Excellent discussion on communication and its application to clinical practice and patient outcomes. Information is accurate and well supported with literature
Good discussion on communication and its application to clinical practice some missing information on affective communication Good supporting literature.
Discussion on communication and its application to clinical practice is present but lacks information and supporting evidence.
Poor or no discussion on communication and its application to clinical practice. Incorrect information supplied.
Excellent choice and analysis of communication experience. Insightful reflection. Discussion well supported with literature.
Communication event discussed with some supporting evidence supplied. Lacks application to clinical practice or reflection. Mostly a recount or communication experience.
Barriers to Effective Nurse-Patient Communication
Therapeutic relationship between nurse and patient is dependent on effective communication skills. Good communication skills improve the quality of care and play a role in building a genuine and meaningful relationship with patient (Kozier et al., 2015). The main purpose of the report is to critically analyze a video on communication between a nurse and patients, and answers questions related to barriers to communication and effective methods to improve nurse-patient communication. The report also provide a reflection on a difficult communication experienced in nursing practice personally while interviewing a patient with dementia and discusses the approach by which personal communication style helped to achieve the outcome.
The video illustrates lack of therapeutic communication between the nurse and patients. Proper therapeutic communication process could not take place because of several barriers to the communication process. Firstly, the nurse was found to be too impatient and instead of patiently listening to the client’s answer, she was assuming things based on few sentences and quickly moving on to next questions. Hence, poor listening skill was one of the barriers that prevented the nurse from assessing patient’s situation and determining their treatment needs. Another element that acted as the barrier in the communication process was the lack of empathy. The nurse was found to be very rash and although the patient was a depressed patient, she did not used kind words to ask questions. Both her verbal and non-verbal language was very unprofessional and by giving personal comments on the patient’s condition, the nurse hampered the process of developing a harmonious and trustworthy relationship with patient. For example, while questioning the patient regarding depressive thought, the nurse expressed that ‘It’s really very weak them to do personally. Such personal comment further deteriorated the communication process between the nurse-patient. Nurses are not supposed to use mobile phone during interaction with patient and use of mobile phone also distracted the nurse. The client was also found to be dissatisfied by the end of the communication process.
According to Kourkouta and Papathanasiou (2014), listening is an important skill in the communication process and by listening, the nurse can effectively assess patient’s situation and enhance their self-esteem. Hence, the nurse in the video should have been patient enough to listen and ensures that all her concentrations were on listening to patient’s response. The nurse should have also displayed empathy during the conversation to express real concern for the patient and enhance patient’s satisfaction with care. The nurse should have also taken care to create a peaceful environment for interaction with patient without any distraction (Feo et al., 2014). However, the video demonstrated an environment full of distraction as the nurse was constantly talking with other staffs in between or answering phone calls. This prevented the patient to express herself freely. In additions, according to ethical principles of care, the nurse should have avoided giving personal judgment to maintain professional boundary in the nurse-patient relationship (Arnold & Boggs, 2015).
Strategies for Improving Nurse-Patient Communication
The above example of ineffective communication can significantly impair patient’s recovery. This can be said because by lack of bidirectional communication process, the client cannot openly express her concerns to the nurse. The nurse attitude of not paying attention to that patient’s response will lead to poor identification of patient needs and required treatment for patients. This would further delay receiving appropriate treatment and increase risk of other health issues in patients. Lack of professional boundaries and passing personal comment can also lower self-esteem of patient and lead to poor psychological health too.
According to the registered nurse scope of practice, a nurse can engage in effective therapeutic and professional communication process with patient by respecting the dignity, values, beliefs, rights and culture of the patient and providing adequate support to optimize health related decisions for patients. It also requires the nurse to conduct holistic assessment of patient (Nursing and Midwifery Board of Australia 2018). In addition, the ethical principles of registered nurse practice require the nurse to respect patient’s autonomy and engage in shared decision making process.
To improve the nurse-patient communication, the nurse can take the step to first create a peaceful environment for patient and eliminate all sources of distraction during interaction process. After that, the focus should be to build rapport with client and clearly state the purpose of communication so that any misunderstand or confusion is removed. After this, listening skills and professional consideration will be important to get in-depth information from patient and ensure that the patient express all his problems openly (Morton et al., 2017).
During one of my nursing practice, I had to interact with a patient with dementia. The patient was a 70 year old lady with dementia and the main issues for the lady was that she had poor memory, loss of orientation and difficulty in using words. The patient had fallen several times in her home due to symptoms of dementia and had been admitted many times for fall related injuries. I was given the task to interview patient to understand the kind of support she get from her family regarding daily needs and understand the motivation of patient to recover from dementia. I felt that this was the most difficult conversation session that I was going to take because the patient had problem in making speech and extracting information from her was difficult because of her failing memory.
Personal Reflection on Communication with a Patient with Dementia
While entering into communication process with dementia patient, my first strategy was to ensure that the environment is clutter free and there is no distraction or other things that can irritate patient. I also decided to be very calm and patient during the communication session. I politely introduced myself to the patient and explained her aim of the conversation. I also fulfilled confidentiality requirement by informing that the session is being recorded and there is no harm to patient. I started to make the patient comfortable by asking general questions like ‘How are you? Are you satisfied with the service here?’. Next, I started to ask her main questions like ‘Who is there to take care of you at home?’ or ‘Do you wish to recover from dementia as soon as possible?’. Although the patient started answering, however she found to be lost in between. I had to gently touch her hands and remind her again that we were in this conversation. I also used non-verbal gestures like hand gestures, eye contact and signs to ensure that patient clearly understands my messages. I also repeated information and asked for confirmation to ensure that no misunderstanding occurs. This approach helped me to complete a difficult conversation in the most effective manner.
The report provided a critique of the communication process between nurse and patient in the video. Listening, empathy, verbal and non-verbal communication skills are some important elements of the nurse-patient communication process and all these factors were missing in the video. Lack of communication acted as a barrier in creating therapeutic relationship with patient and affected recovery of patient too. The importance of patience, listening skills, non-verbal gestures and ethical principles in communication process has been demonstrated by reflection on personal experience of communicating with a difficult patient. The nursing education program should put more emphasis on developing communication skill of nurse to improve the quality of care and develop therapeutic relationship with patient.
Arnold, E. C., & Boggs, K. U. (2015). Interpersonal Relationships-E-Book: Professional Communication Skills for Nurses. Elsevier Health Sciences.
Berman, A., Snyder, S. J., Levett-Jones, T., Dwyer, T., Hales, M., Harvey, N., ... & Stanley, D. (2018). Kozier and Erb's Fundamentals of Nursing [4th Australian edition]. Pearson, Frenchs Forest, NSW.4
Feo, R., Rasmussen, P., Wiechula, R., Conroy, T., & Kitson, A. (2017). Developing effective and caring nurse-patient relationships. Nursing Standard (2014+), 31(28), 54.
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in Nursing Practice. Materia Socio-Medica, 26(1), 65–67. https://doi.org/10.5455/msm.2014.26.65-67
Kozier, B., Erb, G. L., Berman, A., Snyder, S., Levett-Jones, T., Dwyer, T., ... & Parker, B. (2015). Kozier and Erb's Fundamentals of Nursing [3rd Australian edition], Pearson, Frenchs Forest, NSW 4
Morton, P.G., Fontaine, D., Hudak, C.M. and Gallo, B.M., 2017. Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins.
Nursing and Midwifery Board of Australia (2018). Professional standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx