is required to develop and maintain a high level of interpersonal communication in order to provide the best care possible to their patients (Silverman, Kurtz and Draper, 2005). Communication skills have been traditionally classified into two main channels; verbal and non-verbal (Williams, 1997). These must not be considered to be of individual existence as LeMay (2004) states ‘they are complimentary to each other. However, Faulkner (2000) argues that should verbal and non-verbal messages conflict, those most likely to be believed will be the non-verbal ones, therefore the focus throughout this essay will be the non-verbal aspects of communication. Non-verbal communication consists of paralanguage and kinetics. These affect how information is understood (Roper, Logan and Tierney, 2002). Paralanguage is concerned with how we use language rather than what we say. The paralinguistic features of communication are ‘the quality and tone of voice, volume, pitch, speed of speech and the use of filler words such as ‘mm-hmm’ and ‘I see’ (Williams, 1997).Kinetics is more commonly known as body language and is concerned with the messages conveyed in the movements of the body (Alexander, Fawcett and Runciman, 2002) Research by Aronoff, Woike and Hyman (1992) confirms that different postures indicate contrasting emotional states. The patient referred to will be called Harry. This is to maintain confidentiality in compliance with the Nursing and Midwifery Councils (NMC) Code of Professional Conduct (2002). Harry is a 56 year old gentleman with a hearing impairment who has been admitted to hospital after sustaining a fracture to his knee.Harry was placed in a side room on admission as he has a previous medical history of Methicillin Resistant Stapyhlococcus Aureus (MRSA). Admission to hospital has proven difficult for Harry, as he is normally a fit and independent gentleman. The morning staff reported that Harry was aggressive and uncooperative earlier in the day and reasoned this was due to feeling anxious about his impending surgery. Ellis, Gates and Kenworthy (2003) state ‘when a patient is stressed or anxious the likelihood of them displaying behaviours untypical of their norm is more apparent. The physical environment(2002) states to promote effective communication we should take measures to eliminate environmental noise, and highlights this t be of extreme importance when communicating with patients, like Harry, who have a hearing impairment. The side room provides an ideal environment for effective communication to take place as it is warm, light and free from environmental noise. The nurse informed all members of staff that she was about to discuss the surgery with Harry to ensure there were no interruptions.On entering the room, the nurse smiles and introduces herself by name and title and explains the purpose of the discussion. ‘This is important as it allows the nurse to establish a rapport with the patient’ (Williams, 1997). Research has proven that good communication between a healthcare professional and their patients results in improved patient compliance with treatment and improved recovery rates (British Journal of Nursing, 1998). The nurse positions herself directly opposite Harry. McDonnell (2002) states ‘it is important to face your hearing impaired patient as seeing you clearly ill help them to understand all information given. ’ The nurse begins by asking Harry various questions. Faulkner (2000) states there are two types of questions; open and closed. Open questions allow the patient to express their feelings whereas closed questions restrict responses to simple one word answers. The nurse allowed Harry to take control of the discussion by using open ended questions. These allowed Harry to expand on what feelings he was trying to convey. Harry appeared comfortable and happy to answer the questions.He showed this by maintaining good eye contact and smiling. ‘The face is the most important focal point for non-verbal communicating as it is the most expressive part of the body’ (Stewart and Logan, 1997). The nurse also maintained good eye contact. ‘This helps the patient to feel like their problems are of interest therefore they are more likely to discuss any issues on their mind’ (Faulkner, 2000). At times during the discussion Harry appeared reluctant to talk about some issues. To encourage Harry to express his feelings the nurse showed empathy by listening. Empathy requires attentive listening in trying to understand the world from another’s perspective whilst retaining your own separateness’ (Wondrak, 1998 and Ellis et al, 2003). The nurse paid particular attention to the detail in Harry’s descriptions of his feelings. The nurse also used touch to encourage Harry to communicate further. ‘Touch is a very powerful form of communication. It conveys feelings of reassurance, comfort and warmth and can communicate to patients that we are there to help and that we care’ (Williams, 1997).The nurse then brought the discussion to a close by summarizing the main points that were discussed and verifying that Harry had understood all information provided. She also made general remarks about being glad to have had the opportunity to talk to Harry and that she hoped she had provided some reassurance to any of his concerns. The nurse asked Harry if he was happy with the outcome, to which he replied he was. In conclusion, communication is the most vital part of nursing. Good communication is seen as a necessary prerequisite for all healthcare professionals and is taught as an integral part of all healthcare training.As a student nurse, any discussion with a patient, formal or informal is a good opportunity to observe the non-verbal skills used by a qualified professional. If learning from practice is to occur then reflection upon an experience is essential. We tend to acquire good communication skills by observing them, reflecting on them and practicing them repetitively. It is recognized that nurses need to provide information verbally, however the importance of facilitating effective communication through the skilled use of non-verbal communication is clear, and should not be underestimated in the practice setting.

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