Communication in the Nursing Profession - Essay Example

Communication in the Nursing Profession: A Literature Review Introduction Communication is the most important aspect of workplace interaction, becomes even more critical in the medical profession when the client outcome can bear the extreme consequences of life or death. Nurse communication can take various forms such as the affective support for a patient through a pleasant bedside manner, or the highly professionalized terminology that takes place during an emergency operation. Nurses are often time-constrained due to scheduling, emergency response requirements, or workload, and the importance of succinct communications become even more critical. Communication can be casual, intense, or the matter-of-fact writing that produces a clinical laboratory report. Communication may be verbal, non-verbal, or inferred through the actions that a nurse may take or avoid. Communication may be a single sentence that begins with the sender, but the receiver is the integral part of the process where the message is interpreted and placed in context with a larger discourse. Communication is ubiquitous and pervasive. Every bit of information that is transferred from nurses to the world around them comes through some form of communication. In today's fast paced world of nursing, where accuracy and time can make the difference between success and failure, communication becomes the most critical component driving a patient's outcome. Purpose The structure of a health care setting today is far more inter-dependent than at any other time in history. Cultural and social diversity have made the communications between nurses and patients at risk of miscommunication, but has also presented nurses with the opportunity to be more articulated and meaningful. Communication skills are an area where it is sometimes difficult to measure, yet there are always issues that warrant improvement. In addition, knowledge is passed from nurses, specialists, and physicians through the act of communicating. It is one of the single most important activities that a health care worker engages in. Technology has presented nurses with new opportunities and methods of communication, though there is always some resistance to change within any group. This paper will evaluate some of the current literature in regards to communications among the nursing profession. By knowing what technologies are available, the current thinking on communication, and the impact of culture and diversity, nurses can elevate the status of their communications and get more value for the time that they spend communicating Literature Review. Bedside Manner Some of the most prevalent and important communications for a nurse takes place between the nurse and the patient. Known traditionally as bedside manner, these may be critical instructions on self-care, or may be the casual words that offer the patient hope, support, comfort, and esteem. A nurse may be viewed as being positive and caring by being compassionate, genuine, and sympathetic, or alternately display the negative traits of arrogance, rudeness, or indifference (Person and Finch 6-7). This alters not only a patient's view of the hospital and its level of care, but may also have more lasting implications. According to Person and Finch, "the patient's perception of provider bedside manner impacts health status, satisfaction, and compliance" (Person and Finch 1). A nurse may need to communicate instructions that are necessary to maintain the patient's follow up care after they have been discharged from the hospital. This may be in a context where death, illness, and family wishes need to be considered from a cultural vantage point. The nurse may be the most vital actor in explaining and clarifying the information that the physician gave a patient during a hurried period of anxiousness (Ufema 70). The nurse can bridge the critical gap between 'cure' and 'care', and begin to communicate in terms of peace and closure, rather than the more technical language that might be expected from a physician (Ufema 70). If the nurse is unaware of the patient's details, it may necessitate an additional communication with the physician that is based on good listening and questioning skills. "Lack of awareness of the physician's actual communication [with the patient] places the nurse at risk of contributing to the patient and family members' frustration and anxiety" (Gauthier 292). Additional non-verbal communication skills such as warmth and empathy would significantly add to the nurse's effectiveness as a bedside communicator, and give the patient an additional dimension of assurance and confidence in the competence of the health care worker and facility. Along with the words that make up the nurse-patient conversation, there is the non-verbal component, which may be culturally sensitive. Paterson and Zderad (1988) emphasized a holistic approach to communication, which viewed it "as a lived dialogue aimed at nurturing well-being and embracing authenticity rather than a benevolent technical component in nursing" (cited in Wiman and Wikblad 423). In some cases, the patient may have a language difficulty, hearing problem, sight impairment, or be suffering from shock and anxiety that can best be overcome by an open attitude and an open line of communication. A non-verbal caring attitude can also cross cultural and language barriers. Wiman and Wikblad contend that "The importance of meeting the patients' psychological needs and nurses' affective caring behaviour should be emphasized in [. . .] nursing education" (429). Non-verbal caring can be highly useful in situations where the patient may have a mental disability or suffering from dementia. According to Gleeson, touch can have a significant positive effect, and reports that "patients who were given a gentle touch and spoken to during eating had a significant increase in calorie intake" (19). Meeting the patient's holistic needs is a basis of communication that must also eliminate the non-verbal negative cues such as coldness, disinterest, insensitivity, and a general lack of concern (Wiman and Wikblad 426-427). These traits are communicated through distance, silence, lack of eye contact, or the intangible actions that a nurse may unconsciously take during a patient encounter. Eliminating the negative and focusing on the patients needs can more effectively convey non-verbal communications across cultural, disability, and psychological barriers. Official Paperwork In addition to the supportive and informative communication that takes place between the nurse and the patient, nurses must also pass on the knowledge they have to other nurses and staff on a daily basis. Changing shifts is uniquely critical to the nursing profession, where it "signifies a time of careful communication in order to promote patient safety and best practices" (Caruso 17). It is imperative that the nurse going off shift conveys enough critical information, without becoming irrelevant or over-loading the incoming nurse with too much information. The data in these reports reflects on the patient's status, as well as the being a personal reflection of the author. Handover reports are also a means of measuring a nurse's competence by gauging their "ability to use appropriate biomedical language and abbreviations", which are considered to be an important element of professional medical communication (Payne, Hardey, and Coleman 278). In addition to the official handover reports, nurses may make observations or last minute notes regarding a patient and include them with the lengthier report. These are known as 'scraps' and are typically written on any available paper, such as post-it notes (Hardey, Payne, and Coleman 208). While these 'scraps' add to the body of information available on a patient, they can be problematic in the context of the confidentiality requirements of the Health Insurance Portability and Accountability Act (HIPAA)" (Hardey, Payne, and Coleman 209). It is recommended that this type of communication be carefully monitored, as these types of notes may violate a patient's right to medical privacy or their protected health information. Technology Handover, and other forms of reports, are ways for nurses to convey knowledge from one nurse to another, and technology has improved the capability of this aspect of communication. Psychiatric nurses in Oklahoma benefited greatly from a program that introduced teleconferencing to their diverse geographical locations. Specialized nursing professionals are able to discuss theories and other subjects that would have previously been prohibited due to their rural isolation (Wilson 14). Other forms of technology such as twitter, instant messaging, and texting all contribute to the nurse's ability to communicate with the hospital staff. According to Krizner, "thanks to a mix of technologies and wireless systems, communication in the hospital puts critical information in the hands of those caring for patients immediately--regardless of location--to enable bedside decision making", which "has helped improve the clinical care for hospital patients" (21). Still, staff may be slow to embrace new communications technology as it is released. Digitizing all reports and making them available on a network platform may remove some traditional functions from the nurses' comfort-zone. Studies have indicated that handover paperwork works to facilitate a greater sense of cohesiveness among the nurses, and is viewed as a "sacred cow" (Payne, Hardey, and Coleman 283; Caruso 21). The difficulty of changing the communication process should not be underestimated, as it may be met with considerable resistance. Other forms of technology such as digital data imaging and storage allow instant consultation and conferencing with experts and removes geographical limitations. This form of technology-based communication has been accepted and implemented on a widespread basis. Technology based communications, conversations, records systems, reports, and scraps may take an intensified focus to be able to alter the current methods of communication within the nursing profession. Communicating with Physicians, Staff, and Peers. Two of the practical purposes of good nurse communications are to reduce the potential of a bad outcome due to miscommunication, and increase the probability of a good outcome. Conversations with physicians may be some of the most important, as well as the most problematic for the nurse. In respect to the nursing shortage, good nurse/physician communications could lead to greater retention. Physicians, faced with cramped schedules, difficult cases, and over-extended obligations may require that conversations with nurses be short, accurate, complete, and to the point. However, young nurses may feel overwhelmed and frustrated when talking to an inattentive physician. According to Peters, "The critical element in nurse/physician relationships is communication", which comes as a result of "mutual trust, respect and shared decision making responsibilities" (11). Research has shown that "strong collaborative relationships" between nurses and physicians "optimize patient care decision making" and ultimately lead to more positive patient outcomes (Laschinger, Shamian, and Thomson 210). However, mistrust or poor communication that may develop due to a nurse's inexperience can lead to "emotional exhaustion, reduced personal accomplishment, and depersonalization" based on a perceived lack of trust and confidence from the nurse's peers (Ellis and Miller 79; Laschinger, Shamian, and Thomson 213,214). Developing these ideal characteristics may be problematic and it may be difficult to retain these young nurses in the current climate. According to Ellis and Miller, while "communication specifically related to work load and job skills may function to make the job easier, it does not necessarily enhance commitment to the organization" (91). However, supportive communication from other nurses, peers, and staff "can be a potent antidote to the stress inherent in the nursing occupation (Ellis and Miller 92). In essence, a perceived lack of nurse/physician or nurse/nurse trust and good communications creates tension and stress within nurses that can best be mediated through supportive communication from peers. Conclusion and Recommendations Communications within the health care system has made significant advances since the time that all business was conducted over the telephone, and a pager was the only connection that a facility had to a physician. However, the cornerstone of nursing, bedside manner, is still a hallmark of the nurse that can effectively communicate with the patients across emotional, physical, cultural, and language barriers. With the advent of new communications technology has come a greater expectation of communications. Nurses, physicians, and staff have a need for time sensitive information that is complete and yet succinct. Schedules make little allowance for irrelevant information, yet there are demands that the handovers and reports be complete and detailed. Advanced nurses have greater expectations of the nurse/physician relationship that is built on communication and makes possible the trust required for shared decision making. The cost of poor communication, at any level, is nurse burnout and poor patient outcomes. Hospital administrators, physicians, and managers should make nurse communication a focus of their drive to retain young nurses and improve patient care. Physician cooperation can also lead to higher levels of trust and self esteem among the nursing staff. In all, communication, and its implications for nurses, hasn't really changed all that much in the past 30 years. These is just more of it, and it has earned a more critical spot, and a more important position in the career of the nurse that is now communicating with patients, their families, staff, and physicians alike. Works Cited Caruso, Eva M. "The Evolution of Nurse-to- Nurse Bedside Report on a Medical-Surgical Cardiology Unit." MEDSURG Nursing 16.1 (2007): 17-22. 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Laschinger, Heather, Judith Shamian, and Donna Thomson. "Impact of Magnet Hospital Characteristics on Nurses Perceptions of Trust, Burnout, Quality of Care, and Work Satisfaction." Nursing Economics 19.5 (2001): 209-19. Academic One File. 30 June 2009. Payne, Sheila, Michael Hardey, and Peter Coleman. "Interactions Between Nurses During Handovers in Elderly Care." Journal of Advanced Nursing 32.2 (2000): 277-85. EBSCO. 30 June 2009. Person, Amanda, and Linda Finch. "Bedside Manner: Concept Analysis and Impact on Advanced Nursing Practice." The Internet Journal of Advanced Nursing Practice 10.1 (2009). General OneFile. 30 June 2009. Peters, Dorethea. "Nurse/Physician Relationships: Are we Making Progress" Georgia Nursing 10.1 (2007): 11. Academic One File. 30 June 2009. Ufema, Joy. "Insights on Death and Dying." Nursing 28.11 (1998): 68-70. Springer. 30 June 2009. Wilson, Janet. "Bridging the Gap in Communication Among Nurses: Use of the Teleconference." Journal of Nursing Education 18.7 (1979): 13-151. EBSCO. 30 June 2009. Wiman, Elisabeth, and Karin Wikblad. "Caring and Uncaring Encounters in Nursing in an Emergency Department." Journal of Clinical Nursing 13.4 (2004): 422-29. EBSCO. 30 June 2009. Read More