Enhancing Communication Skills

The reflection in this essay is to share the experiences, gathered from caring for patients within the other fields of nursing, such as learning disability, mental health, child and midwifery disciplines. The focused theme of this essay is communication, which I strongly see as foundation for my nursing practice. This essay will explore evidence-based research to support the varying communication styles, which I have adopted and highlighted the areas for improvement.

Looking back on my experience, I reflect on the areas, which I need to improve, if I would face the similar situation in the future, therefore reflection on action is a retrospect analysis of what happened in practice to enable proper improvement on practice and enhance the personal/ professional development and change (Prince and Harrington, 2016; NMC, 2018). Through reflection, the nurses can apply evidence-based understanding into real life situation in practice (Siviter, 2013). Thus, it enables the individuals to identify the weaknesses and strengths, which ease in creation of self-awareness and useful capabilities for future development and improvement (Parbury, 2017). Through reflection, the healthcare professional deliberate on their achievement and incident in other to adopt best possible care for their patient. It also brings about balance between high-quality cares and cost effectiveness to National Health Service by bringing to light, high standard care, which are cost effective in practice (McCarthy et al., 2011).

Reflecting on my experience on other fields of nursing, I realised, the importance of communication methods used, when communicating and assessing the patient’s needs. Verbal and Non-verbal means, such as speech; body language, facial expression, pictures, cards, are used in practice based to identify the patient communication needs and condition (Webb and Holland 2011).

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Going by De Vito (2011), communication in its simplest sense, is an act that transmits information from sender to receiver through verbal and non-verbal mode, however, Boyd and Dare (2014) noted communication can be a complicated process especially in nursing profession as nurses often give great deal of information and must do it effectively. This definition has highlighted important learning intuitions during my placement. According to Webb and Holland (2011), good communication skills are vital element in establishing a therapeutic relationship with the patients in nursing practice. This was pronounced and consistence on my interactions with patients during my placements. In addition, Castells (2013) stated that, good and effective communication is fundamental in framing good and effective professional relationship between nurses and the patients. When combining communication with respect, dignity, compassion and wellbeing, it sets in groundwork for good practice, this result to positive influence on patient outcome (Nursing and Midwifery Council, 2018).

My exposure to care for a learning disability and autistic patient who has very limited speech put my communication skills into trial. I will give a pseudonym Mr P to maintain patient’s confidentiality in compliance with the Nursing and Midwifery council code of conduct (2018), which employs the nurses to respect the right to privacy and confidentiality of their patient. Mr P was admitted following radiator burn sustained during an episode of epilepsy. Nevertheless, there was no care plan, passport or picture exchange communication system (PECS) to communicate with Mr P, which made it difficult for me to get Mr P compliance during the episode of personal care. A passport provides important information about a patient with learning disability, his medication, pre-existing health conditions, communication needs, likes and dislikes (Mencap, 2019). PECS are the tools informing of pictures and card that help the people with little or no communication abilities to communicate with others (National Autism Resources, 2019). Due to this situation, it was challenging to immediately assess Mr P’s needs through communication, as he appeared troubled and restless as a result of possibly new environment, unfamiliar face and inability to voice-out his feelings due to his limited speech. This was evident in Philips (2012) literature review, which found that hospital environment; inability to communicate needs and feeling; being ignored by staff, can contribute to frustration, fear, anxiety and anger among people with learning disability. Also, Arnold and Boggs (2016) acknowledged these challenges among these population group but stated that, the individual has different mechanism to cope with the challenges. Furthermore, National Institute of Mental Health defines autism as a lifetime developmental disability, where the individuals face challenges with their social skills, behavioural pattern, verbal and nonverbal communication skills, relationship and interaction with others and their perception of the world around them. As my mentor approach to explain and gain Mr P consent for episode of personal care (as Mr P was double incontinent), he became anxious and agitated, all effort to get his compliance proved abortive rather his anxiety heightened so we couldn’t carry on at the time. As we were attending to another patient, I kept questioning our communication style as why we could not get his consent. Moss (2017) emphasised that, nonverbal communication has greater impact as compared to verbal and that patient effortlessly infer meaning, but our effort to use nonverbal communication did not yield result. With further research, I have learnt about social communication impairment, associated with autistic individual. According to Crawford et al., (2016) and Philips (2012), they lack the ability to read expression from the face, voice tone, rather they look at other irrelevant part of the face or environment in other to make meaning of the information passed to them. This experience promote barrier in communication, which further affects in building a therapeutic relationship between patient and carer (Zack, Castonguay and Boswell, 2007).

(2019) identifies noises in every communication, known as interference or disturbances which pose communication challenge between the sender and receiver. These noises can present as psychological, cultural, sematic organisation or physical impairment (McCabe and Timmins 2013). Mr P was affected by sematic noise as he misinterpreted our intention; and this heightened his anxiety and agitation (Klatte, Bergström and Lachmann, 2013). However, Boggs (2016) alerted that, the level of anxiety for autistic patient get high, therefore it is important that, time is allowed, for them to process the information. With my mentor’s awareness, I returned to Mr P and with the use of cleaned pad and sheet, where I made gesture to explain further about our intention which proved effective. Kita, Alibali and Chu, (2017), supported this by saying that, gesture is very important method in nonverbal communication, because they express ideas, feeling, attitudes, and aids in cognition change and give courage.

On the contrary, my experience with a paediatric patient was more positive as I have become more aware of the impact communication has on building therapeutic relationship. This patient, whom I have given the pseudonym the child, was scheduled for myringotomy procedure (opening and repairing of the middle ear due to damage from infection or cold). She was accompanied by her parent, but she was anxious and fearful of the procedure. I engaged with her through eye contact, tactical encouragement and expressive touch to get her calm, so the anaesthetist can carry on with their work. Stonehouse (2017) infers, the nurses use touch to convey reassurance, emotions, compassion and empathy to provide comfort and strength and liberate her from feeling of anxiety and tension. This experience created a bond and established therapeutic relationship with the child. Compassionate care positively influences on patient communication irrespective of age, Van der Cingel (2011) stated that, when compassion is demonstrated to patient, it facilitates cooperation and participation in their care. This is supported by NMC code of conduct 2018, which established all the nurses to show compassion, when providing cares to ensure a safe, comforting and reassuring environment.

Healthcare professionals specifically nurses, daily encounter the challenges, which varies from one individual to another in course of their practice. Bereavement and watching a relative received bad news either from me or colleague have been one of the worst experiences that I have encountered and I noted as area for improvement. During my placement in the recovery, I was asked to carry out the post-operative routine on lady who had Dilation and Curettage (D&C) due to miscarriage. I employed a different communication style from that of the paediatric and the learning disability patients.

On hearing a new born cry from the next trolley, her emotional agony was escalated to tears, and this affected my emotional composure, as I tried not to speak a word to control my emotion. Although, I did not share tears, but my facial expression depict emotional sympathy and I realised at the time, if I am to utter a word it would end up in tears and may heightened her emotion. However, as she was highly emotional and in no place to talk I used compassionate person-centred care to empathise with her, which I believed at the time would be more effective to communicate to her, and also in-line with NMC (2018) code of conduct that mandate nurses to recognise a patient in distress to provide a polite and compassionate care. Also, Baughan and Smith, (2013) asserted that, compassionate care aids in changing emotion better than giving sympathy to the situation. To further show compassion and empathy through reassurance, I softly hold her hand and upheld eye contact. Morrissey and Callaghan (2011) supported that, expressive touch is a healing and compassionate act, which has positive impact on emotion and offer comfort and strength. Agreeably, Stonehouse (2017), noted that, liberating intervention heartens the patient to release their anxiety and emotion which releases tension. Research also proved that, touch brings emotional balance and better health. On the contrary, when looking after a patient suffering from depression and suicidal behaviour as a result of sexual abuse she experienced in her childhood, I used active listening to enable her to express herself, literature hold that listening offers patients the chance to voice their worries. Moreso, Morrissey and Callaghan, (2011) asserted that, listening creates in the patient the feeling of being respected, dignity as human, being cared rather than being ignored. I was assigned to take her vital signs, as she declined on several occasion. On entering her room, she was constantly saying things that make no sense and wouldn’t let anybody touch her. I was prompted to sit down and just listen in other to build that rapport with her. Burnard and Gill, (2013) stated that, it is of the idea that good listening encourages foundation for building rapport between the nurse and patient. I occasionally nodded and verbalised in agreement and paraphrased her in own words to ensure that, I am listening and respectful of her feeling, thereby creating a trustworthy relationship, and as a result, the patient was able to bring her arm forward, so I could rap the BP cuff around her arm to check her vital sign. This was done without any resistant from her rather the patient was seen smiling and questioning my decision to become a nurse. Also, she became relaxed and calmly asked, if I could make a nice milky coffee with 2 biscuit for her, which I did without hesitation, as the patient is known to refuse food or drink. This showed development of patient trust in me and convey a ground for therapeutic relationship, which was born out of therapeutic communication. Also, the act of active listening and intentional silent that I displayed helped her to ponder the information and gather herself to respond back to me by bringing her arm forward, and this is supported by Bassett, Bingley and Brearley (2017), that stated intentional silent gives both the nurses and patient opportunity to process and deliberate on communicating information to each other.

In order to summarise, I have learnt that, effective communication is paramount to improve the health outcomes, and also to facilitate effective communication where the nurses must devote time to their patient. I have also learnt that, effective communication in healthcare can take dynamic process depending on the patient, environment and time and I will take this with me into practice. Additionally, I have come to understand that, good communication skills provide healthcare staffs a chance to understand their patient better in other to build therapeutic relationship, which creates foundation for holistic-patient-centred care, promotes patient informed choices and decision making regarding their health. I have also realised that, effective communication facilitates patient’s inclusion and enhances their recovery, as seen in the case with the mental health patient. Further, I will endeavour to use these knowledge and skill of verbal and nonverbal communication to inform my practice for giving the best possible care to my patient.

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References

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