Effective Communication And Feedback Techniques In Nursing Practice Essay.

Conducting interview

1.Ms Susan Sayers, a thirty three year old primary school teacher is scheduled for elective tonsillectomy tomorrow morning. You have been asked to admit Ms Sayers to the surgical unit. What should the nurse do to set up and conduct an effective interview? Explain each point.

2.The admission is progressing well. You note that Ms Sayers seems a little more at ease as you move further into the interview. Discuss the various interviewing techniques for facilitating communication including active listening, give examples and rationales for their use.

3.Explain eight potential barriers to communication. Explain how the nurse should address each one.

4.The admission interview has come to a close – you have taken Ms Sayers on a tour of the surgical ward, orientated her to her bed unit and introduced her to the other patients in her room. It is now time to write up the admission. Explain ten guidelines for correctly completing nursing documentation.

5.Mr and Mrs Singh and their two children aged 7 years and 4 years, arrive in the Accident and Emergency Department at 12md on Saturday afternoon. Mrs Singh appears to be well advanced in her pregnancy – she looks tired. Mr Singh looks worried. He is deeply concerned about his wife. Their spoken English is broken and they rely on hand gestures – they push their 7 year old son Ravi forward to interpret for them. What should the nurse do to facilitate communication in this situation?

6.For Mr and Mrs Singh’s next visit you have arranged for a professional interpreter to be on site. Discuss in detail how the nurse should best work with the interpreter, including preparing for the interview, the nurse’s interview style, and ending the interview.

7.Mr Colin Davies, an eighty year old retired train driver, has recently been admitted to the ‘Golden Age Nursing Home’. Always an active, busy man, Mr Davies is fiercely independent, taking a pride in both his appearance and also in his extensive repertoire of songs which he happily shares with anyone who will listen. Mr Davies has difficulty hearing and is registered as legally blind. You lead the nursing team caring for Mr Davies. What strategies should you put in place to facilitate optimal communication for this gentleman? Describe and discuss each strategy.

8.Within the nursing team you need to both give and receive feedback to facilitate ongoing improvement.

A)Discuss in detail how the nurse should give feedback to another.
B)Explain the strategies for receiving feedback on your own performance

9.Define ‘Open Disclosure’. State the eight key elements of open disclosure and explain the process.

10.In the health care arena there are many opportunities to work in a group situation, including meetings, clinical handovers, and patient education classes. Discuss ten strategies for working well in groups and teams, explaining how and why each strategy works.

11.Discuss the ethical and legal principles of using electronic media with specific reference to:

a) compliance with organisation policies and procedures
b) ethical principles when using social media
c) email etiquette.

12.The nursing role often requires assertive communication by the nurse. Define the concept of assertive communication. Explain how this concept relates to conflict resolution and negotiating solutions.

1.Conducting interview (Silverman, Kurtz & Draper, 2016)-

 Make interview preparation

• Arrangement of chairs and tables
• Maintain privacy  to make information confidential
• Enough time to be kept for interview

Beginning interview

• Greetings in polite manner, formally and take patient’s name
• Introduce  to the interviewee, informing the background
• Explain the purpose of the interview to maintain transparency and effective communication

During interview

• The nurse must maintain eye contact with interviewee
• Present in warm manner to build rapport
• Actively listen to patient – to identify and address concerns

End of the interview

• Summarise the whole interview to the patient to ensure preparation for the next day surgery
• Inform the patient about the next step
• Identify and ask questions if the patient has any worries
• Lastly thank the patient for time

2.Various interviewing techniques that will be used are (Shea, 2016)-

• Use of open ended questions to get in-depth information like – what is your perception about tonsillectomy?
• Use close ended questions for precise information. Ex- Are you ready for tonsillectomy tomorrow morning?
• Clarify the information by paraphrasing
• Enquire about general health, habits  and needs  

3.Potential barriers to communication (Shafipour et al., 2014)

1. Use of jargon-

• nurse use too many medical terms that may be difficult to interpret
• Patient cannot comprehend bodily functions or anatomical terms

2. Values and beliefs

• Patient’s negative perception about the nurses’ experience
• Belief that man cannot be nurse
• Prejudice about the nurses’ poor knowledge

3. Time constraints

• Nurse busy schedule
• Hurried communication with patient
• Brief stating of pressing news
• Patients feel neglected

4. Patient anxiety

• Embarrassment to speak in front of nurse
• Worry about post operative outcomes

5. Environmental factors- such as noise and privacy-

• noise in background- impede communication  
• patient hearing problem may impede conversation
• Patient sensitive to personal information, read or write  
• Need of translator
• Withdraw information from nurse considering too private

6. Educational attainment

• Patient/low educational attainment
• Difficulty understanding care process
• Nurse lacks effective verbal skills
• Nurse lack interview technique

7. Patient perceptions-

• patient may perceive a specific important as non-essential to be discussed  
• over thinking about pain and fatigue   after interview

8. professionalism

• nurses including patient decision making
• Acknowledgement  of patient concerns
• Nurse poor seeking of information

4.Guidelines to completing the nursing documentation (Johnson et al., 2014)-

1. Patient identification

• Use of black wrist band
• Correct spelling of name in black, date of birth, age, gender
• Check wrist band details and match with patient  

2. Removal of jewellery

• As per local policy

3. Allergy status

• Patient mentions about specific drug or food allergy

4. Infection status

• Documenting patient’s existing and past infections  

5. Safety precautions

• Document loose teeth, hearing aid
• Dressing information

6. Obtain consent

• Check before surgery

7. Medication

• Past use of medications- cause of drowsiness
• Premeds administered

8. Insurance information

• Insurance details documented
• Information of Medicare/Medicaid coverage

9. Assessment of vitals

• Abnormal readings reported

10. Site of surgery marked

• Check by nurse
• Check by day units preoperative checklist

5.Arrange for medical interpreter- to  communicate fluently with patient

Effective use nonverbal skills- to avoid misunderstanding

Speak slowly- in shorter phrases to consider the best answer  

Avoid Jargons, acronyms, idioms- to address patient queries and concerns  

Provide written information- for better understanding (Meuter et al., 2015)

6.Interview preparation

• Arrange for chairs
• Schedule sufficient time
• Maintain privacy

 Beginning interview before patient arrives

• Greet formally and introduce (nurse)
• Maintain eye contact, warm gesture
• Give patient history  
• Plan about assessment tools
• Explain the role in dealing with Mrs Singh
• Explain the patient’s language difficulties and reason for interview

During interview

• Inform what data to be collected from patient and family  
• Assist with immediate communication needs

Interview style

• Speak slowly for avoiding misinterpretations
• Pause after each sentence to enable better understanding
• Ask close ended-  in-depth information
• Open ended- single answer
• Advocate the patient through interpreter  

 End of interview

• Summarise  the interview
• Receive translated document
• Decide the next step for patient
• Inquire about any queries/concerns of patient
• Thank the interpreter (Well et al., 2017)

7.Optimal communication with Davis include following strategies (Smeltzer, Avery & Haynor, 2012)-

-Stand in front of the patient, use positive tone of voice

-Avoid background noise- minimise irritation

-Use natural voice- during introduction of self and other person

-Remove tripping hazards- minimise fall

-Walk slowly with patient- guiding them around the place

-Use interpreter-   for emergency

-Install assistive listening for emergency contact and

-Use of Brailey format for written information screen reader that converts information on a computer screen to audio

-Collection of information- safety skills,    use of equipments and risk factors  

8.A)

Nurse can give feedback to other (Altmiller, 2012)-

Planning in advance-

what went right/wrong, prompt reply, goal to be achieve

One-on-one feedback

 To ensue respect and dignity, privacy  

Specific- gentle start

 Derive discussion as planned, brief on performance and outcomes  

Encourage self reflection

Open-ended questions,

Explain learning needs and self awareness  

Awareness of verbal and non-verbal cues

Maintain -Tone of voice, speech, eye contact, positive gesture,

Observe nonverbal cues of other person,

Deduce emotions

Self refection after feedback

Follow up on discussion,

Evaluate further response  

B)Nurse can receive feedback on performance by (Wu et al., 2012)-

Active listening

-To be approachable and feedback,

-Avoid defence

Clarification

-seek repetition

-paraphrase after feedback  

Embrace feedback

-Grab learning opportunity for making changes   

Soft response

-Avoid conclusions,

-take helpful hints  

-Pause and think before response

Positive attitude

-Good sport, appreciate feedback, learn from mistakes  

Be proactive

-Carefully make notes

Follow up with feedback

-share any information   

9.Open discourse can be defined as open discussion with patient and family about harm to the patient during health care process by certain incidents (Reisenhofer & Seibold, 2013).

Elements of the open disclosure are (Birks et al., 2014)-

Interviewing techniques

Open and timely communication

-Open and honest communication about what went wrong

-Provide ongoing information

Acknowledgement

-Acknowledge carers/patients/families about adverse events

Apologizing and regret

-Apologise for harm caused by incident

-Express regret

Supporting the carer, family and patient needs

-Inform patient and family about adverse event facts

-Treat with respect, empathy and consideration

-Support as per needs

Support and meet the health care provider needs

-encourage/recognise/report adverse events

-Training/education participation open disclosure

-Support through process

Integrated clinical risk management and improvement in system

-Investigate adverse outcomes

-incorporate quality improvement activity  

Good governance

-analyse and prevent adverse events

-Accountability of changes

-Internal reporting/performance monitoring

 Confidentiality

-Maintain privacy and confidentiality of the health care and patient information

10.Clarity of the group situation and work

-Ensure clarity over the individual purpose and shared goals

-Effective for achievement

Understanding of team boundaries

-effective to bound together by a common purpose while performing independent tasks

Consider individual roles

-allow group functioning

-Achieve common goals

Positive relationship building

-For effective conflict resolution

-Enhance communication

Positive emotional experiences

-to deal with stress and adverse events

Team dynamics

-Effective listening of team members responses

-Different perspectives improve team performance

Teaming strategy

-Effectively hold diverse group of individuals

-Dealing with conflicts and pressure  

Receiving and giving feedback

-On performance or any event

-Allows for effective group function  

Track contributions in group

-Via effective documentation

-Responsibility and accountability

Peer assessment/Evaluation process

-redress what might be perceived as a problem (Arnold & Boggs, 2015)

11.Compliance with organisation policies and procedures

-Mismanagement of patient records to be avoided

-Avoid boundary violations

-Avoid transmission of information to third party

-Maintain professional boundaries like sharing electronic media with patients

-Compliance to national board and AHPRA by NMBA

b) Ethical principles when using social media

-Maintain privacy and confidentiality of patient information

-Breach may lead to law suit

-Avoid disparaging remarks of patient  

Avoid sharing of patients video and photos

c)  Email etiquette

-Effective use of passwords/Avoid sharing

-Use of encryptions for sensitive PHI via email

-Avoid wireless systems – vulnerable to unauthorised access

-enable automatic log in and log off (case sensitive)

-Avoid storage of emails on unprotected personal archives/hard drives that are not password protected

12.Assertive communication can be defined as effective expression of rights, needs, perceptions, opinions while marinating respect and dignity of others. It is the direct open and honest communication that fosters meaningful and fulfilling environment (Pipas & Jaradat, 2010).

Assertive communication allows for effective negotiation-

• By compromising
• Active listening during negotiation
• Aim for win-win situation
• Taking positive aspect of negotiation
• Concessions and compromise where needed  

Assertive communication allows for conflict resolution-

• Using phrases that seek collaboration
• Identifying areas of agreement
• Able to solicit the view of others
• Self confidence and high self esteem
• Accept mistakes  (Omura et al., 2016

References

Altmiller, G. (2012). The role of constructive feedback in patient safety and continuous quality improvement. Nursing Clinics, 47(3), 365-374.

Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.

Birks, Y., Harrison, R., Bosanquet, K., Hall, J., Harden, M., Entwistle, V., ... & Adamson, J. (2014). An exploration of the implementation of open disclosure of adverse events in the UK: a scoping review and qualitative exploration. Health Services and Delivery Research.

Johnson, M., Sanchez, P., Suominen, H., Basilakis, J., Dawson, L., Kelly, B., & Hanlen, L. (2014). Comparing nursing handover and documentation: forming one set of patient information. International nursing review, 61(1), 73-81.

Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC health services research, 15(1), 371.

Omura, M., Maguire, J., Levett-Jones, T., & Stone, T. E. (2016). Effectiveness of assertive communication training programs for health professionals and students: a systematic review protocol. JBI database of systematic reviews and implementation reports, 14(10), 64-71.

Pipas, M. D., & Jaradat, M. (2010). Assertive communication skills. Annales Universitatis Apulensis: Series Oeconomica, 12(2), 649.

Reisenhofer, S., & Seibold, C. (2013). Emergency healthcare experiences of women living with intimate partner violence. Journal of clinical nursing, 22(15-16), 2253-2263.

Shafipour, V., Mohammad, E., & Ahmadi, F. (2014). Barriers to nurse-patient communication in cardiac surgery wards: a qualitative study. Global journal of health science, 6(6), 234.

Shea, S. C. (2016). Psychiatric Interviewing E-Book: The Art of Understanding: A Practical Guide for Psychiatrists, Psychologists, Counselors, Social Workers, Nurses, and Other Mental Health Professionals. Elsevier Health Sciences. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=0LgcDQAAQBAJ&oi=fnd&pg=PP1&dq=NURSE+interview+techniques+with+patients&ots=b1ESvbM6KA&sig=Soi5ndvPWLBan1QJx1imVQQvE8o#v=onepage&q=NURSE%20interview%20techniques%20with%20patients&f=false

Silverman, J., Kurtz, S., & Draper, J. (2016). Skills for communicating with patients. CRC Press. Retrieved from: https://books.google.co.in/books?hl=en&lr=&id=pRjYCwAAQBAJ&oi=fnd&pg=PP1&dq=NURSE+COMMUNICATION+SKILLS++during+interview+with+ptients+&ots=kmyfnJHsOP&sig=T1dqMzJv7RRSUN3aLxJE-oAKYmM#v=onepage&q=NURSE%20COMMUNICATION%20SKILLS%20%20during%20interview%20with%20ptients&f=false

Smeltzer, S. C., Avery, C., & Haynor, P. (2012). Interactions of people with disabilities and nursing staff during hospitalization. AJN The American Journal of Nursing, 112(4), 30-37.

Well, E., First, F., Dignity, P., it Out, W., & Training, C. B.  (2017). Cross-cultural interview studies using interpreters. Nursing Standard, 21(4).

Westrick, S. J. (2016). Nursing students’ use of electronic and social media: Law, ethics, and e-professionalism. Nursing education perspectives, 37(1), 16-22.

Wu, P. H., Hwang, G. J., Milrad, M., Ke, H. R., & Huang, Y. M. (2012). An innovative concept map approach for improving students' learning performance with an instant feedback mechanism. British Journal of Educational Technology, 43(2), 217-232.