Introduction
Having effective communication skills and being able to employ them in communicating to the patients is very essential for every nurse. A nurse must be able to communicate effectively to his or her patients, the patients family and his or her coworkers. This paper aims to determine the importance of communication to the nurse-patient relationship. The paper aims to determine the important communication skills that a nurse must possess in order to ensure that the nurse-patient communication is effective and efficient. The paper seeks to answer the following questions:
1. Why do Nurses believe communication is an integral part of nursing practice?
2. What communication techniques am I able to demonstrate at a competent level and why?
3. What communication techniques require further development and why?
Literature Review
Communication involves the reciprocal process of sending and receiving messages between two or more people. In general, there are two parts to face-to-face communication: the verbal expression of the sender's thoughts and feelings, and the nonverbal expression (Arnold and Boogs 1995, Balzer-Riley 1996 cited in McCabe 2004). Verbally, cognitive and affective messages are sent through words, voice inflection, and rate of speech; nonverbally, messages are conveyed by eye movements, facial expressions, and body language. Senders determine what message they want to transmit to the receiver and encode their thoughts and feelings into words and gestures. Senders' messages are transmitted to the receiver through sound, sight, touch, and occasionally, through smell and taste. Receivers of the messages have to decode the verbal and nonverbal transmission to make sense of the thoughts and feelings communicated by senders. After decoding the senders' words, speech patterns, and facial and body movements, the receivers encode return messages, either verbally, through words, or nonverbally, through gestures. In an interaction between two people (e.g., a nurse and a client) each person is both a sender and a receiver and alternates between these two roles. When senders are speaking, they are also receiving messages from the person who is listening. Listeners are not only receiving speakers' messages but are also simultaneously sending messages.
One of the most widely adopted nursing models by nursing courses are those proposed by Rogers (1951). These models stem from humanistic, client-centered models. In recent times, these models have been refined. The prime features of these models are respect and genuineness. In these models, the nurse or the helper concentrates on building relationships with the patients founded in trust. The communication skills needed are:
- Attending – oriented towards the client physically and psychologically
- Listening – the helper (nurse) needs to capture and understand verbal and non-verbal messages from the client.
- Empathy – the helper needs to communicate with the clients and understand what they are saying. Empathy means that the nurse needs to make the client feel that he or she understands the client’s situation and feelings.
- Probing – the nurse needs to help client identify and explore experiences, behaviors and feelings (Egan 1994 cited in Arthur 1999)
Nurses play an important role in health communication. The nurse has an essential position on the patient care team according to Skipper (1965). His or her coursework has emphasized social relations more than any other health-care team member. Communication skills according to Tarasuk et al (1965) is among the most important skills that a nurse must posses. Their experiment revealed that patients experience relief from pain more quickly and thoroughly if nurses approach them extending support and recognition. Nursing actions are planned to promote, maintain, and restore the client’s or patient’s well being and health. professional practitioners of nursing bear primary responsibility for the nursing care patients receive. Client-nurse relationships are entered for the benefit of the client, but such a relationship is more effective if it is mutually satisfying. Clients are satisfied when their health care needs have been met and they sense that they have been cared for. Nurses feel a sense of accomplishment when their interventions have had a positive influence on their clients' health status and when their conduct has been competent and caring. Client-nurse relationships may be a mutual learning experience, but in general the goals of therapeutic relationships are directed toward the growth of clients (Stuart and Sundeen 1995).
One of the characteristics and skills that a nurse must posses in order to become an effective health communicator is being assertive. The respondents all agreed that assertiveness is an important skill. According to Riley (2000) assertiveness is the key to successful relationships for the client, the family, the nurse, and other colleagues. The assertive nurse appears confident and comfortable. Another characteristic is being responsible. According to Riley (2000) being responsible is taking accountability for the outcome of one’s professional actions, which are based on knowledge. Responsible communication according to Riley (2000) demonstrates accurate problem-solving behavior for the particular situation. Nursing process is a systematic means for nurses to demonstrate accountability and responsibility to clients.
Another skill that is important is caring. The nursing profession is based on caring. Encompassed in caring is a commitment to the preservation of common humanity and unrelenting respect for the uniqueness and dignity of each individual that a nurse encounters (Delaney 1990). Caring is an essential ingredient in life and must characterize the nurse-client relationship. Caring is the moral ideal that guides nurses through the caregiving process, and knowledgeable caring is the highest form of commitment (Watson 1995). Caring communication is holistic, taking into account the entire person and demonstrating respect for clients as people, not just as bodies requiring nursing interventions. The process of caring began in the nurse's feelings and knowledge and moved the nurse to competent actions that contributed to positive outcomes for the client, family, and nurse (Bush and Barr 1997).
Research Methodology: Interview
In order to ascertain the important roles of nurses in health communication, I conducted an interview with five (5) registered nurses. The interview also aims to determine the skills and characteristics that a nurse must possess in order to communicate properly and how to develop the communication their communication skills.
The respondents were ask to describe the importance of the communication skills (identified by Rogers (1951) in their field of work.
1. Attending – according to the respondents, it is important for a nurse to attend to the needs and wants of the patients. The nurse must satisfy the health needs of the patients and be able to attend to them physically and psychologically.
2. Listening – Listening is an active process of receiving information and examining one’s reaction to the messages received (Riley 2000). According to the respondents the ability of a nurse to listen to his or her patient and to process the information received properly is very important. According to Riley (2000) a nurse who has an effective communication skills nonverbally communicates his or her interest in client. Having effective listening skills, according to the respondents is among the most critical skills that a nurse must have. The nurse must always be attentive to the patients and he or she must make sure that he/she listens carefully to everything that the patients say. According to the respondents, many problems and difficulties in the health care provision arise because of poor listening skills.
3. Empathy – according to the respondents, empathy goes beyond making the patients feel that you understand them. An emphatic nurse puts his or her self in the patients’ situations and conditions. It is far more than just understanding.
4. Probing – according to the respondents, a nurse must be able to encourage the patients to express themselves clearly. The nurse through probing must aim to help patients in exploring their experiences, feelings and behaviors.
Through Research and interview, the researcher was also able to gather other communication skills that a nurse must possess in order to enhance the health care provision. These are:
1. Silence – periods of no verbal communication among participants (Riley 2000). According to the respondents an effective nurse knows when to be silent. They said that sometimes patients do not want to communicate. A nurse must respect that. According to Riley (2000) silence nonverbally communicates the nurse’s acceptance of the client.
2. Ability to Establish Guidelines – guidelines are statements regarding roles, purpose, and limitations for a particular interaction. A nurse, according to the respondents must be able to set guidelines in his or her interaction with the client. This according to Riley (2000) helps clients to know what is expected of him or her.
3. Ability to make Open-Ended Comments – open-ended comments according to Riley (2000) ask the client to determine the direction the interactions should take. An effective nurse according to the respondents must be able to take identify signals from the patient.
4. Ability to Reduce Distance – diminishing physical space between the nurse and client is important in health communication according to the respondents. It nonverbally communicates that nurse wants to be involved with the client.
5. Acknowledgment – recognition given to a client for contribution to an interaction. Demonstrates the importance of the client’s role within the relationship (Riley 2000).
6. Restating – repeating to the client what the nurse believes is the main thought or idea expressed.
7. Reflecting – directing back to the client his ideas, feelings, questions, or content. This skill attempts to show the client the importance of his or her own ideas feelings, and interpretations (Riley 2000).
8. Seeking Clarification – asking for additional input to understand the message received. Demonstrates the nurse’s desire to understand client’s communication. According the respondents, an effective nurse exerts effort to understand the patient.
Non-Verbal Communications Skills
The respondents also stressed the importance of non-verbal communication in nursing. Non-verbal behaviour or communication according to Bensing et al (1995) is essential in conveying warmth, love and support to patients (cited in Caris-Verhallen et al 1999). According to Greene et al (1994), nonverbal communication includes all forms of communication that do not involve the spoken word (cited in Caris-Verhallen et al 1999). Non-verbal communication has different functions. Among these are:
- Non-verbal communication conveys interpersonal attitudes and emotional states.
- Non-verbal communication supports or contradicts the verbal communication.
- Non-verbal communication functions as a substitute for language, if speech is impossible (Argyle 1972 cited in Caris-Verhallen et al 1999).
Forms of Positive Non-verbal Communication
1. Affirmative Head Nodding – affirmative head nods regulate the interaction, especially changing turns in speaking. It also support spoken language and comment upon the interaction concerning the rapport and the content of the communication.
2. Smiling – a nurse may establish a good rapport with patients through smiling. Smiling is positively judged by other people and considered as a sign of good humour.
3. Body Positioning – a person’s body positioning may indicate if he is listening, attending and.
4. Touch – touch is a very important aspect in building rapport and establishing a relationship. Touch has also the potential to convey affection, care and comfort.
According to the respondents non-verbal communication skills are equally important as verbal communication skills. They also add that sometimes, non-verbal communication is more effective that verbal communication and that non-verbal communication goes hand in hand with verbal communication.
Personal Reflection of Communication Skills
Communication Techniques that I am able to Demonstrate
1. Listening – I can say that I have an effective listening skills. I listen carefully to instructions and I always make it a point to listen to what the patients say. I also make sure that the patients are comfortable with me and make them feel that I am interested in what they are saying.
2. Empathy – As a helper and a health service provider, I have developed the skill of empathy. I always make sure that I act, talk and think as if I am in the same situation as the clients are. I always try to view things through the clients’ perspectives. I also make them feel that I care for them genuinely.
Communication Techniques that I need to develop Further
1. Attending – I am aware that my knowledge and skills in attending is only limited and that there are so many things that I can learn. My experiences are not that wide and so I believe that there are plenty of rooms for improvement.
2. Probing - Sometimes I find it hard to ask questions to patients. I’m also finding it hard to understand every patient. There are patients that are hard to deal with. I know that probing is one of the important skills that I must posses. I must be able to deal with the patients and communicate with them effectively. I must encourage them to reflect on their experiences. I must encourage them to express themselves and be comfortable with me. I believe that through practice, training and observation I can develop my probing skills.
What I should do to develop my Skills Further?
One of the important things that I must do to develop my skills further is to participate in the training and other activities that our school and other organizations are facilitating. By participating in learning and training activities I can acquire new skills and develop strategies in order to effectively employ the skills and techniques I learned. Another strategy is practicing key skills. According to Maguire and Pitceathly (2002) practicing with simulated patients and actors has the advantage that the nature and complexity of the task can be controlled. Lastly, I must be able to use new skills in practice.
Conclusion
Nurses play an important role in health communication. Nurses are the ones who are always in close contact with the patients. Nurses have essential positions on the patient care team. Communication plays an important role in the nurse-patient relationship. Based on the interview and the information gathered by the researcher, communication is an important factor in the provision of health services and having effective communication skills is among the priorities of the profession. The basic communication skills according to the reference materials that the researcher consulted and according to the respondents are attending, listening, empathy and probing. As a nurse, one must develop these skills along with other communications skills.
References
Argyle, M. (1972). Nonverbal Communication. In R. A. Hinde (Ed.). Nonverbal Communication. Boston: Houghton Mifflin.
Arnold, E. and Boggs, K. (1995). Interpersonal Relationships: Professional Communication Skills for Nurses. Philadelphia: W.B. Saunders Company.
Arthur, D. (1999). Assessing Nursing Students’ Basic Communication and Interviewing Skills: The Development and Testing of a Rating Scale. Journal of Advanced Nursing, 29(3), 658-665.
Baltzer-Riley, J. W. (1996). Communication in Nursing. St. Louis, MO: Mosby.
Bensing, J. M.. Kerssen, J. J., and Van Der Pasch, M. (1995). Patient-Directed Gaze as a Tool for Discovering and Handling Psychological Problems in General Practice. Journal of Nonverbal Behavior, 19(4), 223-243.
Bush, H. A. and Barr, W. J. (1997). Critical Care Nurses' Lived Experiences of Caring, Heart Lung 26(5), 387.
Caris-Verhallen, W., Kerkstra, A., and Bensing, J. M. (1999). Non-verbal Behavior in Nurse-Elderly Patient Communication. Journal of Advanced Nursing, 29(4), 808-818.
Delaney C. (1990). Computer Technology: Endangering the Essence of Nursing? In J. C. McCloskey and H. K. Grace (Eds.). Current Issues in Nursing. St Louis: Mosby.
Egan, G. (1994). The Skilled Helper: A Problem-Management Approach to Helping. Monterey, California: Brookes/Cole.
Greene, M. G., Adelman, R. D., Friedmann, E., and Charon, R. (1994). Older Patient Satisfaction with Communication During an Initial Medical Encounter. Social Science and Medicine, 38, 1279-1288.
Maguire, P. and Pitceathly, C. (2002). Key Communication Skills and How to Acquire them. British Medical Journal, 4, 679.
McCabe, C. (2004). Nurse-Patient Communication: An Exploration of Patient’s Experiences. Issues in Clinical Nursing, 13, 41-49.
Riley, J. B. (2000). Communication in Nursing. St. Louis, MO: Mosby.
Rogers, C. R. (1951). Client Centered Therapy: Its Current Practice, Implications and Theory. London: Constable.
Skipper J. K. ( 1965). The Role of the Hospital Nurse: Is it Instrumental or Expressive? In J. K. Skipper and R. C. Leonard (Eds.). Social Interaction and Patient Care (pp. 40-50). Philadelphia: J. B. Lippincott.
Tarasuk M. B., Rhymes J. P., and Leonard R. C. (1965). An Experimental Test of the Importance of Communication Skills for Effective Nursing. In J. K. Skipper and R. C. Leonard (Eds.). Social Interaction and Patient Care (pp. 110-120). Philadelphia: J. B. Lippincott.
Watson, J. (1995). Postmodernism and Knowledge Development in Nursing, Nursing Science Quarterly. 8(2), 60.
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