An effective communicator is clear about what they would like to achieve, they are therefore more likely to make an appropriate choice in varied situations. When a nurse makes a choice on an intervention it should be determined by the needs and resources of the other person at that time. There are a range of strategies they can choose from while engaging patients/clients. There are 2 main modes to these strategies. There are those that keep the helper in control and those that give the patient the control. Taking action, advising and challenging keep the helper in control. While supporting, counselling and informing allows the patient to be in control.
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The strategy ‘taking action’ would imply the nurse is acting on behalf of the patient. This strategy would be adopted when a patient is unable to take action themselves, either through ill health or a loss of function.
While ‘advising’ it is important that a decision be made whether the advice given is appropriate. It’s important as inappropriate advice may have a negative effect. Inappropriate advice may undermine the individuals confidence and could lead to dependence for decision making. Advice usually comes from the advisers experience and is usually what that person would do. While this is suitable for specialist issues it may not be as effective for personal issues.
A constructive ‘challenge’ is used to suggest alternative opinion or option for a person to build on or change. It should be non-aggressive. A destructive challenge may be seen as aggressive leaving the other person felling bad or even worthless and leaves nothing for them to build on. Egan (1998) made a distinction between the words ‘challenge’ and ‘confrontation’. Many people describe being confronted as an unpleasant feeling that they would rather avoid. Egan’s (1998, p184) definition of challenge is:
an invitation to examine internal or external behaviour that seems to be self -defeating, harmful to others, or both and to change the behaviour if it is found to be so.
A challenge aims to increase awareness and insight by making others aware of themselves or behaviour. Empathy is of great importance while challenging. This entails listening to what the other person perspective and give acknowledgement to what they are saying while offering constructive advice. Challenging without empathy would cause the other person to feel their perspective is being dismissed causing them negative feelings.
Assertiveness is of great importance when challenging. People often confuse ‘assertiveness’ with ‘aggression’. Assertiveness is expressing your thoughts, ideas and feeling in an appropriate, direct and honest manner. Aggressiveness is a way of expressing your thoughts, feeling and ideas in an inappropriate way and will leave the other person feeling violated and low.
Bower & Bower (1991) developed a useful tool for developing assertive responses know as ‘DESC script’. Not all steps need to be used in every situation:
Describe the situation.
Express what you think and Feel.
Specify your request.
When ‘informing’ others it is important that the other person is ready to receive information. Once it’s determined that its appropriate to give information it must then be determined how much the patient knows and to assess how accurate this knowledge is.
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The timing of giving information is crucial as its been found that shortly after receiving bad news a patients ability to absorb information significantly dropped. Having a follow up interview with the patient and giving them pamphlets to read when they feel lower levels of anxiety has been proven to be effective. Also, a patient should who is given too much information at once may become confused and misunderstand the information. Finally a patient should be asked to relay details of what they understand to ensure their knowledge is accurate.
‘Counselling’ Is a professional activity, though nurses are not counsellors the use of counselling skills will be of great help when developing relationships with patients. The main objective of counselling is to help the individual to help themselves. With this the nurse will be providing assistance to patients to come to terms with life changing experience and potentially dealing with a change in self perception.
Carl Rogers stated that there are three core conditions to be effective at counselling. Empathetic understanding, congruence or genuineness and unconditional positive regard are the foundation to build a trusting relationship.
‘Empathetic understanding’ could be described in part as ‘standing is somebody else’s shoes’. Though this isn’t completely accurate as experiencing others thoughts and feelings through out the day would exhaust even the most energetic of people. kalisch (1971, p203) described empathy as ‘the ability to sense the client’s world as if it were your own, but without loosing the as if quality’. It is important to maintain a grasp ones self, or ones own world.
‘Genuineness’ or ‘congruence’ is the helper being honest and sincere in their desire to help. Genuineness is essential for the patient to build trust. Those who show sympathy to those in distress may be seen as patronising and untrustworthy.
‘Unconditional positive regard’ means that there are no conditions for the patient to meet while talking. It’s important as often in society certain actions taken are perceived as bad, if a person has taken part in a ‘bad’ action they may believe that they may be rejected. Due to the need to relate a person is able to obtain a stronger form of self by relating to others.
While in theory these principals sound easy to follow it requires effective communication on a one to one basis and requires a lot of concentration on the part of the listener. The listener must make accurate interpretation using several senses. The listener is also expected to give up preconceptions in spite of evidence. It is not simply enough to listen, transmission of this message is also required for the patient. The message can be received via a series of verbal and non-verbal channels.
Silence for many, helpers, presents a feeling of anxiety. Often those with good listening skills will feel comfortable in silence. This is due to the listener having the ability to contain their own anxiety.
Those with the ability to convey their thoughts and feelings may still need encouragement to continue talking. This may be done with a simple nod, smile a ‘Mm’ or ‘Aha’
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