Communicating with Clients within the Health Service - Essay Example

Communicating with within The Health Service Swarnambika S Academia Research Part Basic model of interpersonal communication Introduction Communication is a critical skill for nursing. It is the process by which humans meet their survival needs, build relationships, and experience joy. In nursing, communication is a dynamic process used to gather assessment data, to teach and persuade, and to express caring and comfort. Comforting is the process by which nurses assist clients and significant others to face the distresses and discomforts they may encounter. In nursing, communication is an integral part of the helping relationship (Deering & Cody, 2002, pp.34-41). Sometimes a nurse is said to be efficient but lacking in something called bedside manner. The intent of any communication is to elicit a response. Thus, communication is a process. It has two main purposes: to influence others and to obtain information. Communication can be described as helpful or unhelpful. The former encourages a sharing of information, thoughts, or feelings between two or more people. The latter hinders or blocks the transfer of information and feelings. In this section, we would be discussing the outline the basic model of interpersonal communication. Literature Review Many factors influence the communication process. Some of these are development, gender, values and perceptions, personal space, territoriality, roles and relationships, environment, congruence, and attitudes (Bush, 2001, pp.35-37). Development Language, psychosocial, and intellectual development moves through stages across the life span. Knowledge of a client's developmental stage will allow the nurse to modify the message accordingly. Gender From an early age, females and males communicate differently. Girls tend to use language to seek confirmation minimize differences, and establish intimacy. Boys use language to establish independence and negotiate status within a group. These differences can continue into adulthood so that the same communication may be interpreted differently by a man and a woman. Values and Perceptions Values are the standards that influence behavior, and perceptions are the personal view of an event. Because each person has unique personality traits, values, and life experiences, each will perceive and interpret messages and experiences differently. Personal Space Personal space is the distance people prefer in interactions with others. Communication thus alters in accordance with four distances, each with a close and a far phase. Tamparo and Lindh (2000, p. 31) list the following examples: Intimate: Touching to 1 feet Personal: 1 to 4 feet Social: 4 to 12 feet Public: 12 to 15 feet. Intimate distance communication is characterized by body contact, heightened sensations of body heat and smell, and vocalizations that are low. Intimate distance is frequently used by nurses. When someone who wants to communicate steps too close the receiver automatically steps back a pace or two. In their therapeutic roles, nurses often are required to violate this personal space. Personal distance is less overwhelming than intimate distance. Voice tones are moderate, and body heat and smell are noticed less. Physical contact such as a handshake or touching a shoulder is possible. Much communication between nurses and clients occurs at this distance. Social distance is characterized by a clear visual perception of the whole person. The person is protected and Out of reach for touch or personal sharing of thoughts or feelings. Social distance allows more activity and movement back and forth. Public distance requires loud, clear vocalizations with careful enunciation. Although the faces and forms of people are seen at public distance, individuality is lost. Territoriality is a concept of the space and things that an individual considers as belonging to the self. Territories marked off by people may be visible to others. Roles and Relationships The roles and the relationships between sender and receiver affect the communication process. Roles such as nursing student and instructor, client and physician, or parent and child affect the content and responses in the communication process. Environment People usually communicate most effectively in a comfortable environment. Temperature extremes, excessive noise, and a poorly ventilated environment can all interfere with communication. Also, lack of privacy may interfere with a client's communication about matters the client considers private. Congruence In congruent communication, the verbal and nonverbal aspects of the message match. Clients more readily trust the nurse when they perceive the nurse's communication as congruent. This will also help to prevent miscommunication. Congruence between verbal expression and nonverbal expression is easily seen by the nurse and the client. Inter personal attitudes Attitudes convey beliefs, thoughts, and feelings about people and events. Attitudes are communicated convincingly and rapidly to others. Attitudes such as caring, warmth, respect, and acceptance facilitate communication, whereas condescension, lack of interest, and coldness inhibit communication. Caring and warmth convey a feeling of emotional closeness, in contrast to an impersonal approach. Caring is more enduring and intense than warmth (Hilgers, 2003, pp.48-50). It conveys deep and genuine concern for the person, whereas warmth conveys friendliness and consideration, shown by acts of smiling and attention to physical comforts (Brammer, 1988, p.390). Respect is an attitude that emphasizes the other person's worth and individuality. It conveys that the person's hopes and feelings are special and unique even though similar to others in many ways. Acceptance emphasizes neither approval nor disapproval. The nurse willingly receives the client's honest feelings. An accepting attitude allows clients to express personal feelings freely and to be themselves. Conclusion To conclude, communication is an integral part of the nursing process. Nurses use communication skills in each phase of the nursing process. Communication is also important when caring for clients who have communication problems. Communication skills are even more important when the client has sensory, language or cognitive deficits. Nurses who communicate effectively are better able to collect assessment data, initiate interventions, evaluate outcomes of interventions, initiate change that promotes health and prevent legal problems associated with nursing practice. Effective communication is essential for the establishment of nurse-client relationship. Part 2 - Issues faced by a practitioner when communicating with Clients within health service Introduction Communication can occur on an interpersonal level within a single individual level as well as on interpersonal and group levels. Interpersonal communication is otherwise called the self-talk. Both the sender and the receiver of a message usually engage in self-talk. It involves thinking about the message before it is sent, while it is being sent, and after it is sent, and it occurs constantly. Consequently, intrapersonal communication can interfere with a person's ability to hear a message as the sender intended. Nurse practitioners need to take care of safeguarding the client's privacy without any discrimination against the clients. They also need to maintain their individuality in terms of communication with the client and the way they carry themselves with the client. Learning about nonverbal communication is important for nurses in developing effective communication patterns and relationships with clients (Kundu, 1976, pp.31-33). Using the right mode of communication and personal grooming helps the nurse practitioners to maintain their individuality. In this section, we would be discussing the issues faced by a nursing practitioner when communicating with clients within the Health Service in order to maintain their individuality. Literature Review A message that is direct and simple will be more effective. Clarity is saying precisely what is meant and brevity is using the fewest words necessary. The result is a message that is simple and clear. An aspect of this is congruence, or consistency, where the nurse's behavior or nonverbal communication matches the words spoken (Olsen, 2001, pp.36-46). When the nurse tells the client, "I am interested in hearing what you have to say," the nonverbal behavior would include the nurse facing the client, making eye contact, and leaning forward. The goal is to communicate clearly so that all aspects of a situation or circumstance are understood. To ensure clarity in communication, nurses also need to speak slowly and enunciate carefully. Nurses need to be aware of both relevance and timing when communicating with clients. No matter how clearly or simply words are stated or written, the timing needs to be appropriate to ensure that words are heard. Moreover, the messages need to relate to the person or to the person's interests and concerns. This involves sensitivity to the client's needs and concerns. Spoken messages need to be altered in accordance with behavioral cues from the client. This adjustment is referred to as adaptability. What the nurse says and how it is said must be individualized and carefully considered. This requires astute assessment and sensitivity on the part of the nurse. Individuality of the Nurse Nonverbal communication is sometimes called body language. It includes gestures, body movements, use of touch, and physical appearance, including adornment. Nonverbal communication often tells others more about what a person is feeling than what is actually said, because nonverbal behavior is controlled less consciously than verbal behavior. Nonverbal communication either reinforces or contradicts what is said verbally. For example, if a nurse says to a client, "I'd be happy to sit here and talk to you for a while," yet glances nervously at a watch every few seconds, the actions contradict the verbal message. The client is more likely to believe the nonverbal behavior, which conveys "I am very busy and need to leave." Observing and interpreting the client's nonverbal behavior is an essential skill for nurses to develop. To observe nonverbal behavior efficiently requires a systematic assessment of the person's overall physical appearance, posture, gait, facial expressions, and gestures (Usher & Monkley, 2001, pp.91-101). Whatever is observed, the nurse needs to exercise caution in interpretation, always clarifying any observation with the client. The nurse cannot always be sure of the correct interpretation of the feelings expressed nonverbally. The same feeling can be expressed non-verbally in more than one way, even within the same cultural group. For example, anger may be communicated by aggressive or excessive body motion, or it may be communicated by frozen stillness. In some cultures, a smile may be used to conceal anger. Therefore, the interpretation of such observations requires validation with the client. Clothing and adornments can be sources of information about a person. Although choice of apparel is highly personal, it may convey social and financial status, culture, religion, group association and self-concept (Saewyc, 2000, pp.114-128). Charms and amulets may be worn for decorative or for health protection purposes. When the symbolic meaning of an object is unfamiliar the nurse can inquire about its significance, which may faster rapport with the client. How a person dresses is often an indicator of how the person feels. Someone who is tired or ill may not have the energy or the desire to maintain their normal grooming. When a person known for immaculate grooming becomes lax about appearance, the nurse may suspect a loss of self-esteem or a physical illness. The nurse must validate these observed nonverbal data by asking the client. For acutely ill clients in hospital or home care settings, a change in grooming habits may signal that the client is feeling better. A man may request a shave, or a woman may request a shampoo and some makeup. The ways people walk and carry themselves are often reliable indicators of self-concept, current mood, and health. Erect posture and an active, purposeful stride suggest a feeling of well-being. Slouched posture and a slow, shuffling gait suggest depression or physical discomfort. Tense posture and a rapid, determined gait suggest anxiety or anger (Burgio et al, 2001, pp.449-460). The posture of people when they are sitting or lying can also indicate feelings or mood. Again, the nurse clarifies the meaning of the observed behavior by describing to the client what the nurse sees and then asking what it means or whether the nurse's interpretation is correct. For example, "You look like it really hurts you to move. I'm wondering how your pain is and if you might need something to make you more comfortable" Nurses need to be aware of their own expressions and what they are communicating to others. Clients are quick to notice the nurse's facial expression, particularly when the client feels unsure or uncomfortable. The client who questions the nurse about a feared diagnostic result will watch whether the nurse maintains eye contact or looks away when answering. The client who has had disfiguring surgery will examine the nurse's face for signs of disgust. It is impossible to control all facial expression, but the nurse must learn to control expressions of feelings such as fear or disgust in some circumstances. Eye contact is another essential element of facial communication. In many cultures, mutual eye contact acknowledges recognition of the other person and a willingness to maintain communication. Often a person initiates contact with another person with a glance, capturing the person's attention prior to communicating. A person who feels weak or defenseless often averts the eyes or avoids eye contact; the communication received may be too embarrassing or too dominating. Credibility of the Nurse Credibility means worthiness of belief, trustworthiness, and reliability (Nelson, 2001, pp.202-204). Credibility may be the most important criterion of effective communication. Nurses foster credibility by being consistent, dependable, and honest. The nurse needs to be knowledgeable about what is being discussed and to have accurate information. Nurses should convey confidence and certainty in what they are saying, while being able to acknowledge their limitations (e.g., "I don't know the answer to that, but I will find someone who does"). Hand and body gestures may emphasize and clarify the spoken word, or they may occur without words to indicate a particular feeling or to give a sign. A father awaiting information about his daughter in surgery may wring his hands, tap his foot, pick at his nails, or pace back and forth. A gesture may more clearly indicate the size or shape of an object. A wave good-bye and the motioning of a visitor toward a chair are gestures that have relatively universal meanings. Some gestures, however, are culture specific. The Anglo American gesture meaning "shoo" or "go away" means "come here" or "come back" in some Asian cultures. Anti-Discriminatory Practice Nursing has formally endorsed the concept of clients' rights for three decades. The Code for Nurses (ANA Committee on Ethical, Legal and Professional Standards, 1968, pp.350-351), a guide to the ethical principles should govern the practice, conduct and relationships of the nurse, was adopted by the American Nurses' Association in 1950, and revised in 1960 and 1968. Three of the ten standards of the Code speak directly to clients' rights: 1. The nurse provides services with respect for the dignity of man, unrestricted by considerations of nationality, race, creed, color or status. 2. The nurse safeguards the individual's right to privacy by judiciously protecting information of a confidential nature, sharing only that information relevant to his care. 3. The nurse acts to safeguard the patient when his care and safety are affected by incompetent, unethical or illegal conduct of any person. Conclusion To conclude, by performing an expressive role through a skillful practice, the nurse practitioner helps to create an environment of trust essential to the comfort and well being of the client and maintain their individuality. The confidence of the client is built on being accepted as an individual and on the confidence of the nurse to be able to meet his or her needs. It is facilitated by the way care is provided, by its timing, and by attention to details of care, especially that is important to the client. The first obligation of the nurse who wishes to improve effectiveness as a communicator and maintain his or her individuality, is to develop awareness of what body language he or she uses to express feelings and attitudes in a non-verbal communication, so that the nurse may use this mode of communication deliberately to hasten the development of relationship with the client. In 1979, the National League for Nursing (NLN) issued a position paper on the responsibility of nurses to uphold clients' rights in their own practice and to make their influence felt indirectly when the practice of other health team members appears to be in violation of clients' rights (Murphy, 1980, pp.17-25). The NLN position emphasizes the client's right to privacy; to human and unprejudiced treatment; to information about every aspect of care from the names and preparation of those caring for him or her to the cost of the care and services provided; to refuse observation and treatment; to have access to all records concerning his or her care and to be fully informed about rights in all health care settings. According to this, it is the responsibility of the nurse to act without any discrimination towards the clients and safeguard their privacy and individuality while communicating to the client. References ANA Committee on Ethical, Legal and Professional Standards. 1968. The Code for Nurses, Kansas City, M.O: American Nurses Assoc., pp.350-351. Brammer, L M. 1988. The helping relationship: Process and Skills, 4th ed, Upper Saddle River, NJ: Prentice Hall, p.390. Burgio, Allen-Burge, Roth, Bourgeois, Dijkstre, Gerstle, et al. 2001. Come talk with me: Improving communication between nursing assistants and nursing home residents during care routines, The Gerontologist, 41, pp.449-460. Bush, K. 2001. Do you really listen to patients RN, 64(3), pp.35-37. Deering, C G & Cody, D J. 2002. Communicating with children and adolescents, American Journal of Nursing, 102(3), pp.34-41. Hilgers, J. 2003. Comforting a confused patient, Nursing, 33(1), pp.48-50. Kundu, M R. 1976. "Visual Literacy: Teaching Non-Verbal Communication through Television," Ed. Tehnol., pp.31-33. Murphy, C P. 1980. "Ethical Aspects of Decision Making in Nursing," Political, Social and Educational Forces on Nursing: Impact of Social Forces, New York: National League for Nursing, pp.17-25. Nelson, M L. 2001. Helping students to know and respond to human suffering, Nursing Science Quarterly, 14, pp.202-204. Olsen, D P. 2001. Empathic Maturity: Theory of moral point of view in clinical relations, Advanced Nursing Science, 24(1), pp.36-46. Saewyc, E. 2000. Nursing theories of caring: A paradigm for adolescent nursing practice, Journal of Holistic Nursing, 18, pp.114-128. Tamparo, C T & Lindh, W Q. 2000. Therapeutic Communications for health professionals, 2nd ed, Albany, NY: Delmar: Thompson Learning, p.31. Usher, K & Monkley, D. 2001. Effective Communication in an intensive care setting: Nurses' stories, Contemporary Nurse, 10(1/2), pp.91-101. Read More