An Evaluation of the communication skills demonstrated in the assessment of a service user
This assignment will analyse the communication skills of a physical skill that has been observed by a member of staff whilst in practice. Furthermore relevant literature will be explored to interpret if the communication skills that were used were the most effective including that of both verbal and non-verbal communication skills. All names have been changed for patient confidentiality in accordance with the NMC guidelines (NMC, 2008). The name will be changed to Mr. Smith.
Any form of interaction is done through communication as a skill. To human interaction it is pivotal. Communication is a process which enables people to relate with those around them and to make concerns and needs know very well indeed. Communication can be verbal and non- verbal.Peate (2005) states that non- verbal communication reinforces a verbally communicated message. Non-judgemental interactions are focused on therapeutic communication, helps settle emotional conflicts and supports heart to heart talks allowing a patient to feel safe and free to share their true feelings, fears, values, hopes and ideas.
This assignment is going to be discussed about a physical observed assessment which was observed during practice at placement. Mr. Smith was a gentleman who admitted to the ward with a viral infection. This infection caused his stomach and his intestines to become inflamed. At the same time Mr. Smith suffers learning disability were he could brutally impairs both verbal communication and cognition. Due to Mr. .Smith’s condition he lives in a care home .he had lived at this care home for ten years. Mr. Smith had been eating pureed diet food and his drinks used to be thickened however he begun to vomit.
The patient’s bloods were done and showed that his renal function was becoming severely damaged followed by dehydration. Therefore Mr. Smith immediately required a cannula to administer IV fluids intravenously. My mentor went to cannulate Mr. Smith. My mentor was instructed of Mr. Smith’s fragile and was also informed that his level of thoughtful was impaired and he would not be capable of verbal consent due to his condition.
My mentor went to Mr. Smith’s bed side as he was in a bay not in side room. She drew the curtains first for the dignity of the patient. She explained to him as to what she was going to do, she took his left arm which was closer to her and began to look for a clear vein, she could see so that she will be able to administer the cannula. The patient became distressed and started to shout and shows that he was in pain. After the cannula was in position my mentor left the bay and informed the person who was in charge that Mr. Smith can now have IV access and IV fluids could now be started.
My mentor who cannulated Mr. Smith failed to introduce herself which is important when conducting nursing skills. First impressions last, by identifying yourself as well as your role provides patients with the feeling that you are genuine and that they are being respected (Henderson, 2004). Kate Granger, a medical registrar who is terminally ill found that many staff failed to introduce themselves during her stay in hospital. This revelation brought in the “hello my name is…” campaign in order to prompt staff to introduce themselves to all patients (NHS England, 2014). However (Parahoo 2006) stated that “The process of agreeing to take part in a study based on access to all relevant and easily digestible information about what participation means, in particular, in terms of harms and benefits”.
Although Mr. Smith suffered with severe learning difficulties he still should have been addressed the same as any other patient on the ward. Nurses should always maintain a therapeutic nurse-client relationship by establishing and maintaining nursing knowledge and skills as well as applying caring attitudes and behaviors (Forchuk etal, 2000). Therapeutic nursing services based on trust, respect, empathy and professional intimacy contribute highly to the patients’ health and wellbeing (Hupcey etal, 2001).
Mr Smith was given a verbal informative account of the cannulation process and the reason for doing this by the mentor. Verbal language is one of the principal ways in which we communicate and is a successful method in both gathering and informing patients of their condition (Berry, 2007). It is usually a two way process where a message is sent, understood and feedback is given (Apker, 2001). It also successful for a patient to describe their level of pain (Stevenson, 2004).
Ensuring a patient has understood what has been said is vital (Grover, 2005). This process normally involves both open and closed questions and often have the ability to ascertain a vast amount of factual information. The nurse who cannulated Mr. Smith did verbally tell Mr. Smith what she was going to do however this method alone failed to ensure that Mr. Smith had understood what was happening to him. She was aware of his condition but failed to ensure that he understood the process.
There are grouped together into two categories which is Open questions and closed questions. Open questions are used when you want to help someone to ‘open up’ about themselves, or to give you some insights into how they feeling or to explore a situation in more depth. Open questions do not allow a straightforward ‘yes’ or ‘no’ response, but it will invite the patients to talk about the topic like what Mr. Smith did to my mentor. Not everyone will feel able to open up’ easily and share their deep thoughts and feelings. Some people needs to go step by step and to be led by interviewer until they gain confidence to go deeper. This is why closed questions also have an important role to play. Closed questions invite a straightforward ‘yes’ or ‘no’ answer, they are necessary in gathering factual information in as straightforward a way as possible.
Poor listening skills and conducting skills without the patient fully understanding can affect the therapeutic relationship and often form a barrier to communication (Andrews & Smith, 2001). Environmental barriers such as a busy ward or a stressed nurse can often reduce the level of empathy and influence effective communication (Endacott & Cooper, 2009). However nurses should always remain compassionate towards patients regardless of stress levels and workload (Von Dietze & Orb, 2000). My mentor’s technique did not comply with the NMC guidelines in regards to consent as she failed to inform the patient of the process therefore Mr. Smith would not have known what he was consenting too.
Consent in respect of people with learning disabilities is compound and can carry a step of risk for both patients and healthcare professionals. In this situation Mr. Smith was unable to provide consent and the cannula that he acquired was in his best interest. However, nevertheless of the patients understanding the offer of consent should still be attempted (Green, 1999). Timby, (2005) stresses that a patient’s right to autonomy should be upheld and respected regardless of gender, race, religion, culture and disability.
Communication is vital in all aspects of nursing. However well practiced communication techniques are ineffectual if the central notion of the interpersonal connection goes unacknowledged (Arnold & Boggs, 2007). Charlton etal (2008) argue that there are two different communication styles, biomedical and biopsychosocial. The biomedical style concentrates on specific information concerning the patient’s condition that is information focused. The biopsychosocial style is a patient centered approach which is conducted by determining patients’ needs to provide the most effective communication method.
My mentor ideally should have formed an action plan to determine the most effective way of communicating with Mr. Smith in order to carry out the cannulation process. As every patient is different their needs must be assessed prior to carrying out any invasive procedures. A patient centered approach is said to have a more positive
impact on patient outcomes. However there is little research that discusses interpersonal skills in contrast to a vast amount of rich research that discusses basic communication skills despite evidence suggesting that patient centered care is the most effective method (Jones, 2007).
Patients with learning difficulties who have difficulties with both verbalising and thoughtful often have barriers in relation to communication. This leads to a breakdown in communication and in turn can lead to their health needs not being met (Turnbull & Chapman, 2010). Kacperek, (1997) defines nonverbal communication as the term used to use to describe all forms of communication not controlled by speech. Argyle, (1988) suggests that the nonverbal component of communication is five times more influential than the verbal aspect. When Mr. Smith was cannulated my mentor lacked the use of nonverbal communication. Studies have often indicated that language has no real occurrence when communicating with patients (Foley, 2010). Nonverbal action such as body language, touch, posture, facial expressions and eye contact show many emotions without having to verbalise (Foley, 2010).
Furthermore Crawford et al (2006) states that sometimes patients just need you to be there, quiet and listening and this can also be achieved using the acronym SOLER. Consequently, a good listener will always pay attention to non-verbal cues too and this encourages the patients to open up giving more information and expressing their concerns. (Albert’s et al 2012) suggest that from this it can be deducted that respect is given to a patient’s contribution best when they are listened too.
The Soler acronym is also an aid to identify and remember the behaviors that should be implemented in order to achieve effective communication (Burnard, 1992). This tool comprises of position of seat, open posture, leaning towards the patient, eye contact and relaxation. If these techniques of non-verbal communication were used Mr. Smith may have felt less anxious and more reassured (Mason, 2010). Dougherty & Lister, (2008) is in agreement with this theory as he argues that remaining eye contact, lowering stance to the patient’s level and gently touching the patients hand whilst verbally communicating has a great effect at reducing symptoms of anxiety. Although touch is seen to be an effective form of nonverbal communication which can help put a patient at ease if they are feeling anxious or upset.
It is important to note that this technique is not appropriate for all patients as not all patients will feel comfortable with closeness can interpret this as invasion of personal space (Heidt, 1981).
Cooperating with people with learning disabilities appears to contemporary difficulties for health care providers (Thornton, 1999). According to Angermeyer, (2005) a significant stigma exists in regards to learning disability patients as it tends to carry the label of “different” (Angermeyer, 2005). Schafer etal, (2011) says that this negative stigma is due to a range of factors such as ignorance and misinformation stemming from lack of knowledge. However, the NMC, (2015) competency standard instill that all nurses are to deliver high quality compassionate care encompassing ethical and cultural issues as well as disability.
Jormfeldt, (2010) has shown that a high level of nursing education in both theoretical and practical settings can positively influence attitudes of nurse’s perceptions towards learning disability. In addition, reflection is seen as a vital component of coping in these environments as it offers a process where student nurses can challenge, compare and critique their value systems and embrace the process of change to a positive attitude towards patients with disabilities.
Dodd & Brunker, (1999) argue that by forming collaborative partnerships with both carer’s and professionals who are involved in the patients care can enable you to assess the patient’s communication skills and their preferred method of communication. Furthermore, in accordance with the NMC (2015) guidelines it is essential that all nurses must treat all patients with respect and dignity and not discriminate in any way regardless of their age, gender, race and or disability.
To improve the situation the nurse who cannulated Mr. Smith could have liaised with the nursing home where Mr. Smith resided. This could have given the nurse vital information regarding Mr. Smith’s likes and dislikes and could have provided her with the most effective way to carry out the procedure. Carers or family members could have been asked to accompany the nurse which could have put Mr. Smith at ease. Passports are becoming increasing popular which accompany patients who suffer with learning disabilities into the hospital environment. These documents are customised to each individual and summarise the patient and can often aid in providing the best patient centered care.
Health care professionals are legally able to access essential information which carers possess in relation to communication with an individual with special needs or challenging behavior (Michael, 2008). Nurses should always put patients individual needs first and understand what is best for the patient ethically rather than that of a professional opinion alone (Mencap, 2007).
In conclusion, this assignment has explored the communication skills that were observed during the cannulation process. It is evident that communication is important in nursing care and that assessments of patients are paramount in providing patient centered care. However, communication is certainly a principle commanding for the real caring. Performance and communication of caring and capability at this time have a main effect on the ability of patients and relations to adjust the update, reflect choices, and adjust to anything deceptions forward.
Lack of awareness in regards to the best way of communicating with patients can pose a high risk to patients as many people working within the healthcare sector may not have a clear understanding of learning disabilities unless they are specialised. Further training may be needed to ensure that all health care workers are able to provide compassionate care to patients with learning disabilities. Individuals with learning disabilities have the right to be treated the same way as others, regardless of the severity of their disability as all patients should be entitled to a professional and effective service during their experience within the healthcare environment.
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