An Evaluation of the communication skills demonstrated in the assessment of a service user
This essay will evaluate an admission assessment observed a specific assessment observed which was done by mentor. Communication skills that she used will be analysed. Furthermore appropriate literature will be used to understand if the communication skills that were used were the most effective as well as that of both verbal and non-verbal communication skills. All names have been changed for patient confidentiality in accordance with the NMC guidelines (NMC, 2008).The patient will be referred to as Mrs. Smith.
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Mrs. Smith is an 80yrs old lady widower living alone in a bungalow. She was admitted to the ward from A&E. She depends on his son who lives a few miles away and visits him twice weekly. Mrs. Smith was diagnosed of COPD 10 years ago and Ischaemic heart disease 4 years ago. He smokes 40 cigarettes a day. Currently, he is on Salbutamol 200mcg/dose dry powder inhaler 1 puff as required, Spiriva 18mcg inhalation powder capsules once a day, Nicorandil 20mg tablets one twice a day, Simvastatin 40mg tablets once daily and Glyceryl Trinitrate 400mcg/dose pump sublingual spray as required. Over the past few years, he has been admitted to hospital three times owing to exacerbation of COPD and has had a bad chest infection yearly for the past few years.
Mrs. Smith has not been well for two days and has been coughing and wheezing with increased
Phlegm and a temperature. She lost quite remarkable weight in the past few months because she has not been eating and drinking well. Mrs. Smith could hardly finish a sentence without gasping for breath and appeared anxious when the General Practitioner referred him to hospital.
The assessment was done by mentor included the EWS’s. Assessment is the first stage in the nursing process. Kozier, et al (2012) stated that assessment is a systematic collection of data with a view to identifying the patient’s actual and potential health problems. A complete and holistic assessment should take into consideration the individual’s psychological, social, spiritual and cultural needs (Matthews, 2010). Collected data can be subjective or objective (Hoffman, Aitken and Duffield, 2009).
Full assessment should be systematic, patient oriented, evidence based and holistic; and nurses should seek informed consent from a patient before initiating assessment, any treatment or care (NMC, 2008). Consent was sought from Mrs. Smith to conduct an assessment on her. There are three types of assessments namely; mini, comprehensive and targeted. Targeted assessment was used in assessing Mrs. Smith.
Vital signs were recorded to establish the baseline observations which help in early recognition of patient deterioration allowing early intervention before the patient’s condition worsens (Adam, Odell and Welch, 2010). Mrs. Smith’s respiratory rate was recorded as 21 breaths/minute, implying dysponea whereas normal respiratory rate ranges between 12 and 18 bpm (Dougherty and Lister, 2011). His pulse was 102 beats/minute confirming tachycardia against a normal pulse range of 60 to 100 beats/minute (Hastings, 2009). Nurses should count the pulse and respiratory rates for a full minute each, giving ample time to observe any abnormalities in pulse rate, rhythm and volume (Smith, et al, 2008).
With normal blood pressure ranging from 110/60 and 140/90mmHg (Bishop, 2009), Mr Smith’s blood pressure, measured using both an electronic device and a manual cuff was recorded as mild hypertension at 160/90mmHg. Temperature was checked using an electric tympanic thermometer and Mrs. Smith had moderate pyrexia with a core temperature of 38.9 degrees Celsius indicating possible pathogen invasion (Smith and Field, 2011). A normal core body temperature ranges between 36 to 37.5 degrees Celsius (Smith and Robert, 2011).
Arterial blood gases (ABG) test analysis was conducted and pulse oximetry was used to record oxygen saturation which read 87% suggesting hypoxemia. Both Felton (2012) indicated that ABGs analysis produces more accurate oxygen saturation than pulse oximetry.
My mentor failed to introduce herself first before she touched the patient, which is important when conducting with patients during the time she did the observations. (Henderson ,2004) stated that nurses have to show impression by recognizing yourself as well as your role delivers patients with the sensitivity that you are honest and that they are being appreciated.
Mrs. Smith was given a verbal informative account of giving him oxygen therapy and the reason for doing this by my mentor. Verbal language is one of the vital ways in which we communicate and is more helpful way in both gathering and updating patients of their disorder (Berry, 2007).
Communication can be verbal and non- verbal.Peate (2005) states that non- verbal communication reinforces a verbally communicated message. Non-judgemental interactions are focused on therapeutic communication, helps settle emotional conflicts and supports heart to heart talks allowing a patient to feel safe and free to share their true feelings, fears, values, hopes and ideas.
There are two ways to send a message and it has to be understood and the feedback to be given (Apker, 2001).A patients has to describe the level of his pain (Steveson, 2004). Nurse must make sure that the patients understands what has been said to them and that it is important (Grover, 2005).Close and open questions normally have the ability to determine a huge amount of accurate information. Mentor who administered oxygen therapy to Mrs. Smith did verbally tell Mrs. Smith what she was going to do since this process has not been done earlier to ensure that Mrs. Smith had understood the process which was going to be done. My mentor was aware of Mrs. Smith’s disorder but she failed to make sure that she agreed the procedure. Unfortunately if one does not practice listening skills correctly and related skills without the patient fully considerate can disturb the beneficial connection and often form an obstacle to message (Andrews & Smith, 2001).
Environmental obstructions such as a busy ward or a strained nurse can every so often decrease the level of kindness and impact real message (Endacott & Cooper, 2009). On the other hand nurses must remain sympathetic all the times towards service user’s regardless of pressure altitudes and amount of work (Von Dietze & Orb, 2000).My mentor’s procedure did not act in accordance with the NMC guidelines in respects to gaining consent as she failed to notify the patient of the procedure then Mrs. Smith would not recognised what she was agreeing too. Agreement is complex and it can carries a grade of risk for both service user and healthcare staff. In this state Mrs. Smith was incapable to give consent and the oxygen that acquired was in his best interest. Though, regardless of the service user’s understanding the agreement of consent must still be tried (Green, 1999). Timby, (2005) recommends that a service user’s right to self-government must be supported and appreciated regardless of gender, race, religion, culture and disability.
On the other hand well experienced communication procedures are incompetent if the significant idea of the interactive links goes misunderstood (Arnold & Boggs, 2007). Charlton etal (2008) debate that there are two unlike statement styles, biomedical and biopsychosocial. The biomedical style focusses on specific evidence relating to the service user’s disorders that is evidence focused. The biopsychosocial style is a patient centred approach which is directed by determining patients’ requires to offer the most existing message method.
My mentor if possible should have designed an action plan to regulate the lively method of collaborating with Mrs. Smith in order to carry out the oxygen procedure. For example every patient is not the same their requirements must be measured prior to carrying out any invasive methods. A patient centred method is said to have a more confident impression on patient results. On the other hand there is slightly study that debates personal skills in compared to a massive amount of rich study that argues simple communication skills regardless of proof suggesting that patient focused on care is the most actual manner (Jones, 2007)
Patients with breathing problems have difficulties in speaking especially when they are out of breath. The will have problems in communicating sometimes have barriers when trying to speak or trying to explain themselves. This indicate to a failure in communication and sometimes it can cause their health requirements not be met (Turnbull & Chapman, 2010). Kacperek, (1997) describes non-verbal communication as the word used to use to describe all methods of communication not organised by language. Argyle, (1988) advocates that the non-verbal element of communication is five times more prominent than the spoken aspect.
When Mrs. Smith was given oxygen, my mentor did not the use of non-verbal communication. Research have time and again revealed that language has no real incidence when interactive with patients (Foley, 2010). Non-verbal achievement such facial expressions,posture,touch eye contact and body language, display many feelings need to have verbalise (Foley, 2010). The Solar acronym is also an aid to recognise and think of the performances that should be applied in order to accomplish real communication (Burnard, 1992).
This tool includes of position of seat, leaning near the patient, eye contact and relaxation. If the method of non-verbal communication been there Mrs. Smith might have not been nervous and she should had felt more comfortable (Mason, 2010). Dougherty & Lister, (2008) is in contract with this model as he argued that remaining eye contact, take down position to the patient’s level and gently touching the service user hand whilst talking to them it helps them not to be scared. However touch is seen to be a real system of nonverbal communication which be able to put a service user at relax if they are worried or frustrated. It is insignificant to note that this method is not suitable for all patients as not all patients will feel relaxed with understanding can give this as attacking of individual’s space (Heidt, 1981).
Communicating with people with COPD appears to problems for health care givers (Thornton, 1999). However, the NMC, (2015) competency standard in still that all nurses are to provide best excellence sympathetic care near moral and cultural issues as well as ill health.
Jormfeldt, (2010) has presented that a great level of nursing teachings in both academically and practical settings can definitely impact attitudes of nurse’s views near patients. On the other hand, reflection is appreciated as an important factor of managing in these situations as it gives a method where undergraduate nurses can challenge, relate and analysis their assessment systems and hold the method of alteration to a helpful approach concerning patients with illnesses.
Dodd & Brunker, (1999) debate that by creating combined partnerships with both carers and authorities who are involved in the patients care can support you to evaluate the patient’s communication skills and their chosen ways of communication. Additionally, in agreement with the NMC (2015) rules it is important that all nurses must treat all patients with respect and self-esteem and not differentiate in any way regardless of their age, gender, race and or disability.
To develop the circumstances the nurse who administered the oxygen to Mrs. Smith might have communicated with the patient’s family. Since she came to hospital accompanied by her son, this might have given my mentor a good image concerning Mrs. Smith’s about what she enjoys mostly and what she does not like. This might have given her with the greatest means of method of how to carry out all the process. Family members could have been asked to be there with my mentor which might have allow Mrs. Smith to relax.
Nurses should every time put patient’s individual requirements first and recognise what is good for the patient morally rather than that of a qualified staff views only (Mencap, 2007).
In conclusion, this essay has revealed the communication skills that were observed throughout the oxygen therapies procedure. It is clear that communication is important in nursing care and that assessments of patients are vital in providing the patient centred care. Though, communication is certainly a value powerful for the real caring. Performance and communication of caring and capability at this time have a main effect on the ability of patients and relations to adjust the update, reflect choices, and adjust to anything deceptions forward.
Absence of responsiveness in regards to the best method of communicating with patients can position a great risk to patients as several individuals employed within the healthcare area may not have a perfect understanding of ill patients except they are specialised. Extra preparation may be required to make sure that all wellbeing care workers are capable to offer kindly care to patients with disorders. Patients with illnesses have the right to be cured the similar methods as others, regardless of the severity of their illness as all service user would be allowed to a trained staff and genuine service throughout their understanding surrounded by the healthcare atmosphere.
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