Physical environmental factors that may influence communications among patients and nurses include lighting, humidity, space within contact partners, place, comfort and conditions of private space, and disruptions like noise and confidentiality level (Daly, 2017). My partner and I went to the Stenberg College campus and asked the receptionist if we can use a room for our video. The room we got was conducive for effective communication, it is warm, comfortable and had chairs equal in height and a table with the right distance when I and my partner are interacting. Also, a private room will ensure our clients’ privacy as they will not be worried that someone might hear their information. Moreover, the room has adequate lighting and free from any disturbance. As per Stans, Dalemans, Roentgen, Smeets, and Anna (2018), clients and care providers reflected that a peaceful and calm environment in conversations without distractions is relevant as noise makes it hard for clients to focus on what the discussion is about. Furthermore, background noise hindered the capacity of nurses to hear their clients. The clients believed that if the conversation took place in an atmosphere where they felt relax and comfortable, it allowed them to express themselves (Stans et al., 2018). Through this, it is crucial for us nurses that we provide an environment wherein our clients can freely state how they feel, think and show their emotions.
|NURSE TECHNIQUES (VERBAL/NONVERBAL)
|NURSE’S THOUGHTS AND FEELINGS CONCERNING THE INTERACTION
|ANALYSIS OF THE INTERACTION
|“Hi Good morning! My name is Hannah. I’ll be your counselor for today.”
“How would you like me to call you?”
“Hi, Pinky nice to meet you.”
Nonverbal: Relaxed and open posture, leaned forward, smiling and soft tone of voice.
“Nice to meet you”
The client has an open and relaxed posture, smiling and nodding.
|I realized that it is always crucial to introduce ourselves as this will give them a good impression at the beginning of the session. It is always nice to start a conversation with a positive attitude. By asking their name preference is a way of showing our respect. In this phase, this is where we create a good relationship with our clients to have effective communication for them to be more comfortable in sharing their information.
|This is the orientation phase, as per Peplau (1997), as helpers this is where we start to build trust and educate our client about the intent and meaning of our discussion and the time required (as cited in Arnold & Boggs, 2011, p. 91).
In this part of the conversation, we should develop rapport and trust with our clients because they will be more at ease in sharing information. Moreover, utilizing our nonverbal cues will also give a positive impression to our clients as they may feel that we are interested in listening to them.
As per Balzer-Riley (2017), clients may feel valuable and worthwhile when they receive respect (p. 77).
|I should have shaken her hand to be more welcoming and it is also a sign of warmth.
A handshake or gentle touch is a way of showing respect (Balzer-Riley, 2017). For some people, handshake comes naturally especially if they meet new people.
|“How would you like our room?”
“Did you like the private room?”
“Ahh. That’s good.”
Nonverbal: Smiling with hand gestures, used a soft tone of voice.
|“Very nice, I like the view. Uhm, especially the weather is better. It’s cold and I’m sorry I’m a little bit under the weather. I’ve been battling with cough and colds for the past couple of days.”
“But I’m getting better.”
The client was smiling, relaxed and open posture with hand gestures.
|I felt like it is important to consider the environment, as this will make our clients feel more relax and comfortable. Having a personal space will help our clients’ to be more open and direct in sharing their information about the changes that they plan for themselves.
|As per Arnold and Boggs (2011), securing our client’s privacy is a form of respect (p. 39). Also, for a meaningful discussion, we have to make sure that the client is protected, free from any distraction and noise (Arnold & Boggs, 2011, p. 178). This means that our client will be more open and comfortable in sharing information.
Additionally, I should be careful in using closed-ended questions. As this is used to quickly acquire information from our client (Arnold & Boggs, 2011, p. 183).
|I should have said: “How do you find this room? Do you find it comfortable?”
I wanted to ask this question for me to know about my clients’ level of comfort and perception about the private space.
The nurse demonstrates humility, empathy, and respect every time they pay attention to the environment to maintain a good nurse-client relationship (Arnold & Boggs, 2011, p. 91).
|“Before we start, we went over it beforehand. I want you to go over it again and then you can sign.”
Nonverbal: Leaned forward, relaxed and open posture, smiling.
“There you are.”
The client was nodding, appears relaxed.
|I felt the need to explain the importance of confidentiality as the client will feel safe and secure. After asking her to go over the consent form, I was glad that she willingly signed the consent.
|As per Heery (2000), we have to ensure our clients that their personal data is confidential and secured (as cited in Arnold & Boggs, 2011, p. 91).
Also, we have to inform the client that the information gathered will be discussed with other health care providers (Arnold & Boggs, 2011, p. 91). It is important that we are telling our clients our goal and the purpose of the conversation.
|I should have also explained that “This session is strictly confidential. However, our instructors Debbie and Maureen will be watching the video. But I assure you that your privacy is secured.”
|“So, to start, I am here to listen for whatever you wanna share, with whatever you wanna change in your life at this moment.”
“So, feel free to start.”
While the client was talking, I also used silence to give her enough time to freely share her feelings.
Nonverbal: Relaxed and open posture, nodding, smiling, and with hand gestures.
|The client replied: “Hmm.”
“So, I know that this is the second session. Uhm, coz the first one I know I talk to you about, my eating pattern and how the change of my lifestyle from the past year that I have enrolled in the nursing program. So, we know that it is an online course I’ve been sitting in my desk for a long time I don’t pay attention as to the amount of food I eat. So, basically stress-eating and my diet is, I’m Asian so we love rice. Uhm, and my family is such a foody. Me and my husband were, that’s our common past time like we love to dine out go out to eat and we just love food. Coupled with that, it makes me feel good if I eat at the side while reading. Uhm, and that has horrible effect with my weight. So, I really gained weight from the past year that I stopped working up to the present and I wanted to change that and reverse into a healthier lifestyle. Ah, mainly because of again for health reasons and number two I wanna have sustainability in terms of doing that long hours of shift. As we know that for nurses, we do 12 hours.”
The client appears relaxed, with hand gestures. She has a soft tone of voice.
|I felt that when we give assurance to our clients, they will be more at ease in sharing personal information about themselves. Informing them that we are there to listen with them will make them feel that they are important and that someone is showing interest and giving them full attention. Also, in this part, I was just attentively listening to her. I remained quiet and I tried not to distract or interrupt her.
|This is the working process wherein the client addressed specific and more challenging problems and emphasizes self-management and self-direction in promoting clients’ wellness (Arnold & Boggs, 2011, p. 94).
Also, this is where the partnership or collaboration between the helper and the client. The collaborative essence of MI means that our own expectations as well as our client are addressed and controlled (Miller & Rollnick, 2013, p. 16).
As per Egan (2014), empathetic listening is unselfish as helpers have to set their own issues aside in order to be completely with their clients (p. 82). I believe that in this part I was able to show my client that I am interested in listening to her message and she has my full attention.
Additionally, in this part, the client was exercising her right to freely express herself and her choice of changing something in her lifestyle. As per Miller and Rollnick (2013), recognizing the freedom of choice of our client usually decreases hostility and can promote improvement (p. 19).
|I should have also mentioned that “This is a non-judgmental environment and feel free to share whatever you are comfortable to share.”
|“So, from our previous session before, I believe you mentioned that you wanted to go aqua therapy like swimming. Can you tell me about it?”
Nonverbal: hand gestures, relaxed posture, smiling and use a soft tone of voice
“That’s a very good question.”
“We tried one session. It’s actually more of, me inquiring for the client that I support with, then I ended up being curious. So, my sister and I went in for a drop-in session. It was good, it’s a low impact exercise. Ahh, the flip side there is that after we did the aqua therapy, we went out to eat. So, it’s just like carbs in carbs out and then vice versa. So, it’s really me surrounding all the people that I love. And this people that I love also love food so it’s a challenge and it’s how to… I recognize that I have to break that cycle.”
The client was smiling, nodding and with hand gestures. Also, she used a normal tone of voice.
|I felt that it is important for me to know continued her plan of exercising and I wanted to know her feelings and emotions when she engaged herself in this activity.
|Asking open-ended questions is critical in moving forward, empowering and planning a transition to progress (Miller & Rollnick, 2013, p. 33).
An open-ended question is used so that our clients will speak about their situation and think about it and also, it helps integrate the important aspects of our clients’ experience (Arnold & Boggs, 2011, p. 182). This is something that we should use rather than close-ended type of questions. In this part, I was asking my client to tell me more about her experience about her chosen activity.
|I should have also asked: “Tell me about the changes that you experienced from our last session.”
“How was your experience about aqua therapy?”
|“Was there a change from your plan previously and up to this day?”
Nonverbal: nodding, relaxed posture, smiling, kept eye contact, use a normal tone of voice.
|“Here and there, I’d say.”
“So, I’ve been battling with colds and cough and you know when you’re not feeling well you have that inclination to eat healthier. Uhm, so, my husband would cook something for me, it’s always chicken soup with some nice vegetables and I cut down with a little rice, but I don’t know if even that would make some significant impact as to my weight. But I recognize that really the changes of the amount of food intake and carbs that’s something I have to work on. I’d say it’s very minimal but I hope that I’ll reach that point that I’ll be able to overcome these challenges.”
The client giggled, she has an open and relaxed posture, also, while talking she used hand gestures.
|I felt that I need to know my clients’ feelings about her set plans. I am glad that she recognizes the importance of eating healthy foods and that she is willing to take the challenge of losing weight and be more healthy foods.
|In this part, I asked a close-ended question just for me to clarify if the client experienced change from her previous plan. Even though I used this type of question my client seems to be so open and freely sharing her experienced.
Moreover, I realized that I should have used open-ended questions to enhance more my skills. An open question is one that allows an individual to think a little before answering and offers plenty of space to respond (Miller & Rollnick, 2013, p. 62).
|I should have said: “What is the difference in your plan before and the plan that you have right now?”
“What motivates you to pursue your plan?”
|“I’m glad that you are recognizing that.”
“Was there a plan or are you planning of doing something to change your eating habits? Like, let’s say are you setting up a diet plan?”
Nonverbal: Hand gestures, relaxed posture. Maintained eye contact.
|The client nods after I said this.
“Right, I’ve heard about meal preps. My sister-in-law she’s into keto diet and she’s been really watching her diets and she’s into exercise, yoga and all that. And I see how she did a good job as she maintained her weight and everything. So, she shared to me some good food choices like instead of rice change it to quinoa or make a cauliflower fried rice. These are things that we’ve tried and it’s actually good. I enjoyed the cauliflower fried rice. But when I asked my husband, the funny thing is that I recognize, when I asked my husband how he prepared it, of course there is tons of butter and all that. So, I don’t know if that would even help. But psychologically I know that that’s a better option than rice. So, those are things that I would like to start off but it’s really hard.”
The client was smiling, with hand gestures, appropriate eye contact.
|I felt that my client needs commendation to let her know that someone acknowledges her plans. However, I also felt her, it is really hard to lose weight as much as I wanted to share some of the diet plans that I have tried, I just don’t want to divert the focus of our conversation and my diet might not work for her as she has her own preference.
|I am well aware of the importance of asking open-ended questions. I know that the more I practice it will be easier for me to use for my future clients.
The closed question is requiring a quick answer and restricting the individual’s response (Miller & Rollnick, 2013, p. 63). Even though I used this type of question my client seems comfortable and she is still open in sharing data about her plans.
|Instead of asking closed questions. I should have asked: “What is your dietary plan?”
“Tell me more about your eating habits, what type of food that you eat?”
“Good for you, that you are considering to change your eating habits.”
|“Sounds like you’ve got a good plan there.”
“So, in the next two weeks when you come back here, what are the things that you would like to share about the changes that happened to you from the past?”
Nonverbal: maintained eye contact, relaxed posture.
|After stating this the client was smiling and nodding.
“I’ll probably commit to myself like regardless if I have my sister with me or not. I’ll try to go to the recreation centre. I’ll try to commit myself at least to do once a week of aqua therapy coz that’s a low impact exercise that won’t hurt my knee or my ankle given my weight. I’ll try to do that I’ll let you know how I feel about it. I know myself well more than anyone else but I’ll let you know if I’m struggling. But it’s good to take this out of my chest and have somebody to talk too. The fact that I recognize that there is a need for me to change my lifestyle. I think that’s a good start.”
The client kept eye contact, nodding, smiling.
|In this part, I realized that she is really willing to attain her goal of losing weight. Also, I can feel her dedication to push through her plan of exercise and be more physically active.
|An important MI skill is reflective listening. Effective reflective listening keeps the individual speaking, thinking and exploring (Miller & Rollnick, 2013, p. 34).
Reflective comments often enable individuals to listen and focus on the emotions and thoughts they share (Miller & Rollnick, 2013, p. 34). I believe that reflection is necessary for our client for them to engage more themselves in the conversation.
|I should have also stated that: “Sounds like your sister-in-law influenced to continue your plan of losing weight and eat healthier food.”
|“That’s a good plan.”
“So, Pinky just to sum up everything So, you’re planning to lose weight, you’re trying to cut back you’re eating habits like from carbs, you’re planning to do exercise like you said aqua therapy and trying out new exercises just for you to lose weight and think more about your health.”
Nonverbal: hand gestures, open and relaxed posture, kept eye contact.
|The client was nodding replied: “ah-huh,”
smiling, relaxed posture and maintaining eye contact.
|I felt the need that I have recognize her so that she will feel that she is doing something right.
In this part, there is always a hesitation on my part as I might not interpret her message correctly. Thus, I felt good that my client validated it through her nonverbal cues and respond appropriately.
|To affirm is to accept and appreciate what is great, including the intrinsic worth of people as human beings, and to understand and support our client (Miller & Rollnick, 2013, p. 64). This skill is relevant in our practice as this will boost our clients’ confidence and it motivates them to be more positive in their plan of change.
Moreover, summaries are important observations that bring up many things an individual has stated (Miller & Rollnick, 2013, p. 66). I believe that I was able to get the gist of my clients’ message.
Also, reflecting and summarizing is shedding light on the perspective of the client encouraging them to explore more (Miller & Rollnick, 2013, p. 66).
|I think that I should have said: “Just to be clear, you are planning to lose weight by cutting back you stress-eating habits and you are planning to come up with a dietary plan and you are willing to engage in the aqua therapy exercise as you want to be live a healthier life.”
|“Ok! So, next week once we gonna come back here again I hope that you will have the plan that you told me.”
“So, yeah! We are done for today see you next week then.”
Nonverbal: Hand-shake, smiling nodding, normal tone of voice, demonstrated an open and relaxed posture.
|The client was smiling, replied: “Ok! Thank you, Hannah.” She was also, nodding and maintained eye contact, with an open and relaxed posture.
|I felt that I was able to meet her expectations and I responded to her appropriately and I was able to get the core of her message and I gave her enough time to speak without stressing her out.
I felt the need to tell her that I am going to see her for follow-up, for me to be able to know if she follows her plans and continues to pursue her goal.
|This is the termination phase of the interaction process. It is vital to be open to how long a therapeutic interaction should last. During the collaboration, termination might be indicated and clients should be notified well in advance of forthcoming end date (Arnold & Boggs, 2011, p. 97).
|I should have asked my client about her feelings and thoughts about our conversation and I think that I have to consider my clients’ points of view regarding the outcome of our interaction.
I should have also asked: What are your insights about our conversation? How are you feeling right now?
This activity measured my ability to demonstrate the skills we learned and we need to acquire. During the activity, I think I was able to portray the role of a nurse in my conversation with my client. Also, I was able to get the key message of my client regarding her plan of changing her bad eating habits into healthier food, be more physically active and lose weight. In our interaction process, I was able to establish rapport and gained the trust of my client. I used minimal responses to ensure that my client was at the center of our communication process. Minimal signs encouraged client trust in exchanging personal data (Arnold & Boggs, 2011, p. 184). Moreover, in our conversation, I am well aware of the importance of SOLER as this will help in the flow of a good discussion. I was also able to demonstrate my listening skills and show my respect and genuineness with my client by responding to her in an appropriate way. Furthermore, this activity helped me realize the things that I still need to work on.
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Additionally, the highlight of this activity is to exercise our ability in using the spirit of MI and OARS skills for effective motivational interviewing. As per Miller and Rollnick (2013), OARS skills are essential mechanisms for mutual understanding in the communicating process (p. 62). This means that I have to practice more to improve my skills as this is relevant for me to utilize in our upcoming clinical placements. I know that I have used open-ended questions, reflection, and summarization before but I still need to exercise it more so that I will gain enough confidence and be more knowledgeable when I deal with my future clients’. Moreover, in this activity, I have used a few close-ended questions but I am well aware that I should focus more on using open-ended questions for me to get more information from my client. I plan to enhance more my skills so that I will be more prepared in our upcoming clinical placements. Overall, this activity helped me recognize the things that I still have to learn and I intend to fulfill this goal for me to be able to provide good therapeutic communication and be more skillful in motivational interviewing.
- Arnold, E. C. & Boggs, K. U. (2011). Interpersonal Relationships: Professional Communication Skills for Nurses (6th Edition). St. Louis, MO: Elsevier
- Balzer-Riley, J. (2017). Communication in Nursing (8th Edition). St. Louis, MO: Elsevier
- Daly, L. (2017). Effective communication with older adults. Nursing Standard (2014+), 31(41), 55. doi:http://dx.doi.org/10.7748/ns.2017.e10832
- Egan, G. (2014). The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (10th ed.). Belmont, CA: Brooks Cole
- Miller, W. R. & Rollnick, S. (2013). Motivational Interviewing: Helping People Change (3rd edition). New York, NY: The Guilford Press
- Stans, S. E. A., Dalemans, R. J. P., Roentgen, U. R., Smeets, H. W. H., & Anna, J. H. M. B. (2018). Who said dialogue conversations are easy? the communication between communication vulnerable people and health‐care professionals: A qualitative study. Health Expectations, 21(5), 848-857. doi:http://dx.doi.org/10.1111/hex.12679
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