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Example conversation with patient and son

Mrs Edith Jackson is an 82-year-old lady who was recently admitted to The Golden Days Nursing Home where you work. Edith has Parkinson’s disease and early stage Parkinson’s dementia. She also has low vision and is hard of hearing and wears glasses and hearing aids in both ears. Michael is Edith’s son and her sole support person.

1.Provide an example conversation of what you would say when communicating the incident to the patient and son

2.Identify the key/relevant health professionals/ facility teams you are required to contact in this situation and provide a rationale.

You are working as an Enrolled Nurse in a rehabilitation unit and while on your break you check your social media account and notice that one of your colleagues, who is a friend of yours, has posted some information relating to one of the patients on the unit.

1.What ethical principles and regulatory responsibilities do you need to consider in this situation?

2.Provide a definition for the term ‘advocacy’ and describe how you would advocate for the patient in this situation?

3.You are asked by your supervisor to provide feedback to the colleague who has posted this information on social media. Describe at least four strategies you could use to deliver a constructive outcome when providing this feedback.

4.Provide an example of the feedback you could provide to your colleague, using appropriate language and a respectful manner.

David is a 58-year-old cardiac patient who had been verbally aggressive over the last two days since he has been admitted to the ward. You have been asked by the manager to have a chat with David to see how he is feeling.

1.What are closed ended questions and in what situations would you use closed questions with David?

2.What are open questions and in what situations would you use open questions with David?

3.Discuss the term ‘Active Listening’ and provide at least one (1) example of how this could be used in this situation

4.Identify what constitutes effective communication in nursing?

5.Describe de-escalation and provide an example of a de-escalation strategy

6.Explain the benefits of a debriefing process and explain why it would be useful following this situation.

7.Your supervisor provides you with some feedback on how you handled this situation, identify at least three (3) strategies you could use to effectively receive feedback.

Communication and behaviour support for nurses- practice package was implemented for what reason?

  1. Identify the four domains of practice (1.2.1) within the standards for the Communication and behaviour support for nurses- practice package
  2. What are the benefits of completing the “communication and behaviour support for nurses appraisal”
  3. Identify 2 organisational policies and procedures surrounding electronic health care records for health care personnel
  4. Utilising information technology to access data has become a useful tool for nurses, but must be within the organisational policies and procedures.
  5. What 3 tips are available to ensure that the web page accessed is reliable?
  6. Nurses may be asked to lead small group meetings and discussions; therefore they need to be aware of various procedures. List 6 procedures.
  7. What are the 3 main objectives in forming these small groups?
  8. What communication strategies are required to ensure that there is contribution from all participants in a group discussion, including providing and receiving feedback. 
  9. To ensure meetings are of value, the nurse conducting the meetings need to consider at least 5 things?
  10. What are the 2 suggested communication strategies you can use to ensure that you understand feedback in relation to performance improvement conversations.
  11. When giving balanced feedback what 3 step communication technique is recommended?
  12. What are 2 strategies that demonstrate appropriate language and respectful manner when giving or receiving feedback?

Example conversation with patient and son

1. Hello, Mrs. Edith Jackson and Mr. Williams. I would like to inform you that last night Mrs. Edith fell down while going to the bathroom and this occurred because of the fault and negligence of our staff. I would like to deeply apologise for this as this occurred because of the negligence of the nurses present at the ward at that time. The fall occurred because some thing was lying on the floor and Mrs. Edith tripped over it. It was the duty of the nurse to ensure that the Mrs. Edith was safe and the environment around her was safe.  We have allocated another nurse for the care of Mrs. Edith and I assure you such mistake will not be repeated.

2. During the situation of harm to patient, contacting senior clinicians and management is important to engage in proper discussion process, initiate the open disclosure process and identity the desired course of action needed during such situation. This would help to timely report about events and enter into negotiation with patient and their family members (Australian Commission on Safety and Quality in Health Care, 2013)

1. In this situation, I have the responsibility to contact the enrolled nurse and make her aware about obligations in relation to use of social media according to the Nursing and Midwifery Board of Australia. I will inform her that while using social media, considering all obligations mentions in the National Law, their National Board’s Code of Ethics and professional conduct and the Guidelines for advertising regulated health services are important (Nursing and Midwifery Board of Australia, 2014). I will advice her that she has professional obligation to follow the Code of Conduct and maintain privacy and confidentiality of patient information. This will make her aware that posting information related to patient may lead to breach of patient’s privacy and confidentiality.

Advocacy can be defined as the process by which people take the responsibility to advocate for heath promotion of patient and take patient centered care approach to meet diverse needs of patient. It can also be defined as an approach to support patients from overcoming major barrier during accessing care.

I would advocate for the client in this situation by taking the responsibility to protect confidentiality of the client by making the enrolled nurse aware about the breach of privacy and confidentiality policy by posting information about patient’s message on the social media. I would also provide all the documents that restricts use of social media for revealing patient’s private detail as per the National law and Code of conduct ((Nursing and Midwifery Board of Australia, 2016). Being aware about legal and ethical regulations related to use of social media can help the enrolled nurse to avoid using such post in the future.

Key health professionals to contact and rationale

3. Four strategies I could use to deliver a constructive outcome, when providing this feedback would be to be very specific, convey my perspective respectfully, avoiding blaming language and use appropriate tone while speaking. I would try to give assertive feedback to the enrolled nurse by avoiding by describing what is wrong in her behaviour without judging it and concretely connect the behaviour to its consequences in professional life. I would also try to be honest while giving suggestions to promote trust among services users.

4. Hi, I was reviewing my social media site and I came across a post about your experience with a patient in practice setting. I understand you just wanted your friends to know about your experience. However, I would like to point out that posting such message can lead to ethical and legal consequences in your professional practice. This is because as per the National law and Australian Midwifery Board of Australia, clinical professionals are prohibited from using patient’s private details on social media (Balzer Riley, 2017). From my perspective, it is better that patient’s name and any clinical detail is not used in social media. I would prefer if you review the documents for social media policy. You can then understand what conduct is acceptable or not while using social media.

1. Close ended questions are those that are developed in such a way to get a simple ‘yes’ or ‘no’ option. Close ended questions limits options but provides the ability to get necessary information without wasting enough time issue (Gault, 2017). Hence, it can be used during emergency situations with David.

Two examples of closed question are as follows:

Have you taken any medications to control your anger or aggressive behaviour?

Have you ever taken psychological treatment in the past?

2. Open-ended questions are those are developed in a way to get long answers from the responder. This types of questions gives people the liberty to provide answers in their own way either using too little or too much information. This type of question will be useful in case of Davis when the purpose is to extract any detailed information about his health issue (Gault, 2017).

Two examples of such type of questions include:

  • What situations make you lose control of your temper?
  • What have you done so far to control your anger?.

3. The term ‘active listening’ refers to a communication skill required during listening which involves paying attention to hear not only words as well as interpret feelings or hidden emotion behind the words of the speaker. While engaging in active listening, minimising environmental distractions and maintaining appropriate posture is important.

Ethical principles and regulatory responsibilities in social media use

While communicating with Mr. David, active listening can be achieved by following the SOLER acronym. This involved sitting in a comfortable distance away from the person (S), having an open and relaxed posture (O), leaning slightly forwards (L), making eye contact (E) and maintaining relaxed posture (R) (Gault, 2017).

4. The following are the elements that are needed for effective communication in nursing:

  • Therapeutic relationship building skill: This is important to build rapport with client and ensure that the client is comfortable during communication. It is very useful skill as this would increases satisfaction with care and adherence with the care plan too
  • Active listening skill: This skill can help to extract necessary information from patient and plan care accordingly
  • Good gesture: Good gestures like display of courtesy, kindness and sincerity is important to build relationship with patient. Maintaining good distance and avoiding inappropriate gestures works to address conflict during the communication process.
  • Non-verbal gestures: Non-verbal gestures like tone of voice, body language and eye contact also has impact on patient.
  • Honesty and frankness: Being very frank with the patient is also a mark of successful communication process as this would ensure that patient has no doubts or misunderstanding about any care.
  • Patience: Patience is also necessary to tolerate diverse patient with diverse behavioural pattern and method of responding to questions

De-escalation is a type of psychosocial intervention which involves to avoid situations of conflict and using positive approach to engage in conflict resolution

For example, De-escalation is the first line of treatment for responding to violence and aggressive behaviour of patient in health care setting (Hallett & Dickens, 2017). Nurses in clinical setting have used the approach of building rapport and engaging in emphatetic communication with patient using non-confrontational language. Honesty and confidence is also an effective de-escalation skill (The Nurse Path, 2016).

6. Debriefing is an important part of interprofessional team communication during any incident and it involves sharing thoughts and feelings about the problem at hand, reflection on the situation and problem solving strategies used to control the situation. During incidence of adverse events in clinical setting, debriefing plays a role in sharing all knowledge related events that took place during the incident and the challenges faced and interventions implemented during the shift

Debriefing will be important after Mr. David’s display of verbal and physical aggressiveness as this would help to be aware about the things that happened after David became aggressive

7. The three strategies that I can use to effectively receive feedback from the supervisor are as follows:

  • Be focused: I plan to remain very focussed while receiving feedbacks so that I can work on the feedback and build my confidence
  • Have enough time: I plan to receive feedback patiently without any rush for time to indicate respect

Clarifying feedback: To make sure that I understand the feedback, I will actively ask question from my supervisor and respectfully ask to repeat the feedback if I have not understood (Balzer Riley, 2017).

1. Communication and behaviour support for nurses-practice package was implemented to support nurses who are working with patients and families with a disability. The main purpose of the document is to make nurse aware about behaviours that can promote efficiency while caring for people with disability. Hence, the document can be used as a self-directed learning material as well as part of core standard learning (NSW Government, 2014b)

2. The four domains that has been identified within the standards for the communication and behaviour support for nurse-practice package includes the following:

  • Person-Centred Health Care Assessments and the Development of Health Care Plans Practice Package: Two important part of this domain is health assessment and planning
  • Communication and Behaviour Support Practice Package: It involves communication and behavioural support domain
  • Working with People with Chronic and Complex Health Care Needs Practice Package; It involves the components like teaching and coaching, education and research and health care and supportMealtime Management Practice Package for Nurses: It involves components like nutrition and management of dysphagia (NSW Government, 2014b).

3. The main advantage of completing the “communication and behaviour support for nurses appraisal” is that it can increase nurse’s knowledge regarding ways to develop skills related to communication and behaviour support while delivering care to patient with a disability. The appraisal can make nurse aware about ways t communicate with people with disability, identify different levels of communication with client and find link between communication and behaviour support while developing care. The appraisal also gives knowledge about different challenging behaviours in client (NSW Government, 2014a)

4. Two organization procedures surrounding electronic health records for health care personnel include:

  • Adhering to documentation requirements: For all health care professionals, it is necessary that they understand the organizational procedure needed to access documentation. They must also be trained to engage in safe and secure documentation process by providing password or other techniques.
  • Maintaining confidentiality of client’s information: This is also the most vital aspect of policies and procedures related to documentation and it mainly involves implementing legal obligation in hospital to ensure that all staffs maintain patient privacy/confidentiality in care. Many hospital distribute privacy and confidentiality brochure to ensure that all staffs adhere to privacy and confidentiality requirements

5. While utilising information technology to access data, the following three tips will be useful for nurse to ensure that the web page accessed is reliable:

  • Firstly, only health and medical sites related to governments are reliable sources
  • Secondly, to ensure reliability of the web page, review the credentials of the author and evaluate the information and guideline is intended for whom.
  • Reviewing the data and the time at which the website was last updated is also necessary step to make webpage reliable

6. Nuring clinical practice, participating in group meetings and discussion is important. Some of the procedures that the nurse need to be aware about includes the following:

  • Being aware about the notification details and data and time of the meeting
  • Role of chairpersons and other members
  • Agenda for a meeting
  • Being aware of the quorum for meeting such as minimum attendees required during the meeting
  • Making plan regarding time and place for meeting

7. The three objectives of forming small groups are as follows

  • to complete specific projects
  • to establish new policies or guidelines
  • to develop a social group (TAFE Queensland, 2016).

8. To ensure that all persons in the group responds and provide feedback during the meeting, it is necessary that person leading the meeting have a clear goal and objectives of the meeting. While starting the meeting, the nurse should make proper plans regarding the key topics that will be discussed and the main rationale behind the meeting. The other members will be encouraged to take active part in the discussion and suggest their opinion about the topic of the meeting. Communication skills like asking clarifying question or requesting for new suggestion would help to ensure that all members are actively involved in the meeting

9. To ensure that the meetings are of value, the nurse can focus on the following 5 things while conducting the meeting:

  • The meeting should have a clear purpose and value and the meeting must stick to the main agenda of the meeting
  • It should have a suitable time and venue to ensure maximum participation and avoid distraction
  • The meeting should be completed within the scheduled time
  • Appropriate number of people should be invited in the meeting
  • The environment or room for the meeting should be considered to avoid obstructions during the process of the meeting (TAFE Queensland, 2016)

10. The following communication techniques to effectively understanding feedback in relation to performance improvement conversations:

  • The first strategy is to remain focussed and actively listen to the feedback provided without getting distracted
  • The next step is to use clarification and paraphrasing techniques to ensure that the feedback provided is accurately understood. This form of clarification will help to get the right direction regarding the steps that is needed to evaluate feedback

The three step communication technique of ‘commend, recommend and commend’ is important while providing balanced feedback. The first step ‘commend’ starts with the approach to praise the person regarding the good things or achievement that the person has received so far. After this, the person can be recommended to further improve his skills by using communication techniques like ‘one way you could improve the communication skills are. The final step is to again commend the client by praising the person for receiving the feedback in a positive manner

12. While giving or receiving feedback, use of appropriate language and respectful manner is important to avoid conflict during the process. There are two strategies that reflect use of appropriate language and respectful manner during the feedback:

  • Use of non-judgmental comment is important while receiving or providing feedback. This can be done by giving feedback based on what has been observed and never giving any comments on personal characteristics.

Another strategy is to provide balanced feedback by never giving personal comments and starting with commending the client first. Word of encouragement can have positive impact on client and by using the commend, recommend and comment technique, the person can be motivated to change his or her behaviour based on feedback.

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