Therapeutic Communication Skills in Nursing - Case Study Example

Communication has become not only valued, but also essential to the practice of nursing. Nursing is a social activity and so there is a critical need for the nurse to be able to communicate competently as the social relationships they form with patients have a direct impact on healing processes (Klagsbrun, 2001; Queensland Health, 2004). Therapeutic communication is one way of improving the well being of patients. This paper will show how the nurse in the scenario “Tony’s Father” wanted to show concern for her patient’s father, and to be there for him during his distress, and to show that she wanted to understand how he felt. Firstly, interpersonal communication themes in the scenario will be presented. Secondly, a comprehensive description of the key communication themes will be provided. Next, the main characters behaviours that promoted and hindered communication will be noted. Fourthly, additional communication techniques that the nurse could have used will be determined. Finally, a conclusion shall synthesise the main points of the paper, and highlight how the nurse showed concern, and used her communication skills to try and understand the father’s distress. The main characters of this scenario were Tony (the patient), his father, and the nurse, who used different forms of communication as identified by Stein-Parbury (2005). Tony was non-communicative as he was about to be re-admitted to intensive care, and no verbal or non-verbal behaviours during the scenario were attributed to him. His father was distant and withdrawn. He is described as avoiding eye contact, and not talking unless it was in regards to procedures about his son. His non-verbal behaviours included looking tired and stressed, and walking with a slumped posture. The nurse showed active communication skills such as actively listening to Tony’s father when he did finally disclose; expressing empathy when she showed support for the father, such as letting him know she could only ‘imagine’ what he was going through; and by using silence to slow the pace of the conversation, to give the father an opportunity to reflect upon and speak further of his feelings, and to allow her to observe his non-verbal communications. The nurse’s non-verbal communication included touching the father on his shoulder, directing him gently to a quiet area of the ward, and holding his hand during his emotional disclosure. According to the definitions of Stein-Parbury (2005) the communication skills of Tony during this scenario are absent, as he head serious head and spinal injuries it is likely he was not conscious. Tony’s father displayed very poor communication skills. He avoided engaging the nurse in any form of verbal communication beyond that of the essential details regarding his son’s condition. Additionally, when the nurse first approached him he appeared to not be aware of her presence, as he stared ‘through her.’ His communication technique improved after the nurse disclosed her inadequacy to understand his circumstances, as he described his thoughts and feelings in detail. In contrast, the nurse showed strong communication skills through active listening, empathy and use of silence (Stein-Parbury, 2005). I am going to focus on her communication skills for the rest of this section of the paper. Active listening is a vital interpersonal skill for the nurse (Klagsbrun, 2001). It is a skill that allows the nurse to reflect on the deeper meaning of what the patient is saying, and can aid the person to be more in touch with their own feelings. Basically, active listening is when the nurse hears what the patient is saying, reflects back what is said, the intent behind what is said, using different words, and then allows the patient to acknowledge or discount the interpretation (Stein-Parbury, 2005). It is a non-intrusive way for a nurse to share with the patient in regards to their emotions and cognitions (Ellis, Gates, & Kenworthy, 2003). From the patient’s point of view, active listening from the nurse gives them an opportunity to clarify their thoughts and feelings. The technique can help a patient to transform their sense of self. Empathy from the nurse was her ability to perceive the patient’s point of view, and her ability to communicate this understanding to the father (Stein-Parbury, 2005). Empathy has been stated to be the key feature of a helping relationship (Reynolds & Scott, 2001). It appears that a comprehensive definition of empathy needs to include morals, emotions, thoughts and behaviours. As empathy encompasses an understanding of patients, and their present situation, it is evident that empathy is essential to nursing (Stein-Parbury, 2005). However, despite the evidence that empathy is critical to the therapeutic relationship there are high incidences of low-empathy in nursing practice (Reynolds & Scott, 2001). Silence is powerful (Perry, 2005). Perry (2005) notes that silence is often construed as providing small contribution to conversation and its contribution to the therapeutic relationship being inconsequential. When nurses use silence purposefully it can contribute effectively to optimal conversation (Stein-Parbury, 2005). The use of silence has been reported as aiding in the transmission of feeling and emotions, especially when the use of words will not facilitate an expression of an experience (Taylor, Lillis, & Lemone, 2004). Compassion, acceptance and support have been indicated as behaviours that are often best communicated through the use of silence (Perry, 2005). Particularly, during times of intense emotion, the use of silence is often necessary, such as the nurse displayed during Tony’s father’s emotional disclosure. Also the use of silence provides the nurse to observe and reflect on the patient’s non-verbal communications, and so aid the further understanding of the intent behind the patient’s words. Tony’s father was mostly silent, avoidant of conversing and did not make eye contact with the nurse and so hindered communication (Stein-Parbury, 2005). He remained distant when the nurse first approached him, although this did not in itself hinder conversation. It may be that his non-verbal communication of being overwhelmed facilitated the nurse to keep on talking. In contrast the nurse promoted communication by self-disclosing to the father her inability to ‘imagine’ his circumstances, thus showing her willingness to try and understand his thoughts and feelings. Her use of touch, on his shoulder, leading him, and holding his hand, aided communication as the father was able to feel cared for and supported in his time of distress. Her active listening, empathy and silence allowed him to grieve, and to feel comfortable with disclosing his thoughts and especially his fears. The nurse used many positive interpersonal communication skills, although, she could also have drawn on others (Stein-Parbury, 2005). When the father had completed his disclosure she could have responded to the information he had given her. During her response she could have reassured the father with factual feedback on the care being provided to his son in intensive care. She could have expressed reassurance as: I can see that you are better able to be there for your son because you are less overwhelmed by your situation now that you have expressed your concerns. The nurse could have facilitated the father to create meaning from his experience of distress, and to gather more information to assist her to provide care and support for the father, which would aid in the healing process of the son. The communication techniques used by the main characters in the scenario “Tony’s Father,” were identified and described in detail. The communication skills of the nurse were focused on, namely active listening, empathy and use of silence. Both the father and nurse used techniques that hindered and promoted communication. Although the nurse exhibited many positive communication skills, she ignored responding and reassuring the father following his disclosure. Evidently, communication skills are essential for nursing practice as they foster the interpersonal therapeutic relationship and aid the healing process by way of the patient feeling cared for and accepted as a valuable human being. References Ellis, R. B., Gates, B., Kenworthy, N. (2003). Interpersonal Communication in Nursing. London: Elsevier Health Sciences. Klagsbrun, J. (2001). Listening and focusing: holistic health care tools for nurses. Nursing in Clinincs in North America, 36(1), 115-130. Perry, B. (2005). Power of the simplest gesture. Health Progress (Sept/Oct), 17-24. Reynolds, W. J., & Scott, B. (2001). Do nurses and other professional helpers normally display much empathy? Journal of Advanced Nursing, 31(1), 226-234. Stein-Parbury, J. (2005). Patient and Person. Developing Interpersonal Skills in Nursing, 2nd ed. Sydney: Harcourt. Taylor, C, Lillis, C., & Lemone, P. (2004). Fundamentals of Nursing. New York: Lippincott Williams & Wilkins. Queensland Health (2004). Strategic Framework. Retrieved May 19th, 2006, from the Queensland Health Website: http://www.health.qld.gov.au/publications/corporate/QHstratplan2004_2010/Strategic_Framework_pg1_5.pdf Read More