Reflective Account of Communication Skills

 Communication as defined by the Department of Health is a process that involves a meaningful conversation between two people or more. To express a range of feelings and share information through both verbal and non-verbal means (The Open University 2019a)

In healthcare communication is essential in ensuring the delivery of safe and effective care to patients. Good communication with patients ensures patient centred-care, helps them feel at ease, in control and valued. Patients often feel anxious when in hospital, worried about their health and what treatments they may need to have that can make communication challenging (RCN, 2011)

This assignment will explore a reflective account of communication between myself and family members when a patient’s condition deteriorated (see appendices). I have chosen to reflect on this account as I found the communication a challenging experience. There are several models that can be used in the reflection of practice for example Gibb’s Reflective Cycle (1988), Johns Model of structured reflection (1994) and Borton’s Reflective Framework (1970). The communication reflection is structured using Borton’s Model (1970). Borton’s model of reflection incorporates three simple questions to ask of the experience or activity to be reflected on What? So what? Now what? (OU,2019b). It will also encompass different styles of communication skills used and theories on communication.

Confidentiality of the patient will be maintained throughout by not naming the individuals involved. The communication episode began when the patient in my care Mrs. A, condition deteriorated and cardiopulmonary resuscitation (CPR) was started. I noticed the patient’s daughter and other family members were stood at the door of the ward whilst treatment was continuing. Observing their body language, they appeared distressed and anxious. I wasn’t sure if it was appropriate for them to be in the ward witnessing the CPR and no one was currently able to go talk to them about what was happening. I decided to go over to the family and suggested they could go and wait in the day room and guided them to where this was. As stated by Baghcheghi et al (2011) cited in the Open University as a nurse it is expected that you will communicate accurately, clearly and effectively including verbal and non-verbal interpreting others body language not just with your colleagues and patients but also their relatives (OU, 2019c)

I felt quite intimidated as there was quite a lot of family members present, Asian’s have strong family values and this cultural value needs to be respected and considered in the future care of the patient (Carteret. M, 2010) I ensured my approach was calm, clear and friendly and used hand gestures to guide the family to where I wanted them to go. Communication is a transactional process and a person is influenced by the input given or lack of it and mirror a similar approach given. If I had approached the family in a hash manner, stating they could not stand there and had to leave with no further input that may have unnecessarily escalated the situation. This could have impacted the care being provided to the patient. Using a range of verbal and non-verbal communication enables you to build empathy and offer the appropriate support (OU,2019d)

I chose the day room as it offered the family some privacy to discuss the situation as explored in Activity 3.7, I adopted the principles of Soler to communicate effectively with the family. I ensured I used eye contact with the family members and portrayed a relaxed appearance. It was difficult at times to show attentiveness to all family members due to the number of relatives present.

I sat with them, rather than standing over them and used my intuition to provide touch to the daughter who was visibly upset to show empathy and that I was interested in listening to them (OU, 2019e). Illness of a loved one causes anxiety and stress, relatives have an expectation that healthcare professionals will treat them with respect and consider their feelings and wishes. However ethical principles need to be considered when talking to relatives, to ensure the welfare of the patient is at the centre of everything you do. This includes respecting the patient’s autonomy by only sharing information with family members that is agreed with the patient. Acting in non-maleficence when discussing the patient, only sharing relevant information that benefits the patient. In this case no restrictions where in place to share information with family (Al-Jawad, M et al, 2017)

I ensured the information I communicated to the relatives was clear and appropriate with no medical jargon to answer their questions, worriers and concerns. That it provided direction on what would happen next building rapport with the family. As cited in The Open University, Hood and Leddy (2006) acknowledged that clear, appropriate communication is essential for effective healthcare delivery and in the development of interpersonal and therapeutic relationships (OU, 2019f)

An understanding of Bylund et al (2012) theories of communication, I felt this communication episode with relatives fitted to uncertainty management theory (UMT). Uncertainty causes a wide range of emotions and people can still feel insecure about a situation regardless of the information they have been provided with (OU, 2019g)  I found the communication experience with the relatives challenging as I had not been in that position before, I had nothing to compare the experience against and had not had the opportunity to observe conversations with relatives whilst on placement. As Hargie (2011) discussed communication as a professional is very different to communication with your friends and family when you can focus on your own needs. When communicating to patients, relatives and other colleagues you need to remain professional and focused on the needs of the person in your care (OU, 2019h)

The identified barriers to the communication episode though reflecting on the experience was my feelings. I felt out of my depth due to it being my first experience dealing with upset relatives. I was worried that I would upset the relatives further by saying or doing the wrong thing, and I would not be able to answer the questions asked. In previous pressured communication experiences, I have found I get quite nervous and speak fast, this can affect the way the message is received.

After the event I was able to discuss further with my mentor what I thought went well, what didn’t go well and what could be improved. It was identified that completing some further training would be beneficial to increase existing knowledge in communicating with different people.  Also, suggestion of obtaining feedback from patients and relative where suitable on my communication to further improve my skills and build my confidence.

In conclusion effective communication is essential in healthcare delivery. It ensures delivery of high-quality compassionate care. It also provides a positive experience to patients and their relatives. The positive experiences help improve therapeutic relationships meaning patients feel less anxious. The effective communication also gives access to relevant information being shared allowing patients to make informed decisions about their care. (Bramhall, E 2014). Reflecting and acting on feedback is a professional standard to practice effectively and promotes professionalism as set out by the Nursing and Midwifery Council in The Code (NMC, 2015) It creates an opportunity to identify strengths and weaknesses in order to continually improve practice. Reflection can also help apply learnt theoretical knowledge and best evidence to practice.

References

• The Open University (2019a) ‘Unit 1: Principles of communication’, [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501033 (Accessed 01 December 2019)
• The Royal College of Nursing (2011) ‘First Steps’, [Online]. Available at https://rcni.com/hosted-content/rcn/first-steps/role-of-health-care-assistant (Accessed 01 December 2019)
• The Open University (2019b) ‘Activity 1.1: Your own communication’, [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501033§ion=1 (Accessed 01 December 2019)
• The Open University (2019c) ‘Unit 2: Developing therapeutic relationships’, [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501038 (Accessed 01 December 2019)
• Carteret, M (2010) ‘Cultural values of Asian patients and families’, [Online]. Available at http://www.dimensionsofculture.com/2010/10/culture-values-of-asian-patients-and-families/ (Accessed 01 December 2019)
• The Open University (2019d) ‘Section 1: Assessing your communication skills’, [Online] Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501038§ion1 (Accessed 01 December 2019)
• The Open University (2019e) ‘Section 3: Non-verbal communication’, [Online] Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501038§ion3 (Accessed 01 December 2019)
• Al-Jawad, M., Winter, R and Jones, E (2017) ‘Communicating with relatives’, British Medical Journal, p359. [Online] Available at https://pml-eu.hoseted.exlibrisgroup.com/permalink/f/gvehrt/TN_bmj_journals10.1136/bmj.j4527 (Accessed 01 December 2019)
• The Open University (2019f) ‘Unit 1: Principles of communication’, [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501033 (Accessed 01 December 2019)
• The Open University (2019g) ‘Section 2: Theories’, [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501033§ion=2 (Accessed 01 December 2019)
• The Open University (2019h) ‘Section 2: Theories’, [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501033§ion=2 (Accessed 01 December 2019)  
• Bramhall, E (2014) ‘Effective communication skills in nursing practice’, Nursing Standard, Vol.29, [Online]. Available at https://journals.rcni.com/doi/full/10.7748/ns.29.14.53.e9355 (Accessed 01 December 2019)
• Nursing & Midwifery Council (2015) The code: Professional standards of practice and behaviour for nurses and midwifes [Online]. Available at http://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/revised-new-nmc-code.pdf (Accessed 1 December 2019)

Appendices

Reflective account of an episode of communication using Borton’s Model of 1970 reflective framework (The Open University, 2019)

Reflection on practice placement – Firth 7

What?

Today I was working in C Bay – An 8 bedded unit of level 2 beds for acute cardiology patients. Patients are admitted to the ward with various life-threatening heart conditions that need close cardiac monitoring and treatment. The ratio of staff for patients is one staff nurse - two patients. I was assisting with my mentor looking after two patients. Mrs A (changed to protect anonymity) is a 62-year-old Asian lady with limited English, admitted after a suspected myocardial infarction (heart attack). The patient’s daughter was present at bedside and providing comfort to Mrs A and translation when needed. The patients monitor started to alarm and the patient went into cardiac arrest the patient’s daughter left the ward and CPR was started on the patient. As a student I observed the process and passed relevant equipment when needed. Whilst observing I noticed the patient’s daughter was stood at the door of the ward looking very distressed with several other family members. I wasn’t sure if it was appropriate for them to be in the ward, also no one currently was available to go talk to them about what was going on. So, I went over to the family and suggested they could go and wait in the day room and guided them to where this was. What I hoped to achieve was less distress to the family members but also allow staff to provide the care needed to the patient without distraction. I have learnt from this situation that this is an area I feel less confident in.

So what?

Once in the day room the family members obviously upset and distressed wanted to know what was happening, if patient was still alive, if they could go see her. I have not been in this position as a student nurse to talk to relatives in this situation or observed a situation to have knowledge on what to say. I explained to the relatives that she had gone into cardiac arrest and the doctors and nurses was with her now trying to get her heart beating again, the daughter who witnessed the arrest was crying, I held her hand and stated she was in good hands, and as soon as they could someone would come and speak to them to update them. I offered them a drink and stated If they needed anything to let me know. I went back to check on the family several times and once able to updated staff that the patient’s family was in the day room and would someone be able to go speak to them. I felt very out of depth in this situation and was worried about upsetting the family members by not saying the right thing. I have identified I need to increase my current knowledge in speaking to patients and/or relatives in distressing situations.

Now what?

I talked thought the communication episode with my mentor to gain relevant feedback. She suggested I could participate in some further training in communication through eLearning courses provided by the trust – ‘The importance of good communication’ to increase my confidence in communicating in difficult situations. She also encouraged me to shadow staff when talking to patients and relatives and to continue to reflect on practice to look at what went well, an what I could do differently next time.

References

• The Open University (2019) ‘Activity 1.1: Your own communication’, KYN237 Block 1: Unit 1, Communicating with clarity [Online]. Available at https://learn2.open.ac.uk/mod/oucontent/view.php?id=1501033§ion=1 (Accessed 01 December 2019)