The Nursing and Midwifery Council (NMC,2018) recognise the importance of communication in its code of conduct stating that the clear, literal and appropriate communication must be a nurse’s initial tool in order to meet the patient’s response or requests. Communication can be described in different ways, regarding on how it is being used or exposed. Communication can also include numbers, signs, motions which can correspond to signs and also images, tones or noise, but in the nurse’s perspective, it is the exchange of information, thoughts and feelings between a sender and receiver using speech or other means. Many times, this happens within a context and provides some effect and opportunity for feedback (Webb, 2011, p 7-8). Communication is mostly divided into verbal and non- verbal and it is important for nurses to use their words carefully in order to equal the patient’s ability to understand them. The difference nurses make in people’s lives is through how they communicate and interact with them (Kraszewski et al 2010). In this essay, there will be a discussion about how effective communication enhances the quality of care given to a patient through assisting with feeding and how care is delivered through working in partnership with other inter-professionals. Also, there is an exploration of how diversity may affect the quality of care given to a patient. These various factors will be related to the NMC (2018) code of conduct.
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Communication is used as a systematic tool which is, very essential in the nursing field of practice. The standard of communication between nurse and patient interaction has a significant impact on the care provided to the patient. To achieve this specific goal or aim, nurses need to use a range of verbal and non-verbal cues, communicate slowly and effectively, in order to meet a patient’s unique needs. Communication as a vital tool serves as an important role in nursing practice and it is a nurse’s responsibility to understand and ensure that it is used in an appropriate manner and also effectively (O’Hagan et al 2014, NMC 2018, Department of Health (DH) 2010).
In the next content of the essay, the topic of effective communication will be discussed and then dug in to actually give a meaning to how it works, processes and also delivers, and as an end result of how it’s impacts the nursing field of practice.
Effective communication in the nursing aspect, is the understanding of the patient’s opinions and experiences without interruption (Bramhall 2014). Nurses, according to the NMC (2018) code of conduct, are required to understand the patient’s concerns and transmit knowledgeable information that will then serve as an advice to the patient’s treatment and decision making. Barratt (2018) defines effective communication as the ability to provide high-quality care to suit a patient’s satisfaction, through supporting and valuing their decisions. To communicate effectively, nurses must not only try to understand the patient but rather convey and acquire information that are understood regardless and accepted within the working environment. However, the fear of being judged, lack of knowledge, lack of time, lack of privacy and the pressure of working in a busy environment during the nurse and patient interaction causes misunderstanding which leads to ineffectiveness in communication (Baddley & Boles, 2018, DH 2010, Kourkouta et al 2014).
Research studies clarify that, there are a variety of barriers that can lead to ineffectiveness of communication in the nursing field of practice. One of the major factors that contributes to ineffective of communication is patient diversity. During a nurse’s duty of care, they are required to learn and understand, recognise, advise and respect patients from different background regardless of their age, religion, socioeconomic status, gender or ethnicity. McClaimens et al (2014) explains that the nurse’s role is to able to respect and recognise patient’s culture differences, in order to provide enhanced quality care. Even though a patient’s culture differences may have an effect on the quality of care that is delivered and also influence the nurse-patient relationship, it should not be the cause of poor care. For instance, working on patients with strictly cultural boundaries could cause conflict against personal beliefs. An example could be, a female nurse working with a male Muslim patient. This may not be acceptable because of religious traditions. However, it should also not be a barrier to stop the nurse from performing their duty on the individual as treatment or rehabilitation.
Furthermore, being knowledgeable about a patient’s cultural background as nurses has become more relevant in the nursing practice. As it allows nurses to approach patients with different beliefs accordingly (Tallo 2016). However, nurses are not always expected to have awareness about all religions and cultural differences as these two components have been developed over the years (Ferwerda 2016). Moreover, it is the nurse’s responsibility to ask and develop appropriate skills and knowledge that will improve the individual care that the patient receives. This will then result in the nurse’s attitude and behaviour approach towards the patient which will engage them in practicing in a caring, holistic, non-judgemental and sensitive manner that will avoid assumptions, respect and value the individual choices acknowledging diversity (Dhadda 2014, NMC 2018).
It could be suggested that in order to communicate effectively, nurses need to undertake an assessment to improve their interaction with patients. Touhy (2019) presents four stages of assessment that nurses may use when approaching their patients. That is identifying, planning, implementation and evaluation. The process will expand the main reason why it is essential for nurses to undertake such assessments and also to update them. The first process starts with identifying issues concerning language barriers that may cause misunderstanding between the nurse and patient. The second process is planning, the stage that follows the assessment where the nurse is required to recognise the patient’s communication needs and seek help from an interprofessional if needed, for example, an interpreter. The implementation process is where the planning is put into action, which is the patient’s needs that have been identified, however, nurses should note that being open minded and working with colleagues help evaluate the care provided (NMC 2018). Evaluation is the last stage of the process, where the nurse analyses the assessment and identifies any issues that may have made the approach more effective and also take into account whether the care and information provided met the patient’s understanding.
The assessments, however, could be time consuming and cost effective to the healthcare sector, although it may successfully improve effective communication between nurses and patients. Another issue that may arise when working with an interpreter to overcome the language barrier is, the accuracy of the information being translated which sometimes may differ from what was being said. This may compromise the patient’s safety and their experience of quality care (Touhy 2019, McClimens et al. 2014).
Communication is a vital element in all nursing interventions such as assisting a patient with feeding (Kourkouta 2014). Patients with language impairment including stroke, multiple sclerosis, Bell’s palsy and muscular dystrophy, may need assistance with feeding as their conditions can cause eating difficulties (Anderson, 2017). The nurse’s duty to assist a patient may be performed not only to assess the patient’s nutrition, but also to help create a nurse-patient relationship and exchange information (Martinsen B, et al. 2012). When helping patients with assistant with feeding, nurses must take into account the patient’s individual needs. This may include the condition, the position of the patient requiring assistance, and the appropriate utensils they may need to improve their nutrition. For example, statistics from the Royal College of Speech and Language Therapy (2019) facts sheet present findings that 40-78% of stroke survivors are more likely to suffer from dysphagia. The term ‘dysphagia’ is a medical terminology used to describe people with swallowing difficulties with symptoms of chocking, coughing or gagging whilst eating (RCSLT 2019). For the example given, patients with this condition may, therefore, require to be assisted whilst eating in order for the nurses to decide on any treatment or management the patient may need to improve their health. Patients presented with stroke and other conditions who suffer from dysphagia need to be positioned upright when being fed to avoid the risk of chocking or aspirating. Offering modified texture diet: pureed food, soft mashed diet, minced textures and thickened fluids also helps in terms of making chewing and swallowing safer for patients with swallowing difficulties (DH 2010, Anderson 2017, Nhs 2019).
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The purpose of assisting patient with feeding is to identify any special dietary needs and also to make appropriate meal choices to prevent diseases such as diabetes and heart disease. However, nurses do not need to choose or make decisions on what the patient need to eat without the patient’s or family consent if the patient is unable to choose for themselves (Anderson 2017, Nhs 2019). The NMC code (2018) states that nurses are required to gain consent prior to perform any test or treatment on a patient, as patients are entitled to understand any information given to them about their care in order for them to give consent and make decisions. Not merely are nurses required to have the penitent’s consent, but also nurses need to take into account factors that may help improve the patient’s nutrition. For example, inappropriate actives such as ward rounds, visiting times and unnecessary interruptions during mealtimes should be reduce in order for nurses to have all the attention they need whilst assisting a patient with feeding. The University Hospital of Leicester (UHL) has introduced Protected mealtimes which is a period of time put in place on wards to help patients with their nutritional intake. This has become more useful as it has created a peaceful and relaxing environment for patient to enjoy their meals (DH 2010, UHL 2013). However, according to Young (2017) protected mealtimes has not increased the inadequate food intake of patients. This is because protected mealtime has not been put into effect adequately and there is not enough evidence that proves that interruptions during mealtimes is the cause of poor food intake of patients.
Above all the factors listed, it is clear that communication must be the key for nurses, and it is important for nurses to be able to communicate with patient and understand them whilst helping them with feeding. Communication is not only verbal but can happen without words this is known as non-verbal communication. This may include keeping eye contact, using gestures, facial expressions, body languages and a friendly tone of voice to help the patient understand the need of assisting them with feeding (RCN 2016). Nurses also need to be able to listen to their patient actively in order to avoid any distractions that can affect the skill being performed and also to be aware of any food allergies that their patients may be suffering from. As mentioned earlier communicating effectively with patients means explaining and sharing information on what may be needed to do to enhance the patient’s health in order to enable the patient to make well-informed decisions and act upon them. However, patients are easily influenced by their culture and past experiences, which most often affect their point of view and the way they perceive information. Moreover, not all patients equally agree to be assisted with their meals, this may be due to the fact that, they might have had bad experience of assisted feeding. For example, a patient who has been assisted with hot meal previously may find it difficult to accept being assisted with feeding or have a “fear” of being assisted by others, but with effective communication and reinforcing it with nonverbal communication could change the patient’s understanding. Therefore, communicating effectively can have a positive effect when assisting the patient with feeding and it will ensure both the satisfaction of the patient and the nurse and through this nurses will be able to identify the patient’s preferences, understand their needs and also help improve the patient nutrition in situations where by the patient has loss of appetite, or might be losing or gaining a significant amount of weight (Martinsen et al 2012, Robinson et al 2019).
During these observations’ nurses may then decide to start documenting the nutritional intake of the patient’s foods and fluids, as this will allow the nurse to understand what type of support the patient might need to help improve their health. Documentation is one of the most important attributes that nurses need to acquire during their nursing practice to demonstrate the patient’s condition, care and treatment delivered. It is also a means of communication between nurses, doctors and other health care professionals who are not involve or work directly with the patient in order to avoid and prevent any risks from occurring and also help the patient’s safety. Documentation is not only the way for nurses to share information about their patient’s within the health care team , but it is also a way to assess the patient’s nutrition status in order to refer them to interprofessionals when necessary, where they can reassess the patient and develop personalised plans to support the patient’s nutrition (Anderson 2017, NMC 2018).
The referral of an interprofessional worker is important because it helps inform the patient about services available that will improve their self-care and quality of care and also promote their wellbeing (Edwards et al 2007). In this case to help stroke patients with nutritional purposes, nurses may refer them to dieticians or speech and language therapists. Dieticians are members of multi-disciplinary team that inform and help patients to make appropriate choices about their food and nutrition based on their medical conditions and individual needs. They also help in diagnosing and treating any dietary and nutritional problems (Nhs 2016). Speech and language therapists are allied healthcare professionals who provide treatment and support especially for patient with communication and eating difficulties (RCSLT 2019). Therefore, working co-operatively with other healthcare professionals enhances the quality of care and information that nurses provide to their patients (NMC 2018).
In conclusion, communicating effectively in the nursing field of practice is essential because it improves the patient care that is being delivered and also help the patient feel valued and respected. The nurse’s ability to communicate effectively when assisting a patient is vital as patients are entitled to be well informed about what the meal they are about to eat contain and how to eat it. Furthermore, the usage of verbal communication promotes and encourages patients to: identify the food on the tray, help them understand where the food is, and what utensils to use and also inform them on what to do next. Nevertheless, involving patients into communication while assisting them with feeding enhances their nutrient intake, as most patients are easily distracted. Therefore, communicating effectively with patients ameliorate their knowledge about their treatment and health.
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