Effective communication is a prerequisite skill in nursing. Miller and Nicholson defined communication as a way of exchanging information from a source to a receiver, which often stimulates a behavioural response. This is a way in which ideas and feelings are shared in an attempt to establish a successful nurse-client relationship. Department of Health (2006) enforced changes in the way nurses communicate in order to improve care for adults for the purpose of minimising illness, promoting patient autonomy, supporting equalities and providing effective long-term care. Healthcare providers will be able to achieve these goals by having a deeper understanding of self-awareness.
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Patients are sensitive to the ‘affect’ and the body language of the nurses. ‘Affect’ is the word used to describe the way a person communicates, taking into account the intonation, pace of delivery, pauses in between sentences and other paralinguistic behaviours (Lindberg, Hunter and Kruszewski 1983 p.280). An example of a scenario in which awareness is displayed was in my placement. Post-surgery patients were required to be transferred from the theatre back to the ward. However, it was essential that the patient was seated upright first to regain balance as they were on the trolley during the operation. They were then informed to notify the staff when they were ready to walk for transfer, thus they were more in control of the situation. Despite having said that they can manage, it was essential to judge individual patient’s responses with their ‘affect’ and body language. Egan (1977) stated that the recipients are more likely to accept the non-verbal displays exhibited as the truth rather than what was said.
When conversing with a patient face-to-face, Egan (2009) put forward the acronym ‘SOLER’ as a basic guide to demonstrate attentiveness and respect. This is particularly vital when dealing with patients of a different cultural background as they appear more sensitive with the bodily expressions. This acronym provides information of the appropriate posturing, to indicate participation, and the behaviours to display that they are willing to engage in the conversation including open posture, maintaining eye contact and being ‘relaxed’. In this context, Egan (2009) emphasised on the avoidance of ‘distracting facial expressions’ and being comfortable with expressing ideas and thoughts. In my ward, it was essential to approach the tasks with confidence, so that the patients will feel safe and secure at the hands of the nurses. This also meant that masking emotions to the patients became a necessity due to the fact that appearing nervous can result in uneasiness. For example, in an account from a post-general anaesthetic patient, the client felt agitated and stressed as she could not leave the ward as her discharge documents remain uncompleted. The reason was that her blood pressure reading showed a higher reading compared to when she first came for admission. Thus, by explaining to her the circumstances in a calm manner, it became apparent that her behaviour turned somewhat calmer and less anxious. Smith (1759) acknowledged that most people tend to display ‘motor mimicry’ when conversing with someone; ‘receivers’ are likely to mimic emotions or actions performed or displayed by the ‘senders’ and vice versa (Arnold and Boggs 2006).
Moreover, it is important to constantly be self-aware and to discover new truths about oneself. Jourard (1971) stated that a lack of personal awareness can lead to a feeling of vulnerability when approached by patients expressing feelings, due to the fear of not knowing how to respond in an appropriate way. By having self-awareness, the sources of limitations that have the tendency to cause anxiety can be identified, so forward planning can be prepared in order to reduce or eliminate the impact this may have on performing activities and approaches to patients. Certain individuals utilise different techniques to minimise anxiety such as deep-breathing exercises or thinking of the positive outcome that comes once the source of fear or anxiety is overcame. Meanwhile, others prefer being critiqued, since it allows areas within practise needing improvements to be highlighted and alternatives to be considered.
It is crucial to engage in self-evaluation in between practices in order to see the progress of one’s personal growth. Distinguishing what empowers and what hinders one’s desires to achieve is fundamental in the journey of self-awareness (Burnard 1988). This emphasises the significance of reflective practise in healthcare. Oelofsen (2012) and Boros (2009) defined this as the capacity to be cognitive about the ‘events, situations and actions’ that occur during practice with the intentions of engaging in a process of self-growth. Boud, Keogh and Walker (1985) suggested that it becomes beneficial for students to keep a diary for the purpose of reflecting. He proposed several guidelines when recording information, such as being ‘honest’, ‘spontaneous’ and express their thoughts and opinions by the use of ‘diagrams or shorthand’ if found useful.
Dewey (1933) advocated approaches to effective learning in a process called “reflective thinking”. He proposed that this technique will allow students to recognise their weaknesses, so that they can attempt to develop a way in which they can handle their services in a better way. This, at the same time, improves their problem-solving as they are constantly thinking of alternative ways to improve. Therefore, the purpose of “reflective thinking” is to “transform a situation in which there is obscurity, doubt, conflict and disturbance of some sort into a situation that is clear, coherent, settled and harmonious” (Dewey 1933). Several nurses do not engage as much in this process, as a result, many do not perform in their duties the most effective way. Oelofsen (2012) advised setting up meetings and appointing an independent ‘facilitator’ for the purpose of sharing experiences, discussing different point of views amongst one another. This brings about the opportunity to gain criticisms and advices for the purpose of improving service to patients and service-users.
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In my experience, admitting patients in the ward for their operation was challenging. The admission pack provided guidance with the questions that needed to be asked, however the questions were brief, thus it was necessary to give examples. This also meant that judging the mental capacity of the patient was necessary when asking the questions, as it would appear offensive if questions were asked in an intimidating manner. Reflecting in between admissions was important, so that it is possible to recognise how else to approach the questions, hence sounding in a way that would lower patients’ dignity could be avoided. Keeping a diary whilst on the placement meant it became possible to record various activities skills gained each day. In addition, it would also be simpler to keep track of the progress, review and reflect upon the feelings, emotions, and the overall experience that have arisen whilst dealing with people in the hospital. If improvements were plausible, this learning can be turned into action, which is the inception for another reflective cycle (Royal College of Nursing 1995; Oelofsen 2012).
Being in control of one’s own emotions has been a challenge for most nurses. Bond (1986) commented on the perception of ‘getting emotional’ in healthcare settings, stating that it is deemed unprofessional when expressed inappropriately. Due to the social and cultural bias, many nurses are encouraged to manage their emotions to avoid being labelled as a ‘failure’. Several nurses become vulnerable to crying especially after situations of death especially in wards where death is uncommon. However, it is about grief of the patient’s family and not personally the nurse’s, thus crying in the presence of the family can appear disrespectful and may sometimes offend the deceased patient’s family. Nurses can provide improved care and services once they become more aware of when and how to express themselves (Bond 1986; Burnard 1992). Furthermore, Boud, Keogh and Walker (1985) attached importance to keeping abreast with personal ‘feelings and emotions’ whilst on practice, as it has the potential to increase awareness and gain a greater understanding of self.
Self-awareness is a vital skill that nurses of any discipline must practise in order to provide the utmost care and services possible. Putting into practise the constant reflection will require dedication especially with the pressure put on by work. However, the enhanced knowledge of oneself will result not only as a better nurse but a better person as well.
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