Communication Skills for Nurses - Literature review Example

Communication Skills for Nurses Student’s Name: Grade Course: Tutor’s Name: Date: Part A: Introduction According to Rosenberg (2008, p.75), the first meeting between a nurse and a patient sets the pace for their relationship. The nurse being in his/her domain of work has the greatest responsibility and power to ensure that the nurse-patient relationship starts off on a good footing. This would include establishing trust, respect, professional intimacy and empathy (College of Nursing Ontario, 2006, p. 2). In Brian’s case, I would start by introducing myself on our first meeting and explain my role during his therapeutic care. I would also use the first meeting to let Brian know that he has a role to play in the therapeutic care, and also outline the importance of his contribution to his quick recovery. According to the College of Nursing Ontario (2006, p.2) and McCabe and Timmins (2006), addressing a patient by his name or title is an ideal way of establishing direct communication. In addition, giving the patient enough time to express himself and explain his situation is an appropriate way to hearten him to open up. This also enables the nurse to establish the verbal and non-verbal modes of communication used by the patients. My initial communication with Brian would be intended not only to create a good working relationship, but to encourage him to open up and reveal any frustrations, fears, and concerns that may have led to his depression. According to Rosenberg (2008, p. 74), nurses who intend to strike a good rapport with a patient in the initial meeting should avoid asking questions that a patient can consider too personal, respond dismissively, change the subject, or respond without weighing the implications of their words. During my initial meeting with Brian, I would also avoid giving my personal opinion on his condition, because as Rosenberg (2008, p. 74) points out, such advice during the first meeting may be premature and perceived by the patient as unwarranted. Part B: The therapeutic approach According to Kasch & Holder (1998, p. 289) and McCabe and Timmins (2006) therapeutic relationships are only likely if there is effective communication between the nurse and the patient. Such communication creates valuable outcomes for the patients. Dealing with Brian, who suffers from depression would require me to adopt a caring attitude towards him. This will enable me to build trust and persuade him to be sincere with me. More to this, through active listening to what he has to say, I would be able to diagnose his problems and come up with a recovery strategy that will work best for him. According to Champagne (2003), empathising with the patient’s condition is also something that will help him feel appreciated and understood, “Therapeutic communication occurs when a care provider uses techniques and processes on the patient in a goal oriented manner”. My approach in handling Brian’s case will borrow from the objectives stated in Watson’s theory of care, whose carative factors indicate the need for nurses to adopt humanistic-altruistic values such as loving kindness and care for each other, instilling hope in others, sensitivity to other people’s need for help and the development of helpful-trustful relationships (McCabe & Timmins, 2006; Watson, 2007, p. 131). More to this, my approach will seek to encourage Brian to express his positive and negative feelings. As the theory recommends, I will also seek to use scientific and creative ways of solving Brian’s depression issue and encourage him to learn new coping mechanisms. My communication strategy with Brian would seek to cover the following areas; Translation: This would involve informing the patient about the different approaches of care that we will adopt in an attempt to find a lasting solution to his depression problem. As Kasch & Holder (1998, p. 289) notes, the translation phase also involves explaining to the patient the various processes I will be undertaking and also instructing him to do some things. Establishing trust: According to Rosenburg (2008, p. 76), trust is critical to the nurse-patient relationship. I will try as much to keep my promises to Brian because as College of Nursing Ontario (2006, p. 2) observes, trust is initially very fragile, and once breached, the nurse may find it hard to re-establish. Rosenberg (2008, p. 74) further notes that trustful relationships between a patient and a nurse help the former “feel secure enough to share his feelings, pain, frustrations, happiness and improvements” with the nurse. In the case of a depression patient, this would be really helpful because research into depression shows that most people suffer the condition due to “bottling” their feelings and refusing to seek outside help. Respect: Respecting Brian would require me to recognise his inherent dignity, worth and unique personality. According to College of Nursing Ontario (2006, p.2), this requires a nurse to disregard a persons socio-economic status, their personal attributes and the specific health problem that they are seeking care for. Professional Intimacy: Being a depression sufferer, it is inevitable that I will have to access some of Brian’s personal information. This will no doubt help me come up with an intervention strategy that will work better for him. This will especially be in aspects that contribute to his psychological well being. For example; I will need to find out what is influencing his depression (is it his worries about not being able to meet his responsibilities at work, or home, fear of failure, or simply low self-esteem?). My primary goal in establishing a professional intimacy with Brian would to have the best therapeutic outcomes for him. Out of this relationship, I will be able to assess his needs, teach him some of the basics that he needs to know about overcoming depression, empower him and finally evaluate his outcomes through the notable improvements. According to Watson (2007, p. 132), providing information, clarifying, focusing and asking relevant questions are all strategies that can be used by a nurses for therapeutic purposes since it is tantamount to “ attending to the whole person by giving meaning to the plan of care”. Group sessions: After establishing Brian’s main cause of depression, I would consider enrolling him for a group therapy, where he can meet people facing similar situations. After the sessions, I would then ask him some open questions like, “how does the group sessions help you?” to see if he is learning anything from other people in the group. According to, Murphy (2008 p. 24), group therapies in depression patients can help address some of the issues that a nurse could find challenging to get a patient to open up about. Reasons for adopting this strategy: According to Kasch & Holder (1998, p. 289), strategic communication by nurses should be effective in managing the nurse-patient relationship, manage the patient’s identity and well as his emotional state. More to this, the strategy should be able to manage information shared between the patient and nurse as well as the behaviours and beliefs of the patients. Considering that Brian is a depression sufferer, it is evident that he was unable to cope with some of the pressures that came from his environment. My strategy is therefore based on helping him cope better with most of the pressures that he may experience regarding his immediate environment as well as some of the other secondary sources of anxiety and depression. Part C: Health Promotion strategies According to Pincus et al (2006, p. 12) clinical integration is among the core factors that affect the quality of care provided to patients suffering from depression and other mental illnesses. Clinical integration refers to the extent that patient care is provided to a patient through communication, comprehensiveness, continuity and collaboration. A person-centred approach health promotion strategy would be most suited for Brian. According to Champagne & Stromberg (2004, p. 1), patients react well to a therapeutic environment that is supportive, comforting and responsive. The person-centred approach I propose for use on Brian’s treatment puts more emphasis health care providers listening to a patient and responding to their needs in an individualised manner (Champagne & Stromberg, 2004, p.1). Hasselkus (2002, cited by Champagne & Stromberg, 2004, p.1) states that health care providers can learn much of what is needed to treat depression patients if they “actively listen and involve the patients in the co-creation of treatment environments that offer diverse, meaningful and sensory rich opportunities”. Sensory diets Wilbarger (1984, cited by Champagne & Stromberg, 2004, p.3) defines “sensory diet” as the “preferred sensorimotor experience that assists individuals to function optimally within their immediate environments”. In the case, Brian and other depressed people are said to have developed behaviour patterns that are problematic to their sensory needs. Such affect their responses to stress and other pressures. To help Brian improve on his sensory diet, we would have to identify activities that would help self organise through feeling calm, centred and alert as described by Champagne & Stromberg (2004, p. 3). Such activities include cleaning, exercising and moving furniture among others. While finding the right activity to provide a calming experience to Brian, I will need his input in regard to activities he finds calming and helpful because Tschacher (1995) states that different activities have different effects for different people. Preventing Individual crisis Champagne (2003) states that care providers can help prevent individual crises in depressed people by identifying crisis prevention strategies, which would then be used during critical times. In Brian’s case, this means I would be required to work with him so as to identify what agitates or distresses him most. We would then need to develop de-escalation plans or safety tools for use during such times in order to avert a depression. The good thing about such as a strategy is that it would help Brian create a self-awareness sense, whereby, he would make deliberate actions to avoid being depressed by things that would trigger depression in him previously. The strategy also helps depressed people maintain an alertness that helps them go about life with more purpose and self-assurance. Sensory approaches Sensory-based approaches such as therapeutic touch and aromatherapy manage to relax some patients, increase comfort and sleep, decrease pain and anxiety. They are also effective in reducing agitation in depressed patients (Buckle, 2003). If Brian agrees to these kinds of approaches, we can use them on him, monitor the progress and see if any improvement occurs. These approaches must however be used together with any pharmacological treatments and counselling. Champagne (2003) notes that sensory based approaches are classified as complimentary medicine and hence they don’t replace conventional treatment. Multi-sensory Rooms According to Champagne (2003), the multi-sensory rooms are “areas filled with equipment necessary for implementing a combination of directive and non-directive sensory-based therapeutic exchanges”. The rooms can be used by individual patients or groups and are used within health facilities to promote self-organisation among patients by acting as an outlet for self expression, or containment. Ashby et al (1995) state that the use of such rooms improves concentration among depressed patients. Brian would no doubt benefit from such. Conclusion Although one would think that depression is a mild condition compared to other psychiatric diseases, the truth is that depression deserves just as much care and precision like other diseases. For starters, the condition may not respond to drugs for several weeks after commencing the treatment as noted by Eisenberg (1992). This then means that a patient may feel discouraged and may even be tempted to stop the medication altogether. In such circumstances, it is the responsibility of the nurse whose care the patient is under to motivate and encourage them. Psychotherapy plays a key role in the recovery of people suffering from depression. Through such, the patients get to know the benefits and disadvantages of the different treatment options, the risks or significance of side effects associated with the medicine, and they also get to learn the benefits of active decision-making in regard to their participation in therapeutic care. Overall, although effective treatment models for depression involve both pharmacological interventions and psychotherapeutic interventions, the latter helps depression patients most through explicit treatment and recovery plans, follow-up, decision-making support and helping the patient to adopt self-management practices. Through such, patients like Brian are able to cope with the daily pressures and stresses they face in life without suffering bouts of depression. References Ashby, M., Lindsay, W., Pitcaithly, D., Broxholme, S., & Geelen, N. (1995). Snoezelen: Its effects on concentration and responsiveness in people with profound multiple handicaps. British Journal of Occupational Therapy, 58, 303-307. Buckle, J. (2003). Clinical aromatherapy: Essential oils in practice (2nd ed.). Philadelphia: Churchill Livingstone. Champagne, T & Stromberg, N. (2004). Sensory approaches in inpatient psychioatric settings: Innovative Alternatives to seclusion & restraint. Journal of Psychosocial Nursing, 49(9), 1-13. Champagne, T. (2003). Sensory modulation and environment: Essential elements of occupation. Southampton, MA: Champagne Conferences & Consultation. College of Nurses of Ontario. (2006). Therapeutic nurse-client relationship, revised 2006. Practice standard. Retrieved March 09, 2010 from: http://www.cno.org/docs/prac/41033_Therapeutic.pdf Eisenberg, L. (1992). Treating depression and Anxiety in the primary care setting. Health Affairs, 149-157. Kasch, C.R., & Holder, T. (1998). Nursing and Communication: a Reflection. Scholarly Inquiry for Nursing Practice, 12(3), 289. McCabe, C. & Timmins, F. (2006). Communications skills for Nursing practice. New York: Palgrave Macmillan. Murphy, M. C. (2008).Cognitive Therapy for depression. Critical CBT tools in Group Therapy, 1-24, Retrieved March 9, 2010 from: http://www.dbsasandiego.org/speakers/marc-murphy-presentation.pdf Pincus, H., Houtsinger, J. K., & Wrobleski, G. (2006). Depression in primary Care: Linking Clinical & System Strategies. IBHI Colloquium 2006 Leadership Forum. Pp. 1-12. Retrieved March 09, 2010 from: http://www.ibhci.org/events/Dec2006Presentations/Pincus-Knox%20Houtsinger-Wrobleski.pdf Rosenberg, S. (2008). Therapeutic Communication in a clinical setting. In Transit, 72-95. Retrieved March 09, 2010 from: http://www.lagcc.cuny.edu/CTL/journal/v3/pdf/Rosenberg.pdf Watson, J. (2007). Watson’s theory of human caring and subjective living experiences: Carative Factors/ caritas processes as a disciplinary guide to the professional nursing practice. Texto Contexto Enferm, Florianopolis, 16 (001), 129-135. Read More