Communication and Relevance of Communication in Nursing - Essay Example

COMMUNICATION AND RELEVANCE OF COMMUNICATION IN NURSING Communication According to Wikipedia the encyclopaedia Communication is a process of information exchange by using a common protocol. Humans communicate to share experiences, knowledge, cooperate, issue or receive orders. The common forms of human communication are speaking, writing, gestures, sign language and broadcasting. The communication may be verbal or nonverbal, interactive or transactive and may also be intentional or unintentional. The communication could be internal that is within ones own self is intrapersonal and between two individuals is interpersonal. With a component of time also being considered communication could be synchronous or asynchronous. Communication could be explained stepwise in following way - creation of message, sending of message to another individual or organisation or a group of people, message being received and interpreted, and finally responded, thus completing the communication process. Communication in Nursing Gail P. Poirrier stated that "Communication is an area where nurses can experience autonomy, really connect with other human beings, and truly make a difference in other people's lives." Nurses use communication as a medium for exchanging thoughts and information, influencing behaviours and feelings and also experiencing intimacy with clients and colleagues. By focussing on client's needs and feelings nurses are able to help the patients heal and participate in their care, solve their problems, clarify thoughts and of course move towards their human potential. An effective communication is a must in a nurse to assess a client or a situation, planning, executing and evaluating care. The nurse is expected to quickly establish a nurse-client relationship to gain client's trust. The National League of Nursing identified communication as one of the most important in baccalaureate of nursing and considers it as must for accreditation (1997). According to Roger B Ellis, Bob Gates and Neil Kenworthy, in a professional nurse setting, communication could be between a nurse and a doctor, a nurse and a patient, between two nurses, nurse/doctor/manager etc., this appears to be a simple process of one person talking to another, but is actually a highly complex process which needs to be analysed. The basic unit of communication comprises of a sender, a receiver and a message set in a particular context with the unconscious or hidden content of communication being an integral and important part. As such the sender may convey a particular message but may send much beyond direct awareness. Similarly the receiver may register what was intended to be sent, but may receive more especially the unconscious or hidden component. The one way communication is common between a nurse and a patient or a doctor and a nurse. The simple one way communication (also called the basic components of communication) can be explained with the help of following diagram: Above diagram is adopted from the book titled Interpersonal Communication in Nursing by Ellis et al (2003). Bradley and Edinberg (1990) stated in Ellis et al that though nurses believe in a two way model they may adopt one way communication for following reasons: The communicator controls one way communication. Clearly, listening to a response makes demands on the nurse's capacity to adapt to the unexpected and she may feel more vulnerable or intimate with the patient as a result. One way communication can take place more easily whilst doing something else, e.g. whilst making the bed. Full attention on the receiver is not always necessary. Nurses feel under pressure to do lots of tasks. Two way communication may take time away from other important aspects of patient care. Two way communication can be depicted just by adding in a feedback loop to the one way communication, which is depicted as follows: Above diagram is adopted from the book titled Interpersonal Communication in Nursing by Ellis et al (2003). According to Ellis et al there are four basic principles of communications based on Watzlawick et al (1967) ideas: 1. One cannot not communicate. All behaviour has a message of some sort so that as well as the more obvious carriers of message like words or gestures, saying or doing nothing is itself a message. Not smiling is just as potent message as smiling. Once a message has been sent it cannot be retracted. If a judge tells the jury to disregard the evidence given she cannot change the fact that the members have heard it. All communication is irreversible - as many a public figure has learned to her cost. 2. Every communication has a content and relationship aspect such that the latter classifies the former and is therefore a metacommunication. Any communication sequence has a message content and also has aspects which refer to the way in which the message is received. How communicators relate to each other is sometimes consciously controlled but is more commonly unconsciously controlled. For example: Patient: I don't want to take these pills. Nurse: You must. Doctor says so. The last comment is a communication about the communication (a metacommunication) and marks out clearly how the nurse sees her relationship to the patient - that of control. 3. A series of communications can be viewed as an uninterrupted series of interchanges. There is no clear beginning or ending to a series of interchanges: any communication between two individuals has a history and a future in itself and is affected by the totality of the past experiences of the each individual. Hurtful past experiences can set up a pattern in which the person ignores the offender who then ignores the offended and thus the situation becomes an unhelpful communication chain reaction. It is difficult to deal with this pattern when a patient's manner is habitually offensive. 4. All communication relationships are either symmetrical or complementary, depending on whether they are based on equality or inequality. With two equal partners, such as two close friends, the interaction is likely to be symmetrical. With a status or power differential between two people, such as a teacher and pupil or doctor and nurse, the complementary relationship (one 'superior' to the other) will affect any communication between them. In general, how any communication is interpreted depends on the relationship the sender has with the receiver (2003). According to Andrea B O'Connor an essential component of clinical learning in nursing practise is transiting from a predominantly social style of communication to the situationally determined communication style. "Nurses must be adept in interviewing, counselling and teaching patients; documenting observations and interventions, both orally and in writing and; delegating up and down the chain of health care workers." Nurses are inclined to use a common language to communicate with patients and their families by translating the medical terminology into terms that they can easily understand. Thus nurses tend to adjust based on patient's age, educational qualification, culture, native language and existing communication problems such as hearing disability or disability to talk. Nurses also make use of gestures, touch, facial expressions and reassuring vocalisations depending on patients' abilities. To communicate with each other particularly co-workers nurses' use an abbreviated communication style called "nurse-talk". Nurse talk consists of acronyms and terms specific to the clinical environment (2001). Bailey and Wilkinson (1998) cited in Mark Knapp and John A. Daly that a patient requires an effective care provider's communication to be listening, asking simple questions, clear, articulate and loud enough to be heard; and maintain an eye contact (2002). According to Cegala et al (1998) cited in Knapp and Daly a patient's concerns remained hidden from the care providers (nurses) and the patients were differentiated based on four main clusters of behaviours namely information giving, information seeking, information verifying and socio-emotional communication. Cegala and McGee (1998) cited in Knapp and Daly stated that patients trained in communication skills sought more information by asking direct and indirect questions and acquired some useful information (2002). According to Abramson (1997) cited in Knapp and Daly communication skills training programs have reportedly led to better medical outcomes in patients, speedy recovery and less stay in hospital. According to Wong, Lau and Mok (1996) cited in Knapp and Daly the nurses tend to show increased willingness to communicate and achieve a perceived competence in communicating with patients (2002). According to Sanchia Aranda and Margaret O'Connor "Good communication is central to effective assessment." Accurate assessment of physical status or psychosocial concerns leads to proper diagnosis and appropriate treatment, whereas poor assessment may have an adverse effect on the patient. Wilkinson, Roberts & Aldridge cited in Aranda and Connor studied assessment skills of nurses' pre and post training course. The results indicated a low score in all core areas of assessment and were also oriented towards physical complaints, but after training in communication skills the results indicated higher levels of confidence and knowledge in the nurses (2003). However according to a study conducted by Heaven and Maguire (1997) cited in Aranda and Connor 60 percent of the patients did not disclose their concerns, nurses stated that only 40 percent registered their concern of which only 20 percent were identified correctly. Thus the nurses need to improve skills to identify and elicit concerns correctly. "Evidence suggests that effective communication skills are essential for identification of unmet needs and ongoing distress, and that those who practise such skills have the potential to improve quality of life in this high-risk patient group." An important point to be noted is that it is not always possible to participate in skills training and once the training is completed the motivation to continue in patient centred communication may wane in the monotonous work routine. Thus a diary needs to be maintained to reflect on the practice of communication skills, discussions and little rehearsal with the peers would be of a certain help to the professional practicing nurses (2003). Summarising according to Sheila Dark Videbeck following key points are to be borne in mind: 1. Communication is the process people use to exchange information through verbal and non-verbal messages. It is composed of both the literal words or content and all the non-verbal messages (process), including the body language, eye contact, facial expression, tone of voice, rate of speech, context, and hesitations that accompany the words. To communicate effectively the nurse must be skilled in analysis of both content and process. 2. Therapeutic communication is an interpersonal interaction between the nurse and client during which the nurse focuses on the needs of the client to promote an effective exchange of information between the nurse and client. 3. Goals of therapeutic communication include establishing rapport, actively listening, gaining the client's perspective; exploring client's thoughts and feelings, and guiding the client in problem-solving. 4. The crucial components of therapeutic communication are confidentiality, privacy, respect for boundaries, self-disclosure, use of touch, and active listening and observation of skills. 5. Proxemics are concerned with the distance zones between the people when they communicate: intimate, personal, social and public. 6. Active listening involves refraining from other internal mental activities and concentrating exclusively on what the client is saying. 7. Verbal messages need to be clear and concrete rather than vague and abstract. Abstract messages requiring the client to make assumptions can be misleading and confusing. The nurse needs to clarify any areas of confusion so that he or she does not make assumptions based on his or her own experience. 8. Non verbal communication includes facial expressions, body language, eye contact, proxemics (environmental distance), touch and vocal cues. All are important in understanding the speaker's message. 9. Understanding the context is important to the accuracy of the message. Assessment of context focuses on who, what, when, how and why of an event. 10. Spirituality and religion can greatly affect a client's health and health care. These beliefs vary widely and are highly subjective. The nurse must careful not to impose his or her beliefs on the client or allow differences to erode trust. 11. Cultural differences can greatly affect the therapeutic communication process. 12. When guiding a client in the problem solving process, it is important that the client (not the nurse) chooses and implements solutions. 13. Therapeutic communication techniques and skills are essential to successful management of clients in the community. 14. The greater the nurse's understanding of his or her own feelings and responses, the better the nurse can communicate and understand others (2004). In addition to above cited key points, I feel that nurse should learn the professional language, meaning usage of medical and nursing terminology to explain the situation in a simple and understandable way to the patients and their family members. Learning the communication in professional language would also help in giving a better end-of-shift report, writing down patient status and discuss the patient condition with doctor in rounds, teaching other nursing students and discussing with other colleagues. Bibliography Communication from Wikipedia, the free encyclopaedia. (2005). Available on [January 07, 2005] Gail P. Poirrier. Writing-To-Learn: Curricular Strategies for Nursing & Other Disciplines. (1997). ISBN 0887377238. Roger B Ellis, Bob Gates and Neil Kenworthy. Interpersonal Communication in Nursing. Defining Communication.(2003). ISBN 0887377238. Andrea B O'Connor. Clinical Instruction and Evaluation: A Teaching Resource. (2001). ISBN 0763716871. Mark Knapp and John A Daly. Handbook of Interpersonal Communication. (2002).ISBN 0761921605. Sanchia Aranda and Margaret O'Connor. Palliative Care Nursing: A Guide to Practice. (2003). ISBN 0957798849. Sheila Dark Videbeck. Psychiatric Mental Health Nursing. (2004). ISBN 0781740495. Read More