Compassion in Relation to Communication in Nursing Practice - Essay Example

Compassion in Relation to Communication in Nursing Practice INTRODUCTION: Communication of ideas is one of the first skills that humans learned (Scholarly Paper: Communication and Therapeutic Nurse-Patient Relationship n.d.). It evolved as a part of socialization and it is an important aspect of being part of a society (Scholarly Paper: Communication and Therapeutic Nurse-Patient Relationship n.d.). Communication between individuals occurs in different ways and may differ between cultures and societies. However, certain forms of communication, like the non-verbal modes of touching, kissing etc., remains common for all the communities. Communication may be explained as the means of sharing one’s experiences, perceptions or feelings. It is an integral part of nursing. Communication with compassion is not new. It may be briefly explained as showing compassion through communication. This builds the frame work of nurse-patient relationship and is the basis of therapeutic communication. Communication skills are recognized as the fundamental element in the quality of nursing. On the contrast, even with recognized importance of communication in nursing practice, many researchers suggest that quality of communication as a matter of concern (Vydelingum 2006). As the profession of nursing is in relation to variety of disciplines, it is important for the nurse’s to follow the conduct and legal principles while making a decision related to care. Care in nursing if practiced by unprepared professional or incompetent professionals, it possess a threat to the public, therefore, laws in nursing are essential. In other words, this implies the importance of nursing profession. In the following essay, I will explain the way I have learned to develop my skill of communication through nursing and how I learned to incorporate the skill of compassion in my communication with patients. I will also explain the 6 Cs in relation to the NHS constitution. I will also detail the different aspects of legislation, such as NMC code of conduct and Francis report, as also these ensure safety to nurses and patients who are in care from unprofessional and incompetent nursing practice. COMPASSION AND COMMUNICATION IN NURSING Therapeutic relationship can be explained as the relationship between the nurse and the patient. It is related to the patient’s need for “care, assistance and guidance” (Therapeutic Relationship Patients 2003). This relationship is solely meant to meet the patient’s need and hence, it is therapeutic in nature. It can be said that interpersonal and therapeutic relationships are the foundation and center of nursing. Communication along with compassion strengthens this relationship and provides the necessary energy, motivation and strength to both the patient and the nurse, to continue the treatment or to enable them to face the difficulties at the times of life threatening situations. There are increased incidence of complaints and studies in relation to lack of communication. Francis report also provides evidence on the lack of communication in health care profession as “patients not heard” and the report also signifies the negative culture developed by hospitals. Other studies in relation to lack of communication among nurses were carried out by Barbara A et al, 2010, and found that nursing communication skills are important features of an effective course. Communication problems accounted for 60% of the 1,243 sentinel events report submitted to the Joint Commission in 2011All these motivated me to choose this topic. Communication is also suggested as an important factor in attaining a magnet status (Valentine 2013). MY DEVELOPED COMMUNICATION SKILL IN PRACTICE I felt the need to develop therapeutic relationship through communication, so as to establish a good rapport with the patients. Through this, I ensured that the patients develop a sense of trust and confidence in me, and gain a feeling that I was not only available to provide care to them but also to listen to their problems and to talk to them. Communication is a part of good interpersonal skill which is a part of therapeutic relationship. It is one of the 6 Cs recommended by the NHS constitution. Therefore, I made sure to maintain a good rapport along with the patients. Some of the essential communication skills are empathy, listening and attending, giving information and support in terms of therapeutic relationship (Bach & Grant 2009). This is the crucial skill needed for all nurses. Though communicating with others is a skill that all human beings posses, it is of utmost importance for nurses. Hence, I felt the need to develop my communication skills before entering a ward. When I was first posted in a ward as a student nurse, I was overwhelmed with the thought of being able to communicate with the other staff and the patients. Communicating with patients was my primary concern, as it is important to establish a rapport with the patients and to understand the modes of care. Prior to each of my postings, I prepared myself by attending classes on how to effectively communicate with the patients and the staff. So, in order to eliminate the barriers in effective communication, I went through certain tips which would help to develop my communication skills. Before my placements, I thoroughly studied the cases that may be admitted to that particular ward, so that when the patients ask questions relating to their condition I may be able to answer them correctly. The NMC also suggest the student nurses to update their knowledge and skill in nursing practice. I also gathered information about each of the patients, who were assigned to my care, from the other members of the staff and from the chart sheets, in order to update my knowledge and to provide elaborate answers to questions if asked to. Establishing rapport is of prime importance (Schuster 2000). I introduced myself to each patient, explained my role in their care, reviewed their medical records and asked them the basic questions, just to establish their trust in me. This practice was based on the NMC guidance to gain consent. Maintaining eye to eye contact is essential to make the patient feel comfortable (Schuster 2000). I tried to make eye contact with the patients. I felt that this helped the patients to be more comfortable and to share their concerns with me. Active listening is another important part of communication. Listening helps us to gain more information to understand the patients and to provide them with better care. Patients co-operate more effectively with the staff who are good listeners (Tonarelli 2013). Francis report entails that most of the nursing staffs were not good listeners and that the patient’s problems and concerns were not attended to. Keeping this in mind, I listened to their concerns and paid attention to solve them. It is also important to ask the right questions to the patients. Probing questions are not to be encouraged because they remain a barrier to effective communication. It is also important to show respect to the patients and to treat them with compassion and without judgment, in order to gain their trust. Therapeutic communication lies in the same line with that of evidence based practice, knowledge etc. Therefore, it is important that all health care professionals learn effective communication. There are many barriers that hinder effective communication. Realizing this, before meeting each patient, I carefully assessed my patient’s culture, religion, socio economic status and educational background. Thus, I was able to resolve the barriers and respect my patient’s beliefs. Therapeutic communication helps the nurses to establish positive relationships by showing respect, empathy, and warmth to the patients. It enables the nurses to ask for help, support, overcome anxiety and thereby increase their confidence level. This enables the nurses to provide maximum care to the patients. For effective patient care, nurse-patient relationship can be viewed as a major therapeutic tool. Communication plays a key role in therapeutic relationship (Schuster 2000). Different forms of communications, like allowing patients to verbalize their feelings, asking those questions, or touching them to reassure, are important in patient care and they increase the client satisfaction and well being. Attending and listening helps the patient to be comfortable. It is evident that nursing plays a central role and nurses are required to establish good interpersonal skills as a part of therapeutic relationship with the patients and to communicate effectively with the patient’s relatives and other health care professionals. It would be difficult to provide the aimed care without proper communication between the nurse and the patient. Since the chances of transferring the wrong messages are more, one should be careful while communicating with the patient. Touching is mode of non verbal communication. An affectionate feeling of warmth is communicated through it. When the patients are upset or anxious, I would tap their shoulders or hold their hands to comfort them. Touching is not approved by all patients; therefore I knew to keep individual boundaries with each patient. Silence is another type of non verbal communication. It provides time to determine the future course in patient care. It is important that the nurses should communicate with the patients through other means like touch or play. Communication is most effective with minimal distraction. This may be achieved by drawing the curtains, or asking the patient to meet in a private room. Trust is essential for a patient to communicate his/her feelings. Nurses should encourage the patients to verbalize their feelings. This may be done through humor, touch and tears (Scholarly Paper: Communication and Therapeutic Nurse-Patient Relationship n.d.). Understanding all this, I was able to observe patients non verbal cues like facial expression, body language, voice tone and so on to ensure whether the patient has any distress or issue. There were instances when I stopped my work to listen to my patient’s concern. If I noticed something disturbing the patient, I would sit down and talk to the patient to find a solution to the particular issue concerning the patient. Therefore, it becomes evident that in hospitals communication is highly important. It is to be noted that information is not only given and understood through communication, but also the patient’s feelings and needs are understood and learned through communication. Compassion is an essential quality in nursing. This quality may be innate or acquired. It is essential that all health care professionals especially nurse must have this quality. This quality can be learned. According to Merriam-Webster Dictionary compassion is defined as “a sympathetic consciousness of others’ distress together with a desire to alleviate it”. It is an element of recognizing other’s suffering. Dr. Gudrun Rudolfsson (Tonarelli 2013) describes that a caring nurse is not only the one who follows the “protocols” but also the one who exhibits attributes like “honesty, respect, wisdom, compassion and sensitivity”. The nurses consider the patients’ emotions and try to alleviate their suffering. Considering all this in mind, during my placements I was able to incorporate compassion in my care. When the patients are cared with compassion, they tend to share their problems and concerns. Then it becomes easier to identify and treat the patients. Caring the patient with compassion also helps to reduce the level of anxiety and increase the speed of recovery in patients. Most of the patients consider a compassionate attribute in a nurse as the most desirable quality. Even a simple smile can be a strong key of compassion. Compassion is the best way to express the empathy. If the patient feels the empathetic attitude of the nurse, he/she may feel more secure and safe. It is one of the essential Cs suggested by the NHS constitution. Compassion starts by addressing the basic needs of the patient. NHS constitution recommends that to show optimum level of compassion, we need to know the impact of what we do and say. As a professional care assistant, I greeted the patients with a warm- hearted smile and kept polite manners. It is said that keeping a smile in everything we do, helps the clients to be refreshed. I also maintained a good eye contact, which helped me to gain their trust in me. I made sure that the clients are kept well dressed, clean, comfortable and free from pain. The patients should be well looked after. Nurses should keep their promises to the patients. The NMC guideline urges nurses to maintain the dignity of patient and to treat the patient with respect. For instance, when I assisted the patient for his bath, and informed him that I will be back in 5 minutes, I always came straight away and kept my promise. It is also essential to maintain the dignity of the patient. A compassionate care giver must be sensitive and should consider the needs of the elderly ones. Doing simple things affectionately results in the formation of a compassionate nurse. Assisting the patients to bath on their preferred method makes them feel relaxed. The nurse can place the picture of the patients’ loved one at their bed side. A small vase with flowers may be kept at their bedside. All these types of activities form the basis of compassionate nursing. Compassion is the essence of nursing, whereas communication is the integral part in understanding the client needs. Nurses may be good communicators but they need not be compassionate enough. Communication is an innate skill available to all whereas compassion may be learned. When compassion is intertwined with communication or vice versa it results in holistic approach in care. This helps in shorter stay of patients at hospital, faster recovery, and patient satisfaction. Non-verbal means of communication are mostly used in explicating compassion. The most important mode is touch. It is most crucial in the case of elders. Touch may be showed as a form of concern or comfort. Holding the hands or stroking the arms provides comfort and reassurance to the elders. Looking into the patient’s eyes with confidence gives them an assurance and it will boost their confidence. Knowing the patient well is an important technique. The more a nurse knows the patient, the more she can help him. This in turn allows the nurse to treat the client in a loving and compassionate way. A lot of information about the client may be gained through friendly conversations. Happy conversations will make the patients feel good. So the nurses should try to be with the patient as much as possible. They can visit the patients often and start a conversation of common interest. Nurses are accountable for answering questions to which they are asked to. Nurses should elaborate the questions they are asked to rather than just answering. Effective communication will help nurses to communicate their concerns and stories in an effective manner. During the initial periods of my placement, I was nervous and unsettled, but later I realized that this was natural. Gradually I learned to listen to the patients’ concerns and worries. In order to be genuine to each patient’s situation, I tried to visualize myself in his position and tried to see things from his perspectives. The nurse’s attitude has a profound effect on the patient. The francis report also suggest the same, in the category of ‘ inadequate risk assessment of staff reduction. Lack of skilled nursing staff may result in overburden and fatigue to nurses and may result in poor nursing care. With sufficient number of nurses and adequate rest periods, this may change. For example: when a nurse walks into a client’s room depleted and exhausted, it creates an unhealthy environment. On the other hand, if the nurse enters the room, after adequate rest and with a peaceful mind, she creates a healthy and wholesome environment by her presence. This results in a holistic approach of care. After incorporating the skills in my practice, I reviewed the code of conduct in my practice. In order to establish a therapeutic relationship with compassion, I treated the patients with respect and dignity. I remained polite, kind, caring and compassionate in my care. There was no discrimination among patients on the basis of culture, race, ethnicity and cultural differences. Client’s confidentiality of information was maintained. I was able to listen to the clients and address their concerns and was able to support them to improve their health. I was able to uphold the standard of my profession. Taking in to account the above mentioned approaches of care the NHS constitution has proposed the following values: 1. Working Together for Patients: The guidelines suggest that patient should be treated as more important than anything else. The constitution urges to involve all the disciplines of health care to work together for the welfare of the patient. 2. Respect and Dignity: Every person should be valued and treated so as to understand their priorities, abilities, limits and needs. 3. Commitment to Quality of Care: This value ensures a safe and effective care for better patient experience. 4. Compassion: Compassion is essential while caring the patients and each nurse should treat the patients with kindness. The nurse should find time for the patients and their family members. The nurse should be able to provide a feeling of being special to the patient. 5. Improving Lives: This accounts to improve the well being of patients through better clinical practices, improved services and innovations. 6. Everyone Counts: This is to make sure that no person is excluded or discriminated from care. The alignment of NHS change model and 6 Cs of nursing strive for the development of excellence in nursing profession. The 6cs are highly valuable. Each value stated in 6cs is important as well as equal. Not even a single value outshines the other. Together, it paves an easily understandable way towards our values as nurses. 1. Care: It is important to ensure that the best possible care is given to patients. It is patient-centered, evidence based. It must be documented clearly and accurately. The patients must feel safe due to the care. Most importantly the care must be given on time. The care which is given to the patient helps him/her to improve their health. 2. Compassion: To provide compassionate care, the nurse must understand the impact of what he/ she tells and does. It is about how the care is provided, how the patient’s concerns are listened to, what the nurse does, and more importantly how the nurse performs this. The new model urges for a strong leadership for the delivery of high quality and compassionate care. 3. Commitment: Commitment is necessary to increase the patient’s level of contentment. The nurse should be committed to innovative changes and implications of modern tools in practice. This can be ensured, by understanding the impact of care. Lack of commitment may lead to lack of developments in health care delivery, health improvement and health promotion. 4. Communication: This involves not just talking but also observing and hearing. Communication may be done by a wide range of communication skills and tools. The nurse must be efficient enough to handle all situations regarding the patient through different communication tools. 5. Courage: For the deployment of innovative measures, it not only requires commitment but courage also. The nurse needs to develop courage to do the right thing, and to overcome the barriers. The nurse should not be afraid to make suggestions for improvement and to influence her seniors in position. It helps the nurse to speak up for the patient. 6. Competency: It is essential not only in the fundamentals of care, but also in the delivery of quality care. The nurse should make sure to document the assessments, identify and communicate the care, delivery of the best quality of care at the right time and in the right place. The nurse should also need confidence to do the work. Combining NMC guidelines and NHS constitution, we can see that the nurse should ensure the care of the patients as her primary concern. She should treat them with dignity and respect. The nurse should work with the others to protect and promote the health and well being of the patients, their families and the wider community. Nurses should provide high standard of service at all times. The nurse should be open, honest and uphold the standards of the nursing profession. In my professional practice, I followed the code of conduct and the NMC guidelines CONCLUSION: Skills of communication and compassion develop with a variety of experiences while engaging with patients, relatives, and other health care professionals. The very nature of health care is rapidly changing, complicated and unpredictable. As the professionals are involved in a 24 hour care of client, this may limit the chances for face-face communication. The skill of effective communication involves influencing the audience what they hear, enlist, believe and remembers. On looking back I feel that I have developed my already present skill of communication and acquired the skill of compassion from my every day relationships in the medical setting. Even though it was a daunting task to listen and talk to patients during my first year, I have learnt the ways of listening and talking to patients, staff and family members. In the following years, I developed this and my confidence comes from my personal experience. In future, I hope to develop the interpersonal skills further and help my patients through compassionate ways in whatever settings I find them. I have learned to treat all patients equally and to attend to their needs with privacy and dignity, and to co-operate with their needs individually. This was done through certain techniques like fulfilling the promises given to them, smiling, being polite taking care of all their needs. By applying these techniques, I have managed to win several hearts. I have learned to use the most appropriate therapeutic communication techniques for particular situations. Being a care assistant I had to attend to all the needs of my patient. Therefore, I deployed the various skills of communication and compassion that I learned during my schooling for optimum care of the patient. For example, I used different techniques when my patients faced difficulties, like asking open questions, observing them, encouraging them, accepting them, offering them some helps, or just by being silent beside them. These may be used in the future too to know my patients better and to help them to be healthy soon. I will incorporate my learning in professional practice and approach the nurse-patient relationship much more carefully than I have been in the past. References Bach, S. & Grant, A. 2009. Communication and Interpersonal Skills for Nurses. Learning Matters Ltd. Available at [Accessed on 30 April 2014] Compassion. 2014. Merriam-Webster. Available at [Accessed on 30 April 2014] Guidance on Professional Conduct. 2012. NMC. 2nd Ed. Print. Hollis, M. 2012. Using the NHS Model to Support the 6 C’s of Nursing. Oxford University Hospitals. Print. Keogh, B. 2013. Review into the Quality of Care and Treatment Provided by 14 Hospital Trusts in England. Overview Report. Print. Mullan, B. A. & Kothe, E. J. 2010. Evaluating a Nursing Communication Skills Training Course: The Relationships between Self-Rated Ability, Satisfaction, and Actual Performance. Nurse Education Practice, Elsevier Publishers. Nurse Practice Act, Rules & Regulations. 2014. NCSBN. Available at [Accessed on 30 April 2014] RN and RPN Practice: The Client, the Nurse and the Environment. 2011. College of Nurses of ONTARIO. Available at < http://www.cno.org/Global/docs/prac/41062.pdf> [Accessed on 30 April 2014] Scholarly Paper: Communication and Therapeutic Nurse-Patient Relationship. n.d. Sa Rah Sheen. Available at < http://sheensarah89.wordpress.com/scholarly-paper-communication-and-therapeutic-nurse-patient-relationship/> [Accessed on 30 April 2014] Schuster, P. M. 2000. Communication the Key to the Therapeutic Relationship. Phiadelphia: F.A. Davis Company. Sentinel Event Data: Rout Causes by Event Type. 2004. The Joint Commission. Available at [Accessed on 05th May 2014] Susan, H. 2003. Nursing Practice Healthcare. 4th (Ed.) Arnold Publication. The NHS Constitution, the NHS belongs to Us All. 2013. England. Print. Tonarelli, L. 2013. What Makes a Compassionate Caregiver, and How to become One. Alzheimer’s Care Guide. Available at [Accessed on 30 April 2014] Tornton, L. 2008. Holistic Nursing: A Way of being, A Way of Living, A Way of Practice. NSNA Imprint. Available at [Accessed on 30 April 2014] Valentine, N. M. 2013. Communicating Nursing’s Excellence and Value: On the Way to Magnet. Nursing Economy. Available at [Accessed on 30 April 2014] Vydelingum, V. (2006), ‘Nurses’ Experiences of Caring for South Asian Minority Ethnic Patients in a General Hospital in England’, Nursing Inquiry 13 (1). pp. 23-32. Read More