Health And Social Care Communication Analysis

This assignment will define communication and discuss the importance of effective communication within the healthcare sector. It will then look at how I can develop an active listening skill that I currently feel is a personal weakness. (Appendix 1)

Le May (2004) defines communication as a process of exchanging a message intentionally or unintentionally between two or more people using either both verbal and non verbal communication skills. In order for communication to be effective, the sender and the receiver must have a clear understanding of what is being communicated, because a breakdown can have a negative outcome (Riley 2008).
Effective communication is an essential tool used throughout the healthcare profession. The reason why
communication is so vital in the healthcare profession is due to the simple fact that peoples lives are at risk if communication fails (Riley 2008). Yet research shows that poor communication is one of the general complaints in the healthcare profession (Campbell 2006). Communicating effectively will help us to understand the needs and the expectations of the patient (Neville & Donnelly 2008). It also assists the nurse to a better understanding of what they are doing and also enhances their morale and promotes job satisfaction. It also enables us to provide the highest possible standard of care (Towers 2008).

Communication can be verbal and non verbal (Rana and Upton 2009). Verbal communication entails the formation of words either by writing, orally, or sign language, whereas non-verbal communication includes body language, facial expression, touch, posture, gesture, gaze and active listening (Rana and Upton 2009). Le May (2004), describes non-verbal communication as the act of using our behaviour to portray a message without the use of spoken words either intentionally or unintentionally. Non verbal communication has been acknowledged as the most powerful form of communication (Rana and Upton 2009). Mehrabian (1971 cited in Rana and Upton 2009) suggested that facial expression account for fifty-five percent of our communication, for example a patient’s facial expression clearly displaying pain, but verbally stating he is fine. It is vital that nurses become aware of these non-verbal communication cues to help them identify the mood or the condition the patient may be in, so as to determine how best to approach or deal with the patient (Sheldon 2009).

As mentioned in the SWOT (Appendix 1) I have realise that my strength are being able to approach people, talk to them with an open mind and not being judgemental, as well as maintaining confidentially as it is important. I was also able to use touch as a way of assuring a patient as stated in my evidence of strength (SWOT).
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The aim within my SWOT is to develop the skill of active listening. As a student nurse, acquiring these skills will enable me to become a better nurse. Active listening can be seen as an element for a patient’s care (Sheldon 2009). Active listening as a skill requires your full attention because it is not just hearing their spoken words, but what the underlying thoughts and feelings are by looking at their body language such as gesture (Moss 2008). It involves asking open and close questions which encourages and empowers the patient to talk more openly about their problems (Arnold and Boggs 2007). It also uses paraphrasing, summarizing and clarifying to eliminate the guesswork to ensure messages are received properly (Lloyd and Bor 2009, Riley 2007). As the Nursing and Midwifery Council code of conduct (2008) emphasises, that by making the patient your first priority and listening with an open mind, mixed with facial expression and body language such as posture and gesture (Riley 2007), it will help in gaining important information and relay it to the rest of the health care team. This is vital because it provides a basis for a therapeutic relationship between patient and nurse which can then promote holistic care (McCabe and Timmins 2006). There are many skills involved in active listening such as eye contact, facial expression, posture, gesture, proxemics, summarising, touch and paraphrasing but for the purpose of my self awareness I would like to focus on developing the use of facial expression and eye contact (Moss 2008, Boggs 2007).

Maintaining eye contact is very important part of active listening, because it gives your undivided attention to a patient. This shows you are listening, which create a sense of warmth, respect and trust (Duryea 1991 cited in Arnold and Boggs 2007).A nurse needs to show confidence in dealing with a patient. For example, a nurse needs to show that they are not shocked or moved by what a patient tells them through eye contact (Arnold and Boggs 2007). Eye contact is an important communication tool which can be used for both adults and children to demonstrate your interest (Sheldon 2009). To show undivided attention to the patient the nurse should be at the eye level with the patient and maintain eye contact this can help to ascertain any pain or anxiety the patient may be feeling as these can sometimes be conveyed through their gesture and facial expression (Darley 2002).

In the absence of eye contact or eye wondering, the speaker might interpret this as being disinterested, dishonest, rude, guilty or ashamed (Rana and Upton 2009) and as the NMC (2008) underline the importance of being honest, nurses therefore needs to consistent make eye contact throughout the conversation to honour the good name of the profession. Kuhnke (2007) pointed out that maintaining eye contact whilst listening to a patient, gives them encouragement to express their thoughts and feelings. Nurses need to put effort and attention into listening to ensure they understand every word and its meaning (Sheldon 2009). By paying attention and demonstrating care it makes the patient feel valued. However, maintaining eye contact for more than three seconds can be uncomfortable for both the speaker and the listener especially with regards to physical touch as it might indicate a sign of intimacy (Sheldon 2009). Therefore they must not stare as it might make the patient uncomfortable (Sheldon 2009). Maintaining eye contact and then occasionally shifting to the forehead will reduce the chance of staring (Rana and Upton 2009). In cultures such as Asia and Africa maintaining eye contact with the elderly is seen as rude and challenging, so to show respect most people from these culture do not maintain eye contact when communicating with the elderly or people in a higher position (Sundeen et al 1998), and as Husband (2007), suggested there is a likelihood of poor communication and misunderstanding when we converse across different cultures. Therefore it is important for a nurse to have an awareness of the relationship between culture and communication as well as an understanding of the differences between cultures so as not to misjudge a patient (Riley 2008).

Appendix 1 also highlighted that having a better understanding of facial expression will further improve my active listening skills. To listen actively means focusing on the individual which will then enable a nurse to pick up cues that are not being said as facial expression communicates inner information about pain, emotional state and attitudes (Akunjee et al 2010). During interaction the face can express more than what the individual communicate verbally contradicting the message that is being conveyed (Argyle 1994). It is nearly impossible to avoid certain emotion, when it could be strongly desired to (Hargie et al 2004).
The face can express surprise, happiness, interest, fear, sadness, anger, or disgust. Therefore as a nurse whilst listening there is a need to beware of the expression on the face as it can promote or discourage communication (Randle et al 2009). For example a frown or a squint can communicate anger or confusion, which will discourage communication as they might feel judged (Sundeen et al 1998). However, smiling and nodding can encourage the patients as it shows that you are listening and that their needs are important (Sheldon 2009).
Although research shows that facial expressions help us gain a better understanding of a person’s emotion and what is being communicated, in contrast people from Japan have a rule of not showing their negative emotions through their facial expression (Argyle 1994, Sheldon 2009).

Knowing that facial expression can vary from patient to patient depending on their culture; this will then help me to carefully analyze each patient before responding appropriately (Antai-Otong 2009). .
There are barriers that can hinder active listing, such as busy wards, timing, the environment and language (Wainwright 2009). Some patients may have difficultly in expression their feelings due to limitation with their language and encouraging them using non verbal cues such as hand gesture or nodding may help them communicate more freely (Freshwater 2003). Whilst we are training as an English nurse, it is an important factor to bear in mind that not every patient will be fluent or confident in communicating through the English language. In such case where a patient is not fluent in English, actions and gesture as expressive and important as words (Akunjee et al 2010). Another barrier to communication can be intrapersonal factors as I have experienced. That is stated by Arnold and Boggs (2007), listening to a patient talking about their problem can trigger your memories which in turn affect the way we interpret what we hear. Furthermore when dealing with patients it is vital that we become aware of ourselves, so not to impose our own beliefs and values on them, since the main tool used during interaction is ourselves (Freshwater 2003). Acknowledging and developing this self awareness with the help of my mentors, other staffs and personal tutor will enable me to overcome my weakness and be able to provide holistic care to the patients (DOH 2004).

In conclusion this assignment has been enlightening as it has established the importance of effective communication in healthcare. In reflecting back I have acknowledged the importance of communication through active listening. When a message is communicated wrongly the consequences can be profound. Therefore putting you and the people you care for at risk. What I have learnt through this discussion on communication is how to put my own belief and culture aside and take on the role of a nurse. I need to overcome my own barriers and work towards improving and developing my active listening skills.

Reference List

Akunjee M, Akunjee N, Siddiqui S and Malick A S (2010) The Easy Guide to OSCE for Communication Skills. United Kingdom, Radcliffe Publishing Ltd

Antai-otong D (2007) Nurse-Client Communication A life span approaches. London, Jones and Bartlett

Argyle M (1994) The Psychology of Interpersonal Behaviour.5th edition London, Penguin

Arnold C. E and Boggs U K (2007) Interpersonal Relationships professional Communication Skills for Nurses. 5th London, Saunders Elsevier

Bach S and Grant A (2009) Communication & Interpersonal Skills for Nurses. London, TJ International Ltd

Boggs K U (2007) Communication Styles. In Arnold E C and Boggs K U Editor (2007) Interpersonal Relationships professional Communication Skills for Nurses. 5th London, Saunders Elsevier pg 185-198

Campbell S (2006) A project to promote better communication with patients. Nursing Times, 102 (19) 28-30

Darley M (2002) Managing Communication in Health Care. London, Harcourt Publishers Limited

Duryea E J (1991) Principles of nonverbal communication in efforts to reduce peer and social pressure, Journal of School Health Nursing, 61(1) 5-10 cited in Arnold E and Boggs K U (2007) Interpersonal Relationships Professional Communication Skills for Nurses.
5th edition London, Saunders Elsevier

Department of Health (2004) Appendix 2: Core Dimension 2 Personal and People Development NHS Knowledge and Skills Framework. http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4107980.pdf [20/01/2011]

Freshwater D (2003) Counselling Skills for Nurses, Midwives and Health Visitors. Philadelphia, Open University Press

Hargie O, Dickson D and Tourish D (2004) Communication Skills for Effective Management. New York, Palgrave Macmillan

Husband C and Hoffman E (2007) Transcultural health care practice: Transcultural Communication and Health Care Practice. Royal College of Nursing. http://www.rcn.org.uk/resources/transcultural/communication/index.php
[20/11/2010]

Knhnke E (2007) Body Language for Dummies. United Kingdom, John Wiley & Sons Ltd

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McCabe C and Timmins F (2006) Communication Skills for Nursing Practice.
New York, Palgrave Macmillan

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Nursing and Midwifery Council (2008). The code standards of conduct, performance and ethics for nurses and midwifes, London

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Appendix 1 [pic]

Faculty of Health Pre-Registration Nursing

Name: 10003154 Date: 12/12/2010

Title of SWOT Analysis: Developing Communication Skills

Cross Referenced to: How to use communication skills Action Plan

Strengths:

• Touch • Being able to listening without judgemental • Confident in speaking • Keeping confidentiality, privacy and dignity

Evidence of Strengths:

• During placement I use touch to reassure a patient that it was okay to relax and not to be afraid and to trust the nurses when an NG tube was being inserted through the patient nose by touching and rubbing his shoulders which made him calm down allowing the procedure to be done.
• Gained knowledge in communication skills from Lecture of the faculty

• Reading Text books and journals on communication

• Internet and getting feedback from staff

Weaknesses / Areas for Development:

I will like to improve my knowledge of Active listening by focusing on the skills below.

• Maintaining eye contact in relation to active listening • Facial expression in active listening • Develop self awareness

Opportunities Available:

• Researching the effectiveness of using active listening in
books • Mentor • Other available health profession • Personal tutor

Threats:

• My confident • Language barriers • Culture differences • Self awareness

Appendix 2

[pic]

Faculty of Health Pre-Registration Nursing

Name: 10003154 Date: 12/12/2010

Title of Action Plan: How to use communication skills

Cross Referenced to: Developing communication Skills SWOT analysis

What do I want to achieve:

• To feel confident to use verbal and non verbal cues during communication • To be able to achieve the skills of active listening focusing on the following:

• Eye contact: why it is important, the role it plays in communication, it barriers and it cultural differences.

• Facial expression: why is it important, the role it plays in communication and the cultural differences

• As well as my self awareness so not to impose my belief on to others.

• Good feedback from both mentors and personal tutor

What action will I take to achieve this:

• Reading and applying the various method in various books • Seeking help from my personal tutor and peer • Watching how my mentor and other staffs demonstrate active listening • Enthusiasm

I will need the following resources or support:

• I will need to talk to my mentor and my personal tutor for support if I am finding it difficult to demonstrate or apply any of the given actions above. • Tutorial support, Text books and Journal • Library • Internet • Exploring evidence based knowledge

When will I commence my Action Plan and when will I review it:

I will commence my Action Plan now.

By applying it during my 2nd placement

Evaluation of Action Plan:

I have achieved all of my set Action Plan? Yes No

Comments:

Student Signature: Mentor / Facilitator Name and Signature

(if applicable):

______________________ ________________________________

Date:_________________ Date:____________________________