Essentials of Nursing and Care Report

Our task information for this assessment instructed: As a neutral observer, write a report on communication skills and barriers to communication. A video was provided to watch and we were given instruction on what to include in each section. I received a High Distinction for this report.

Please note my writings are published for educational purposes only, all of my works have been submitted to Turnitin so please do not copy and paste or you will be flagged for plagiarism. My reference list is included at the bottom.

The feedback I received from my marker was:

“Abstract: Excellent overview of your report.
Introduction: Also very good outline of what you will cover. Well done.
Results: Excellent interpretation of the scenario’s. You are stating exactly with no judgement. Well done.
Discussion: Great discussion points. Just be mindful of long sentences with a lot of content/ideas in them.
Conclusion: New information not previously mentioned therefore should not be in your conclusion. Very good summary of your report.
Literature/Referencing: Well integrated excellent articles sourced. List and in text formatted correctly. List does need to be on a separate page. Just some very minor issues I have given you some tips to improve. Well done
Presentation: A couple of minor errors only. A lovely read.
Comments: Thank you for putting in such a great piece of work. An absolute pleasure to read. Well done.”

Abstract
This report presents the findings of a neutral observation of a split scenario video containing both inadequate communication and skilfully articulated conversations between nurse and patient. The goal is to review both scenarios for communication skills and barriers to communication and consider how that may affect the quality of care given to a patient. During the viewing of the first scenario, key areas of poor communication from the nurse were identified, including closed body language, standing over the patient and dismissive language. Alternatively, while viewing the second scenario clear signs of beneficial interaction were noted that included sitting down, speaking with a soft voice, asking open questions and imparting information to the patient about their procedures. The discussion section contains evidence from the literature that shows the positive effects to health outcomes of a therapeutic nurse-patient relationship, being empathetic to the patient and their situation, building trust and allowing patients to communicate their needs. Evidence of the negative impacts of poor communication skill is also examined to convey the adverse health outcomes to patients when rapport is not established. Three recommendations are then outlined to show how nurses can communicate better with patients, create caring rapport when interacting with patients and build on their own skills to be more efficient.

Introduction
This report discusses communication skills and barriers to communication within a health care setting between nurse and patient; and is written from the perspective of a neutral observer. A short video demonstrating two very different approaches from nurse to patient was observed in order to determine individually how poor communication skills versus quality, caring interaction can impact upon the level of care a patient receives or perceives themselves to receive from a nurse. The first scenario presented a shorter interaction between a busy, apparently uncaring nurse who did not display any feeling toward the patient and an agitated patient wanting pain relief, while the second scenario presented a slightly longer interaction from an empathetic and noticeably more caring nurse who sat down with the patient and made time to talk with them about how they were feeling, what was going to happen and reassuring the patient. The report first presents observations from both scenarios and interprets the results of these observations, determining which major features from each scenario contribute towards both effective communication and barriers to communication. Secondly, the report continues on to discuss those features and present research from current literature that provides more perspective. Finally, the report gives three recommendations on how nurses can more effectively communicate with patients to create therapeutic relationships, be more empathetic and develop skills that will further help build understanding and caring nurse-patient rapport. This report will demonstrate that empathy and caring from a nurse builds a trusting reciprocal relationship with a patient and leads to better health outcomes.

Results
The video shows two scenarios displaying contrasting communication styles between nurse and patient. In the first scenario, the patient is clearly agitated and in pain. The nurse is impatient and dismissive; appearing uncaring toward the patient with curt words, crossed arms and closed off body language. In the second scenario the nurse enters and immediately sits down with the patient displaying open body language and a caring, comforting demeanour. The nurse takes the time to talk with the patient to understand how they are feeling, informing the patient of the procedures about to be undertaken and reassuring them.

The major barriers to communication in the first scenario include body language, posture and verbal communication from the nurse. The standout feature of the first scenario is the unwillingness of the nurse to engage compassionately with the patient or address the patient’s demands for pain relief, further agitating the patient. The nurse displays closed off body language with folded arms across the chest, remaining standing over the patient. The spoken language of the nurse towards the patient is abrupt, dismissive and impatient. The nurse refers to lack of time to care properly for patient and states that patient is not the only one nurse needs to attend to. The responses of the nurse to the expressed concerns of the patient create an imbalance of power between the nurse and patient that does not promote a healthy environment for the patient to feel the nurse is approachable or attentive to patient’s particular needs.

The second scenario demonstrates a far more effective communication strategy from the nurse, showing the nurse entering, sitting down to the patient’s level, engaging compassionately with the patient and reassuring the patient with open, relaxed body language and soft spoken, gentle voice. The nurse takes the time to inform the patient of medical procedures and explain in detail what will happen, reassuring the patient when concerns are expressed. The nurse endeavours to let the patient know that the nurse was there to look after the patient and would be there for further needs, assuring that the patient felt that they were able to communicate any needs they may have or may arise. The nurse’s communication with the patient creates an environment in which the patient relaxes and feels comfortable and cared for, enabling the patient to feel they can approach the nurse thereby promoting better conditions for healthy outcomes for the patient.

Discussion
The first scenario in the video highlights several barriers to effective and satisfactory patient outcomes. A busy nurse with many patients to care for presents a serious communication barrier that may generate a disregard for the importance of quality communication, leaving the patient feeling frustrated and ignored (Ali, 2017). Research has indicated that nurses mostly focus on physical care and correspond in a cursory, routine manner with little emotional and social interaction; time constraints and workloads are commonly cited reasons for this lack of interaction (Gordon, Ellis-Hill, & Ashburn, 2009). The quality of health care is heavily impacted by poor nurse-patient communication bearing an adverse outcome on patient services – nurses need to become familiar with their patients’ needs though effective communication to deliver high quality care and services (Norouzinia, Aghabarari, Shiri, Karimi, & Samami, 2015). Norouzinia et al. (2015) further state that for a successful relationship to occur between nurse and patient there needs to be a bilateral understanding of barriers to communication. Studies reveal that patients experiencing psychological distress often do not directly convey their concerns explicitly but rather through indirect cues that may go undetected by a nurse who lacks the skill to perceive them (Uitterhoeve, Bensing, Dilven, Donders, deMulder, & van Achterberg, 2009).

As demonstrated in the second scenario in the video, good communication skills from a nurse who listens to the patient and takes the time to both understand the patient’s needs and reassure the patient while providing information about their medical care is essential to promoting better health outcomes and fostering a sense of confidence in the patient. Pullen & Mathias (2010) describe a therapeutic nurse-patient relationship as being a beneficial relationship that is founded on reciprocal respect and trust, cultivating hope and faith, being empathetic to both self and others, and helping with satisfying the patient’s physical, spiritual and emotional requirements through one’s proficiency and expertise. An understanding of patients and their verbalised experiences forms the basis of effective communication (Lambrini & Papathanasiou, 2014). Trust has been identified as being integral to the nurse-patient relationship and is an ongoing process throughout the interaction – while the patient needs to be able to trust the nurse, the nurse also must trust the patient to give accurate information (Belcher & Jones, 2009). Effective communication between nurse and patient ensures that the patient’s basic needs are met, while establishing a respectful and trusting relationship allows the patient to feel confident to communicate their needs and know they are receiving the care they need.

Conclusion
It is evident through the research and discussion that nurses need to be able to establish an emotional relationship with their patient that is more than just superficial medical routine. They need to build a trusting relationship that works both ways between nurse and patient. A patient who has such a therapeutic relationship with their nurse feels relaxed enough to be able to communicate more effectively about their health issues, leading to improved health outcomes. A nurse who focuses more on their workload and less on their patient does not foster any sense of trust from the patient, leaving the patient feeling overlooked and dissatisfied. Teaching nurses and nursing students how to communicate more effectively using techniques such as SOLER and encouraging them to engage in further education on how to form therapeutic relationships, advance their efforts to develop empathetic skills further and develop additional skills for efficiency such as time management or delegation can only benefit their nursing career and nursing practice as a whole, leading to productive and satisfying interactions with positive results for patients.

Recommendations
The first recommendation this report will make is to teach nurses and nursing students how to develop more effective communication skills to interact better with patients. O’Hagan, Manias, Elder, Pill, Woodward‐Kron, McNamara, Webb, & McColl (2014) identified four primary points of interrelation as being applicable to effective communication between nurses and patients – approach, manner, interaction techniques and communication itself as a non-specific notion. The SOLER (Sit squarely, Open posture, Lean forward, Eye contact, Relax) technique has been used for around 30 years as a primary model for learning and teaching non-verbal communication (Stickley, 2011). Though Stickley suggests there is some room for improvement in this technique, it remains widely used in nurse-patient relations.

The second recommendation this report will make is to advocate further education for nurses on how to form therapeutic relationships with their patients to promote better health outcomes. An empathetic relationship between nurse and patient has been widely shown to promote a shared understanding and gaining of mutual trust; it is an integral component of any effective nursing care and the core of a therapeutic nurse-patient relationship (Williams & Stickley, 2010). Many nursing publications agree that the concept of empathy derives from an array of different perspectives and requires continual expansion to be useful to nursing (Williams & Stickley, 2010), suggesting that nurses should continue to develop their empathy as an ongoing process.

The third recommendation this report will make is to aid nurses to develop a range of skills designed to help them to spend time to build a rapport with their patients to establish a trusting, therapeutic relationship. Shortage of time was highlighted as a prohibitive factor to a person-centred approach (Bolster & Manias, 2010). Being organised, setting priorities and co-ordination were described by Bain & Baguley (2012) as being fundamental factors in managing caseloads. A well-managed team relies on efficient organisation to ensure time and resources can be adequately managed. Additionally, effective delegation within team members’ scope of practice (Bain & Baguley, 2012) also helps ensure nurses feel comfortable to take a few extra minutes to sit down and talk with their patients.

References:

Ali, M. (2017). Communication skills 2: overcoming barriers to effective communication. Nursing Times, 114, 40-42. Retrieved from https://www.nursingtimes.net/clinical-archive/assessment-skills/communication-skills-2-overcoming-the-barriers-to-effective-communication/7022518.article
Bain, H., & Baguley, F. (2012). The management of caseloads in district nursing services. Primary Health Care, 22, 31–38. Retrieved from http://search.ebscohost.com.ezproxy.scu.edu.au/login.aspx?direct=true&db=rzh&AN=104565281&site=ehost-live
Belcher, M., & Jones, L. K. (2009). Graduate nurses’ experiences of developing trust in the nurse-patient relationship. Contemporary Nurse: A Journal for the Australian Nursing Profession, 31, 142-52. Retrieved from http://ezproxy.scu.edu.au/login?url=https://search-proquest-com.ezproxy.scu.edu.au/docview/203172385?accountid=16926
Bolster, D., & Manias, E. (2010). Person-centred interactions between nurses and patients during medication activities in an acute hospital setting: Qualitative observation and interview study. International journal of nursing studies, 47, 154-165. Retrieved from https://www.sciencedirect.com/science/article/pii/S0020748909001801
Gordon, C., Ellis‐Hill, C., & Ashburn, A. (2009). The use of conversational analysis: nurse-patient interaction in communication disability after stroke. Journal of advanced nursing, 65, 544-553. doi:10.1111/j.1365-2648.2008.04917.x
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26, 6-67. doi:10.5455/msm.2014.26.65-67
Mick, J. (2017). Call to action: How to implement evidence-based nursing practice. Nursing2019, 47, 36-43. Retrieved from https://www.nursingcenter.com/cearticle?an=00152193-201704000-00011&Journal_ID=54016&Issue_ID=4077921
Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M., & Samami, E. (2015). Communication Barriers Perceived by Nurses and Patients. Global journal of health science, 8, 65-74. doi:10.5539/gjhs.v8n6p65
O’Hagan, S., Manias, E., Elder, C., Pill, J., Woodward‐Kron, R., McNamara, T., Webb, G. & McColl, G. (2014). What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of Advanced Nursing, 70, 1344– 1355. doi: 10.1111/jan.12296
Pullen, R. L., & Mathias, T. (2010). Fostering therapeutic nurse-patient relationships. Nursing Made Incredibly Easy, 8, 4. doi: 10.1097/01.NME.0000371036.87494.11
Stickley, T. (2011). From SOLER to SURETY for effective non-verbal communication. Nurse education in practice, 11, 395-8. doi:10.1016/j.nepr.2011.03.021
Uitterhoeve, R., Bensing, J., Dilven, E., Donders, R., deMulder, P., & van Achterberg, T. (2009). Nurse-patient communication in cancer care: does responding to patient’s cues predict patient satisfaction with communication. Psycho-Oncology, 18, 1060-1068. https://doi-org.ezproxy.scu.edu.au/10.1002/pon.1434
Williams, J., & Stickley, T. (2010). Empathy and nurse education. Nurse Education Today, 30, 752-755. https://doi.org/10.1016/j.nedt.2010.01.018

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