Nursing Communications Methods to Respond to Patient Needs

Discuss the communication methods that nurses use to understand and respond to people’s personal and health needs

This essay will examine different communication methods used by nurses, and when they are appropriate to use; and how can we adapt these methods to be culturally sensitive to patients. In modern society, healthcare professionals must be culturally sensitive in adherence to the NMC ‘domains’, now known as professional values, in compliance with section 7.3 of the Nursing and Midwifery Council code of conduct (NMC 2018), which states that we should take consideration of patients’ cultural needs when using both verbal and non-verbal communication to deliver quality care for their personal and health needs. It is an accepted belief that effective communication is important to ensure every patient receives the same level of care.

This essay argues that cultural sensitivity education for nurses is necessary in order to effectively communicate in a way in which is appropriate for the patients’ needs. Furthermore, different verbal and non-verbal strategies must be applied in instances where patients have communication impairments to improve patient outcomes and satisfaction.

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Communications are at the core of healthcare provisions and effective communications are important for all patients to receive the same level of care, but they can be inhibited by several reasons. Difficult communications between healthcare providers and patients have been well-documented. For example, (Kennedy et al. 2006) identified 5 main themes in difficult communications with patients faced by nurses. They used multiple levels of analysis of interviews of nurses which increased the reliability of the results. Also, (Jirwe et al. 2009) studied the effects of communication difficulties between nurses and south Asian patients and their carers. More than half of these did not speak English. They found that, because of communication difficulties, they suffer poorer service provision.

As (Hall & Ritchie 2013) stated, nurses must demonstrate effective, safe, compassionate and respectful communication. It is particularly important that their communications are adapted well in our multicultural society. We must be sensitive to patients’ cultural, religious and spiritual beliefs. (Resnicow et al. 1999) defines cultural sensitivity by surface and deep structures. Surface structure includes the superficial characteristics of a target population. This involves characteristics such as people, language, food, etc. Deep structure comprises incorporating the social, psychological, environmental, cultural, and historical aspects that influence a person’s behaviour. An example of a situation whereby cultural sensitivity is demonstrated is student nurses are advised by their university not to shake patients’ hands-on first meeting them due to patients’ varied views on personal space.

Now that the definition of cultural sensitivity has been established, (Brooks et al. 2018) defined culturally sensitive communication as “effective verbal and non-verbal interactions between individuals or groups, with a mutual understanding and respect of each other’s values, beliefs, preferences and culture…”. Therefore, nurses can be culturally sensitive to patients of all backgrounds by communicating with them appropriately. In a study conducted by (Majumdar et al. 2004), 114 healthcare providers and 133 patients who were randomly assigned to training group and control group were followed for 18 months. They found that healthcare providers who underwent the cultural sensitivity training program were made more aware of multiculturalism and thus had an increased ability to communicate with minority people. The number of participants seems large enough and the follow-up period sufficiently long. The training included understanding multiculturalism and the ability to communicate with minority people. They concluded that the training had a positive impact on both satisfaction and outcomes, however, the patients were mostly European and British, so patients from different backgrounds could have also been incorporated to ensure diversity in a real sense is considered. In any case, this study demonstrates that being able to communicate with patients from all backgrounds leads to improved patient outcomes, without an increase in healthcare expenditures.

Furthermore, (Tuohy 2019) concluded that in order to deliver optimal care, nurses must be able to communicate with patients and their families from different backgrounds. An example of cultural differences that could affect their care is that some patients do not feel it is acceptable with being touched by the opposite gender which could exclude care being given by them such as toileting, washing, and more. Thus, culturally sensitive communication is necessary for patients to be provided with care that is not compromised by their cultural differences. In order to establish cultural sensitivity for patients, the communication methods available to nurses will be discussed.

The Code specifically states that a range of verbal and nonverbal communications are needed to ensure healthcare providers can understand patients’ needs. Particularly, nonverbal communications become paramount when nurses are faced with patients who are unable to speak due to a health condition or for those who do not speak the same language as the healthcare providers, which is not uncommon in the modern society. For example, (Caris‐Verhallen et al. 1999) studied the occurrence of nonverbal communication between nurses and elderly to be very frequent. They observed the different types of non-verbal communications such as patient-directed eye gaze, affirmative head nodding, smiling, forward-leaning, affective touch and instrumental touch. Of note, these were analysed using videotapes of their communications and the analysis was qualitative. This study demonstrates that elderly patients are more receptive to nurses with open nonverbal communication, which shows the importance of nurses being aware of different methods of effective communications.

These communications are also frequently observed in NHS hospitals. For example, a study by (Bowers et al 2010) analysed interviews of NHS managers and nursing leadership at three London mental health trusts with nurses who communicated with patients that were acutely psychotic. They observed both verbal and non-verbal communication. Verbal communication included the nurse introducing themselves to the patient, focusing on a light, normal conversation and with appropriate humour. They would focus on the patient holistically rather than a set of symptoms. Non-verbal cues were also used, such as talking slowly, using simple vocabulary and short sentences. The nurses were also using a caring and quiet tone. The study concluded that patient outcomes could be improved when applying this nurse-patient interaction – indicating rapid de-escalation in aggressive patients, adherence to medications, and a reduction in social isolation which could potentially lower the risk of suicide.

(Chant et al. 2002) states that, despite a new emphasis on communication skills in nursing education, a large barrier in healthcare is indicated in ineffectual communication. There are different strategies to overcome these difficulties, such as using non-verbal communication cards called Augmentative and Alternative Communication (AAC). This is typically used in patients with severe communication impairment. A study by (Hemsley et al. 2001) interviewed 20 nurses who had cared for at least two patients with severe communication impairment within 12 months. The interview showed that, although the nurses received communication training in the form of lectures and clinical placements, none had received extra training from a speech pathologist about communication methods specific to patients with severe communication impairment. When the sample of nurses was given AAC materials, a positive communication response was indicated in more than half of the responses. However, this study was limited due to the preliminary nature of it. A bigger sample would be required to obtain clearer results in the nurses’ experiences and training. Additionally, (Finke et al. 2008) reviewed research concerning nurses and their patients with complex communication needs (CCN). They found that it is a paramount effective communication is carried out by nurses in providing quality care to CCN patients. Further using AAC strategies is supported in circumstances where using speech is not a possibility.

Ineffective verbal communication is also indicated in elderly patients with a communication difficulty. (Murphy et al. 2005) studied the effects of using Talking Mats with 10 frail older people who were experiencing communications difficulties due to several conditions including dementia, dysphasia, Parkinson’s disease and stroke. Talking Mats are a visual framework using image symbols allowing patients to organise them in a way that nurses and other healthcare providers would understand their needs and wants. The study found that using Talking Mats is an innovative communication strategy for patients with a communication disability. It is a tool that allows confused or mute patients to express their views. Nevertheless, the sample is limited due to the small sample size of 10 patients. The symbols must also be interpreted by the nurse, and the patient to also be taught how to use the tool correctly. This could lead to a misunderstanding between nurse-patient interactions.

In addition to knowing effective communication methods, nurses must be aware that appropriate language must be used for patients personal and health needs. (Singleton 2009) studied patient health literacy and the barriers associated with this for nurses to facilitate interconnections between patient language, health literacy and culture. It was concluded that an assessment of the patient’s linguistic skills was needed for nurses to form an understanding of a patient’s level of health literacy. It is important to use the right language for patients, particularly when they are required to make vital health decisions so that they can contribute to their care plan which is indicated in person-centred care. This includes deciding their treatment options, outweighing risks and benefits, deciding on care providers, etc.

Language barriers are present in minority ethnic communities, hindering their access to healthcare. (Gerrish et at. 2004) undertook five focus group interviews in the UK, with primary care nurses in different specialities who provided services to minority ethnic communities. The patients within these communities generally had limited proficiency in English and often required an interpreter. However, it was found that an interpreter was not always available. Rather, many of the participants relied on a family member to interpret for them. Some expressed their concern when using their children who had to discuss sensitive information with the nurse. Overall, they found that poor communication for minority ethnic communities has detrimental consequences. The care delivered was of poorer quality by using a family member as it intruded on their privacy and led to a negative impact on social relationships. Additionally, they identified that primary care nurses acted as gatekeepers to interpreting services. This study highlights that interpreters must be utilised more appropriately and that primary care nurses need additional training on this in order to enhance patient outcomes for minority ethnic communities.

As endorsed by section 7.3 of the NMC code, using effective communication methods is necessary in order to respond to people’s personal and health needs. Before appropriate communication can be established, the cultural background of an individual must be considered. Several pieces of research reviewed in this essay demonstrated how non-verbal communications have been useful in serving the patients’ needs, particularly those with communication impairments. Verbal communications are needed to accompany non-verbal communications in most patients who can listen and understand the nurse delivering care. However, this essay shows limitations in basic communication methods, and instead, tools, such as AAC’s and Talking Mats, can be integrated into nurse-patient interaction. It is shown that the use of these tools resulted in positive outcomes for the patient. Conversely, these studies are limited due to the small sample acquired and further research is required to fully understand the effectiveness of these tools. When communicating with a patient, it is significant to assess the patient’s health literacy so that the language nurses use is appropriate and easily understood by the patient. Medical jargon may be unfamiliar and overwhelming to them, so it is important to establish what they understand about their care plan so that suitable decisions can be made for their health. Finally, a study on minority ethnic communities and access to interpreters demonstrated that their quality of care was significantly lower than those proficient in English. This was due to primary care nurse’s gatekeeping interpreting services. This essay highlights the need for transcultural nursing and effective communication, focusing on discriminated groups of people such as from minority ethnic communities.

References

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         Brooks, L. A., ManiasE. & Bloomer M.J.(2018). Culturally sensitive communication in healthcare: A concept analysis. Collegian 0(0).

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