Nurse Practitioners Communication Skills
This paper will first discuss how a pregnant, anxious, sixteen year old patient will need to be approached and cared for by healthcare professionals, in this case a staff nurse in a hospital ward, it will consider how interpersonal communication skills can be applied to improve the patient outcome, before outlining the legal issues of consent. Following, it will then continue to discuss moral and ethical issues in healthcare and consider the patients’ rights, dignity, preferences, beliefs and cultures. Then proceeding to describe how an individual’s health could be affected by their psychological wellbeing and economic and social status.
Approaching the patient known as Emma who is vulnerable, agitated and upset and who is also pregnant …show more content…
and in pain, will take a great deal of skill from the nurse in handling this case. It will need to be tailored to meet the patients’ individual needs, beliefs, educational level and cultural preferences (Raines et al, 2000) in order to achieve a positive outcome and address the cause of her abdominal pain. According to Montgomery (2002) care of pregnant adolescents compared to adults are similar; however, adolescents require additional unique needs. Informed consent must also be obtained before carrying out any healthcare provision following legal guidelines. The patients’ rights (confidentiality), dignity, preferences, beliefs and culture will need to be respected at all times taking into account, the legal and ethical frameworks that exist. In order to build trust and confidence, which is paramount, the nurse will need to be patient/person-centred and have a non-judgemental approach towards the patient, furthermore, a style of communication that builds rapport gently and sensitively whilst displaying signs of empathy will need to be adopted so that important back ground information can be obtained. However it is noteworthy that Bach (2009) argues that it can be problematic to obtain too much information as this could be considered as being intrusive, furthermore gaining unnecessary information could become confusing and result in valuable time being wasted.
The patient will need to be empowered so that they can take part in any decision making, thus building self-esteem. In addition, acknowledging the patients’ mentality at all times, as well as continuing to raise the patient’s self-esteem and eliminating any sense of fear from stigmatization and stereotyping from the nurse or any other staff. Timmins (2007) attests that there is evidence that certain patient groups are stereotyped by nurses.
The nurse will need to take into account any feelings of anguish that the patient may have in deciding what to do, especially if the pregnancy was unplanned. Moreover the patient will need emotional support throughout to help relieve their anxiety, stress and fear, that maybe caused by the suggestion of surgery.
According to Mead and Bower (2000) cited in The Kings Fund (2008 p.19 ) they conceptualize some aspects of patient-centred communication as seeing the ‘patient as a person’, understanding how each patient perceives personal illness, being sensitive to the patients’ preferences in receiving information and shared involvement in making decisions, thus empowering the patient. In addition, the bio-psychosocial perspective which in essence is a perspective on illness that considers social and psychological factors was also included. However, Charlton et al. (2008) corroborates that the bio-psychosocial perspective has a considerable impact on patient outcomes. It could be seen that involving the patient in all aspects of their care, treating them as an individual, seeing them as a whole person, can enhance the relationship between the patient and the nurse, which is essential for building trust. It could be argued that trust from the patients’ perspective centres on requiring care, concern and compassion from the nurse. Listening forms one of the most important components; hence, communication and trust are interlinked (Chin, 2001).
Trust in healthcare professionals reveal the idea that patients’ will discuss their problems freely, and the nurse will need to ensure that this trust is not destroyed, for example, the patient may not want their family to know about their medical condition, however the patient needs to be informed around the issues of confidentiality and informed consent. The nurse cannot betray confidentiality of the patient. Therefore trust shapes a major chunk of the relationship between patient and nurse.
This can be vastly improved by active listening, which means that there is a two-way communication, and that that patient realises that the nurse is listening, while they are talking. This can be made possible, through verbal prompts, for example “ I see”, as well as non-verbal behaviours, such as good eye contact, open posture so that the patient does not feel intimidated , not using any distracting behaviour, which would allow the patient to share information easily. Additionally, the nurse can ensure that the patient has understood by repeating or reflecting on the pointers that arose within the discussion. Furthermore, for improved communication, the nurse could also encourage the patient to take part in the discussion, and provide more information, by using open ended questions; understanding the patients’ feelings, and showing them by responding appropriately, for example, when emotional response is needed. (Kahle, 2009).
Goold and Lipkin (1999) found that good communication can prevent spending unnecessary time to reassure an anxious patient, repeatedly about a certain thing. A patient model of communication will signify that the nurse is complying with his/her duty to respect the patient as an individual. This will result in informed consent, and the patient will respond positively to the treatment plan (Chin, 2001). In Emma’s case she is refusing to let anyone examine her, obtaining consent could prove difficult in these circumstances and she could be at risk due to her abdominal pain. The patient’s mental capacity to refuse will need to be addressed, following the NMC and HPC codes of practice. The Family Law Reform Act 1969 lowered the age of majority to eighteen years and gave sixteen and seventeen year olds the same right of consent as adults. (Shaw 2001).
The Mental Capacity Act 2005 stipulates that ‘A person must be assumed to have capacity unless it is established that they lack capacity’ (Gallagher, 2012, p.55). Section nine of the Health Professionals Council (HPC) code, advises that, if a patient declines treatment and you as a healthcare professional believe that it is necessary to maintain the wellbeing of the patient particularly if you feel that their life is at risk, you must make every reasonable effort to persuade the patient. Pearce (1994) suggests that it would be advisable to delay treatment until every effort is made to reach a consensus. In contrast; The British Medical Association (1993) suggests that a different health professional attempts to act as an independent arbiter in order to negotiate an agreement.
The Nursing and Midwifery Council (NMC) (2008) and The HPC (2008) standards cited in Gallagher & Hodge (2012, p.53-4) both require health professionals to obtain consent prior to care or treatment; moreover you must respect the patient’s wishes to decline or accept medical intervention. It is noteworthy that the HPC Code (2008:11) supports that health professionals, before gaining informed consent must explain to the patient, the planned treatment and any risks it may present offering other alternative treatments. In addition, the patients’ treatment decision must be recorded and passed to all staff involved in the care of the patient. However, Gallagher and Hodge (2012) suggests that consent could be invalidated if the patient was coerced into agreeing with the planned treatment and that patients’ need to be offered more than one opportunity that enables them to consent or refuse treatment.
Health care can involve numerous ethical issues and present many situations that place nurses in the position of making moral decisions. Health care ethics is a thoughtful exploration of how to act well and make morally sound choices, based on beliefs and values about health, life and suffering. According to Gallagher & Hodge (2012) you must consider in the context of care, the patients’ wellbeing and preferences. In addition there may even be conflict of what you feel is best compared to the patient; it is then that it will be considered essential that you will have to provide sound, ethical and legal judgements for your actions.
The comment ‘You’d better watch out for that one; she’s stubborn and won’t let you do anything, so you are going to have to persuade her’ in this scenario could have damaging effects on the handling of this case; it could of meant that the patient has been labelled as difficult without consideration of the patients feelings and stressful predicament, which may have been attributes to the patients’ behaviour. According to Sully and Dallas (2010) the patient should feel an unconditional positive regard, achieved by being accepting of the patient, moreover concentrate on the patients’ needs and rights more willingly than your own personal values.
The nurse, will have to ask themselves about their own ethics and morals in order to help the patient no matter what her condition is at the present time. In dealing with any ethical dilemmas this case may present, the nurse cannot state their own ideas or assume what could be happening and make decisions for the patient as this would not be an ethical thing to do. One must not have ‘Cultural Tunnel Vision’ when dealing with these types of cases. One must have more than one set of cultural assumptions, must be sensitive to others, must evaluate and to accommodate the behaviours of others, and must have different ways of thinking, make adaptions, moreover, make alternatives to find a solution to the presenting problem. (Corey et al, 2011).
The patient may feel the stigma of teen pregnancy; this may have helped along the feelings of anxiety when entering the hospital. The patient needs to feel that they do not have to be embarrassed and they would not be rejected. Importantly the patient will need to know that they have the power to make decisions and still ask to be helped. Egan (2007:52, cited in Sully & Dallas 2010, p.3) believes that the nurse can learn that culture is shared beliefs and assumed thoughts which combine with shared values and in turn produce shared norms that control shared behaviour patterns.
It is widely acknowledged that an individuals’ psychological and emotional wellbeing can be affected by their economic and social circumstances, and maybe influenced by family background and the community or society they live in. The separation between the patients’ parents may have had a psychological effect, and there may be a breakdown in the relationship between the mother and the patient which in the patients’ case may have led to them running away from home. It is noted that Holdnack (1993) identifies, that emotional closeness between parents and children is interrupted following divorce, leading to negative impacts on the child’s self-esteem. All these factors could have had a contribution to the patient’s poor attendance at school, affecting social and economic wellbeing. Sun (2001) found that following divorce, there is less parental interest in children’s education and fewer economic resources.
The Department for Education and Employment (2001) (DfEE) confirms, that there are circumstances which pose greater risks of vulnerability to multiple risk factors for adolescents that make emotional harm conceivable. These situations include involving loss and separations resulting from parental separation; some groups of adolescents are more apt to being exposed to these events and, consequently will be at more risk of mental health problems through the build-up of collective risk factors. These include looked after children, children of divorced parents, runaways, teenage mothers. According to Colman (2009) having strong, psychological and emotional wellbeing can help protect adolescents against emotional and behavioural problems and teenage pregnancy.
Therefore, it could be argued that social determinants of health such as geographical location, gender, age, education level and socio-economic status are all factors that contribute to an individual’s health and wellbeing leading to health inequalities (Wilkinson 2005). Statistics from World Health Report 2001 supports the veracity of these connections. Furthermore, according to Payne (2000) considerations of social divisions such as class, ethnicity, gender and age are helpful to analyse explanations to health inequalities.
To conclude, it is clear that a commitment and understanding of ethical, legal and professional issues, including the importance of consent and confidentiality is necessary for nurses to practice as an accountable professional; keeping check of the NMC and HPC will inform you of any changes to the codes (Gallagher & Hodge, 2012). “Care whether it is emotional or physical for the pregnant adolescent is similar to that of an adult. However, adolescents often need additional support; as the patient may have fewer life experiences than that of adult women, making them less able to cope with life changes related to pregnancy and birth. Non-judgemental care and simple instructions are essential to caring for the pregnant patient” (Montgomery, 2002, p.255). There is evidence to suggest that adolescents that come from broken homes are on average, suffer more impacts on their wellbeing than those from intact families (MacKay, 2005). Communication plays an important role in medicine, in establishing the nurse-patient relationship; it leads to improved understanding and coping, thus producing better treatment decisions and compliance (Roter & Hall, 1992, Cited in (Kaptein et al 2004, p.268).
REFERENCES:
Bach, S, Grant, A (2009).
Communication & Interpersonal Skills for Nurses, Exeter: Learning Matters Ltd.
British Medical Association (1993). Medical Ethics Today: Its Practice and Philosophy. London: BMA.
Charlton, CR, Dearing, KS, Berry, JA, and Johnson, MJ (2008). Nurse Practitioners’ communication styles and their impact on patient outcomes: integrated literature review. Journal of Clinical Nursing, 11: 12-21.
Chin, JJ (2001). Doctor-Patient Relationship: A Covenant of Trust. Singapore medical journal, 42 (12), 580. (Online) Available at: http://www.sma.org.sg/smj/4212/4212sf3.pdf (accessed 7th December 2012).
Coleman et al (2009). Outcomes of conduct problems in adolescence: 40 year follow up of national cohort. British Medical Journal, 338: a2981
Corey, G, Corey, MS, Callanan, P (2011).Issues and Ethics in Helping Professions,8th edition, USA; Brooks/Cole Genage Learning.
DfEE (2001). NCH, Literature Review: The Emotional Harm and Well-being of Children (2007). (Online) Available at: http://www.actionforchildren.org.uk/media/145524/emotional_harm_and_well-being_of_children.pdf (accessed 7th December …show more content…
2012).
Egan, G (2007). The Skilled Helper: A Problem - Management and Opportunity – Development Approach to Helping, 8th edition. Pacific Grove: Brooks/Cole.
Gallagher, A, Hodge, S (2012). Ethics, Law and Professional Issues, Hampshire: Palgrave Macmillan.
Goold, SD, Lipkin, M (1997). The Doctor-Patient Relationship. (Online) Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/ (accessed 7th December 2012).
Holdnack, JA, (1993). The long-term effects of parental divorce on family relationships and the effects on adult children’s self-concept, cited in Everett, CA, (ed) Divorce and the Next Generation: Effects on Young Adults’ Patterns of Intimacy and Expectations for Marriage, New York: Hamworth Press.
Kahle, A (2009). Practitioner /patient Interaction: How to Avoid and Resolve Conflicts. OANDP Publishing. (Online) Available at: www.oandp.org/publications/jop/2009/2009-20.pdf (accessed 12th December 2012).
Kaptein, A, Weinman, J (2004). Health Psychology, Oxford: BPS Blackwell Publishing Ltd.
Mackay, R (2005).
The Impact of Family Structure and Family Change on Child Outcomes: A personal Reading of The Research Literature, Social policy Journal of New Zealand. (Online) Available at: http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj24/24-impact-of-family-structure-and-family-change-on-child-outcome-p111-133.html (Accessed: 7th December 2012).
Mead N, Bower P (2002). ‘Patient-centred consultations and outcomes in primary care: a review of the literature’. Patient Education and Counselling Journal, vol 41, no 1, p.51-61. (Online) Available at: http://www.kingsfund.org.uk/sites/files/kf/Seeing-the-person-in-the-patient-The-Point-of-Care-review-paper-Goodrich-Cornwell-Kings-Fund-December-2008.pdf (Accessed: 7th December 2012)
Montgomery, KS (2002). JOGNN, Clinical Issues, Nursing Care for Pregnant Adolescents, vol 32, p249-257. (Online) Available at: http://deepblue.lib.umich.edu/bitstream/2027.42/73476/1/0884217503252191.pdf (Accessed: 15th December 2012)
Payne, G (2000). Social Divisions, London: Macmillan Press Ltd.
Pearce, J. (1994). Consent to treatment during childhood: The assessment of competence and avoidance of conflict, British Journal of Psychiatry,
165,713–716.
Raines, DA, Morgan, Z (2000). Culturally sensitive care during childbirth. Applied Nursing Research, 13,167-172.
Shaw, M (2001). Competence and consent to treatment in children and adolescents. Advances in Psychiatric Treatment Journal, 7: 150-159. (Online) Available at: http://apt.rcpsych.org/content/7/2/150.full (Accessed: 7th December 2012)
Sully, P, Dallas, J (2010). Essential Communication Skills for Nursing and Midwifery, 2nd edition. London: Mosby Elsevier.
Sun, Y (2001) Family environment and adolescents’ well-being before and after parents’ marital disruption: A longitudinal analysis, Journal of Marriage and Family, vol 63, 693-713.
Timmins, F (2007). Communication Skills: revisiting the fundamentals. Nurse Prescribing, 5: 395-9.
Wilkinson, RG (2005). The Impact of Inequality: How to make sick societies healthier, Oxfordshire: Rouledge.
'I confirm that the submitted work is my own work and that I have clearly identified and fully acknowledged all material that is entitled to be attributed to others (whether published or unpublished) using the referencing system set out in the programme handbook. I agree that the University may submit my work to means of checking this, such as the plagiarism detection service Turnitin ® UK. I confirm that I understand that assessed work that has been shown to have been plagiarised will be penalised.'
6218895.
Approaching the patient known as Emma who is vulnerable, agitated and upset and who is also pregnant …show more content…
and in pain, will take a great deal of skill from the nurse in handling this case. It will need to be tailored to meet the patients’ individual needs, beliefs, educational level and cultural preferences (Raines et al, 2000) in order to achieve a positive outcome and address the cause of her abdominal pain. According to Montgomery (2002) care of pregnant adolescents compared to adults are similar; however, adolescents require additional unique needs. Informed consent must also be obtained before carrying out any healthcare provision following legal guidelines. The patients’ rights (confidentiality), dignity, preferences, beliefs and culture will need to be respected at all times taking into account, the legal and ethical frameworks that exist. In order to build trust and confidence, which is paramount, the nurse will need to be patient/person-centred and have a non-judgemental approach towards the patient, furthermore, a style of communication that builds rapport gently and sensitively whilst displaying signs of empathy will need to be adopted so that important back ground information can be obtained. However it is noteworthy that Bach (2009) argues that it can be problematic to obtain too much information as this could be considered as being intrusive, furthermore gaining unnecessary information could become confusing and result in valuable time being wasted.
The patient will need to be empowered so that they can take part in any decision making, thus building self-esteem. In addition, acknowledging the patients’ mentality at all times, as well as continuing to raise the patient’s self-esteem and eliminating any sense of fear from stigmatization and stereotyping from the nurse or any other staff. Timmins (2007) attests that there is evidence that certain patient groups are stereotyped by nurses.
The nurse will need to take into account any feelings of anguish that the patient may have in deciding what to do, especially if the pregnancy was unplanned. Moreover the patient will need emotional support throughout to help relieve their anxiety, stress and fear, that maybe caused by the suggestion of surgery.
According to Mead and Bower (2000) cited in The Kings Fund (2008 p.19 ) they conceptualize some aspects of patient-centred communication as seeing the ‘patient as a person’, understanding how each patient perceives personal illness, being sensitive to the patients’ preferences in receiving information and shared involvement in making decisions, thus empowering the patient. In addition, the bio-psychosocial perspective which in essence is a perspective on illness that considers social and psychological factors was also included. However, Charlton et al. (2008) corroborates that the bio-psychosocial perspective has a considerable impact on patient outcomes. It could be seen that involving the patient in all aspects of their care, treating them as an individual, seeing them as a whole person, can enhance the relationship between the patient and the nurse, which is essential for building trust. It could be argued that trust from the patients’ perspective centres on requiring care, concern and compassion from the nurse. Listening forms one of the most important components; hence, communication and trust are interlinked (Chin, 2001).
Trust in healthcare professionals reveal the idea that patients’ will discuss their problems freely, and the nurse will need to ensure that this trust is not destroyed, for example, the patient may not want their family to know about their medical condition, however the patient needs to be informed around the issues of confidentiality and informed consent. The nurse cannot betray confidentiality of the patient. Therefore trust shapes a major chunk of the relationship between patient and nurse.
This can be vastly improved by active listening, which means that there is a two-way communication, and that that patient realises that the nurse is listening, while they are talking. This can be made possible, through verbal prompts, for example “ I see”, as well as non-verbal behaviours, such as good eye contact, open posture so that the patient does not feel intimidated , not using any distracting behaviour, which would allow the patient to share information easily. Additionally, the nurse can ensure that the patient has understood by repeating or reflecting on the pointers that arose within the discussion. Furthermore, for improved communication, the nurse could also encourage the patient to take part in the discussion, and provide more information, by using open ended questions; understanding the patients’ feelings, and showing them by responding appropriately, for example, when emotional response is needed. (Kahle, 2009).
Goold and Lipkin (1999) found that good communication can prevent spending unnecessary time to reassure an anxious patient, repeatedly about a certain thing. A patient model of communication will signify that the nurse is complying with his/her duty to respect the patient as an individual. This will result in informed consent, and the patient will respond positively to the treatment plan (Chin, 2001). In Emma’s case she is refusing to let anyone examine her, obtaining consent could prove difficult in these circumstances and she could be at risk due to her abdominal pain. The patient’s mental capacity to refuse will need to be addressed, following the NMC and HPC codes of practice. The Family Law Reform Act 1969 lowered the age of majority to eighteen years and gave sixteen and seventeen year olds the same right of consent as adults. (Shaw 2001).
The Mental Capacity Act 2005 stipulates that ‘A person must be assumed to have capacity unless it is established that they lack capacity’ (Gallagher, 2012, p.55). Section nine of the Health Professionals Council (HPC) code, advises that, if a patient declines treatment and you as a healthcare professional believe that it is necessary to maintain the wellbeing of the patient particularly if you feel that their life is at risk, you must make every reasonable effort to persuade the patient. Pearce (1994) suggests that it would be advisable to delay treatment until every effort is made to reach a consensus. In contrast; The British Medical Association (1993) suggests that a different health professional attempts to act as an independent arbiter in order to negotiate an agreement.
The Nursing and Midwifery Council (NMC) (2008) and The HPC (2008) standards cited in Gallagher & Hodge (2012, p.53-4) both require health professionals to obtain consent prior to care or treatment; moreover you must respect the patient’s wishes to decline or accept medical intervention. It is noteworthy that the HPC Code (2008:11) supports that health professionals, before gaining informed consent must explain to the patient, the planned treatment and any risks it may present offering other alternative treatments. In addition, the patients’ treatment decision must be recorded and passed to all staff involved in the care of the patient. However, Gallagher and Hodge (2012) suggests that consent could be invalidated if the patient was coerced into agreeing with the planned treatment and that patients’ need to be offered more than one opportunity that enables them to consent or refuse treatment.
Health care can involve numerous ethical issues and present many situations that place nurses in the position of making moral decisions. Health care ethics is a thoughtful exploration of how to act well and make morally sound choices, based on beliefs and values about health, life and suffering. According to Gallagher & Hodge (2012) you must consider in the context of care, the patients’ wellbeing and preferences. In addition there may even be conflict of what you feel is best compared to the patient; it is then that it will be considered essential that you will have to provide sound, ethical and legal judgements for your actions.
The comment ‘You’d better watch out for that one; she’s stubborn and won’t let you do anything, so you are going to have to persuade her’ in this scenario could have damaging effects on the handling of this case; it could of meant that the patient has been labelled as difficult without consideration of the patients feelings and stressful predicament, which may have been attributes to the patients’ behaviour. According to Sully and Dallas (2010) the patient should feel an unconditional positive regard, achieved by being accepting of the patient, moreover concentrate on the patients’ needs and rights more willingly than your own personal values.
The nurse, will have to ask themselves about their own ethics and morals in order to help the patient no matter what her condition is at the present time. In dealing with any ethical dilemmas this case may present, the nurse cannot state their own ideas or assume what could be happening and make decisions for the patient as this would not be an ethical thing to do. One must not have ‘Cultural Tunnel Vision’ when dealing with these types of cases. One must have more than one set of cultural assumptions, must be sensitive to others, must evaluate and to accommodate the behaviours of others, and must have different ways of thinking, make adaptions, moreover, make alternatives to find a solution to the presenting problem. (Corey et al, 2011).
The patient may feel the stigma of teen pregnancy; this may have helped along the feelings of anxiety when entering the hospital. The patient needs to feel that they do not have to be embarrassed and they would not be rejected. Importantly the patient will need to know that they have the power to make decisions and still ask to be helped. Egan (2007:52, cited in Sully & Dallas 2010, p.3) believes that the nurse can learn that culture is shared beliefs and assumed thoughts which combine with shared values and in turn produce shared norms that control shared behaviour patterns.
It is widely acknowledged that an individuals’ psychological and emotional wellbeing can be affected by their economic and social circumstances, and maybe influenced by family background and the community or society they live in. The separation between the patients’ parents may have had a psychological effect, and there may be a breakdown in the relationship between the mother and the patient which in the patients’ case may have led to them running away from home. It is noted that Holdnack (1993) identifies, that emotional closeness between parents and children is interrupted following divorce, leading to negative impacts on the child’s self-esteem. All these factors could have had a contribution to the patient’s poor attendance at school, affecting social and economic wellbeing. Sun (2001) found that following divorce, there is less parental interest in children’s education and fewer economic resources.
The Department for Education and Employment (2001) (DfEE) confirms, that there are circumstances which pose greater risks of vulnerability to multiple risk factors for adolescents that make emotional harm conceivable. These situations include involving loss and separations resulting from parental separation; some groups of adolescents are more apt to being exposed to these events and, consequently will be at more risk of mental health problems through the build-up of collective risk factors. These include looked after children, children of divorced parents, runaways, teenage mothers. According to Colman (2009) having strong, psychological and emotional wellbeing can help protect adolescents against emotional and behavioural problems and teenage pregnancy.
Therefore, it could be argued that social determinants of health such as geographical location, gender, age, education level and socio-economic status are all factors that contribute to an individual’s health and wellbeing leading to health inequalities (Wilkinson 2005). Statistics from World Health Report 2001 supports the veracity of these connections. Furthermore, according to Payne (2000) considerations of social divisions such as class, ethnicity, gender and age are helpful to analyse explanations to health inequalities.
To conclude, it is clear that a commitment and understanding of ethical, legal and professional issues, including the importance of consent and confidentiality is necessary for nurses to practice as an accountable professional; keeping check of the NMC and HPC will inform you of any changes to the codes (Gallagher & Hodge, 2012). “Care whether it is emotional or physical for the pregnant adolescent is similar to that of an adult. However, adolescents often need additional support; as the patient may have fewer life experiences than that of adult women, making them less able to cope with life changes related to pregnancy and birth. Non-judgemental care and simple instructions are essential to caring for the pregnant patient” (Montgomery, 2002, p.255). There is evidence to suggest that adolescents that come from broken homes are on average, suffer more impacts on their wellbeing than those from intact families (MacKay, 2005). Communication plays an important role in medicine, in establishing the nurse-patient relationship; it leads to improved understanding and coping, thus producing better treatment decisions and compliance (Roter & Hall, 1992, Cited in (Kaptein et al 2004, p.268).
REFERENCES:
Bach, S, Grant, A (2009).
Communication & Interpersonal Skills for Nurses, Exeter: Learning Matters Ltd.
British Medical Association (1993). Medical Ethics Today: Its Practice and Philosophy. London: BMA.
Charlton, CR, Dearing, KS, Berry, JA, and Johnson, MJ (2008). Nurse Practitioners’ communication styles and their impact on patient outcomes: integrated literature review. Journal of Clinical Nursing, 11: 12-21.
Chin, JJ (2001). Doctor-Patient Relationship: A Covenant of Trust. Singapore medical journal, 42 (12), 580. (Online) Available at: http://www.sma.org.sg/smj/4212/4212sf3.pdf (accessed 7th December 2012).
Coleman et al (2009). Outcomes of conduct problems in adolescence: 40 year follow up of national cohort. British Medical Journal, 338: a2981
Corey, G, Corey, MS, Callanan, P (2011).Issues and Ethics in Helping Professions,8th edition, USA; Brooks/Cole Genage Learning.
DfEE (2001). NCH, Literature Review: The Emotional Harm and Well-being of Children (2007). (Online) Available at: http://www.actionforchildren.org.uk/media/145524/emotional_harm_and_well-being_of_children.pdf (accessed 7th December …show more content…
2012).
Egan, G (2007). The Skilled Helper: A Problem - Management and Opportunity – Development Approach to Helping, 8th edition. Pacific Grove: Brooks/Cole.
Gallagher, A, Hodge, S (2012). Ethics, Law and Professional Issues, Hampshire: Palgrave Macmillan.
Goold, SD, Lipkin, M (1997). The Doctor-Patient Relationship. (Online) Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496871/ (accessed 7th December 2012).
Holdnack, JA, (1993). The long-term effects of parental divorce on family relationships and the effects on adult children’s self-concept, cited in Everett, CA, (ed) Divorce and the Next Generation: Effects on Young Adults’ Patterns of Intimacy and Expectations for Marriage, New York: Hamworth Press.
Kahle, A (2009). Practitioner /patient Interaction: How to Avoid and Resolve Conflicts. OANDP Publishing. (Online) Available at: www.oandp.org/publications/jop/2009/2009-20.pdf (accessed 12th December 2012).
Kaptein, A, Weinman, J (2004). Health Psychology, Oxford: BPS Blackwell Publishing Ltd.
Mackay, R (2005).
The Impact of Family Structure and Family Change on Child Outcomes: A personal Reading of The Research Literature, Social policy Journal of New Zealand. (Online) Available at: http://www.msd.govt.nz/about-msd-and-our-work/publications-resources/journals-and-magazines/social-policy-journal/spj24/24-impact-of-family-structure-and-family-change-on-child-outcome-p111-133.html (Accessed: 7th December 2012).
Mead N, Bower P (2002). ‘Patient-centred consultations and outcomes in primary care: a review of the literature’. Patient Education and Counselling Journal, vol 41, no 1, p.51-61. (Online) Available at: http://www.kingsfund.org.uk/sites/files/kf/Seeing-the-person-in-the-patient-The-Point-of-Care-review-paper-Goodrich-Cornwell-Kings-Fund-December-2008.pdf (Accessed: 7th December 2012)
Montgomery, KS (2002). JOGNN, Clinical Issues, Nursing Care for Pregnant Adolescents, vol 32, p249-257. (Online) Available at: http://deepblue.lib.umich.edu/bitstream/2027.42/73476/1/0884217503252191.pdf (Accessed: 15th December 2012)
Payne, G (2000). Social Divisions, London: Macmillan Press Ltd.
Pearce, J. (1994). Consent to treatment during childhood: The assessment of competence and avoidance of conflict, British Journal of Psychiatry,
165,713–716.
Raines, DA, Morgan, Z (2000). Culturally sensitive care during childbirth. Applied Nursing Research, 13,167-172.
Shaw, M (2001). Competence and consent to treatment in children and adolescents. Advances in Psychiatric Treatment Journal, 7: 150-159. (Online) Available at: http://apt.rcpsych.org/content/7/2/150.full (Accessed: 7th December 2012)
Sully, P, Dallas, J (2010). Essential Communication Skills for Nursing and Midwifery, 2nd edition. London: Mosby Elsevier.
Sun, Y (2001) Family environment and adolescents’ well-being before and after parents’ marital disruption: A longitudinal analysis, Journal of Marriage and Family, vol 63, 693-713.
Timmins, F (2007). Communication Skills: revisiting the fundamentals. Nurse Prescribing, 5: 395-9.
Wilkinson, RG (2005). The Impact of Inequality: How to make sick societies healthier, Oxfordshire: Rouledge.
'I confirm that the submitted work is my own work and that I have clearly identified and fully acknowledged all material that is entitled to be attributed to others (whether published or unpublished) using the referencing system set out in the programme handbook. I agree that the University may submit my work to means of checking this, such as the plagiarism detection service Turnitin ® UK. I confirm that I understand that assessed work that has been shown to have been plagiarised will be penalised.'
6218895.