Communication

Introduction:

Communication is a key skill used by nurses to engage with the individuals and their families across a variety of professional settings. As individuals we engage in communication with others across a variety of forums: face to face using both verbal and non-verbal communications, using our phones to call, text and send messages via social media apps, and video calls. In healthcare nurses are key members of the health care team often spending the most time with patients. Communication underpins all areas of nursing practice and the provision of quality and safe healthcare. Communication is a skill that all nurses must have to provide safe, collaborative and effective care. Communication is more than speech it is the way that we gather, share and validate assessment findings. Using this information allows nurses to build an understanding of persons and their current health experience and need for comfort and care. Communication underpins a successful therapeutic nurse patient relationship (Levett-Jones, 2020). To create effective relationships with individuals and high-quality healthcare nurses need to have an awareness of self and the skills to create positive conversations. As student nurses you will engage in communication across a variety of areas.

Learning Outcomes:

At the completion of this module students are expected to be able to:

Provide a brief explanation that explains communication and its importance in nursing

Define person-centred care

Access the national standards that govern the provision of care in acute and aged care settings

Discuss the key elements of professional communication

Developing an understanding of their communication strengths and areas for development.

Aware of the core elements of effective communication.

Explain what a therapeutic relationship is and the importance of this in healthcare.

Discuss skills for interviewing and asking questions of patients to elicit the most information possible.

1. Introduction

3. Person-centred Care

Week 1

Communication

Communication in health care is a process in which information is exchanged and shared during interventions and the provision of care. Communication is a tool that is used to share information and meaning to others and across groups. Communication in healthcare is helpful in building stronger relationships with others, avoiding conflict, solving problems and creating better outcomes.

The Nursing and Midwifery Board of Australia, the regulatory body for the profession, explains that effective communication is built on being respectful, kind, compassionate and honest (Nursing and Midwifery Board of Australia, 2018). As an undergraduate student you are expected to begin to embrace these requirements and demonstrate communication that algins to the expectations placed upon a registered nurse.

Throughout your degree you will communicate with peers, academic staff (lecturers, tutors, patients, clinical staff and others that support you and impart knowledge associated with your course. In your communication you are expected to be respectful, kind, compassionate and honest, just as you will expect this of them

 

Please read Chapter 1 from O’Toole (2020) Effective Communication for healthcare professionals: a model to guide communication.

This reading will address the principles of communication and shares key points that you will utilise moving forward.

Learning to Communicate

Ineffective communication in healthcare settings results in dissatisfaction for consumers of healthcare, delays in diagnosis and treatment and can lead to injury and sometimes death of patients (Australian Commission on Safety and Quality in Health Care, 2019a). Effective communication within healthcare is difficult and requires a deep understanding of yourself along with developed skills in all forms of communication.

 

Communicating in a positive manner

As you progress through the degree you will engage in a variety of educational activities, forums and interactions. To progress and maximise your learning and access the support offered, you will need to communicate effectively. In order to effectively communicate it is important to reflect upon how you communicate.

Types of Communication

 

Verbal communication is the use of speech. Tone and choice of words are important in verbal communication.

Non-verbal communication includes facial expressions, postures, gestures and movements. These can be easily misinterpreted by others.

Visual communication refers to the ideas and information being shared with images.

Styles of Communication

Each person communicates differently with their own style which is influenced by their personality, past experiences and behavioural traits. As a result needs and opinions of others can be expressed in a manner that you may find odd or even confronting. Below are four (4) broad forms of communication styles.

Passive communicators

Shy and rarely standing up for themselves

Overly easy going and rarely if ever says no

Normally find themselves over worked and stressed

Tend to hold their feelings and become resentful

Passive Aggressive communicators

Tend to mutter to themselves rather than confront the person

Have difficultly acknowledging their anger

Use facial expressions that do not match their mood (smiling when angry)

Appear cooperative while purposely doing things to disrupt

Plan to appear cooperative but are aware they will use strategies to disrupt and frustrate others

Aggressive communicators

Disrespect the needs / opinions of others

May be considered a bully by others

Does not listen to the opinions of others

Intimidates and humiliates others when they express themselves

Uses closed and hostile body language

Not approachable

Feel their needs are more important than the needs of others

Assertive communicators

Are empowered

Respectful of needs of others

Can effectively share an opinion

Direct and to the point

Approachable

 

Reflection

Take a moment and complete this class survey:

What is your preferred type of communication? Do you like to talk? Send texts? Send emails? Send messages via social media? Or other means?

Do you know your style of communication? Visual, verbal, non-verbal?

What is your style of communication? Are you an aggressive, passive aggressive, assertive, or passive communicator?

 

Question 1

What is your preferred type of communication? Do you like to talk? Send texts? Send emails? Send messages via social media? Or other means?

2.Do you know your style of communication? Visual, verbal, non-verbal?

3.What is your style of communication? Are you an aggressive, passive aggressive, assertive, or passive communicator?

ommunication is not just talking its listening too

Effective communication requires individuals to actively listen.

Activity:

Please access the link below and begin to develop your understanding of active listening.

https://youtu.be/t2z9mdX1j4A

Image taken from https://www.mindtools.com/pages/article/listening-skills-infographic.htm

Poor Communication

Activity:

An effective way to learn positive communication skills in health care is through watching others. Using the information gained to this point in the module and your reading of Chapter One in O’Toole (2020) watch the video below. Please document (write) your thoughts on key areas where communication could have been better and suggest alternative approaches for better communication.

https://www.youtube.com/watch?v=I6TqSwlDtoY

 

Reflection

Please document (write) your thoughts on key areas where communication could have been better and suggest alternative approaches for better communication.

Areas where communication needs attention

Suggested alternative approaches and words

Document Export Page

 

2. Communication

4. Clinical Handover

Person-centred Care

Person, client, consumer and patient are used to symbolise the individual who is the recipient of care. These can be used interchangeably and relate to the context of practice. The choice of word depends upon the environment of clinical practice. In hospitals the use of patient is most common, in mental health the terms consumer and client are used and in community settings the term client is preferred. Person-centred care means seeing more than the disease or health need and looking at the whole person. People are not their disease i.e., the acute myocardial infarction (heart attack) in bed three (3) or the renal sepsis (kidney infection) in bed five (5), they are individuals with names, and that have loved ones that care for them (Levett-Jones & Palmer, 2020).

Person-centred nurses are empathetic, respectful, ethical, open-minded and self-aware. They use agency (the right to choose) at the centre of the care they provide respecting the persons wishes and advocating (speaking up when needed) to support the person’s requests. A key element of person-centred care is the need for nurses to have strong therapeutic skills. Nurses also need to build an understanding of the persons beliefs, values, life, culture and linguistics. Person-centred care contributes to positive outcomes for patients and fewer errors in care (Levett-Jones & Palmer, 2020).

This concept is explored more in module two (2) weeks three (3) and four (4). 

 

National Standards

Australian has National Safety and Quality Standards for Acute Care environments and Aged Care Quality Standards for Aged Care settings. The aim of these standards is to assist health care service providers (hospitals, aged care settings, community environments) to implement safer and higher quality care. The standards outline the expectations of organisation that provide health care. As nurses we need to have an understanding of the standards that govern our work environments. The national standards define the minimum level of care to be offered and guide the practice of nurse’s.

Image: https://www.safetyandquality.gov.au/standards/nsqhs-standards

Activity: Click on here to access the NSQHS: Communicating for Safety Standard page. Once on the page please scroll towards the bottom of the page until you find ‘Background to this standard’.

Please read this to develop your understanding of how and why this standard has been developed. 

Acute Care Standards

In acute care settings the National Safety and Quality Health Service (NSQHS) Standards purpose is to ensure that the health system is better informed, supported and organised to deliver high quality and safe care (Australian Commission on Safety and Quality in Health Care, 2019a). The Communicating for Safety Standard aims to support timely, purpose-driven and effective communication and documentation. Clear communication is important for the continuous, coordinated and safe care for patients. This standard requires that the organisation sets up systems and processes that support communication with patients, carers and families and the healthcare team. It is also important that health care professionals can communicate across their organisation.

In healthcare communication is critical to patient safety. The three main areas addressed in the NSQHS standard of

Communicating for Safety are:

Patient identification and procedure matching

This includes administration of medications, taking handover and organising treatment.

Transferring a patient from one organisation to another (hospital transfers), and movement around the hospital (from one ward to another or to a different department for an x-ray for example).

Sharing critical information as risks emerge or changes occur in the course of care

This might be when a patient deteriorates quickly, a test might have been missed, or a test result was overlooked that was important for the care of the patie

 

3. Person-centred Care

5. Aged Care Standards

Clinical Handover

 

Clinical handover is the process where information is passed from one nurse to another. This common nursing practice is governed and guided by the Communicating for Safety Standard. When nurses change shifts, they conduct a handover passing key information about the patient to the next nurse. The topic of handovers will be in other modules but for now in this module you just need to be aware that handover occurs each shift change and is the sharing of key information. Clinical handover is a period of time when patient care can be compromised if nurses fail to share all information, the communication is poor or active listening skills are not utilised. 

Activity:

To understand more about the use of communication in handover please read the Communicating for Safety Standard, 6.7 and 6.8 which are accessible at

https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard/communication-clinical-handover

Verbal communication is not the only form of communication in nursing. Written communication is an effective form of communication, this will be addressed in more detail in module five (5) in weeks nine (9) and ten (10). As nurses we document (write and record) on daily basis our interactions with our patients and the care that was provided. This information shares a summary of the patient condition, any care you provided and concerns you may have, and appropriate actions taken. The amount of documentation and paperwork in nursing depends upon the area in which you practice and the needs of patients.

Each organisation has their own documentation tools the most common of which are:

observation charts (for patient’s heart rate, blood pressure, temperature and respiratory rate to be recorded),

progress notes (a place to write a shift summary),

a medication chart (to track their medication administration), and

risk assessment tools (to minimise harm through assessing for falls risk or pressure area risks).

 

Activity

To understand more about the use of communicating through documentation please read the Communicating for Safety Standard, 6.11 which are accessible at

https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard/documentation-information

Activity

Please watch a nursing handover from QLD Health. The video is set in an emergency department which is not a beginning level nursing placement but it does demonstrate what is a bad handover and what is a good handover. Please watch and take note of the patient involvement in the good handover. 

https://youtu.be/DbGlwoQ53Gc

Aged Care Standards

 

The Aged Care Quality Standards address communication as a threaded element that aligns to all standards. Aged care providers in Australia are required to meet standards of practice and work towards achieving the highest quality of care possible.  

Meeting the requirements of Standard 1: Consumer Dignity and Choice, is only possible with good communication. The standard opens with the statement about the right to be treated with dignity and respect and the right to maintain an identity. The documents continues stating that there must be a right to make informed choices about care and services and live the life chosen (Aged Care Quality and Safety Commission, 2018)

Think for a moment about elderly Australians or those that require full time care and therefore are placed into residential facilities. What are some of the communication barriers that they face? How will you as a nurse support them to achieve the above statement?

You are not expected to have all the answers now, but as you move through this module and the unit content you are encouraged to think about this question. Impaired communication is not unique to aged individuals or setting and it is important for nurses to be able to navigate this area. A strong understanding of communication skills will support you as you build and advance your own communication abilities.

Activity

Please have a look at the Aged Care Standards and start to build your understanding of the area of aged care and what the standards focus upon.

Please visit here: https://www.agedcarequality.gov.au/sites/default/files/media/Guidance_%26_Resource_V11.pdf

What type of communicator are you?

 

Communication is a process that aims to elicit responses with the purpose to obtain and share information and at times influence others. Communication has multiple meanings depending upon the context in which it is used. Communication can be the sharing of information and ideas with individuals talking and listening or writing and reading (as is this form). Communication can also occur through dance, drawings, storytelling, yarning, use of symbols and images. Body language is also a key element of communication, sharing unspoken meaning (Levett-Jones, 2020).

Activity:

Do you know what type of communicator you are? We explored this a little in Module One.

Complete the below activity to gauge your communication skills in a self-assessment. Don’t over think the answers. You will be the only person to see this so go with your first response.

5. Aged Care Standards

7. Nursing Communication

What type of communicator are you?

 

Communication is a process that aims to elicit responses with the purpose to obtain and share information and at times influence others. Communication has multiple meanings depending upon the context in which it is used. Communication can be the sharing of information and ideas with individuals talking and listening or writing and reading (as is this form). Communication can also occur through dance, drawings, storytelling, yarning, use of symbols and images. Body language is also a key element of communication, sharing unspoken meaning (Levett-Jones, 2020).

Activity:

Do you know what type of communicator you are? We explored this a little in Module One.

Complete the below activity to gauge your communication skills in a self-assessment. Don’t over think the answers. You will be the only person to see this so go with your first response.

https://cdu.h5p.com/content/1291261026370456929

Were you surprised by your communication style? Reflect for a moment and think about the activity and what you gained from it. It might have confirmed what you already knew. Do you need to change anything as a result? How can you use this information to be a better communicator? Remember we all need to continue to build our communication skills, growing and developing on a continual basis is a core component of being a registered nurse. 

Nursing Communication

 

In nursing, communication is often very personal and involves the sharing of sensitive and sometimes very private information. The use of communication (in all forms) allows patients and nurses to share their thoughts and ideas and feelings. Therapeutic communication is helpful communication that allows the safe sharing of information, thoughts and feelings between the nurse and the individual (patient or client) and their family. If communication is poor, then it is termed as non-therapeutic. Communication that non-therapeutic is unhelpful and hinders or impairs the transfer of information between nurses and those that require care. The key to successful communication in nursing is trust. With trust individuals are more likely to communicate their needs and concerns and this allows the nurse to provide support.

The Nursing and Midwifery Board of Australia, the regulator of practitioners for the nursing profession in Australia, have embedded therapeutic and professional relationships into the standards for practice. Look over the image below and consider for which of the below points under standard 2 require strong communication skills. 

PLEASE REFER TO Standard 2 of NMBA (The Nursing and Midwifery Board of Australia)

Reading activity:

Please read Chapter 27 pages 1888 -1902 ‘Therapeutic relationships’ from Audrey, Berman, et al. (2020) Kozier and Erb’s Fundamentals of Nursing, Volumes 1-3 EBook. (to end of “A continuum of professional nursing behaviours in nurse therapeutic relationships”. This section looks at communicating and therapeutic relationships.

Activity

Watch the video below and consider how you can navigate these types of conversations. While this one may be part of a tv show it does reflect conversations that we can have with people in life.

https://www.youtube.com/watch?v=-O18rYBieww

Using the knowledge, you have about communication consider how you can navigate such situations where the conversation is not positive and instead of being a shared experience is about two separate conversations.

Therapeutic Relationships from effective communication

 

Therapeutic relationships are an integral to safe person-centred care. In order to have effective therapeutic relationships there needs to be a strong understanding of communication but also an understanding of self.

Reading Activity

To continue to develop your understanding of therapeutic relationships please read pages 1892-1897 from Kozier and Erb Fundamentals of nursing 2020 edition from ‘Phases of the therapeutic relationship’ to end of ‘termination phase’. Note the phases of the therapeutic relationship are clearly illustrated in a relevant example.

 

Awareness of Self

Self-awareness allows us to navigate all elements of life to the best of our abilities. Self-awareness is an essential skill for nurses to have. It allows an understanding of personal and professional strength and areas for development and support. Self-awareness facilitates a deeper understanding of personal traits and allows you to predict reactions and adjust as necessary as a professional. Using self-awareness nurses can be productively self-conscious and balance the demands of an interaction while simultaneously being aware of your own internal thoughts and reactions (O’Toole, 2020). Self-awareness has been identified as a key attribute in the ability of individuals to develop therapeutic relationships allowing the development of honest and genuine health professionals who are not afraid to be caring. Of course, there is a professional line that should not be crossed. Self-awareness allows the protection of professional boundaries.

Self-awareness is not a skill that occurs naturally. It requires the ability to reflect upon one’s own behaviours with a critical lens. The building of self-awareness requires a conscious reflection upon your actions, reactions and values.

Reading Activity:

Please read pages 1841-1842 from Kozier and Erb Fundamentals of nursing 2020 edition. ‘Intrapersonal communication’. This reading elaborates upon Self Concept and Self Awareness.

 

REFLECTION

Watch and Reflect Activity:

Watch the video below and think about the self-awareness that is lacking? How do you navigate these situations? Can you use these skills in the professional environment, or do you need to create a wider skill set to navigate such frustrating

https://www.youtube.com/watch?v=-O18rYBieww

Key skills for better conversations and interviewing

 

The ability for nurses to engage with individuals is built upon the ability to create a quick rapport and therapeutic relationships. In nursing to gain information from our those in our care we use a variety of approaches ranging from clinical assessment skills, observing non-verbal cues and using verbal discussions. The information that is gained is vital for a positive experience for individuals and their families that is person-centred. This also minimises the risk of harm occurring from missed information or poor communication. 

Asking questions is one manner in which nurses gain information about patients. This is a skill that will develop overtime. The use of open-ended and closed-ended questions is common in nursing. The use of open-ended questions can be challenging to master with the right approach needed to elicit the information desired. Close-ended questions tend to be specific and much easier to ask. Effective communication requires that nurses utilise both open and close-ended questions.

 

Close-ended questions

Close-ended questions are directive and restrictive often requiring a simply ‘yes’, ‘no’ or factual answer with specific information. Typically, a close ended question will begin with:

When …

Where …

Who …

What …

Do you …

Are you …

Examples of closed ended questions are:

Do you have pain?

Where is the pain?

What triggers the pain?

When did the pain start?

Are you able to get any relief from the pain?

 

Closed ended questions are good in emergency situations or in situations where the person finds it difficult to communicate for example a respiratory infection.

 

Open-ended questions

Open-ended questions invite the individual to share information with you using their own words and in a manner that they can elaborate or clarify where needed. Open-ended questions tend to be broad topics that invite more than one- or two-word answers. An open-ended question allows the individual to share the depth and breadth of information they choose. These can be helpful to gain the experience from the individual. An open-ended question often starts with:

What …

How …

Tell me about …

Examples of open-ended questions:

How are you feeling lately?

What brings you to hospital?

What is your mobility like at home?

Open-ended questions are helpful when you want to gain an understanding without providing direct prompts or guides to the patient. You can then follow up with close-ended questions about specific topics.

The image below highlights the advantages and disadvantages of using open and close-ended questions.

Activity:

Watch the video below and consider the points that are made. In the video there is a point that the presenter says that all the skills / information regarding what to do to be an effective listener are redundant. However, what she goes on to say is that if you are genuinely interested then you will mirror these behaviours. The video also talks about using key communications skills in interviewing, which is what nurses do when they elicit information form patients and their families.

https://www.youtube.com/watch?v=R1vskiVDwl4&feature=youtu.be

 

REFERENCES

 

 

Aged Care Quality and Safety Commission. (2018a). Guidance and resources for providers to support the aged care quality standards. https://www.agedcarequality.gov.au/sites/default/files/media/Guidance_%26_Resource_V11.pdf

 

Aged Care Quality and Safety Commission. (2018b). Aged care quality standards. https://www.agedcarequality.gov.au/sites/default/files/media/Aged%20Care%20Quality%20Standards.pdf

 

Australian Commission on Safety and Quality in Health Care. (2019a). Communicating for safety standard. https://www.safetyandquality.gov.au/standards

 

Australian Commission on Safety and Quality in Health Care. (2019b). Standards. https://www.safetyandquality.gov.au/standards

 

Levett-Jones, T., & Palmer, L. (2020). Medical-surgical nursing. (Chapter 1) In P. LeMone-Koeplin, K. M. Burke, G. Bauldoff, P. Gubrud-Howe, T. Levett-Jones, T. Dwyer, L. Moxham, K. Reid-Searl, K. Berry, K. Carville, M. Hales, N. Knox, & D. Raymond (Eds.), Medical-surgical nursing: Critical thinking for person-centred care (4th Australian ed., Vol. 1, pp. 3). Pearson Australia.

 

Lemone, P., Burke, K., Bauldoff, G., Gubrud, P., Levett-Jones, T., Hales, M., … Reid-Searl, K. (2020). Medical-surgical nursing, critical thinking for person-centred care. (4th ed.). Melbourne, Victoria: Pearson Australia.

 

National Safety and Quality Health Service (NSQHS) Standards. (2019). The national safety and quality health service standards. https://www.safetyandquality.gov.au/standards/nsqhs-standards

 

Nursing and Midwifery Board of Australia. (2018). Code of conduct for nurses. http://www.nursingmidwiferyboard.gov.au/documents/default.aspx?record=WD17%2F23850&dbid=AP&chksum=L8j874hp3DTlC1Sj4klHag%3D%3D

 

O’Toole, G. (2020). Effective Communication for healthcare professionals: a model to guide communication (4th ed.). Elsevier Australia.