“ Communication and interpersonal skills are essential components in delivering good quality nursing care. ” With reference to academic literature, you are required to discuss the elements and importance of effective communication in the context of nursing. Communication is the way in which people can exchange information.
Information can be given either verbally (use of words) or non-verbally (body language or behaviours). (DeVito (2004) as cited by Videbeck (2009). Interpersonal skills are a core nursing skill. Nurses interact with people of different cultures and walks of life on a day-to-day basis so they must be able to communicate effectively and easily to provide the highest quality of care to each patient.
There are eight core elements that make up the communication process: sender (person initiating the communication process) , message (idea being communicated), channel (way in which message is communicated), receiver (person receiving message ), feedback (indication as to whether message has been received and interpreted correctly), validation (confirmation that message has been received and interpreted correctly), context (place in which communication takes place) and noise (any sound that could interrupt message being sent clearly).
For the purpose of this essay the elements ‘message’ and ‘channel’ and ’feedback’ will be looked at in more detail. ‘Message’ is the verbal or non-verbal information that must be encoded (simplified) by the sender and decoded (interpreted) by the receiver. ‘Message’ is the most important part of the communication process as it includes not only the verbal but also the non-verbal. According to Argyle (1998), as cited by Guerrero, L.
K (1999) , communication is five times more effective through non-verbal skills rather than verbal, in fact only 7% is verbal, 38% is to do with vocal skills (tone, speed, pitch) and 55% is visual (eye contact, body language, hand signals, posture). The person exchanging information (‘sender’), wants to express a message to the person accepting the message (‘receiver’), so particular words or movements are chosen so their message is understood.
The message must be easy to understand and interpret by the receiver. (Riley-Balzer ,2000). The message element, although important, can also cause a barrier to effective communication. The sender must be able to create his message carefully and estimate the different ways the message can be interpreted to avoid confusion. The meanings that are sent might not be interpreted the same when they are received.
No two people associated the same gestures or words with similar things, for example, in South America not enough eye contact is seen as disrespectful whereas in some Asian cultures too much eye contact is seen as invasive and impolite. The way in which to communicate with different cultures vary because each culture has a different set of social rules regarding proper communication. (Sheldon, 2004) Sometimes the sender may fail to communicate certain messages as they lack the proper skills and find it difficult to convey messages properly.
‘Channel’ is the way in which the message is communicated from the sender to the receiver. The receivers uses their five senses to interpret this message. This is an important aspect of effective communication as it allows the sender to choose the most appropriate way in which to communicate the message. There are many different ways this can occur : through spoken word (radio, television, conversation), to written word (article, letter, case file, books). There are advantages and disadvantages to both forms of communication.
For example if a message is being communicated in a book or article , the receiver might interpret the message wrong and without the sender there to answer any questions or explain the message clearly again. Likewise in verbal communication, the nurse must be able to use simple language so that the patient can easily understand and interpret. In a hospital environment people can become anxious easily and therefore have a decreased ability to handle large and complex amounts of information, therefore a nurse must be able to recognise this and change the way information is channelled.
(Videbeck,2009) ‘Feedback’ is an indication as to whether the message has been received and interpreted correctly. This is an important element as it shows whether the message has been conveyed properly and had it’s desired effect. The receiver is then able to relay back to the sender whether or not the information has been understood, if they understand and how they feel about the message being conveyed. This allows the sender to change, repeat or adjust the message to help the receiver understand.
For example is a nurse is explaining to a patient about their illness and she feels by the person’s body language or by listening to the questions they may have that they don’t fully understand , she could ask the patient a few open ended questions (’tell me about your pain‘ instead of ‘ do you have a pain in your chest‘), ask them to repeat back what you have told them and then begin to paraphrase the information in everyday language with no medical jargon so it is easier to understand.
A barrier of the feedback element is if the patient is too embarrassed to admit that they don’t understand fully and the nurse doesn’t notice this from body language and gestures and doesn’t rephrase it for the person. The patient is then left confused and embarrassed. When nurses are not ‘patient-centred’ and don’t respect the importance of the nurse-patient relationship it results in the nurse making guesses about the patients wants and needs instead of listening to the patient and getting feedback of them.
(Bergen, 1992 ; Booth, 1996) The most important aspect of a nurse-patient relationship is motivated the patient to become involved in their own care and making decisions as well. (Langewitz, 1998) In the feedback element the nurse must learn to listen and observe body language to ascertain whether the patient has grasped the concept or not. According to Laverty (2005) , the top three areas of communication are listening, willingness to communicate and explaining.
The patients in the research explained that they wanted a nurse who was willing to take the time to listen to them, to show that they were interested with non-verbal signals and that they were happy to take time to communicate and not give up so easily when faced with barriers. Unfortunately even though these communication skills play and important role in the healthcare profession the patients were still have poor experiences with daily communication with the nursing staff. (DH and Farrell. 2004).
Communication and interpersonal skills are important parts in a nurse’s ability to deliver good quality nursing care as it allows them to be able to ‘assess, identify, and prioritize patient’s needs, facilitate the expression of feelings and build a relationship for effective care. ’ (Dougherty and Lister,2008) Communication is a core skill that is needed to provide quality care. Effective communication can increase rates of recovery, decrease the patient’s discomfort and complication rates. (Wilkinson, 2003).
For most patients the nurse is the main person that they see and interact with everyday so it is important that a nurse’s interpersonal skills are effective so as to build a therapeutic relationship with the patient and also the family. This relationship allows the patient to feel like they are part of their care and are being listened to and that they will receive the quality of care they deserve. Patient’s experiences are influenced by how care is given, nurse’s must strive to make sure the patient’s experience of their care is good every time.
Building relationships with patients allows nurse’s to gain the patient’s trust, know by their body language when something is wrong and make the patient feel respected and that they matter. Through the effective use of the elements message, channel and feedback, a therapeutic nurse-patient relationship is established.. On reflection, I feel that the communication skills that I currently hold are good listening skills and verbal skills. I find these skills are my strongest as I am constantly using them on a day-to-day basis and so they are improving and developing each time I do so.
Two skills that I would like to improve are my non-verbal skills and the ability to be able to distinguish between social and professional communication. I would like my non-verbal skills to be able to mirror my verbal skills, so as not to cause confusion. I find this very difficult to do. I also need to work on my non-verbal skills by looking into social rules set out by different cultures on communication so as not to cause offence or disrespect by not knowing about another cultures view on certain symbols or gestures.
I would like to be able to distinguish between social and professional communication so I can focus more on the patient’s needs, wishes and feelings and by doing this become more patient-centred and provide them with the standard of care that they deserve. Reference List Argyle, M (1998) as cited by Guerrero L. K (1999) The nonverbal communication reader: Classic and contemporary readings . Illinois: Waveland Press. 135-148 Bergen, A (1992) Case Management in Community Care: Concepts, Practices and Implications for Nursing. Journal of Advanced Nursing. 17. 1106-1113 .
Booth, K (1996) Perceived Professional Support and the Use of Blocking Behaviours by Hospice Nurses. Journal of Advanced Nursing. De Vito, J. A (2004) The Interpersonal Communication Handbook. 10th Ed. Boston: Pearson Education. Department of Health and Farrell, C. (2004) Patient and Public Involvement in Health : The Evidence for Policy Implementation. UK: Department of Health, London. Dougherty and Lister (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. Blackwell : John Wiley & Sons. Langewitz, W. A. (1998). Improving Communication Skills.
Psychosom Medicine, US : Wolters Kluwer Health. 268-276. Laverty, H. Challis JP, Easters S, Smitheringale E, Thompson P (2005) Build a Nurse! Learning Disability Practice Riley- Balzer, Julia (2004) Communication in Nursing. 6th Ed. Missouri: Mosby 2008. Sheldon-Kennedy, Lisa (2004). Communication for Nurses. 2nd Ed. Massachusetts: Jones and Bartlett. 132 Videbeck, Sheila (2009). Mental Health Nursing. UK: Wolters Kluwer Health. 101-118 Wilkinson David, Harries Gareth, Thelwall Mike, Price, Liz (2003) Journal of Information Science. US: Sage Publications. 49-56