Communication is vital to us as human beings. It enables us to interact with others and make sense of what is going on around us. Effective communication is an essential factor in establishing a positive helping relationship. The ways in which care-workers communicate convey to the service user how they value that person.
For communication to be effective, a person must use all the means at their disposal to make sure that they send a clear message. Michael Argyle (1972) argued that interpersonal communication was a skill that could be learned and developed. Argyle further suggested that skilled interpersonal interaction involved a cycle where you have to translate or ‘decode’ what other people are communicating and constantly adapt your own behaviour in order to communicate effectively. Verbal and non-verbal communication is not always straightforward.
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Effective communication involves many features, such as, listening skills, non-verbal communication, using appropriate language together with the right tone and pace. Listening to patients is not just about hearing what the patient is saying, but about giving them time to express worries or concerns that they may have. Listening involves being aware of what patients do not say, through non-verbal communication. Facial expressions, hand gestures and postures can often express emotions that the patient may have difficulty verbalising. Listening skills can be maximised by paraphrasing the patient’s thoughts and expressing understanding of their feelings (Bush, 2001). The importance of listening skills is also underlined by the Nursing and Midwifery Council (NMC), Code of Standards of Conduct (NMC, 2008a) , which states that in caring for patients the Professional Nurse must:
“Listen to the people in my care and respond to their concerns”.
Non-verbal communications are the messages that we send without using words. Gaze, body posture and facial expressions are all used to convey messages about our interest in another’s communication and our willingness to communicate with them. Not being aware of non-verbal communication may impair nurse-patient communication. Patients continually monitor care-staff responses and will need constant feedback concerning understanding and reactions. For example, if staff lean away and look elsewhere patients will assume they are not interested, the way staff sit or stand can send messages. Leaning back can send the message that you are relaxed or bored; leaning forward can show interest or intense involvement. Care-staff may appear friendlier if they adopt an open body posture; this is where their body is not covered by folded arms or legs. When two people are talking they generally feel more comfortable if they are at the same level. If the care-worker towers over the patient they may feel intimidated, or that cannot move away. Facial expressions can often convey how that person is feeling and can be used effectively to communicate feelings. Therefore it is essential that the care-worker shows warmth and friendliness. (Miller et al, 2007).
The language used in interactions with patients is of great importance, each patient/service user is an individual and therefore it is necessary for care-workers to adapt and tailor their language to suit each individual patient/service user. Too often care-workers, without thought, use ‘jargon’ and acronyms which can frighten patients. Clear language should be used when speaking to and in front of patients and relatives to allow them to feel part of the decision-making process. Asking clear questions secures the information more easily. The age of the patient should be considered, using childish words when speaking to an older person for example is patronising and shows no respect. It is useful to check that what is being said has been understood.
Patients are often in pain, scared, in a new environment and may never have been in hospital before. Sensitivity, caring and empathy help to build relationships and facilitate good communication but, even so, there are barriers to positive communication including pain, hunger and lack of understanding. All of these can cause anger, defensiveness and inhibit effective communication. (Neville, 2009). These effects can be minimised by keeping patients informed of changes to their care; answering their questions to the best of your ability; allowing time for questions. Communication barriers usually arise because there is a breakdown in understanding between the person who is sending the message and those who are meant to be receiving it. Communication barriers can be within the social environment of the person, in their physical environment or occur because of personal disabilities or experiences. Once barriers to effective communication have been identified they can be addressed, there may be practical issues to consider, such as the provision of a private place, the provision of an interpreter, or simply the physical presence and support of a staff member to encourage and advocate if necessary.
Lack of understanding of what the patient is feeling can be a barrier to effective communication. Building empathy enables the carer to recognise and try to understand something that is affecting the patient. It is about imagining yourself in the other persons shoes (Egan, 1998).
Carl Rogers (1902-1987) emphasises three core conditions to promoting good relationships (Rogers, 1991): empathy, congruence and unconditional positive regard. Service users may have completely different experiences from the care-worker so it is important to try genuinely to understand a service user’s thoughts and feelings. Through the carer’s expression of empathy and the opportunity of talking freely, many service users experience great relief at being able to tell their innermost feelings without getting a negative reaction from the care-worker. Understanding can grow from a conversation which conveys value for the service user.
Congruence is genuineness: being totally sincere. It means that care-workers have to be honest, open and be themselves. There is no room for acting or using language that confuses the service user. Like any other skills, forming a supportive relationship with a service user improves with practice, and care-workers should continually evaluate themselves. It is necessary for care-workers to accept feedback from peers, mentors and most importantly the service users.
Unconditional positive regard means accepting someone unquestioningly as having worth. It is conveyed through showing both acceptance and warmth. The care-worker may reflect warmth by non-verbal communication, such as a warm smile, a confident manner calm and gentle gestures and movements. Warmth may be reflected through verbal communication such as expressing a wish to help, giving reassurance about confidentiality, using friendly words, not patronising.
If the care-worker pretends to be interested, warm or understanding then the service user will sense this and it will jeopardise the whole relationship.
In all areas of care it is essential that accurate records are maintained not only on the service users but also on organisational matters. A part of every care-workers role is to take responsibility for the accurate, legible and complete recording of information. Records provide a historical record of events which may be required at a later date. The NMC states that every nursing professional must:
“keep clear and accurate records”. (NMC, 2008a).
Confidentiality is a key element within written communication; this is based on the requirements of the Data Protection Act 1998.
When completing records and reports it is important to ensure appropriate language is used, it needs to be clear what are facts and what are opinions. When there is a good system of record keeping progressive changes in individuals needs can be identified and appropriate amendments made to that individuals plan of care.
Within this assignment the writer has identified a range of verbal, non-verbal and written communication skills required for health and midwifery practice. The main focus of the work has been based on the SWOT Analysis (Appendix 1), which identifies non-verbal communication as an area of weakness. The writer has completed an action plan (Appendix 2), which identifies opportunities to develop this area of weakness.
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The writer has developed an understanding of the work of Carl Rogers (1902-1986), and will endeavour to ensure his approach underpins her future practice. The writer has experienced misunderstanding in practice as a result of inappropriate facial expressions and body language, for example the habit of folding her arms across her body, the writer now recognises this to be a barrier to communication. When the writer is nervous or unsure in a situation she puts her hands in her pockets or over her mouth, again these are now recognised as non-verbal barriers to effective communication.
Cutcliffe and McKenna (2005) and Long (1999) reported that during treatment, hospital and community patients interact more with nurses than any other health professional in the multidisciplinary team.
Nurses should try to interact with patients by using the full range of communication skills at their disposal, to help patients realise that practitioners are there to help as much as they possibly can, both physically and psychologically, in light of patients vulnerable state of health. Patients must be given time and space to express their fears, anxieties, concerns or worries they may have. Therefore, patient expression can be facilitated by the very presence of nurses, and by nurses’ willingness to engage, interact and communicate.
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