This assignment aims to explore communication theories and how the nurse uses communication in her role.

When admitting the patient the nurse can choose to use open or close questions. Closed questions are questions which require a yes or no answer, for example 'do you have angina?' Faulker (1998) criticises the use of close questions because she feels the patient is denied the chance to release any underlying fears which are not related to the procedure such as social or psychological circumstances. Faulker (1998) also believes that closed questions will direct the focus of the patient's response and restrict them to a preferred response.

Westwood et al (2001) agrees with Faulker (1998) that open ended questions should be used when assessing the patient because they enable the nurse to discover how much the patient understands and how the patient is feeling about the procedure. Westwood et al (2001) believes that open ended questions allow the patient to have an active part in the decision making process. Open ended questions persuade the patient to disclose information as the patient is the lead in the conversation. On reflection to practice when the patient is being admitted and information needs to be gathered, closed questions are used. Probing questions are used in nursing as these assist in the nurse discovering as much information about the patient as possible. Probing questions provide the nurse with the opportunity to enquire about the patient's problems. In clinical practice this was demonstrated by the nurse asking 'where is the pain?'

Communication in nursing needs to be effective. Allen (1991) defines effective communication by stating effective communication must succeed in 'conveying information and evoking understanding.' Therefore what the speaker is saying must be understood by the receiver. This means giving information to the patient in terms that they can understand and ensuring that they have understood the information. According to Faulkner (1998) communication in nursing needs to be effective to enable care to be planned on the basis of the potential and actual problems. Nurses often speak using medical terminology especially when discussing things with colleagues and the multidisciplinary team. However when speaking with patient's they need to use language that the patient or relative can understand to avoid confusion. The nurse needs to ensure that what has been said to the patient or their relatives has been understood correctly because misunderstandings can cause distress for the patient. The nurse has to act as an advocate between her patient and colleagues. By reflecting on clinical practice this was demonstrated by the admissions nurse clarifying information on behalf of the patient with the doctor and technical

staff. This protected the patient from any risks or danger throughout the procedure.

The nurse needs to support the patient by using communication in an open and honest manner. This can be achieved by ensuring that the patient understands why the procedure is conducted. On reflection to clinical practice this occurred by the nurse explaining to patients who had sedation that oxygen was routinely given to help their recovery.

Communication is used to care for the patient holistically. Holistic care is caring for the patient as a whole. This means caring for all their needs. Saunders (2004) states that the nurse must have the patient as the focus of the care being provided. To care for a patient holistically, the nurse needs to use interpersonal communication skills which demonstrate warmth; this shows concern for the patient by adopting a friendly approach. This will encourage the patient to disclose information. The nurse needs to respect the patient by maintaining privacy and dignity. On reflection to clinical practice this is demonstrated by the door being closed when the patient is being admitted. This encourages the patient to disclose information because the patient is aware that only the nurse can hear. The nurse can demonstrate that she is a genuine person by sharing personal experiences and empathising with the patient. The nurse needs to portray herself as a trustworthy character. Faulker (1998) believes 'the aim of the first interaction should be to engender trust so that the patient feels able to disclose as much information as he is able.' This helps the nurse to build and maintain a therapeutic relationship with the patient. The therapeutic relationship will help to build trust encouraging the patient to disclose information and their personal concerns and worries.

Verbal and non verbal communication need to be in collaboration with each other, however they often counteract each other. Argyle (1988) demonstrated that when verbal communication is contradicted by non verbal communication the verbal message is often discounted. Hargie et al (1998) believes that words are only a minor part of conveying any message and non verbal cues communicate meaning. In my experience this was demonstrated by a nurse emptying a vomit bowl which smelt offensive whilst reassuring the patient. However whilst reassuring the patient the nurse displayed a disgusted look on her face. The patient could see the expression on her face and therefore knew she was disgusted. This demonstrates that non verbal messages are often more powerful than verbal messages. Non verbal communication is difficult to control because it occurs on a subconscious level.

Non verbal communication is the transmission of a message without using words. The nurse needs to uses her non verbal communication skills appropriately to establish and maintain a therapeutic relationship with the patient. Argyle (1975) believes that non verbal communication can improve the interpersonal relationship which the nurse and the patient form. The function of non verbal communication is assisting speech by reinforcing what has been said verbally by non verbal actions such as raising an eye brow. Non verbal communication signals emotional states and attitudes.

Non verbal communication consists of posture, touch and gestures, eye contact, dress and personal grooming and proximity which means the amount of personal space a person needs to feel comfortable. Argyle (1992) believes that if the nurse is trying to convey a friendly approach she sits closer to the patient and leans forward. Argyle (1992) feels that head nods during interactions encouraging the patient to continue disclosing information. Facial expression is an example of non verbal communication as it conveys expressive body language by showing emotions. Facial expressions are related to eye contact. If a patient who is being assessed fails to make eye contact and gives one word answers, they portray themselves as being anxious and frightened. The nurse would need to interpret this by using her communication skills and building up a rapport with the patient.

Touch can convey warmth and understanding with the patient. Argyle (1992) states touch can convey friendliness if it is used appropriately. Saunders (2004) believes that the use of appropriate touch such as a comforting touch on the arm can have an encouraging effect during tense moments. On reflection to clinical practice this is done in the anaesthetic room when the patients or their relative is feeling most stressed and fearful.

Posture is an important factor of non verbal communication. Argyle (1992) states that the nurse should sit with her arms stretched out towards the patient instead of having her arms folded which creates a barrier to communication. If the nurse slouched in a the chair and showed no interest whilst assessing the patient, this would create a barrier to communication. However to be a good communicator the nurse should sit slightly forward and lean towards the patient. The nurse's arms and legs should not be crossed. This is displaying an open posture and will encourage the patient to communicate because the patient knows that the nurse is showing interest in them.

Gerad Egan (1988) devised an acronym for body language. It spells the word SOLER. Each letter represents a word that aids effective communication. S means sit squarely because it shows the patient that the nurse is interested in them, O means display an open posture. L means lean slightly forward to demonstrate that the nurse is ready to start the conversation. E represents eye contact which needs to be maintained because the signals that the nurse is ready to start and R means relax to prevent the patient from being nervous by the nurse displaying nervous behaviour.

The nurse needs to be able to understand the body language the patient is conveying. In my experience this was done by the nurse verbally asking the patient if they were in any pain, to which the patient responded that they were not. The nurse looked at the patient's face and discovered that they were in some considerable pain because their eyes were closed tightly, their legs and arms were tightly crossed. The look of pain was expressed on their face.

The nurse utilises her communication skills for many tasks in her job role. However this assignment states the main reasons for the nurse to use communication are assessing the patient, providing the patient with support to reduce anxiety, communicating with the multidisciplinary team about the condition of the patient, and providing the patient and their relatives with information. When the nurse is communicating she needs to be aware of her body language and paralinguistic to encourage the patient to communicate. The nurse needs to be able to use verbal and non verbal communication effectively. The nurse also needs to make good use of probing questions when she is questioning the patient. The nurse needs to reinforce verbal communication with written communication to aid the patient's memory. This means being aware of non verbal behaviour and ensuring that verbal communication has been understood. This assignment demonstrates that communication is vital to the nurse's role.