This of a patients care, making it the role

This essay will concern the topic of communication in
relation to my placement and how I have utilised these skills to relay meaning
and ideas to patients. Being able to communicate effectively as a nurse is
fundamental to the role as it is a prerequisite for developing patient
relations and facilitating recovery in all its forms. According to the
Department of Health 2010: ‘One of the most basic goals for nursing staff is to
ensure that their patients and clients and those who care for them experience
effective communication’. The process of using and developing communication
skills 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 be
able to relate to patients and accept their needs regardless of any perceived
differences (unconditional positive regard), this links closely with emotional
intelligence as it is a facilitator of affective and meaningful interactions
among diverse groups of patients. This essay will discuss two interactions that
I had with patients, assessing the strengths and weaknesses present in my
communication with them, while honouring both the privacy and confidentiality
of patient information.

A patient’s right to confidentiality and privacy are
pivotal, 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’s
rights to confidentiality and privacy. The code is structured around four main
themes: prioritise people, practise effectively, preserve safety and promote
professionalism and trust. These will feature heavily as they mean that a nurse
should be dignified in their approach to patients and must monitor the
information they share with others, judging it in alignment and per the NMC
code of conduct. Therefore, for the purposes of this essay I will label my first
patient with the name patient A and my second patient with the name patient B,
with any personal or identifiable information being altered to protect their
privacy and dignity. Permission for the use of our interactions has been
granted and they have been informed of my obligations in relation to
professional, moral, and safe practice.

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The first interaction
I partook in was with an individual known as patient A, for the purposes of
confidentiality. This patient suffered from persistent delusional disorder,
this is characterised by having unshakable beliefs which are not true or
imaginary (delusions). Patient A believed that they were was being controlled
and manipulated by electricity, via an application outside of their control.
This delusion was based on their experiences with neighbours that moved next to
them. They would feel electrical currents passing through their legs and eyes,
this would sometimes cause them pain and was especially prevalent at night. In
addition to this they would lose awareness of their left leg, as if it had
disappeared. Patient A, believed this was a phenomenon brought on by electrical
applications that their new neighbours used. They believed they were
controlling them and inflicting these electrical shocks. The patient became
very sensitive to electrical equipment in their environment and had them all checked
to gain some clarity on the issue. Patient A accepted the fact that these
experiences caused them a lot of anguish as they had to deal with selling their
home.

During the
conversation, I asked patient A about their social life and how selling their
home and moving could affect this component of their life as they had lots of
friends where they lived. This was a very testing time as they found it
difficult to describe what moving could mean for the future mental health. They
described how their family had always been supportive of treatment, they looked
forward to seeing them more often and enjoying their life. Family and support
have been a key theme throughout my interactions with patients, patient A spoke
highly of their daughter’s success, but did express that they missed seeing her
as 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 important
aspect of communication as it allows a nurse to ascertain what makes the patient
who they are and where they are in their journey within the healthcare setting
and outside of it, these are two vital components of recovery and to establishing
therapeutic relationships. We also spoke about more jovial matter as we were
sitting in the lounge, this helped to diffuse any tension had and helped them
feel at ease. It was apparent that they wanted to improve their condition and
had a sense of optimism about moving forward and overcoming their current
problem. Patient A, was very emotional about this transition, they were still
confused about their experiences with electricity, but felt that a new setting
would help.

In retrospect, there
were several areas of my interactions which I believe constitute towards my
strengths in communication. During our conversation, I conveyed warmth and
compassion towards patient A and allowed them to freely express themselves,
asking open and closed questions about their condition for insight showing
genuine concern. It was extremely important for me to show empathy. This is a
difficult skill to demonstrate, however I felt that during this conversation it
was a pivotal component as it allowed me to show care and appreciation for their
feelings. This is a very important part of care and the values that the NHS strives
to embody in daily practice, otherwise known as the 6C’s (care, compassion,
courage, commitment, and competence). Through my body language and
communication, I showed compassion and empathised with their feelings I used
reflection and paraphrasing which allowed us to explore the feelings they had,
this helped us to relate to each other. Moreover, compassion allows patients to
feel more comfortable with themselves and their condition, this subsequently
helps them to improve their lives. I was also very aware of the emotions
involved and gave the patient a chance to express how they felt on many levels
without interrupting them. I clearly demonstrated Carl Roger three core
competencies (empathy, congruence, and unconditional positive regard).

On the other hand, I
could have improved my interaction by making use of Gerard Egans SOLER theory
(non-verbal communication) standing for: sitting squarely, observe and open
posture, lean forward, establish eye contact, and relax. During my initial conversation
with patient A, I was sitting next to them while they were watching the
television rather than facing them squarely which meant that I could not make
eye contact regularly and gauge their emotions which is crucial in gaining
rapport and showing compassion. This seating arrangement subsequently hindered
my ability to use non-verbal communication effectively. Furthermore, this also
hindered my ability to interpret the non-verbal communication elicited by the
patient, according to Carter Kessler and Paper (1999) the ability of a nurse to
read non-verbal communication is vital in establishing and maintaining therapeutic
relationships. Therefore, in the future it is important that I employ the SOLER
theory and acknowledge the importance of non-verbal communication and how
important it is in initial meetings with patients.

 The ‘NHS Plan’ (2000) recognises the
significance of communication for preregistered nurses and the necessity for
continual improvement. Upon registration, it is important for nurses to ‘have
the ability to recognise their communication skills limitations in practise and
be committed to personnel development in this area’ (DOH, 2000, NMC, 2008). I
recognised this in my interaction with patient A as communication was between
multidisciplinary teams and family. It was important for me to balance showing
empathy and compassion with attaining knowledge about the patient so that I
could communicate with them and understand their care needs, feedback could
then be given.

According to Carl Roger
empathetic listening means: ‘entering the private perceptual world of the other
and becoming thoroughly at home in it. It involves being sensitive moment by
moment, to the changing felt meanings which flow in the other person, to the
fear or rage or tenderness or confusion or whatever that he or she is
experiencing. It means temporarily living in the other’s life, moving in it
delicately without making judgements’. This reveals how difficult it is to
truly listen to a patient and how this aspect of communication is one for continuous
development in the future. Moreover, this is essential in providing person
centred care as every individual ‘private perceptual world’ is different and
requires different elements of care. Although empathetic listening was one of
my strengths with this patient this is still an aspect of communication that I
can improve on as empathetic listening can be enhanced when incorporating the
SOLER theory of communication. Showing concern for a patient through facial
expressions and body language can help to establish therapeutic relationships
more quickly and effectively.

My second interaction
was with patient B. This individual suffered with Bipolar affective disorder
which included manic episodes. Bipolar disorder is a mental condition marked by
alternating periods of elation and depression. This meant that they went through
manic periods where they were very active and outgoing and other periods where
she was very depressed. I enjoyed my conversation with Miss B, although her
mood and persona did fluctuate she was very interesting. I believe that
learning about an individual’s life and experiences is fundamental to being an
effective 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 that
facilitates “clinical mindfulness” as opposed to “clinical drift”. This was
particularly pertinent in my conversation as Miss A was an elderly woman who
experienced conflicting emotions and many stressors which needed to be
considered in her assessment.

When communicating
with patients their needs are paramount and it is important to have an
understand of all aspects of care in a multidisciplinary team, for this reason
I worked closely with healthcare assistants, occupational therapist, nursing
staff and observed ward rounds. I spoke frequently with Miss B about her
personal life and how it had affected her mental health and lifestyle.  We mainly conversed about her sectioning and
how she felt it was unjust and preventing her from being happy. Her section
dictated that medication was mandatory and could be forced upon her, before
receiving a depot injection she became very aggressive and needed to be
restrained by ‘teamwork’ who were accompanied by two nurses. This was required
because she was not taking medication and has had to be restrained numerous
times while on the ward.

We discussed the
relationship that she had with her husband and how this has affected her mental
health and way of life, I empathised with this aspect of her life and noticed
the importance of relationships in recovery from mental illness. It was
apparent that her family was important to her as she spoke fondly of her
grandchildren and her influence in their lives. Her habits in terms of smoking were
also discussed, she had been smoking for over 55 years but didn’t suffer from
the same symptoms most people under similar circumstances would. She did not
feel that she needed treatment and often refused medication against the advice
of staff, this led to her being put on a section three. She explained to me how
she felt as if she was trapped and not getting the appropriate care she needed.

 

 

These communication
skills are important when assessing a patient because they allow a nurse to
empathise with a patient and ascertain what their current problem is and how
they can be treated. This lead to a diagnosis and a prognosis which can be used
to create an affective care plan which is holistic in its approach to
treatment. These skills are integral to the maintenance and execution of a care
plan as communication and understanding form the basis of recovery and good
health.

On the other hand,
there were several areas where I could have improved. I felt that I could have
shown 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 has
compassion and understanding of a patient’s situation. This helps to show
congruence (genuineness), by paraphrasing a nurse shows that they have not only
listened to the patient but also tried to empathise with their circumstances. Furthermore,
the use of reflecting could have been deployed more throughout our
conversations as there was a need for clarity when I spoke to her. The patient’s
behaviour was very unpredictable and she could sometimes be aggressive,
therefore it was important for staff to show unconditional positive regard
towards the patient even if they had negative experiences with her. I felt that
the staffs attitude towards her was affected by her behaviour towards them,
this inevitably affected the care we collectively gave her at times. It could
be argued that we were less attentive to her care and therefore having unconditional
positive regard for her, regardless of the circumstances would have prevented
countertransference and improved my performance helping me to be more aligned
with the NMC guidelines.

Additionally, I could
have listened more actively. Miss B was a very energic and active patient
during manic episodes, therefore it was often hard to continuously listen to
her and follow her conversations. Burnard (2005) describes three main aspects to
the active listening process, they include: linguistic, paralinguistic, and
non-verbal. These aspects of listening are all crucial to empathising with
patients, a key component of this is attention. Bernard differentiated the
listening process from the ‘attending’ process, he distinguishes three separate
possible zones of attention. Zone one is where an individual is solely
attentive to the patient outside of them rather than any internal dialogue
(zone two) or fantasy (zone three). Miss B was very expressive and therefore
required active listening and engagement. During my interactions with her I
found it very difficult to always be attentive, our conversations were less
structured and I was more susceptible to becoming distracted by my own thoughts
and feelings. This hindered me from fully appreciating her feelings and
perspective on the care she was receiving from myself and the team. Miss B
often expressed her feelings through her body language (non-verbal
communication) rather than speech, therefore it was even more important for me
to recognise how she was presenting herself on a regular basis. Knowledge of
her non-verbal communication could help prevent future acts of aggression
towards staff and help staff to modify and develop her care plan.

 

 

In conclusion, for my
future development I would like to improve my non-verbal communication. This
includes how I present myself to patients, specifically my sitting position and
metacommunication. This is an overlooked area of communication. I could also make
better use of feedback, using open and closed questioning. This would allow me
to explore what patients know about themselves but perhaps not shared, this is
important in helping patients with mental illness to manage their illness. In
the 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 challenged
myself with less accommodating patients who require a larger and more diverse
set of communication skills. As I develop and begin to make care plans for
patients and address their needs it is important for me to acknowledge the
importance of communication skills in this process. Peplau’s suggests that
there are four phases to the therapeutic nurse-patient relationship they
include: orientation, identification, exploitation, and resolution. Presently I
am 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 are
sufficient to facilitate therapeutic relations throughout the patient’s journey

 

References:

Egan G, 2014, The
Skilled Helper: A Client-centred Approach, Europe, Middle East & African
Edition, Cengage
Learning EMEA, Hampshire, UK.

Carl Roger (2014: 63) empathetic
listening means: ‘entering the private perceptual world of the other and
becoming thoroughly at home in it. It involves being sensitive moment by
moment, to the changing felt meanings which flow in the other person, to the
fear or rage or tenderness or confusion or whatever that he or she is
experiencing. It means temporarily living in the other’s life, moving in it
delicately 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 and
Paper (1999), (2014: 69) the importance of non-verbal communication.

Gerrard Egans SOLER
theory (non-verbal communication) standing for: sitting squarely, observe and
open 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), The
Handbook of Communication Skills (third edition), Routledge Taylor and Francis
Group, London and New York.

 

Accessed
on the 26/04/17:    

Hildegard E Peplau:
Theory of Interpersonal Relations (2011). Nursing Theories Website. Data
retrieved from: http://nursingtheories.weebly.com/hildegard-e-peplau.html

The 6Cs: Defining the 6Cs (09/09/2015). Health Careers
Website. Data retrieved from: https://www.healthcareers.nhs.uk/about/working-health/6cs

Carl Rogers’ Core
Competencies (05/05/2012), Chenoyceil website. Data retrieved from: https://chenoyceil.wordpress.com/2012/05/05/carl-rogers/

The NMC communication competencies (page 24). Data
retrieved from: http://www.bcu.ac.uk/cmsproxyimage?path=/_media/docs/standards%20for%20pre-registration%20education.pdf

Core communication skills in mental health nursing. Data
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Accessed
on 28/04/17:

The
Johari Window (Joseph
Luft and Harry Ingham). Data retrieved from: http://www.businessballs.com/johariwindowmodel.htm

The
NHS plan. Data retrieved from: http://pns.dgs.pt/files/2010/03/pnsuk1.pdf

 

 

 

 

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