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Importance of communication in nursing

Introduction:

This essay seeks to describe an interaction between healthcare professionals and a patient, and identify the importance of communication in nursing. The objective is to discuss the key concepts of communication and how it applies to nursing. It will draw on the example of communication given to identify the skills and knowledge required in nursing practise.

Communication is a key skill in modern nursing practise and with the ever growing diverse communities we live in, this skill is becoming more and more important. (Hinchcliff pg 244, 1979) states that:

Communication is a process by which people influence one another by transmitting and receiving ideas, opinions, feelings and attitudes, usually involving the use of language. Whether what is received is the same as what is transmitted therefore depends on a common perception of the meanings of the language used.

Communication is a vital part of everyday nursing. From asking a patient how they are feeling, to the movement of notes between departments (Balzer-Riley 2004). The transferring of information between healthcare professionals and the patients themselves, allows us to see the patient in a holistic way (Balzer-Riley 2004). From a patients point of view communication can also be therapeutic, that is, caring and thoughtful communication can be beneficial to the patients well-being.

This essay will discuss the concept of communication and its different forms along with their effectiveness. A description of the interaction and how communication was used and the barriers that were faced will also be discussed. In the example of clinical practise, the method of communication was ineffective so there will also be a discussion of how, if repeated again, the situation could have been improved.

All names and locations have been changed in order to maintain confidentiality in accordance with Nursing and Midwifery Councils Student Code of Professional Conduct 2009 (NMC 2009)

"During baby clinic Mrs Otumbi, a Nigerian woman with moderate English skills, came in to see the health visitor and myself with her baby Jasmine. Baby Jasmine was due her second immunisations. Her mother was concerned as she felt her baby was not well enough to have them. I asked Mrs Otumbi to undress Jasmine so we could weigh her, Mrs Otumbi said 'she has already wee'd' I asked did she have any clean nappies? With a rather confused expression on her face she said she did. I then asked her again to prepare Jasmine to be weighed. Mrs Otumbi said 'The other Dr has already

weighed

her' not 'wee'd' as I had thought. We asked Dr Patel to come and have a look at her to see if she was well enough for the injections. He examined her and took her temperature which was normal. He explained to Mrs Otumbi that as she did not have a temperature she simply had a cold and there was no reason why she should not have her immunisations. However like Mrs Otumbi, Dr Patel also had quite a strong accent which she struggled to understand. Dr Patel again repeated the information regarding her daughters' well-being. Despite trying to reassure her that Jasmine was well enough Mrs Otumbi decided against having the immunisations and said she would bring her back when she felt she was well enough"

Communication:

Communication at its most basic is the transferring of information to another person and their receiving of that information (Balzer-Riley 2004).

In my clinical example the communication was given verbally and non-verbally (Hinchcliff 1979). There were also language barriers which prevented the full comprehension of the communication on both sides

There are two ways of orally transmitting information in communication, either verbally or non-verbally, verbal being the actual use of language and speech, whereas non-verbally concentrates on the intonation and pitch as well as accent (French 1983). There are many aspects to verbal and non-verbal communication. (French 1983 pg49) gives this oral transmission channels model:

Verbal communication is the use of language to transmit a message. From birth we are bombarded with verbal messages and begin, over time, to distinguish a meaning from them in order to be able to communicate our wants and needs (Burton 1979). Language is used everyday in everything we do. In nursing especially verbal communication allows us to inform patients of information regarding their health or pass on important facts between healthcare professionals about a patient (Balzer-Riley 2004). However there are many barriers to verbal communication which can render it useless (French 1983). If the person you are trying to transmit a message to cannot hear you properly, speaks a different language or is confused then the message will be lost. So as humans we use our bodies, our faces to help convey our message. Our facial expressions or body language can convey a message, as can the use of hand signs to demonstrate a point which could be the use of complex sign language or a simple wave action.

In the incident with Mrs Otumbi I realised after I had asked if she had any spare nappies that she looked confused. This use of facial expression made me realise that she did not understand what we were discussing. I found her accent very difficult to understand properly and she may have also struggled to understand me too. In the room we had people with Nigerian, Welsh, Pakistani and Southern England accents so more effort should have been made to ensure that all parties fully understood the situation. Both Mrs Otumbi and Dr Patel had very strong accents. Dr Patel and Mrs Otumbi found it hard to understand each other and I and my health visitor found it hard to understand Mrs Otumbi. However she may have also found it difficult to understand myself and my Health visitor.

Questioning did not take place and I did not make sure that all those parties involved fully understood the situation. (Cohen-Cole et al 1991) maintain that in order to gather data, there must be open-ended questions, checking of the situation and clarification. The use of questioning is an important factor in communication and can be used to clarify or gather more information. Closed questions are those which we only need to glean a yes or no answer from e.g. are you in pain? Does your head hurt? Alternatively it may be necessary to use open questioning which will provide more information, for instance why have you brought your child to clinic today? A simple question which would provide useful information regarding the child's attendance. Questions can also be reworded or repeated in order to gain clarification from the person you are speaking to and provide us with facts about the situation.

In the early stages I did not make sure that Mrs Otumbi had fully understood my question by using closed questioning to check. Dr Patel did not tailor his communication to suit the need of the situation. It was clear by Mrs Otumbi's facial expressions that she was confused and struggling to understand the information Dr Patel was trying to give her, however he continued talking at speed. Although I felt that Dr Patel's interaction with her was unsuitable I did not try to intervene. I think Mrs Otumbi was made to feel that she was overreacting about her daughter's health and she was not given the opportunity to ask any questions. Had she been given the opportunity to ask questions she may have felt more confident in allowing her child to be vaccinated.

Although Mrs Otumbi spoke a good level of English, there was better understanding from her when the language was kept simple and spoken more slowly. Dr Patel did begin to realise this once he began explaining that Jasmine was well enough, as his rate of speech slowed. From my part in the whole scenario it may have been a more useful communication tool to have clarified the question with Mrs Otumbi again or I could have asked if baby jasmine was wet rather than asking if she had any spare nappies.

Listening is an important skill in communication. To actively listen is to listen with the intent to gain meaning whereas passive listening is not contributing but simply listening (French 1983). Active listening would be used when discussing a subject between e.g. Patient and nurse discussing a diagnosis. Passive listening could be in a difficult situation such as giving a patient bad news where the most important issue is for the patient to listen to what you are telling them information. Adequate listening either passively or actively is needed for successful communication (French 1983) without it there can be confusion and important facts missed. During the interaction listening was an issue, when Mrs Otumbi spoke she was listened to passively but had she been listened to actively then follow up questions should have been asked to make clear what she needed. I could have listened to Mrs Otumbi more actively and asked whether or not she understood what Dr Patel had said to her. I also could have asked her why she felt Jasmine was too unwell to have her immunisations and given her the opportunity to ask any questions with regard to anything we had told her.

Non-verbal communication can also include body language and facial expressions such as eye contact, frowning etc (Balzer-Riley 2004). A lot can be communicated without even saying a word and non-verbal expressions can enforce the verbal message being communicated (French 1983). Non-verbal expressions can also be seen as confusing, they may not necessarily convey the same message as the verbal message. These are conflicting non-verbal messages. (Hinchcliff 1979) states that it is possible for the verbal message to convey one message while the non-verbal behaviour conveys a different meaning. Most non-verbal expressions are involuntary and the individual is unaware of their actions.

In my scenario there were a lot of body language and non-verbal cues being used. I think this was subconsciously trying to make up for the lack of verbal understanding. Mrs Otumbi seemed very confused when I asked her if she had any spare nappies. Her facial expressions were giving the impression that she was perplexed by the relevance of that question to her previous answer. Communication does not have to happen verbally and during stressful situations non-verbal communication is extremely important (Miller 1994), I felt that Dr Patel was exuding an air of frustration which added to the stress for Mrs Otumbi. I felt he was trying to rush the exchange whilst being as polite as possible. I could sense that he found Mrs Otumbi's delayed understanding frustrating, along with the actual annoyance of time constraints. Doctors normally refuse to see babies in clinic for anything other than medicals and, although on this occasion he obliged to look at Jasmine, I sensed he was slightly annoyed by the situation. Then lastly there was the rejection of his views on Jasmines health, by Mrs Otumbi, when he suggested that her baby was perfectly well enough for immunisations. There was much non-verbal communication taking place that should have been recognised by all the health care professionals in the situation not just myself.

Miller 1994) stated that the inability of parents to communicate with professionals may cause them to feel ill-informed. It also may lead them to feel that they are unable to take an active role in their child's care and it was clear from her body language, early on in her interaction with Dr Patel, that Mrs Otumbi had already made a conscious decision that she was unhappy for Jasmine to have the immunisations. She had a displeased expression on her face and was clutching Jasmine very territorially, giving the impression of 'protecting' her daughter. This may have been as she felt it was her only way to take control back in a situation she did not fully understand. Lack of communication is more likely to result in non-compliance with treatment, even where treatment is understood (Miller 1994). In the case of Mrs Otumbi this is true because she refused the immunisations at that time. Her compliance with the first immunisations in the immunisation programme leads us to believe that she understands immunisations. Her belief that Jasmine is not well enough may be based on previous experience, for instance if jasmine suffered flu like symptoms after her first immunisations. If Mrs Otumbi did not understand immunisations it is unlikely that she would have turned up to have them done on previous occasions, and may have allowed them to take place even with jasmine being poorly.

Persuasive communication is the attempt to persuade someone to do something or to persuade them not to do something (Mason et al 2003). It is an important skill in nursing as there may be times when, as a nurse it is needed to persuade a patient to allow a procedure to be carried out or to take their medication as it is in their best interests. There was a small use of persuasive language being used in my example, however it was wholly ineffective. Dr Patel was trying to persuade Mrs Otumbi to continue with the vaccinations as he felt that she was perfectly well enough. However his persuasion did not work as he did not take the time to communicate effectively with Mrs Otumbi. Time plays a vital factor in communication and simply taking the extra time with a patient can make the difference between them understanding and misunderstanding (Smettem 1999). It may also be necessary to alter the type of communication in order to aid understanding. This could be in the form of alternative language pamphlets or the use of pictures (Bothamley 1996).

There was a lack of responsible communication which means when a problem must be solved, communication should be in a logical way based on your nursing knowledge and on the facts presented in the situation (Balzer-Riley 2003). The problem was reassuring Mrs Otumbi that Jasmine was actually well enough for vaccinations, however the communication was not responsible or logical. Her limited understanding of the information he was trying to give her, led to her be suspicious of Jasmine having the vaccinations and instead decided to bring her back another time when she was happier with the health of her daughter. In this example of communication in clinical practise it is easy to see how quickly communication can go wrong. In this case it was a simple misunderstanding which did clarify itself eventually providing Mrs Otumbi does take Jasmine back the next week there is no detrimental effect to her health. However in a more serious situation it could make a difference between someone's life or death (Mason et al 2003). This is why effective communication between any healthcare professional and a patient is so important.

Conclusion:

Effective communication is a skill which can enhance nursing from both the nursing perspective and the patient perspective. The patient gets better understanding and clarification and the nurse has more satisfying interactions with patients, which in turn can lead to better nursing, what goes around comes around.

In order for this to happen there has to be a greater emphasis on time and taking that time to spend it with patients. I have found that the use of open and closed questioning is a useful tool to clarify situations and is a vital part of effective communication. It can avoid mistakes being made and make situations a lot easier to understand by all involved.

Non-verbal communication plays a pivotal role and when communicating with any individual. It is important to pay attention not just to what they are saying but also how they are saying, to take notice of their body language. By taking note of their body language can help simplify the communication, in the case of Mrs Otumbi by noticing that she had a confused expression on her face immediately told us that something was not being understood. It is easy to assume situations and thereby miss important details.

Communication is a key role in nursing and taking the time to communicate effectively should be seen as an aid to nursing rather than wasting time. This essay has shown that communication is a highly important role in nursing and if used properly can be used to great therapeutic and informative effect. Communication is a key skill that must not be brushed aside in haste and is central to effective and successful care.

References

Cohen-Cole et al (ed.) (1991) The Three Function Approach to the Medical Interview Mosby Year Book: St Louis

Balzer-Riley (ed.) (2004) Communication in Nursing Mosby: Missouri

Bothamley R. (1996) Issues of Race Journal of Community Nursing: Vol 10, Issue 10, pg 22-25

Burton (ed.) (1979) Interpersonal relations a guide for nurses Tavistock: London

Hinchcliff (1979) Teaching clinical nursing Churchill Livingstone: New York

French (1983) Social Skills for Nursing Practise Croom Helm Ltd: Kent

Mason & Whitehead (2003) Thinking Nursing Open University Press: Glasgow

Miller S. (1994) Disability in Asian communities, Paediatric nursing. Vol 6. Issue 1, pg 16-18

Nursing and Midwifery Councils Student Code of Professional Conduct 2009 (NMC 2009)

Smettem S. (1999) Welcome: Improving communications with ethnic minority families Paediatric Nursing Vol.11, Issue 2, Pages 33-35