The purpose of this assignment is to express different ways of verbal and non verbal communication. The benefits of, and why, it is important to communicate with others and to discuss the importance of communication within the healthcare profession. In 2008-2009 the NHS received a total of 89,139 complaints regarding hospital and community settings. 8970 of those complaints were associated with communication / information to patients (written and oral). In GP practices and dental services 11,003 complaints were made regarding issues of communication. The Health and Social Care Information Centre (2009)
Anthony Robbins once quoted that “To effectively communicate, we must realise that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.” Anthony Robbins (2001)
To understand how to communicate effectively, one has to understand the need and importance of communicating, whether it is through verbal means or non verbal ways of communication. Everyone has their own way of communicating, our personality, upbringing and our beliefs differentiate us from everyone else. It helps shape who we are today, how we cope in certain situations, how we communicate with others and how we share our opinions. Ones beliefs may help in the way they understand and cope with death while the introverts (the quiet and the thoughtful) and the extroverts (loud and proud) each have their own way of communicating. The spoken and physical aspects of communication are usually thought of as being the most significant. British Medical Association (1998).
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In any occupation communication is important it is what good team work is all about, team work whether working with each other, working with different companies or when dealing with patients, to work together and to have a good understanding of whatever the situation. It is a fundamental role within a Nursing environment, when dealing with any aspect of a patient’s life, communication is vital. Often the nurse will be an advocate for the patient if unable to do so themselves dealing with any social issues or to converse with social services or other companies for extra help once the patient is back at home. Bradley et al (2007) quotes that communication skills including information giving and listening were ranked the single most important skills that nurse prescribers must possess.
Effective communication is dependent on both doctors and patients being able to give and receive information. Royal College of Physicians of London (1997).
Many people have a phobia about hospitals as they often feel that hospitals cause pain, it is an unfamiliar place one which is separated from family. Doctors can be intimidating as they are seen as respected figures in society or they could have had a bad experience within a hospital setting with a past relative or friend. Control issues over health, undergoing an operation or just put out of their daily routine can cause anxiety. If there is no rapport with the doctor and patient then this can hinder the communication process with not all information being passed on. If the patient feels anxious and scared about what the doctor might say along with being in a strange environment as out of their comfort zone, then the patient may not communicate as effectively. Kenworthy et al (2002) quotes “The communication process has three components – the sender, the receiver and the message. For communication to take place, the message must be not only received but also understood”.
There are many ways to communicate not just verbally. Non verbal communication can be just as effective as using your voice. A person’s body language, facial expressions, gestures, touch, eye contact and a person’s posture and are all means of communicating. Argyle (1978) quoted “non verbal communication can have five times as much effort on a person’s understanding of a message compared with the words spoken at the time”.
Touch is an effective form of non verbal communication and an emotion that happens instinctively. When a person is upset then for some an automatic reaction would be to touch as a way of showing we care. Holding a patients hand or placing your hand on their shoulder can be a sign of comfort and to let them know you care. Deaux and Wrightsman (1984) suggested that touching is not negative but works on a variety of levels. Not everyone will feel comfortable with closeness and feel their personal space is being intruded upon and for some patients who have communication difficulties touch is a way of showing their appreciation for what you do for them.
Maintaining eye contact while with patients helps build rapport, it shows they are being listened to. The way you look at a person can mean that you are interested in what they have to say which helps keep the flow of conversation going. Altschul (1972) suggested that the failure to maintain direct eye contact may be interpreted as a lack of attention, a lack of interest or a lack of trustworthiness. Eye contact in some countries is not important, for some religions it has other meanings. In some parts of the world including Asia constant eye contact means aggression and being rude. Muslims consider constant eye contact particularly with the opposite sex other than their legitimate partners ‘adultery of the eyes’. Wikimedia Foundation Inc (2010).
Good conversational skills are a must in Nursing, the ability to get to know your patients and to get involved in their life will make them feel like an individual and help breakdown any barriers. To show an interest in them personally helps build rapport between you and the patient. The tone of your voice is important when engaging in conversation; your voice can be a giveaway as to how your feeling and also the volume at which we speak are all important elements of communicating. Listening and attending to your patient, engaging in the conversation, sharing experiences, and having good body language makes communication more effective and makes work more enjoyable. Sometimes the smallest gesture like offering to get a cup of tea when a patient is down can build on that relationship.
When dealing with patients who have undergone any procedure or have been involved in an accident a person’s body may change as they may acquire a colostomy bag or a horrific wound from an accident, the most important thing to do is to not show the patient that it has an effect on you which can be conveyed by facial expressions. When dealing with someone who has had a newly formed colostomy, they have to come to terms with this new addition to their body both mentally and physically and to get used to the smells it produces. When people are looking for a reaction the first place they will look is another person’s face. Velangi (1980) quotes that quite often there are fear and anxieties regarding stoma appearance, odour, leakage and fear of coital pain”. Facial expressions change during the course of a conversation as talking face to face with continued eye contact each individual is continually aware of each other’s facial expressions.
There are many barriers that can effect communication especially when dealing with the elderly, mentally or physically impaired people. People who are in pain, find it difficult to communicate and find other means to let people know how they are feeling. A person’s surroundings or environment may also have an effect on the way they communicate. Children are often shy in front of strangers or in unknown surroundings; this could be the same for adults. Being in an unfamiliar place can intimidate and scare people. Nurses often have to ask very personal questions with people they have just met, this can be quite embarrassing although talking to a professional, this may cause a barrier until they can fully open up after building some rapport with the patient.
11,331 complaints were made to the NHS regarding staff attitude during 2008-2009. The Health and Social Care Information Centre (2009)
When a patient is admitted to hospital, they have a sense of security as they are being looked after by trained professionals and it is important for the patient to be reassured by that. Being able to talk to your Nurse or Doctor, having that rapport helps make communication easier. Working as a Nurse will on times be stressful, often wards are short staffed, sickness or poor management all have an effect on the staff which may cloud judgement and hinder the way they would normally do their job. Often these maybe the times when communication fails and patients feel let down. This type of barrier will hinder the listening process as may feel too rushed to be able to sit down and listen to their patients. Being stressed and anxious and having minds focused on other tasks to be done rather than the one that is currently being done can cause patients to keep communications to themselves as feel like they are hindering the Nurse. Communication is irreversible once it has been said it may not be set in stone but it is hard to take back.
Working well with your patients is key; it helps to build rapport and makes communication easier for the professional and the patient, making sure you remember their name but more importantly what they want to be known as helps build that relationship as they feel important and respected by you and not just another patient. Humour is a great way to build rapport with patients, as long as it is in good taste, it can help put people at ease, it helps form a bond between you and the patient and can help build trust. Rak and Major (1997) quoted that patients used humour as an indirect message, it was a way of communicating their deeper concerns in an oblique fashion. Others found humour as a means of letting others know that they understood that they were going to die. Humour helps take the seriousness out of a situation. McGhee (1980) quotes “Humour can also help build relationships with clients and colleagues. After all, it is hard not to like a person who makes you laugh”.
Another form of communication which is effective when dealing with patients is in written form. When patients are admitted to hospital they each have a file with their personal and medical information in it. Correspondence from the GP or other health professions will be kept in the file regarding the patient’s diagnosis or previous medical history and treatment. Nursing notes are kept to record the patients progress every time they stay in hospital, this allows the health professionals to have an accurate record of past health problems and to give an insight into the patient. The nursing notes are there to help other nurses understand the needs of the patient, what the patients routine may have been with regards to when they last opened their bowels or how they slept the night before. The doctors are also able to take a look at these notes if they have any queries about the patient. It is important to keep an up to date record of the patient to make sure there condition is not worsening and so that when the next nurse takes over, they have a fair idea of the patient before they talk to the patient themselves. NMC guidelines state that “good record keeping is an integral part of nursing and midwifery practice, and is essential to the provision of safe and effective care”. Nursing and Midwifery Council (2009).
At the start and end of every working shift doctors and nurses each have handover of the patients they are looking after for their shift. This type of verbal communication allows information to be passed on about the patients giving more detail about how they have settled, what treatment they are receiving, any drugs that need to be administered or are due and any procedures they may have had. Any problems or queries with the patient can be passed on verbally without the nurse having to look back through the notes.
Communication models are models used in Nursing and other occupations to give guidance on communication. It is a framework that breaks down the communication process to help us understand in more detail. There are various different communication models which all have theories behind the model. There are many models of communication whose theories are based on;
The Psycho -social models which looks at the biological and social factors of disease or illness. This particular model is used in medicine, nursing, psychology and sociology.
The Cognitive neuropsychology model looks at how the structure and the function of the brain is connected to psychological processes. The emphasis is on the cognitive effects of brain injury or neurological illnesses, and looks at the ability of perception, attention, spoken and written language, thinking, memory and action.
Linguistic models look at the grammatical rules that control the human verbal communication. Speech Therapy Information and Resources (2009)
Whilst on placement with the Health Visitor I attended some baby massage classes which was a good way of communicating and bonding with baby. The massage helps mum communicate with her baby by understanding non verbal communication by understanding baby’s body language. The class helps them both to relax and to build up confidence and competence together and teaches them about touch. Heller (1997) believes that baby massage is an important means by which parents and babies communicate through touch. From observations of parents massaging their babies, it does indeed seem to communicate caring, love and warmth through touch. The health visitor runs the class going through each of the massages for the limbs and torso of the child and makes sure that baby is happy during the whole class. If the baby becomes distressed then Mum stops what she is doing so the baby does not associate crying or stress with the class. The baby massage class had many health benefits for mum and baby. It would help babies sleep better and helps with the treatment of colic and would help mum with postnatal depression and feel closer to their baby. The class was run through the Sure Start scheme and parents thoroughly enjoyed the class and continued to massage their babies once the classes had finished.
Whilst on placement the Health Visitor and I visited a mum who had 6 children, one of her children was autistic and the other child was 12 months old and obese for his age weighing in at 26kg.
In the house the little autistic girl was able to communicate by speech but was not very clear and most words could not pronounce properly so used sign language, a type of communication which is used with your hands. It was fascinating to watch her communicate with her brothers and sisters at such a young age and with her disability as she had developmental and learning difficulties. This type of communication not only helped the little girl to get across her feelings but it helped mum understand her frustrations and to let her know what she wanted.
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The Health Visitor weighed the baby who was 12 months old to discover he had put on more weight. The Health Visitor dealt with the matter appropriately. She spoke to the mother in a friendly and professional manner explaining the baby was obese and to start cutting down on his milk feeds and to try other alternatives like watering down the baby milk, using juices or squash or just water. The baby also had not started crawling or pulling himself up onto the settee or other pieces of furniture most probably because of his weight and emphasized that the more the baby moves the more likely baby will start to lose weight and went on further to discuss ideas on how to get him to move around more by way of encouragement. The mother took in all the information and appeared to be comfortable with the whole situation and was grateful for the advice. The health visitor and mother had a good rapport together and were able to communicate on a personal level making sure that the child’s best interests were at heart and not just the health visitor preaching to the mum. The key to success in forming a trusting, effective, working relationship with the client, is to be constantly aware of the individual; it is important to focus not only on the problem but on the person Wells (2005)
Building a rapport with the family is essential, as you do not want to come across as preaching and judging making the family feel uncomfortable and feel like they are unable to communicate at ease.
The Health visitor needs to keenly use all senses of observation and instincts and be able to “read” non-verbal signs. By observing the environment and using a biographical approach in assessment, it is possible to pick up clues about the background, history and life of the client – also visual evidence: the state of the home, photos, warmth, cleanliness, furniture, safety aspects and evidence of hobbies. These facilitate understanding and communication; thus providing a basis for a good working relationship with the client. Journal of Community Nursing (2009)
Working at Ty Gobaith a hospice for terminally ill children and children with a life limiting illnesses, there were 4 children staying at the hospice at the time, none of the children could talk because of their disability. Their only way of communication was through laughter, smiling and crying. The staff communicated with the children by talking, laughter and cuddles. They would read stories, include them in conversations and when they were upset cuddle them. On the Thursday two children were taken to a private hydrotherapy pool. The youngest boy aged 2½ years old, had poor muscle tone and developmental problems. When the little boy was picked up he was very floppy and could just about hold his head up but in the hydrotherapy pool with the physiotherapist holding him he loved splashing about and was able to move around and kick his legs as he floated in the pool. The little boy was laughing and had a huge smile on his face and could tell he was happy to be in the water. If he was feeling a little uneasy then he would cuddle into the physio so she would hold him closer to her.
There was a 14 year old girl who also went into the pool after the little boy. She was hoisted into the water where the physio held her in the water. The girl was uneasy at first and did not want to be let go and the physio could tell she didn’t want to be let go she wanted the security and reassurance of being close to her. The physio and the girl had a good rapport together, the girls face would light up when they were together and was always watching the physio and smiling. O’Connor and McDermott, (1996), offer insight into whether the ability to build rapport is the result of acquired skills, or is dependent upon the inherent qualities of the individual. There was good communication between the physio and the children although there was no speech the physio was able to determine what the children were enjoying in the pool and when they were feeling unsure. The non verbal communication was easily understood and this built up a good rapport with the children and the physio.
Conclusion
It can be easily assumed that everyone knows how to communicate, and they can, but it takes more to understand and read a person whether they are using verbal or non verbal communication. Many barriers can hold people back and sometimes it often takes a little more observation to recognize when someone is feeling a little out of their comfort zone or feeling anxious about being in a different environment surrounded by strangers albeit professionals. It is also important to treat people as individuals not just as patients, to respect each person’s personality as well as their dignity which can so often be lost within a bay of patients. Communication not only has to be clear and effective, it needs to be understood by both patients and professionals.
Good rapport is essential for breaking down any barriers with patients and their families and puts the patients at ease knowing they have this good rapport. Going into hospital can be an unsettling time but to be able to talk to your nurse and other health professionals builds up a good relationship and can take the edge off any anxiety.
For a nurse or any other health profession communication seems to be a fairly simple process. When dealing with any matter of a person’s life communication would be high up on that agenda but professionals are still getting it wrong and mistakes are still being made. Nearly 9000 complaints were made last year regarding communication both written and oral. Workloads are increasing, staff shortages and poor management are all contributing to added stress and the basics of nursing are being forgotten because of this. People’s expectations are high and expect to receive a good quality service but is sometimes not always possible.
Never underestimated humour and the qualities of having a shared sense of humour, it breaks barriers and creates relationships between you and the patient and your colleagues, it makes going to work that much more enjoyable.
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