Communication

11 November 2018

Communication is an integral part of human life, it is a way of bringing people together as well as a means of making our concerns and needs known to others [Casey, 2014]. According to Sabo [2006], Kourkouta and Papathanasiou [2014], they believed, communication is not only a successful means of conveying people skills and information, but it is also a medium which allows people to interact with one another within a different environment.
Communication can be described as a process of sending and receiving verbal and non-verbal message between two or more people [De Vito, 2011; Balzer Riley, 2011]. Non-verbal communication can be expressed by gestures, postures, physical barriers and facial expressions which are interpreted by both the sender and the receiver [Hargie, 2011]. Importantly, non-verbal communication allows spoken messages to be adjusted and reinforced, thereby gives room for flowing of information to be regulated and make it easy for the relationship between the communicators to be recognised [Webb, 2011].
In addition, transmitting of message or information from sender can be effective by not only considering the clarity, tone and purpose of the message and interpretation through the feedback from the receiver [Berlo, 1960; Miller & Nicholson, 1976]. But it put into account the intrinsic factors such values, belief, culture, roles, goal, and education and the extrinsic factor such as physical environment like loud noise and sounds that can distort the message [De Vito, 2011].
In nursing, communication is another life entirely in which nurses live, Royal College of Nursing, 2012 believe that ‘nurses are the heart of the communication processes’. This means, nurses are the one who spent majority of time closely with their patient more than the other healthcare practitioners, hence, it gives them the ability to organise the patient’s care by communicating with them as well as the other practitioners involved in their care [McCabe and Timmins, 2006]. Furthermore, communication is a day-to-day job activity in nursing with different multi disciplinaries [Hart, 2010], with that, nurses must be a good communicator to be able to relay information to other practitioners to ensure the best service is delivered. With effective communication, nurses help other practitioners to receive more information from the clients they cared for, Casey [2011] believes that nurses and other practitioners form an important part of the communication process in a healthcare industry.
However, for a nurse to deliver a successful communication, it must be patient-centred [McCabe and Timmins, 2006], thus this practice shows that we put the clients at the heart of their care by involving them in their care planning through communication process. By doing so, it creates a kind of trust relationship between the nurse and their clients leading to client confident and empowerment which allows them to discuss their emotional and physical needs with their nurses because they feel more valued and relaxed with them [Bensing, 1991].
Communication involves interpersonal and intrapersonal means of dissemination of information [Ruesch, 1961] which can be either be positive or negative depending on the feelings, thought and intention of both the receiver and the sender [Catherine ; Fiona, 2013].
This essay will look at the importance of communication in general, as well as how vital communication is in nursing, at the same time to analysis a reflective account on my interaction with two different clients during my placement as a student. Meanwhile, part of this reflective account will be centred on what I did not do well that I needed to improve on that will enable me do things differently next time to deliver a good standard of care. The essay will also stress on what I did well and why did I do it well.
Collins, [2015] described the communication in the nursing profession as an on-going process of keeping a good therapeutic relationship with patients and maintaining consistency and steadiness between professionals for a quicker recovery and quality healthcare delivery. To achieve better understanding of the importance of communication in nursing profession, this essay will focus on the report of my experiences and interactions with two different clients during placement in which Sue and Lona will be used to denote the names of the clients as a good practice to protect their confidentiality [Nursing and Midwifery Council, 2015].
SCENARIO 1
This scenario was my first interaction was a remarkable experience with a client named Lona [not real], Lona was a young girl with a learning difficulty, she has profoundly deaf on right ear while on the left ear, she relied on hearing aid for support. I was aware that Lona does communicate with orally which was not great but can as well make use of Picture Communication Exchange System (PECS), to pass her message.
However, because her community leave was postponed due to severe weather, she was low in mood and worried that she might never get to go out to the community again. I was about to support another client when Lona approached me for one to one session as part of her coping skills. Furthermore, according to Carl Rogers, 1951, he believes, there are three main conditions to deliver an effective communication in nursing, they are empathy, unconditional positive regards and congruence. Empathy is about putting yourself in someone situation to understand their feelings. Unconditional positive regards mean as a nurse you must be non- judgemental, you must show empathy and compassion to their patient in respective of their past, their feelings and thought must be respected. Lastly, congruence is about nurse ability treat client with sincerity and control. These values help to maintain the Genuity of the client’s thus, enable them feel relax with the nurses as well as being valued.
REFLECTION
Reflection is a self-motivation awareness, believe and procedure, in which our previous practice is examined, and our mistakes are learn from which help individual respond to the similar situation in an effective manner [Nursing Center, 2011]’
Reflection is a vital tool in nursing practice, that helps nurses recollect what they did and reflect on whether it went well or not and if not, and how they do it differently next time. Reflective account allows nurses to provide the best standard of care to their clients thereby empower them to measure their communication skills [Siviter, 2008].
Sully and Dallas [2010] argued that reflective account is vital to the development of nursing profession. They emphasised that reflective account is aimed to promote their efforts which will lead to their individual better practice. There are many barriers to reflection, they are; professional pride, lack of time and criticism, nevertheless, reflection can help us to avoid mistakes, it can also help to increase job opportunities as well as allowing people to make use of the best skill available [RNC,2013].
Majority of the people discover they learn from their experience and reflection is a good means to achieve that. According to Professor Graham Gibbs, in 1988, he pinpointed six stages that can help reflective procedure thereby creating awareness to the people by learning from their past mistakes [Mind Tools, 2015]. Gibbs reflection stages includes, experience, feelings, evaluations, conclusion and action. Gibbs, 1988, emphasised that emotions and feelings have effect in a situation, he also recognises how individual feeling can have impact on situation and how person can reflect upon it [The Open Univrsity,2015].

On the first scenario, I think did not go well because I failed to take many factors into consideration, but still it was a great experienced because we learn by mistake, I believe next time I will not make such mistakes.

At the end, I questioned myself whether the pace at which I communicated with Lona was appropriate? Did I really show enough empathy to Lona? Did Lona really receive the quality care he deserved? [Bagay, 2012]. I got myself answered with all these questions and reflect on it for future amendment.
To achieve best healthcare delivery, successful communication of the messages that links the clients, nurses and the carers together must be comprehended through active listening [Mary Ann Boyd, 2008].
I think empathy shown to Lona was not great, because despite I am aware of Lona hearing impairment, which I failed to notice that she did not wear her hearing aid at the time we were talking could be a big barrier to her understanding. She was also trying to tell me something but I could not understand, and I was not bothered, this could affect Lona’s emotion because I failed to listen.
To deliver an effective communication, we need to show empathy, which is about putting yourself in someone situation as well as knowing their need [Skill You Need, 2014]. To show an effective empathy, we must know the person we are working with and the type of communication that is the best for them, this will enable us to communicate effectively and thus make is easy for them to understand us better as well [Improve Your Social Skills.com, 2015]. In nursing, learning disability in particular, thorough understanding of understanding of our clients will give us ability to care and communicate with them genuinely and accordingly this will make them comfortable around us. As a result, person-cantered approach of communication will develop once we have understood their individual needs and able to deal with it accordingly [Improve Your Social Skills.com, 2015]. With my inability to show good empathy towards Lona, next time I believe I will do things differently. I will ensure that before starting conversation with Lona of anyone of her nature I will make sure not to rush to any communication to ascertain that everything is in place to achieve an effective communication between both party.
Furthermore, I needed to work on my pace whenever I am communicating with other people to ensure better understanding on the other party. The reason being that, apart from the fact that I was in hurry when dealing with Lona because of another commitment which I had, I realised my pace in general was too fast to meet with the need of the people I am working with.
According to [Skill You Need, 2014], the rate at which we take to speak or talk to people is called pace. To achieve an effective communication, Speaking Freely, 2015, argues that we must not talk too fast to allow the receiver to process it otherwise, it will turn to jargon. At the same time talk should not be too slow so as not to make it bore to the receiver.
As a learning disability nurse, it is vital to maintain the same pace when dealing with our clients according to their individual need to keep the communication going smoothly. During reflection I realised Lona was not with me when I was talking to her probably because of my pace as well as some other factors, she was just sitting there staring at something without any sign of acknowledgment of what I was saying, showing she did not comprehend anything. Next time I will make sure that apart from putting everything in place, I will ensure my pace of speech is controlled to individual need and I will maintain it to the end.
However, I will also ensure that, communication takes place in a perfect environment to avoid distraction, I should also make sure more time is allowed whenever I want to have conversation with any client to prevent rushing.

I think, I did not give Lona full concentration when she was talking to me, I was using body language to communicate with someone else again, therefore, I failed to respect her thought [Perry, 1996].
Also, I realised that when interacting with Lona, the pace of my speaking was too fast, which I considered as a barrier that might make it difficult for her to process and comprehend what is being said [Miller & Nicholson, 1976], thinking this could left her confused because she can understand what I said due to the fact that she did not wear the hearing aid.
Furthermore, I felt empathy shown to Lona was not great, because empathy is one of the determinants of good communication, it allows you to understand the feelings and the needs of the other party (SelfGrowth.com, 2015).
I realised that Lona did not wear her hearing aid could be a barrier that can have impact big impact on her emotion as she might not hear me properly and she could not express herself properly. I made it difficult for her to understand my message by not taking her hear impairment into consideration before the start of the communication [William J Reynolds, 2000].
I felt guilty when I realised that Lona did not have her hearing aid on and I failed to check it before commencing the communication with her. Again, empathy shown to Lona was not great because she was left out as she might not hear me properly and she cannot communicate properly, she was not relaxed nor involved I supposed [Rushton, 1981].

SCENARIO 2
The second scenario was between me and a client called Sue – not the real name, with her personal hygiene. Sue is a young lady with Autism Spectrum Disorder [ASD] Disorder and Down syndrome disease who appeared to be distressed due to coming up of her mum death anniversary. Sue has slow ability to process information, she needed more time when talking to her to allow her process it. I approached Sue with a warmth by being genuine, I was able to comfort her with empathy. I demonstrated sincerity to show that I care, as I was aware of her feelings. I did not ignore her, and I put myself in her position, I was there for her to show her all the emotional support she needed, I did not criticise nor judge her for what she did. I did all these to make her feel valued, respected and supported.
I used question to obtain information from Sue, Skills You Need, 2014, recommends that, for a successful communication, questioning is the primary technique in gathering information. The essence of communication can not be over emphasis in nursing because it promotes therapeutic relationship in nursing which encourage client’s participation and give them sense of belonging and reassurance [Nursing Time.net, 2007]. I allowed Sue’s more involvement using more open questions so as not to make it difficult for her, on the other hand, I tried not to use any closed question in other not to get Sue confused.
At the end, because of my previous experience which I have learnt from, I am pretty sure my interaction with Sue was far better. I think, I displayed many communication skills which facilitates effectiveness and this is down to better understanding of the client condition [William J Reynolds, 2000].
Active listening and more time allowed helped to map out when Sue was struggling through her body language, but with patient and warmth support, I will consider the whole communication to be successful.

Conclusively, there is no doubt that communication play a significant role in delivery of good quality health care. Communication gives room for effective coordination and sharing of information among nurses, clients and other healthcare professionals. It is now concluded that through good communication skills, nurses can create a peaceful environment whereby the patient can feel safe, cared for, feel respected and also achieve a sense of control over their care. On my reflection, combined the two interaction I had with different patient, I have explored into communication skills which I acknowledged the needs for further improvement in my personal practice which I thought may affect healthcare delivery, more importantly the need to know and understand patient feeling, needs before interacting with them, control the pace of speaking to ensure they are communicated and comprehend, then build up therapeutic relationship will enhance successful communication flow. I therefore assured that these communication skills will be developed and put into practice in my nursing career.

REFERENCE:
Asselin M and Cullen A, 2011, Improving Practice Through Reflection, Nursing 2011, Volume 41 (4), pp 44-46
Bagay J, 2012, Self-Reflection in Nursing, Journal of Professional Nursing, 28 (2), pp 130-131

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