A 2000 word reflection on one specific conversation where personal communication and interpersonal skills has had a direct impact on the patient's nursing care.
‘A 2000 word reflection on one specific where personal communication and interpersonal skills has had a direct impact on the patient's nursing care.’
During this assignment I am going to write a reflection, relating to communication and interpersonal skills in clinical practice. Throughout the piece of work I will be maintaining confidentiality at all times by not mentioning the real name of the client, or the trust that I worked in.
The Nursing and Midwifery Council (NMC) have set out a code of conduct on how to maintain confidentiality within a health care setting. They say that you must treat information about patients and clients as confidential and use it only for the purpose in which it was given. Nursing staff should ensure that clients understand that some information may be made available to other members of the team who are involved in the delivery of care. We as nurses must safeguard against breaches of confidentiality and protect information from improper disclosure at all times (NMC Code of Conduct 2006).
As I am reflecting on an incident that happened whilst I was working out in practice, I will be using a reflective cycle to help me thoroughly describe what happened during the incident, the one I will be using is known as the Gibbs’ Reflective Cycle (Gibbs, 1988).
The incident that I am going to write about involved a gentleman aged 55. I am going to change the name of the gentleman for confidentiality reasons and therefore will name him Frank.
Frank was admitted to the ward for rehabilitation due to his condition of Huntington’s disease (HD) which is an inherited disease causing rapid un-coordinated jerking movement of limbs, personality changes and dementia (Waugh & Grant 2010). He had been admitted to the ward the previous evening and this was my first interaction with him. Along with another nurse I was assigned to Frank to get him washed, dressed and have breakfast. I asked Frank if he would like a wash in his bed or if he would like a shower, Frank just looked at me so I smiled and asked him again thinking that he didn’t hear me properly. He responded by mumbling. Louise, the other nurse I was working with then had to attend to another gentleman so I was left on my own with Frank. Before she walked away she just said to me ‘just give him a wash, I will be back in a few minutes’. I had never come across anyone suffering with HD and I didn’t know much about the condition so wasn’t sure if he could understand me or not so I didn’t want to just assume that he wanted a wash. I wanted to see if would prefer a shower. I went on to try to see if he could say ‘yes’ or ‘no’ but with no success. I then held two pieces of card in front of him one saying ‘yes’ and one saying ‘no’. I then sat down beside him and spoke slowly and explained to him to try and lift his arm to one of the cards with an answer to if he wanted a shower. Finally he responded and managed to touch to the card saying ‘yes’ and gave me a smile.
This is a preview of the whole essay
I knew as my role as a student nurse I had to do everything possible to make Frank comfortable and it was also in his best interest to have a wash or shower and most importantly I wanted him to have the choice and able to make an informed decision about his care and for him to be able to express himself and for him not to feel intimidated in any way.
Initially I found the situation very frustrating as I just wanted an answer from Frank but then the feeling changed to empathy towards him as how must it feel like for Frank? I felt immensely happy that Frank was finally able to communicate, especially when he smiled back at me; however I was also saddened by the fact that he was a young man and tried to empathise with what he must be going through.
I felt that I spent a lot of quality time with Frank trying to communicate with him to enable me to give him the best care possible and to make him feel at ease with me. My own insecurities initially made me too nervous to try to communicate with Frank and I noticed that other members of staff would also avoid communicating with him. I think that we as nurses do not spend enough quality time with clients whom have difficulties in communicating and that most of us take it for granted the ability to communicate our needs to others.
Throughout the incident communication played a huge role in the care that Frank was to receive and it soon came apparent that Frank did have communication problems linked to his diagnosis of HD as Lemone & Burke (2008) suggests the disease affects fine motor which gives the inability to control muscles related to speech, swallowing and facial movement therefore this is explains why Frank has difficulties communicating verbally. However, non-verbal which can also be described as ‘therapeutic communication’ was able to stimulate a conversation and reduce Frank’s anxieties.
Sometimes even nurses and other professional practitioners fail to remember that just because a client has problems with speech doesn’t necessarily mean that their hearing is also impaired, so talking to clients is extremely important (Lemone & Burke, 2008).
Pollard (2008) goes on to identify that people with HD may have cognitive difficulties, such as slower thought processes and problems maintaining focus and organising their thoughts. This means that it is important for us as nurses and other healthcare professionals to give someone with HD time to process what is being said to them and to wait for an answer without interrupting or asking further questions, which is exactly how I managed to interact with Frank.
Communication is the first step in building a personal relationship with a client and is an important technique for us as nurses to use when we assess the care needs of a client to ensure they receive the best care possible. As Marquis & Huston (2009) points out communication is a vital source in client care and communication starts when we initially make contact with our clients.
I found that non-verbal communication is an extremely effective method of communication to use especially with people whom have impairment with communication due to their diagnosis like in Frank’s situation. An acronym to describe non-verbal communication is SOLER which is used by Egan (2002) this summarises non-verbal communication: face clients Squarely; maintain Open posture; Lean slightly over patient; keep Eye contact; stay Relaxed. After reading Egan (2002) and reflecting back to my incident with Frank, this is the way in which I approached Frank and found it a very effective way to make him feel at ease. This enabled me convey to him that I wanted to help care for him.
However, most emphasis appears to be placed on verbal communication with the non-verbal communication seldom being considered suggests Hargie & Dickson (2004) as in Franks case this can easily be argued as non-verbal communication played a vital role as not all clients are able to communicate verbally due to a disability, medical diagnosis or trauma.
During my interaction with Frank my interpersonal skills were vital in which I picked the words that I used very carefully and spoke slowly as I did not want Frank to get confused or mishear anything I said to him. I feel this comes with self awareness as pointed out by Berman, Snyder & Kozier (2008), self awareness is the key to build interpersonal relations as this enabled me to show sensitivity towards Frank. Berman, et al (2008) also recognises that as a nurse the effective use of interpersonal skills is fundamental in all aspects of a nurses activities such as caring, comforting, advocating and supporting our clients to give each and every client the best care they deserve, along with nursing activities a nurse must also be able to practice ethically including having appreciation of the client's cultural values and lifestyle and taking into account their feelings.
As I gain more experience within the hospital setting I believe my skills in all aspects of nursing will develop. I will use this reflective practice throughout my training and then into my professional life as a registered nurse and will look into why I did a particular task, how I and others performed and most importantly the view from the clients perspective and how it will develop my nursing skills moving forward.
Reflecting back upon my incident with Frank, it has enabled me to increase my knowledge on the different forms of communication, the communication difficulties others may have and the way to overcome that barrier to communicate in a non-verbal way. This will help me in future practice and should this situation arise again my feelings of frustration and anxiety would not surface again as I would know how to deal the situation and hopefully once again overcome the barrier and deal with a situation in the best way I can.
My time with Frank enhanced my self-awareness as I have showed that I am able to show sensitivity and empathy towards others and has opened my eyes to medical conditions such as Frank’s. It has also showed me the affect it has on their lives and how they must feel living with the condition. I feel confident as a student that my communication and interpersonal skills made a great difference to Frank.
I understand that within a hospital setting nurses are extremely busy and are not always able to spend as much quality time with clients as they would like to. However, I feel like it greatly important in our role as a nurse that we do spend that little bit of extra time with clients whom need that additional support to make a difference to them. There were numerous occasions that I would see a nurse treat Frank with no eye contact or no verbal communication. I think back now to how Frank will have felt. Fortunately I was able to spend valuable time with Frank to enable him to communicate effectively to me. However I will always be aware of the importance of communication and interpersonal skills for the appropriate interaction with clients to meet their individual needs.
If another situation occurred that was similar to the one I encountered with Frank I believe I would be better equipped to deal with it due to the invaluable experience I gained from the one with Frank. I would act in a similar way by putting my communication and interpersonal skills to good use and rely on my determination to make a difference in the lives of clients. The empathy and understanding I felt towards Frank would have come much sooner as it did take a me a quite some time to learn how to deal with the situation but I am confident that in future I would be less hesitant and more confident in my ability and I would not feel the feelings of frustration which I initially felt in this one. Overall, I am pleased with the outcome of my time with Frank and have learned valuable lessons in the importance of adapting to different forms of communication.
Berman, A., Snyder, S., Kozier B., Erb, G. (2008) Kozier & Erb's: Fundamentals of nursing: concepts, process, and practice (8th Edition) New Jersey: Prentice Hall
Egan, G. (2002) The skilled helper: a problem management and opportunity development approach to helping (7th Edition) California: Brooks & Cole
Gibbs, G. (1988) Learning by doing: a guide to teaching and learning methods Oxford: Oxford Brookes University
Hargie, O. & Dickson, D. (2004) Skilled interpersonal communication (4th Edition) London: Routledge
Lemone, P. & Burke, K. (2008) Medical-surgical nursing: critical thinking in client care (4th Edition) New Jersey: Prentice Hall
Marquis, L. & Huston, C J. (2009) Leadership roles and management functions in nursing: theory and application (6th Edition) Philadelphia: Lippincott, Williams & Wilkins
Nursing and Midwifery Council (NMC) (2008) The NMC code of professional conduct: standards for conduct, performance and ethics London: NMC.
Pollard, J. (2008) Hurry up and wait: a cognitive care companion Huntington’s disease in the middle and more advanced years USA: Lulu.com.
Waugh, A. & Grant, A. (2010) Ross and Wilson: anatomy and physiology in heath and illness (11th Edition) Edinburgh: Churchill Livingstone