The student then Chatted to Mrs Brown about her friend who claimed to have the flu vaccine but still got flu. The student pointed out to Mrs Brown that the flu could still be caught but was in a much milder form. The student explained to Mrs Brown that the flu can be a fatal virus and anything that could be done to prevent seriousness of this level was surely worth considering. Mrs Brown still seemed sceptical.
Communication.
What is communication?
According to the oxford reference library (2003) Communication is “An interaction between two organisms in which information is conveyed from one to the other” However there are many more complex and accurate definitions.
I believe that communication is the core of a relationship between any 2 people. Communication is what is used to show people how we feel about them as well as telling them. There is often tell tale signs in our body language or non-verbal communication that we may be lying or feeling uncomfortable, pressured etc. Non-verbal communication can often give away our true feelings whilst the tongue thinks it is falsifying.
There are 2 schools of thought in communication the Process school and the semiotic (sign) school. The process school believes communication to be the transmission of messages that concerns itself with how the ‘sender’ encodes the message and how the receiver decodes the messages. The process school believes communication can only be completed when the message sent is exactly the same as the message received.
The Semiotic school believes communication to be the production and exchange of meanings. It is concerned with how people interpret messages in order to produce meanings. The Semiotic school accepts that misunderstandings occur without being a communication failure, as things such as language barriers, colloquial terms and culture differences. Examples of this occur frequently such as “Cool” To a teenager it means something good and to an elderly person it is simply a description of temperature. It is the semiotic school of thought that the student uses to communicate to the client throughout the scenario.
Communication.
Verbal Communication.
As the student had built up a relationship with Mrs Brown before their chat together, the student knew that Mrs Brown had hearing difficulties and could often be forgetful, however this was through age and not disease. The student knew that when she was talking to Mrs Brown it was best to look at her face directly, but with a smile. The student had to speak slowly for Mrs Brown to understand everything she was saying and also to give her time to take in the information she was being given.
The student also understood that it was important to speak in language that Mrs Brown would be able to understand – Talking in medical jargon about the vaccine would have confused the client, therefore making her feel uneasy. Coulter et al (1998) recommend language that is 'reassuring and non-alarmist'. This was the student’s aim. The student wanted Mrs Brown to understand everything that was being discussed so that after being informed of the facts the client would be able to make an informed decision, not one she felt she was being pushed into due to a lack of understanding.
The student understood that communication is “dyadic” - a two-way method of interaction. (Berlo’s SMCR Model 1960) When the student spoke to Mrs Brown she expected a response. Mrs Brown responded to the student well, which showed that the student was communicating effectively with the client.
The student also used several variations in her tone and emphasis of her voice when speaking to the client; this helped to retain the client’s attention and also emphasise the importance of certain facts that the student wanted Mrs Brown to remember.
To combat Mrs Browns forgetfulness the student asked Mrs Brown a few questions regarding their conversation after a summery of what they had discussed. The student was pleased to find that Mrs Brown had taken in most of the information given to her and now felt able to make an informed decision.
Communication.
Non-Verbal Communication.
Non-Verbal communication ‘does not rely on the spoken or written word. Facial gestures and hand signals can often give messages to another person without a word being said’ (Oxford reference dictionary) and is a huge aspect of life. Many people are unaware of the signs they give off however as a student nurse the student in the scenario had to be very aware of the signs she may give off whilst talking to the client.
The student wanted to keep the chat with the client informal, so it took place in the clients room with the client sitting on a chair and the student sitting beside her close enough to touch but far enough apart to respect personal space. The 2 could easily make eye contact, which could be easily broken if either felt uncomfortable.
The student made good use of gestures and active listening concepts throughout the conversations, which helped put the client at ease. By actively listening to the client’s apprehensions the student was able to identify the clients particular needs and was able to concentrate particularly on what the client wanted to know.
Mrs Brown’s non-verbal communication was very useful for the student to observe. Her body language showed that she was alert and interested in what the student was saying. The student was particularly interested in looking at the client’s kinesics and proxemics as well as listening carefully to her Para linguistics (feedback noises).
The student was particularly careful about her Para linguistics also. The student knew that if she was unprepared or surprised that this could effect the communication that was happening and knock the client’s confidence in the student.
Communication.
Written Communication.
The student was well prepared with literature for the client during the chat. The leaflets the student had were selected to be suitable for the client concerned. The student did this by assessing the level of the client’s knowledge of the subject before the chat.
The student provided leaflets of an informative nature, which provided information such as simple statistics, information on side effects and what to do if she suffered from any of them.
The student also made sure the leaflets were brightly coloured and included diagrams or pictures that could be easily understood. She also found the leaflets, which has quite large print so it was not difficult for the client to see them. A brightly coloured leaflet with pictures often attracts and would encourage the client to pick it up.
The student also identified here was a good place for Health promotion. If perhaps, these kinds of leaflets were left in the sitting rooms clients would pick them up and read them at their leisure. They would not feel forced into reading the literature and this is perhaps the easiest way to promote good health without clients realising it.
(Please see Appendix 1, 2, 3 & 4)
Nursing Concepts.
Touch / Comfort / Reassurance.
How people take comfort and touch from others vary from client to client as well as between students. Each will have their own opinions on the matter and have their own feelings regarding this, which is a basic human right of both client and student. This right should NEVER be infringed, as it would go against NMC code of conduct section 2 that states, “You must respect the patient or client as an individual.” It continues further to say “You must, at all times, maintain appropriate professional boundaries in the relationships you have with patients and clients”
The Student nurse fully complied with the NMC code of Conduct whilst speaking to the client. The client was concerned that she had caused the student “a lot of bother” by getting her to speak to her. The student correctly identified the client’s need for reassurance. Steven’s (1975) states that “Touch is effective in providing comfort”. The student reached out and touched the client’s hand and the patient responded by placing her hand on top of the students. This showed the student that she had done the right thing.
The student also reassured the client using words, that she had not been put to any trouble. The student explained to the client that it was very nice to get the chance to speak to her and help to inform her of the choices she was free to make. The student emphasised throughout the chat that she was there simply to chat, not to pressure the client into taking the vaccination. The Student pointed out the client still had a free choice. This helped to reassure and comfort the client a great deal.
Reassurance, touch and comfort are some of the simplest things that anyone can do to calm someone down. It is Human nature to attempt to help someone who is distressed and as the student nurse was able to do this effectively she was able to express her professionalism towards the client and the concept of nursing.
Nursing Concepts.
Empathy.
Empathy is one of the most important abilities a nurse can have. Even as a student these concepts must be apparent when dealing with any client.
There is a huge difference between empathy and sympathy, which the student in the scenario must also grasp.
The student could understand some of the client’s apprehensions about receiving the vaccination. Both Client and student had been open with each other about their dislike of needles and injections. The Client was able to laugh with the student about this, however the student retained her professionalism throughout.
The client explained her feelings well to the student who was able to put herself in the place of the client thus understanding what empathy is. The student was able to express herself well through language and reassured the client that she could empathise with her.
Ethics.
There are many ethical situations, which the student has dealt with within this scenario. From consent to acting as the patients advocate, the student had a lot of ethical issues to deal with in this scenario.
Consent.
It is vital for any practitioner (student or otherwise) to gain consent before any treatment has been carried out. It is also a good ethical issue to identify if a student nurse should be asked to speak to a client about a treatment they have already refused - on the grounds that the client may feel pressured into having the treatment, which is unethical.
Consent to carry out a treatment should always be given by the patient or the patients next of kin in extreme circumstances, This scenario not providing such extremities. This gives clients like Mrs Brown the right to make her own choices no matter how detrimental to her health.
Right to Refuse Treatment.
As Mrs Brown is conscious and is of a legally competent state of mind she has the right to refuse treatment regardless if it is detrimental to the rest of the clients in the home and herself. The right to refuse treatment is a deontological-based theory which outlines that the client should do whatever they feel is best for themselves regardless of consequences for others. A utilitarian Point of view would see Mrs Brown Take the vaccination, as it would be the best thing that she could do to protect her peers and herself from catching a more severe bout of flu, which has been proven to kill.
Acting as the patients Advocate.
The student in the situation must act as the patients advocate. This would involve the student reporting back to the doctor with a truthful, clear and accurate reflection of the client’s wishes. It is the student’s responsibility in this situation to ensure that the wishes of the client are upheld.
Conclusion.
The student within the scenario has defined communication and client care to her optimum abilities. After reassuring, comforting and presenting the client with facts through the use of verbal, non-verbal and written communication the student and the client decided that if Mrs Brown was to have the vaccination it wouldn’t be until she was fully back on her feet, as she still feels a little run down. The student put no pressure on the client however she did provide her with the proper facts she needed to know before making an informed decision. The student was positive about the vaccine but did point out the negatives as well as it is the clients right to know about all aspects of any treatment they are to receive. Mrs Brown was free to make her own decision as has been emphasised throughout. The student will act as the clients advocate when the client feels ready to inform her G.P of her decision.
I have learned through this report that communication in all its forms is a very important aspect of nursing. The client in all situations easily interprets every form of communication especially non-verbal and I feel that is essentially important that communication is addressed throughout any nursing course.
(Word count 2572.)
References.
Berlo’s SMCR (1960) Model of communication. Cited in Roper, Logan & Tierney (1999) “Activities of daily living – a nursing model.”
“Flu can Kill” Information leaflet Published by Evans vaccines July 2003 FL/03/BR/008
“Flu can kill – do you know the facts?” Patient information leaflet. Published by Evans Vaccines July 2003 FL/03/BR/012
“Flu don’t let the flu bug bite” Published by NHS Scotland and the Scottish Executive.
“Flu related complications” Patient information leaflet. Published by Evans Vaccines July 2003 FL/03/BR/005
NMC Code of Professional Conduct Published by nursing and midwifery council April 2002. In effect from June 2002.
(Oxford reference library, Accessed 6/11/03 )
Stevens R (1975) Interpersonal communications. In social skills for nursing practice, 2nd edition (p. French, ed) Chapman and Hall, London. Cited by; Wondrak, R, (1998) interpersonal skills for nurses & health care professionals. Oxford Blackwell Science ltd.
Sundeen S.J, Stuart G.W, Rankin E.A.D and Cohen S.A Nurse-Client interaction- Implementing the nursing process 5th edition Mosby, Missouri 1994 p94
Turnbull. A. How nurses can develop good patient information leaflets Cited Coulter et al (1998)
Nursing Times Volume 99 no 21 27th may 2003 p26-27.
Bibliography
Foundation studies in nursing edited by Grandis S, Long G, Glasper A, and Jackson P. Houndmills Palgrave Macmillan (2003)
Various Lectures notes By Jootun D and Waterstone L. Bell College of Technology Hamilton.
Appendix 1.
“Flu can Kill” Information leaflet Published by Evans vaccines July 2003 FL/03/BR/008
Appendix 2.
“Flu can kill – do you know the facts?” Patient information leaflet. Published by Evans Vaccines July 2003 FL/03/BR/012
Appendix 3.
“Flu don’t let the flu bug bite” Published by NHS Scotland and the Scottish Executive.
Appendix 4.
“Flu related complications” Patient information leaflet. Published by Evans Vaccines July 2003 FL/03/BR/005
