Giving comfort is a key nursing function and there are many different interpersonal and communication skills involved. While the spoken word can be very supportive, it is mostly the tone of speech that is soothing. Reassurance may therefore be less about what the nurse says and more about the way they say it. A soft or gentle voice, not demanding immediate decisions or in-depth answers, can be very comforting.
Using the person’s name or chosen form of address is important here too – it shows respect – letting the person know that they are the focus of attention.
Possibly more important, however, are non-verbal communication skills, such as active listening and the ability to recognize increasing tension and anxiety in oth- ers. An unhurried nurse with an open posture who shows genuine concern in her facial expression is obviously more likely to appear approachable and comforting to someone who is troubled than a busy nurse who seems tired and stressed herself.
Touch is another aspect of non-verbal communication that has a role in reassur- ance. Touch via a supportive hand on a shoulder or forearm may convey accep- tance, warmth and caring (Chang 2001). Sometimes the slightest touch can trigger an outpouring of emotion, and this may be of great benefit. It must be acknowl- edged, however, that not all people like being touched, so caution must be exer- cised. Usually it is possible to see by a person’s body language if this is the case (see Chapter 1).
Sometimes, the presence of a nurse is enough to help a distressed person. Com- fort, in such instances, comes from knowing there is another person to share their feelings with – someone they trust. Actions such as accompanying a patient to an- other department or perhaps just sitting next to them in companionable silence are very much appreciated.
In fact, knowing when to speak and when to be silent is a critical skill. Sometimes silence says more than words. Accepting and feeling comfortable with it may take experience, but it is important not to ‘jump in to fill the gaps’ when a person is trying to think something through or just needs time to be quiet.
If the patient is distressed, it may be tempting to try to find quick, easy solutions in an attempt to resolve their issues. Yet, wherever possible, the person should be encouraged to find their own solutions. The best communicators facilitate the patient’s own decision-making and problem-solving. Sadly, this may sometimes mean helping them to accept that there is not always an immediate solution.
Heron (1989) has devised a useful system for categorizing different types of inter- personal interventions that can be applied to the processes of giving comfort and support. This system is outlined in Table 2.3.
Table 2.3 Heron’s six categories of intervention AUTHORITATIVE INTERVENTIONS
1 Prescriptive – interventions that involve giving advice and direction 2 Informative – interventions about providing information
3 Confronting – interventions that challenge or raise the patient’s awareness of their own behaviours or attitudes
FACILITATIVE INTERVENTIONS
4 Cathartic – interventions that encourage the expression of emotions
5 Catalytic – interventions that encourage the patient to explore their own behaviours and thinking and ‘draw out’ insights
6 Supportive – interventions that seek to validate and affirm the worth of the patient and their qualities/actions
A final point: the most important thing nurses bring to work each day is them- selves. Being your ‘natural self’ or the ‘real you’ is the key to effective communica- tion. Rewarding relationships will nearly always be the result – a fine achievement for all concerned.
Conclusion
Nurses today work in an environment of ever more complex technology, rapid-pace treatments and increasing patient expectations. The need to possess and make use of a wide range of communication skills has never been greater. The skills discussed in this chapter are some of the most important ones to meet that need. From patient
assessment to the provision of comfort and reassurance, consistent messages are evolving and include:
r listening actively;
r observing carefully;
r generally speaking less than the patient;
r using empathy rather than sympathy to build relationships so that patients feel safe to discuss sensitive issues;
r understanding that patients’ relatives need care, reassurance and empathy;
r developing advocacy skills – a necessary component of a nurse’s communication skill set.
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3 Communication: the essence of care
Jayne Crow
This chapter considers how nurses communicate the dignity and respect that is the essence of healthcare and is the right of all service users in healthcare settings. Through the use of vignettes and examples it will encourage reflection on the attitudes, behaviour and situational influences that may compromise effec- tive communication of these values, and will seek to focus the reader’s attention on strategies to enhance this key aspect of care.
Learning outcomes
By the end of this chapter you should be able to:
1 Describe the interpersonal skills used in healthcare settings to convey dig- nity and respect to others.
2 Identify and reflect on the attitudes and situational factors that underpin treating people with dignity and respect in a healthcare setting.
3 Identify strategies for enhancing the dignity and respect afforded to people in a healthcare setting.
Introduction
What exactly are we trying to communicate in a healthcare setting? This will de- pend on the context in which we are working and our role within it. Perhaps it involves giving information, breaking news, asking or answering questions, mak- ing an agreement, trying to reassure, calm or motivate. The list is endless and each activity demands particular skills and strategies from practitioners. However, there is one underlying requirement for all communication engaged in by healthcare professionals: we must convey that we value the patient or carer as an individual person who deserves to be treated with dignity and respect. This must be achievable even in the most difficult and trying circumstances. It is what makes a professional health carer and is ‘the essence of care’.
Patient perspective
‘As you walk in the door of the hospital your dignity goes out of the window.’
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