This essay will concern the topic of communication inrelation to my placement and how I have utilised these skills to relay meaningand ideas to patients. Being able to communicate effectively as a nurse isfundamental to the role as it is a prerequisite for developing patientrelations and facilitating recovery in all its forms. According to theDepartment of Health 2010: ‘One of the most basic goals for nursing staff is toensure that their patients and clients and those who care for them experienceeffective communication’. The process of using and developing communicationskills is a continual one which influences all aspects of a patients care,making it the role of a nurse to be adaptable. Subsequently, nurses should beable to relate to patients and accept their needs regardless of any perceiveddifferences (unconditional positive regard), this links closely with emotionalintelligence as it is a facilitator of affective and meaningful interactionsamong diverse groups of patients. This essay will discuss two interactions thatI had with patients, assessing the strengths and weaknesses present in mycommunication with them, while honouring both the privacy and confidentialityof patient information. A patient’s right to confidentiality and privacy arepivotal, and must be upheld by nurses under all circumstances. The Nursing and Midwifery Council (2008)Code of Conduct obliges by law that nurses must respect and uphold patient’srights to confidentiality and privacy.
The code is structured around four mainthemes: prioritise people, practise effectively, preserve safety and promoteprofessionalism and trust. These will feature heavily as they mean that a nurseshould be dignified in their approach to patients and must monitor theinformation they share with others, judging it in alignment and per the NMCcode of conduct. Therefore, for the purposes of this essay I will label my firstpatient with the name patient A and my second patient with the name patient B,with any personal or identifiable information being altered to protect theirprivacy and dignity. Permission for the use of our interactions has beengranted and they have been informed of my obligations in relation toprofessional, moral, and safe practice. The first interactionI partook in was with an individual known as patient A, for the purposes ofconfidentiality. This patient suffered from persistent delusional disorder,this is characterised by having unshakable beliefs which are not true orimaginary (delusions). Patient A believed that they were was being controlledand manipulated by electricity, via an application outside of their control.
This delusion was based on their experiences with neighbours that moved next tothem. They would feel electrical currents passing through their legs and eyes,this would sometimes cause them pain and was especially prevalent at night. Inaddition to this they would lose awareness of their left leg, as if it haddisappeared.
Patient A, believed this was a phenomenon brought on by electricalapplications that their new neighbours used. They believed they werecontrolling them and inflicting these electrical shocks. The patient becamevery sensitive to electrical equipment in their environment and had them all checkedto gain some clarity on the issue. Patient A accepted the fact that theseexperiences caused them a lot of anguish as they had to deal with selling theirhome.During theconversation, I asked patient A about their social life and how selling theirhome and moving could affect this component of their life as they had lots offriends where they lived. This was a very testing time as they found itdifficult to describe what moving could mean for the future mental health. Theydescribed how their family had always been supportive of treatment, they lookedforward to seeing them more often and enjoying their life. Family and supporthave been a key theme throughout my interactions with patients, patient A spokehighly of their daughter’s success, but did express that they missed seeing heras she lives abroad.
This led to a more in depth conversation regarding life,people’s values, and what matters to different people. This is a very importantaspect of communication as it allows a nurse to ascertain what makes the patientwho they are and where they are in their journey within the healthcare settingand outside of it, these are two vital components of recovery and to establishingtherapeutic relationships. We also spoke about more jovial matter as we weresitting in the lounge, this helped to diffuse any tension had and helped themfeel at ease. It was apparent that they wanted to improve their condition andhad a sense of optimism about moving forward and overcoming their currentproblem. Patient A, was very emotional about this transition, they were stillconfused about their experiences with electricity, but felt that a new settingwould help.In retrospect, therewere several areas of my interactions which I believe constitute towards mystrengths in communication.
During our conversation, I conveyed warmth andcompassion towards patient A and allowed them to freely express themselves,asking open and closed questions about their condition for insight showinggenuine concern. It was extremely important for me to show empathy. This is adifficult skill to demonstrate, however I felt that during this conversation itwas a pivotal component as it allowed me to show care and appreciation for theirfeelings. This is a very important part of care and the values that the NHS strivesto embody in daily practice, otherwise known as the 6C’s (care, compassion,courage, commitment, and competence).
Through my body language andcommunication, I showed compassion and empathised with their feelings I usedreflection and paraphrasing which allowed us to explore the feelings they had,this helped us to relate to each other. Moreover, compassion allows patients tofeel more comfortable with themselves and their condition, this subsequentlyhelps them to improve their lives. I was also very aware of the emotionsinvolved and gave the patient a chance to express how they felt on many levelswithout interrupting them. I clearly demonstrated Carl Roger three corecompetencies (empathy, congruence, and unconditional positive regard).On the other hand, Icould have improved my interaction by making use of Gerard Egans SOLER theory(non-verbal communication) standing for: sitting squarely, observe and openposture, lean forward, establish eye contact, and relax. During my initial conversationwith patient A, I was sitting next to them while they were watching thetelevision rather than facing them squarely which meant that I could not makeeye contact regularly and gauge their emotions which is crucial in gainingrapport and showing compassion. This seating arrangement subsequently hinderedmy ability to use non-verbal communication effectively.
Furthermore, this alsohindered my ability to interpret the non-verbal communication elicited by thepatient, according to Carter Kessler and Paper (1999) the ability of a nurse toread non-verbal communication is vital in establishing and maintaining therapeuticrelationships. Therefore, in the future it is important that I employ the SOLERtheory and acknowledge the importance of non-verbal communication and howimportant it is in initial meetings with patients. The ‘NHS Plan’ (2000) recognises thesignificance of communication for preregistered nurses and the necessity forcontinual improvement. Upon registration, it is important for nurses to ‘havethe ability to recognise their communication skills limitations in practise andbe committed to personnel development in this area’ (DOH, 2000, NMC, 2008).
Irecognised this in my interaction with patient A as communication was betweenmultidisciplinary teams and family. It was important for me to balance showingempathy and compassion with attaining knowledge about the patient so that Icould communicate with them and understand their care needs, feedback couldthen be given.According to Carl Rogerempathetic listening means: ‘entering the private perceptual world of the otherand becoming thoroughly at home in it. It involves being sensitive moment bymoment, to the changing felt meanings which flow in the other person, to thefear or rage or tenderness or confusion or whatever that he or she isexperiencing. It means temporarily living in the other’s life, moving in itdelicately without making judgements’. This reveals how difficult it is totruly listen to a patient and how this aspect of communication is one for continuousdevelopment in the future.
Moreover, this is essential in providing personcentred care as every individual ‘private perceptual world’ is different andrequires different elements of care. Although empathetic listening was one ofmy strengths with this patient this is still an aspect of communication that Ican improve on as empathetic listening can be enhanced when incorporating theSOLER theory of communication. Showing concern for a patient through facialexpressions and body language can help to establish therapeutic relationshipsmore quickly and effectively. My second interactionwas with patient B.
This individual suffered with Bipolar affective disorderwhich included manic episodes. Bipolar disorder is a mental condition marked byalternating periods of elation and depression. This meant that they went throughmanic periods where they were very active and outgoing and other periods whereshe was very depressed. I enjoyed my conversation with Miss B, although hermood and persona did fluctuate she was very interesting. I believe thatlearning about an individual’s life and experiences is fundamental to being aneffective nurse who can relate to patients and embrace their multifaceted needs.
Glat and Stover (2007) argue that familiarity with patients: experiences,thoughts, emotions (affects) and behaviour provides a good schema thatfacilitates “clinical mindfulness” as opposed to “clinical drift”. This wasparticularly pertinent in my conversation as Miss A was an elderly woman whoexperienced conflicting emotions and many stressors which needed to beconsidered in her assessment.When communicatingwith patients their needs are paramount and it is important to have anunderstand of all aspects of care in a multidisciplinary team, for this reasonI worked closely with healthcare assistants, occupational therapist, nursingstaff and observed ward rounds.
I spoke frequently with Miss B about herpersonal life and how it had affected her mental health and lifestyle. We mainly conversed about her sectioning andhow she felt it was unjust and preventing her from being happy. Her sectiondictated that medication was mandatory and could be forced upon her, beforereceiving a depot injection she became very aggressive and needed to berestrained by ‘teamwork’ who were accompanied by two nurses. This was requiredbecause she was not taking medication and has had to be restrained numeroustimes while on the ward. We discussed therelationship that she had with her husband and how this has affected her mentalhealth and way of life, I empathised with this aspect of her life and noticedthe importance of relationships in recovery from mental illness. It wasapparent that her family was important to her as she spoke fondly of hergrandchildren and her influence in their lives. Her habits in terms of smoking werealso discussed, she had been smoking for over 55 years but didn’t suffer fromthe same symptoms most people under similar circumstances would.
She did notfeel that she needed treatment and often refused medication against the adviceof staff, this led to her being put on a section three. She explained to me howshe felt as if she was trapped and not getting the appropriate care she needed. These communicationskills are important when assessing a patient because they allow a nurse toempathise with a patient and ascertain what their current problem is and howthey can be treated. This lead to a diagnosis and a prognosis which can be usedto create an affective care plan which is holistic in its approach totreatment. These skills are integral to the maintenance and execution of a careplan as communication and understanding form the basis of recovery and goodhealth. On the other hand,there were several areas where I could have improved.
I felt that I could haveshown more understanding by moderating the way I spoke to her by paraphrasing.These are two vital skills in communication as they show that an individual hascompassion and understanding of a patient’s situation. This helps to showcongruence (genuineness), by paraphrasing a nurse shows that they have not onlylistened to the patient but also tried to empathise with their circumstances. Furthermore,the use of reflecting could have been deployed more throughout ourconversations as there was a need for clarity when I spoke to her. The patient’sbehaviour was very unpredictable and she could sometimes be aggressive,therefore it was important for staff to show unconditional positive regardtowards the patient even if they had negative experiences with her. I felt thatthe staffs attitude towards her was affected by her behaviour towards them,this inevitably affected the care we collectively gave her at times. It couldbe argued that we were less attentive to her care and therefore having unconditionalpositive regard for her, regardless of the circumstances would have preventedcountertransference and improved my performance helping me to be more alignedwith the NMC guidelines.
Additionally, I couldhave listened more actively. Miss B was a very energic and active patientduring manic episodes, therefore it was often hard to continuously listen toher and follow her conversations. Burnard (2005) describes three main aspects tothe active listening process, they include: linguistic, paralinguistic, andnon-verbal.
These aspects of listening are all crucial to empathising withpatients, a key component of this is attention. Bernard differentiated thelistening process from the ‘attending’ process, he distinguishes three separatepossible zones of attention. Zone one is where an individual is solelyattentive to the patient outside of them rather than any internal dialogue(zone two) or fantasy (zone three). Miss B was very expressive and thereforerequired active listening and engagement. During my interactions with her Ifound it very difficult to always be attentive, our conversations were lessstructured and I was more susceptible to becoming distracted by my own thoughtsand feelings. This hindered me from fully appreciating her feelings andperspective on the care she was receiving from myself and the team. Miss Boften expressed her feelings through her body language (non-verbalcommunication) rather than speech, therefore it was even more important for meto recognise how she was presenting herself on a regular basis. Knowledge ofher non-verbal communication could help prevent future acts of aggressiontowards staff and help staff to modify and develop her care plan.
In conclusion, for myfuture development I would like to improve my non-verbal communication. Thisincludes how I present myself to patients, specifically my sitting position andmetacommunication. This is an overlooked area of communication.
I could also makebetter use of feedback, using open and closed questioning. This would allow meto explore what patients know about themselves but perhaps not shared, this isimportant in helping patients with mental illness to manage their illness. Inthe Johari Window model (Joseph Luft and Harry Ingham) this is known as the’hidden self’. The patients I spoke to were very welcoming and easy to talk to.In the future, it will be more beneficial for my development if I challengedmyself with less accommodating patients who require a larger and more diverseset of communication skills. As I develop and begin to make care plans forpatients and address their needs it is important for me to acknowledge theimportance of communication skills in this process. Peplau’s suggests thatthere are four phases to the therapeutic nurse-patient relationship theyinclude: orientation, identification, exploitation, and resolution.
Presently Iam not able to fully engage at each with patients due to my lack of knowledge,as I acquire more knowledge it is important that my communication skills aresufficient to facilitate therapeutic relations throughout the patient’s journey References:Egan G, 2014, TheSkilled Helper: A Client-centred Approach, Europe, Middle East & AfricanEdition, CengageLearning EMEA, Hampshire, UK.Carl Roger (2014: 63) empatheticlistening means: ‘entering the private perceptual world of the other andbecoming thoroughly at home in it. It involves being sensitive moment bymoment, to the changing felt meanings which flow in the other person, to thefear or rage or tenderness or confusion or whatever that he or she isexperiencing.
It means temporarily living in the other’s life, moving in itdelicately without making judgements’. Glat and Stover(2007), (2014: 64) argue that familiarity with patients: experiences, thoughts,emotions (affects) and behaviour provides a good schema that facilitates”clinical mindfulness” as opposed to “clinical drift”.Carter Kessler andPaper (1999), (2014: 69) the importance of non-verbal communication.Gerrard Egans SOLERtheory (non-verbal communication) standing for: sitting squarely, observe andopen posture, lean forward, establish eye contact, and relax. (2014: 58-59).Burnard P, (1992: 50),Effective communication skills for Health Professionals, Chapman & Hall,Hong Kong. Active listening skills.Silverman J, Kurtz S,Draper J, (2005), Skills for Communicating with Patients (second edition),Radcliffe Publishing, Oxford.
Hargie O, (1997), TheHandbook of Communication Skills (third edition), Routledge Taylor and FrancisGroup, London and New York. Accessedon the 26/04/17: Hildegard E Peplau:Theory of Interpersonal Relations (2011). Nursing Theories Website.
Dataretrieved from: http://nursingtheories.weebly.com/hildegard-e-peplau.
htmlThe 6Cs: Defining the 6Cs (09/09/2015). Health CareersWebsite. Data retrieved from: https://www.healthcareers.nhs.
uk/about/working-health/6csCarl Rogers’ CoreCompetencies (05/05/2012), Chenoyceil website. Data retrieved from: https://chenoyceil.wordpress.com/2012/05/05/carl-rogers/The NMC communication competencies (page 24). Dataretrieved from: http://www.bcu.ac.uk/cmsproxyimage?path=/_media/docs/standards%20for%20pre-registration%20education.
pdfCore communication skills in mental health nursing. Dataretrieved from: http://www.colleaga.org/sites/default/files/attachments/core%20communication%20skills.pdfAccessedon 28/04/17:TheJohari Window (JosephLuft and Harry Ingham).
Data retrieved from: http://www.businessballs.com/johariwindowmodel.htmTheNHS plan. Data retrieved from: http://pns.dgs.pt/files/2010/03/pnsuk1.pdf