Ordinary to extraordinary: skilled communication in nursing

Megan Blinn and Helen Noble

Queens University Belfast, Northern Ireland.

Communication is generally acknowledged as essential to nursing practice and managing clinical situations in challenging clinical environments, working within a system that serves increasing numbers of people with complex health needs using static or dwindling resources. There are many definitions of communication in the nursing literature. Riley defines communication as “a reciprocal process…between two or more people” (Riley 2012, p.3) and Petrie considers it “information which people send out to and receive from each other…” (Petrie 2011, p.17). Communication, therefore, refers to both a process and a product. The product may be verbal, non-verbal, written or electronic and the process must have as its goal a common understanding of the message that is sent and received in order to contribute to safe and effective care. Good communication is an advanced skill that develops from the innate human desire to relate to others. In order to achieve high level communication, a nurse requires self-awareness, willingness to listen, insight into other people’s needs and responses, and the ability to think logically and choose the most appropriate words at the right time. Communication barriers may be present in the nurse or the other persons with whom she communicates. In clinical settings, these barriers range from unchangeable attributes, for example, permanent cognitive deficits, to malleable ones such as differing languages, reduced consciousness or temporary inattention and an attempt to remove barriers or ameliorate their effects while managing clinical care is paramount.

Patient care is the ultimate function of clinical nursing and communication is the foundation of the nurse-patient relationship should be “open, honest and transparent” and suited to the needs and abilities of the patient or client with whom the nurse interacts. When nurses practise patient-centred communication, they are fulfilling the expectations of patients, regulatory bodies, and government. Where the communication is substandard, the management of patient care and outcomes are poorer In the recent investigation of care in the Mid Staffordshire National Health Service (NHS) Foundation Trust, poor communication played a part in almost every aspect of systemic failure (Francis, 2013). Though nurses were not solely at fault for these failures, nurses who fail to use communication and interpersonal skills appropriately are likely to fail patients who need high quality care and advocacy in hospitals struggling to serve them.

Though respect for and the duty of care to patients may encourage nurses to communicate well, respect for individuals should also underpin team interaction. Creating a work environment that encourages open communication contributes to a sense of well-being for nurses and can empower, build trust and improve clinical care. Unfortunately, many nurses work within systems where professional hierarchies might influence the way members of the healthcare team view one another; indeed, even those writing about the issue continue to use terms like “lower status health professionals” (Nembhard et al., 2011, p. 26), while critiquing problems arising when doctors, nurses and unregistered staff work together.

As stated, nursing is predicated on a helping relationship between two people but modern healthcare systems require a team of nurses working together within a multidisciplinary group to provide care for their patient or client. The responsibility for team functioning, and, ultimately for effective patient care, is divided between the organisation and the individuals within it. The organisation must be responsive to economic contingencies, service user needs, and the needs of the healthcare professionals. Nurses and other individual healthcare professionals must take responsibility for skills development which includes checking individual values, attitudes and beliefs that influence their practice and communication within and beyond their working team. It is beyond the scope of this assignment to look in detail at the deeper aspects of values, attitudes, beliefs and their impact on organisational culture but as the basis for individual actions they must be acknowledged.   Teams in contemporary clinical settings have not time to fully explore the emotional and psychological underpinnings for individual communications; however, every member of a team has a responsibility to acknowledge that each person, whether patient or nurse, has an inner experience that informs how they perceive clinical interactions and communication. Each person must ensure that they participate in assertive and open communication that enables teamwork and quality care for patients.

Communication is the ordinary human behaviour that may become the extraordinary skill employed by a nurse in the clinical setting to manage safe, effective, respectful care for every patient. Compassionate and respectful communication can also serve the team in which the nurse works by contributing to collaboration. Each nurse has a responsibility to develop communication skills alongside other clinical skills in order to meet professional requirements, serve patients and work with colleagues through the challenges of contemporary healthcare.

References

Francis QC, R. (2013) Report of the Mid Staffordshire NHS foundation trust public inquiry executive summary. London: HMSO. Available at: http://www.midstaffspublicinquiry.com/sites/default/files/report/Executive%20summary.pdf (Accessed: 13 November 2014).

Nembhard, I., Alexander, J., Hoff, T. and Ramanujam, R. (2009) ‘Why Does the Quality of Health Care Continue to Lag? Insights from Management

Research.’, Academy of Management Perspectives, 23(1), pp. 24–42.

Petrie, P. (2011) Communication skills for working with children and young people: introducing social pedagogy. 3rd edn. London: Jessica Kingsley Publishers.

Riley, J.B. (2012) Communication in nursing, 7th edn., St. Louis: Mosby-Elsevier.

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