In 2006, a patient named Robin became pregnant. Within the 5th month of pregnancy, the individual began having trouble with diarrhoea and then developed a severe infection in her upper the respiratory system. Robin's obstetrician immediately hospitalized her and within 24, hours, Robin had a temperature of 105 degrees and was in preterm labour. Right before Christmas, Robin was diagnosed with Acute Viral Pneumonia. After getting permission from the doctor to go back home for Christmas, Robin was back at the hospital 15 days later because she was in preterm labour yet again. It was then that Robin was introduced to a gastroenterologist who diagnosed her with Crohn's Disease. Robin was immediately placed on medications to attempt to save her and her unborn child's lives. On 3rd February, Robin's contractions were five minutes apart but her deadline was the 17th of March. Robin came to a healthcare facility and within 1 hour, I performed an ultrasound on Robin, and then let her know that her unborn baby boy was no longer alive. Following the funeral of her son, Robin was identified as having Deep Vein Thrombosis (DVT) in her inner thigh.
Reflection: Interpersonal communication skills
Listening is an active and basic process that involves not only taking this content of the individual speaking by looking at their body gestures and listening to their words, but also being perceptive. Good listening skills are shown by attending behaviour that is practiced by establishing eye contact, maintain a relaxed posture and sending appropriate messages to the individual through gestures. Attending behaviour is effective in that it encourages the individual to verbalise their feelings and ideas freely. During listening, the nurse paraphrases what of the patient in fewer words in order to ensure that the nurse understood what the patient wants. Paraphrasing can be an important part of listening because it exposes and clarifies any mixed or double messages sent when the patient fails to make a direct statement. The 3rd part of listening is clarifying. Clarifying goes beyond paraphrasing with an intention of bringing vague material into sharper focus. Perception checking is a powerful part of ensuring accuracy of any communication because it is a way of giving and receiving feedback from the individual. When helping Robin, I could say that I needed effective listening skills. I made a point of hearing what Robin explained and I made sure that when she was talking, I made her feel comfortable and showed that I was considering what she was saying.
Leading is a communication skill that encourages the individual to respond within an open communication to be able to invite verbal expression. The helper slightly anticipates what the individual is thinking and where those thoughts are headed. In anticipating these thoughts, the nurse leads the patient to be able to stimulate the communication. Leading encourages the individual to retain primary responsibility for the direction of the communication and helps these to be active in the process. Leading also encourages the individual to explore and elaborate on the feelings. Among the tools found in leading is using open questions that may be answered by more than only a 'yes' or a 'no'. Choosing appropriate questions lead to clarification for the individual. Another tool found in leading is when you are indirect when leading the individual. Indirect leading keeps the duty of keeping the communication happening the individual. Indirect leading allows the patient to regulate the direction of the communication and protect their ideas. Direct leading on the other hand specifies a subject and the nurse uses recommendations to direct the individual. Direct leading is important in elaborating, clarifying and illustrating what the individual has been saying. In the case of a patient that has multiple problems or is vague, focussing is an important aspect that needs to be used in leading the communication. Focussing is a means that emphasizes over a certain idea or feeling and helps the individual get in touch with their feelings. I did not use leading skills when communicating with Robin which is an art I should in the foreseeable future. I'll enhance my skills in leading skills by using open questions that will encourage the patients to share their ideas and feelings freely.
Reflecting feelings, experience and content of the individual expresses that the nurse understands and wants to perceive the planet as the individual does. Reflecting the patients' feelings brings those feelings into clear awareness from the vague expressions that these were. Helping the patients to possess their feelings is performed by identifying both the obvious and subtle feelings that are hidden behind words. In reflecting experience, the nurse broadly observes the patient's verbalised feelings and their nonverbal feelings. Like paraphrasing, reflecting content involved repeating the essential ideas of the patient in fewer and fresher words. When the individual is having difficulty in expressing an idea, reflecting content helps the nurse to clarify those ideas. During communication, reflecting helps the patient to discover and express their feelings effectively. In communicating with Robin, I sounded monotonous and insincere as i began my reflection with saying, 'It seems you were very upset even after yelling for everyone to get out. ' In saying this I also said words that that Robin was unprepared for because they had too much depth of feeling. In future communication with patients, I should not learning much more interpretations into the statement than was intended, and I will use less monotonous words that sound sincere.
Confronting the patients is supposed to help them recognize what is going on or the particular nurse infers is certainly going on. A patient may feel threatened and anxious initially when they are confronted. However, the individual is also grateful for the honesty albeit direct expression that shows that the nurse cares. Confronting the patient presents feedback that is difficult to listen to, and therefore, the nurse should poses good timing to ensure that the individual is ready for honest feedback. Sometimes I think it is hard to confront patients. In Robin's case, I was finding it hard to comprehend and deal with her. I know that confronting the individual is one of the crucial skills that I have to poses. I have to recognize my feelings as the nurse and share those feelings with the individual. I must have the ability to involve myself in self-reflection as a form of confrontation. I think that by practicing, training and observing others, I could develop my confronting skills.
Using interpretation helps the individual to see their problems in new ways. Unlike paraphrasing where the patient's frame of reference is maintained, in interpreting, the nurse supplies the patient a new frame of reference. The nurse adds his or her own meaning to the patient's basic meaning. If the nurse adds to the basic message from the individual, and the individual understands the new idea, then communication is accelerated. Interpreting is useful in helping the individual get a broader perception their feelings. Interpretation is a communication skill that we used in combination with Robin. While speaking with Robin, she mentioned that she felt that the nurses around her were angels who lit her turn up in a period when she needed much encouragement. I told Robin that just how I saw it, she could join also turn into a nurse. Due to the Crohn's disease, Robin could only live a stress-free life. However, after living a healthcare facility, the initial thing that Robin did was to go to Upper Valley Joint Vocational School where she applied for pre-requisite classes in the Licensed Practical Nurses (LPNs) program. Robin graduated in November 2009 and has been working in the nursing profession since then.
The most significant thing a nurse can do for the patient is sharing simple facts. Informing is a communication skill that is integrated with giving advice. Under some circumstances, where advice giving will not foster dependency and it is not arrogant, giving advice are a good idea to the patient. Communication through informing provides patient a recommended course of action that the nurse has experience with. Through giving suggestions, the patient can decide the course of action that he or she will need. Crisis situations where in fact the patient must change to a readjustment in life are an appropriate situation for giving the patient advice. In Robin's case, after she had a stillbirth, I advised her to have her time with her son, Benjamin. I encouraged Robin to spend as enough time as she wanted holding the five pound fifteen ounce baby boy. Just as much as Robin didn't want to, I took pictures of robin and Benjamin for the memory album. I knew that that was the best albeit hardest thing robin had ever done.
Summarising skills involve watching what, how, why, when and the effect of what the individual said. After communicating with a patient, the nurse should try to gather all the ideas and feeling expressed in a single statement. Summarising is important for the reason that it gives the patient awareness of progress in exploring ides and feelings, problem solving and learning. In summarising, the communication ends in a natural note that clears a way for new ideas and clarifies scattered ideas. Patients also gain confidence in that the nurse was mindful of them throughout the conversation. The nurse can use summarising as a way to check the accuracy of the ideas and feelings which were communicated by the individual. When communicating with Robin, I did so not use summarising skills. In future communications, I will use the ideas from the patients to produce a summary of the statements made. Rather than making the summary myself, I could ask the patient in summary the themes, agreements and plans made during the communication.
Enablers and impediments to interpersonal communication
While communicating with Robin, the physical environment didn't pose as an obstacle. However, my discomfort as a nurse was an obstacle when communicating with Robin. This discomfort originated from death and dying in general. I handled this discomfort by thinking that it had not been my responsibility to talk to Robin about hospice care and prognosis. My desire to maintain positive thoughts in Robin and her parents was also an obstacle. I would defer discussions about Robin's possibility of a stillbirth until I felt that Robin and her parents could handle that conversation. In the future, I'll initiate communication on prognosis and hospice care without thinking it is too much trouble. I am going to also control fear that emerges after telling the patient bad news. The patient can also be an obstacle to effective communication when they're unwilling to accept prognosis or hospice care. This unwillingness that was evident in Robin's case is ascribed to her non-acceptance of her son's death and her diagnosis with Crohn's disease. In assisting with Robin's acceptance, I encouraged her by letting her know that I would be there to help her and listened to her. Because this worked well, I'll continue being an encouraging factor for future patients. Cultural and social issues didn't become an obstacle while I was communicating with Robin. During Christmas, Robin when home to celebrate the holiday with her family, and when she was admitted back a few days later, I gave Robin a Christmas present that facilitated communication.
Conclusion and recommendation
Nurses play an important role in communicating with patients because they are always in close contact. A nurse-patient relationship is improved by communication and as such, having effective communication skills is an essential aspect and a priority for each nurse. I have to develop my skills further in leading, confronting and summarising by participating in training activities. By participating in learning activities, I could develop strategies and find new skills as well as effectively employ those skills. Another strategy I will use is practicing key skills with actors and simulated patients because I will be in a position to control the nature and complexity of the duty. Lastly, I must use the communication skills acquired in practice.
