From there, Jackie moved full-time into primary care education and also became involved with the East of England Deanery working as an Associate Director of Nursing as part of the multi-professional team. Her professional interests include the sociology of risk, public health and the development of new roles in the NHS.
Preface
Acknowledgements
Learning outcomes
Introduction
Terminology: assessment or consultation?
The term "assessment" is used so often in health care that it's easy to assume that everyone understands it the same way—an assumption far from the truth. Different models can be adopted and these affect not only the type of information collected, but also the manner in which it is collected.
Modes of communication
It is important to consider what the patient's words and body language are really saying and listen to the response. In summary, it is important for the nurse to understand that communication consists of sending messages between the patient and the healthcare professional.
Consulting effectively with patients
The listener should provide nonverbal messages that encourage the patient to share while feeling safe and cared for. The patient also needs to know that the listener will not judge and will be honest.
Using a model or framework for patient assessment
During listening, the information received must be processed, sorted and used to plan the next step of the interaction demonstrating that the patient has the listener's full attention. We need to assess the patient's level of dependence at each AL in order to set goals to help toward independence or acceptance of dependence.
Other models
Patient Communication Skills (Silverman et al. 2005) provides further details about individual communication skills. Subsequent chapters of this book will help the student build on this basic introduction.
Building relationships
Switch roles and try different ways of playing the nurse to see how it changes the patient's behavior and the way the nurse feels. It is usually better to use the patient's own words, to keep language simple and concise.
Providing structure
However, it is also very important to understand how the patient sees what is happening. The nurse should explain to the patient what the examination involves and obtain the patient's consent.
Conclusion
It is also very helpful for the patient to provide clearly written evidence-based information. Encouraging the patient to read the information and note any questions or concerns to discuss during a return visit is not only reassuring to the patient, but also helps build rapport.
Uys (ed) The nursing process: A global concept. 1990) Nursing in transition: an analysis of the state of the art in relation to the practice conditions and society's expectations, Journal of Advanced Nursing, 15:.
Appendix
Gathering Information
Explanation and planning with patient What the patient is told Plan of action is negotiated. It is essential to develop and refine communication skills when working with adult patients in sensitive situations.
Patient assessment: a holistic approach
However, it is important to be aware that becoming a patient can be a stressful experience and that not everyone will react in a mature way. However, the focus is not only on health and medical problems – we are also concerned with broader issues and often sensitive ones, in terms of how a person lives their life, their wishes and goals.
Empathy and sympathy
Without being invasive, the goal is to address the patient's "total" physical, psychological, and social well-being—to achieve a holistic assessment. As you approach, you notice that the patient's arms are folded and they look very angry.
Dealing with sensitive issues
In patient assessment, empathy is necessary because it allows the nurse to understand the patient's perspective and get a feel for their world (Egan 2002; McCabe and Timmins 2006). Careful observation and listening usually gives a signal that a topic is difficult territory for the patient.
Breaking bad news
On the other hand, however, nurses should avoid situations where patient information is discussed away from the patient or without the patient's consent. In other words, listen to the patient's wishes, as patient needs vary widely.
Communicating with people for whom English is not their first language
The aim is to put the patient (not just the translator) at ease (see Chapter 6). Both the patient and the healthcare professional need to know the exact role and capabilities of the person supporting the patient, whether they are a professional or a family member.
Advocacy
At some point, the exact nature of Angela's injuries will have to be communicated to Monique. Angela's mother is distraught; she cried and waved her arms in a state of shock.
Providing comfort and reassurance
3 Coping – interventions that challenge or increase the patient's awareness of their behaviors or attitudes. 6 Supportive – interventions aimed at validating and affirming the value of the patient and his/her qualities/actions.
Communicating dignity and respect in healthcare
What do we mean when we talk about ‘dignity and respect’?
The elements of care listed above are clearly reflected in the Code, which states: 'The people in your care must be able to trust you with their health and well-being. To justify that trust, you must make the care of people your first concern, treat them as individuals and respect their dignity'.
Communicating dignity and respect verbally and non-verbally
Nonverbal communication skills that express active listening are discussed in more detail in Chapter 2. It is essential that nurses develop the skills to assess their own non-verbal communication.
Threats to good communication
The importance of empathy
This indicates to Mrs. Garcia that she is a nuisance and not really important enough to warrant disturbing the nurse. Identify the ways in which the nurse's behavior in this vignette shows a lack of respect and dignity for Mr. McKay.
Respecting personal space, privacy and confidentiality
However, consent to do so must be sought from the patient on each occasion. What steps would you take to protect the patient's privacy and modesty in the following situations?
Humour in communication dignity and respect
In the above examples, it is clear that securing privacy often depends on communication both with colleagues and the patient. Therefore, being sensitive to the verbal and non-verbal cues they offer is the only answer, and taking the lead from the patient is safest when assessing whether humor is appropriate.
Stereotyping and labelling: the enemies of dignity and respect
There are no hard and fast rules for using humor to communicate dignity and respect, but it is wise to be careful and gentle with humor. If part of being treated with dignity is to be treated as an individual, the opposite can be achieved by acting on the assumptions that come with stereotyping and labeling.
Communicating using technology
Synchronous and asynchronous communication
It may not be possible to provide an immediate response if one party needs to consult with a third party. Telephone calls may be recorded (eg NHS Direct) but this may not be routine, affecting the accuracy of record keeping.
Commonly-used technologies The telephone
Many nurses are now equipped with mobile devices to aid communication in the work context. If you receive a rude or angry email, wait a while before responding to avoid reacting in the heat of the moment.
Selecting an appropriate medium to communicate
The Data Protection Act (1998) affects the use of computers and the management of the information stored on them. To extend this further, the “who” aspect requires attention to the details of the communication.
NHS Connecting for Health
Electronic prescribing allows prescribers to send prescriptions electronically to a pharmacy of the patient's choice, making the system safer and more convenient. For patients, it means a shorter journey, as they will go directly to the pharmacy to get their prescription, and this system can also reduce waiting times at the pharmacy.
Telemedicine
This chapter has explored a range of issues relating to the use of IT in healthcare and encouraged nurses to consider the following issues. University of Liverpool (2009) Guidelines for the Effective Use of Email, www.liv.ac.uk/csd/.
5 Effective communication in teams
The vignette in this chapter illustrates the complex nature of the patients referred to in this policy.
Interprofessional teams
Pearl also has decreased mobility and has great difficulty moving between a chair and a bed. It has a care package that includes four visits a day to maintain personal hygiene, manage continence problems, prepare food and feed.
Joining a team
Due to the urgency of the situation, the team quickly came together; there was no time to plan the formation of this team. In this phase, team members must feel accepted and play a role within the team.
How do teams function?
Practical solutions to this problem may include the student actively engaging with the team they want to join before their placement. At all times throughout the process, Pearl should also be recognized as part of the team and should be involved in decisions about her care.
Communication within teams
The group is specific to the project:. skills within the team reflect the needs of the patient. However, it clearly shows collaboration/communication between health care professionals and agencies to provide a. seamless service' as proposed by the NHS Plan.
Giving and receiving feedback
Lucia is a 75-year-old lady with bilateral leg ulcers who have not responded to treatment. At the next visit, the community nurse reads the notes but is unable to implement the changes as the dressings have not been requested.
Team member roles and attributes
Managers must also ensure that their teams communicate effectively; If a manager has poor communication skills, this can be reflected in the team's ability to communicate effectively. As a result, managers can be described as functioning outside the team, while team leaders are seen as functioning within the team.
Working in teams
Pre-registered students will be part of a number of teams and must recognize that the nature of the team will reflect the task/goal they are to achieve. In Pearl's case, the team caring for her is best reflected in the client team: the team met but disbanded when Pearl was discharged.
Hierarchies
Tribalism
Tribalism is defined as "the state of existing as a separate tribe" and has been identified as a major barrier to integrated and collective working within the NHS (Van Der Weyden 2006). Vera's husband said of the above: “The fact that Naresh can prescribe means we don't have to wait for an appointment after the weekend, nor do we have to call the GP over the weekend, Vera can start taking her pills straight away. away.'.
What is learning disability?
Rosie is a 32-year-old woman with Down syndrome and lives at home with her 70-year-old mother. However, over the past year, Rosie's behavior has become more challenging and she has begun to self-harm by hitting the sides of her face with her hand.
Healthcare and people with a learning disability
Autism
Communicating with people with learning disabilities
Confusing displays of challenging behavior can be difficult to interpret, even for the most experienced caregiver or professional. Along with listening, it is essential to use observation skills as sometimes people may respond in one way verbally, but their body language may tell you something different.
Sign language
There may be simple solutions such as needing the toilet, a drink, a favorite toy, feeling too hot or cold, or anxiety about a new person; or more complex interventions may be required. This is particularly evident with people who have learning disabilities and the way they behave and express themselves.
Service provision
Cultural influences
Even when English is spoken fluently, accents, dialects, euphemisms, colloquialisms, abbreviations, and acronyms (see Chapter 3) can obscure understanding to the point where the patient may be disappointed, alienated, or worse, their healthcare may be compromised.
Physical disability
The nurses tell him not to disturb the other patients and give him paracetamol. The nurses laugh at Fred and tell him that he sounds like a woman in labor and to stop making such a fuss.
Older people
Furthermore, you may have noted the lack of dignity, respect and compassion afforded to Fred, while he is completely disempowered in the hospital environment. You may have been surprised to find how fit and active some older people are.
Sensory deprivation
Barriers to good communication are often related to the person on the receiving end of the communication rather than the author of the communication. People on the receiving end need to be alert, aware, alert, with the right attitude and ability to respond appropriately.
Environmental influences
A nurse notices Bob parked in a corner with his hands covering his face and assumes he is being ignored and left out, so the nurse decides to move Bob to the other side of the bed, closer to other people. Upon observation, it may appear that Bob is being ignored and left out, but attempts to bring him into the center of the room to socialize result in extreme arousal.
Attribution theory
On arrival I was taken to the waiting room, but no one seemed to know what was going on. This went much better than when I saw one of the other partners who called the reception and you had to find your own way to the consultation room.
Reflection and critical incident analyses
To him, Derek is a stranger, and Derek's touch of his hand and proximity to his body invaded George's personal space and was likely interpreted as an attack. The lessons learned from what went wrong can be used to better manage George's behavior in the future and address how staff are deployed to care for him.
Empowerment
She may have been authoritarian in her communication and 'told' Mrs Templeman instead of asking her. Aapti's approach may have led to a parent-child interaction instead of an adult-adult approach.
Ego defence mechanisms
The client may have underlying issues related to her past care and past experience that make her reluctant to bathe, or she may have reacted to Aapti's parental approach by taking on the role of the child in the interaction. However, Aapti's approach could have used adult mode, but Ms. Templeman's reaction could still be that of a child.
Conflict resolution
The second action should be to separate the protagonists, but to take into account the fact that both individuals need support. Bowie (1996) suggests that using touch at the right time is calming and helpful for fearful clients, but must be culturally appropriate.
Working with colleagues
In an emergency assessment unit scenario, this is a priority because of a possible underlying medical problem. If Georgina asks the lecturer to deal with the situation, it is not easy either.
Negotiation and conflict resolution
If anyone in the group feels that a solution cannot be found, the meeting may fail. The other outcome of the meeting may be the inability to resolve the conflict within the group, and this should be considered as a possible outcome.
Preventing a situation arising in the first place
At the beginning of the meeting, the mediator will remind everyone of the reasons for meeting and negotiate the establishment of rules of the game with the participants. The recording of minutes and summary decisions made at the end of the meeting allow individuals to agree or clarify any misunderstandings.
Assertiveness skills
In this case, Michael is doing his best to meet with his tutor to address his learning needs. He can understand why the tutor could not meet with him, but further delays will affect his learning in the clinical setting.
Mentor responsibilities
NMC (Nursing and Midwifery Council) (2006) Standards to Support Learning and Assessment in Practice, www.nmc-uk.org/aDisplayDocument.aspx?documentID=1914 (accessed 12 April 2009). Self-awareness is critical to effective learning, teaching and communication; it illuminates our potential to learn and communicate and the limitations we might want to overcome.
Communication at the heart of learning and teaching
Learning and teaching is a transactional task in which information, ideas and experiences are exchanged. If the exchange can be further developed into an exploration, learning and teaching can be a collective meaning-making process.
The learning environment
The service user is a central part of the model as it provides a key site for the student's direct learning and is also the focus of the theoretical teaching that takes place at the university. To illustrate aspects of the relationship between university and practice, consider a patient who has become a case study for you.
Understanding yourself as a learner
Consider the complexity of the learning environment and how personal values and attitudes can influence relationships. In the case of Alexa, consider the complexity of the learning environment and the range of values and attitudes that learners, service users and practitioners bring to the environment.
Identifying learning opportunities
This type of learning opportunity can also be managed as an observation of the student's practice (without mentor talk, unless the practice is unsafe). Consider, for example, the implications of the patient experience on the perspective of the future patient.
Developing reflective practice
One or more of the questions may be useful; none carry more weight than others and practitioners may find it useful to 'play' with them. Very often our reflective processes are not explicit to us, but are part of the 'hot action' (Beckett and Hager 2002: 23) of the practical experience as it unfolds.
Presenting your learning
Effective reflective practitioners need to listen, observe, and take notes on the things that catch their attention so that they can return to them later for more research, consider the perspectives of others, and ask curious questions about how things are known and how things are. To understand and learn from this raw data, we must: r recognize that learning and teaching is an ongoing interaction between students, teachers and service users, which requires us to open ourselves to dialogue with others; r recognize the complexity of the learning environment and strive to build constructive relationships with others who may think differently from us; r take a holistic and authentic approach to communicating with others so that we can listen and be open to the exploration of new, or even 'tried' ideas; r taking advantage of learning opportunities wherever they arise and seeking them respectfully through purposeful negotiations with education teams and service users; r develop our capacity as reflective learners and practitioners, seeking to improve or change our personal performance, or that of the collective.
What is ethics?
As the latter author notes, these two principles indicate that it is possible to assess the quality of any decision or action in terms of the benefit or harm that results from it. As noted, one author, Englehardt (2001), has written about the importance of the ethical dimension of interpersonal communication.
Ethical issues in non-verbal communication
On one level, she is not on time and ready for work, and she will probably be able to complete her work in a satisfactory manner, even if it seems rather sloppy. One of the passengers later noted that passengers expect flight attendants to be able to reassure them in such situations rather than cause uncertainty and panic (Hickman 2006).
Ethical issues in verbal communication
Alternatively, we could argue that this approach, although open, seems brutally honest and that it is legitimate to ask whether Joyce gains anything as a result of the disclosure. On that basis, we can argue that disclosing the fact of the mistake would do little good for Joyce, and furthermore she would suffer no harm if she did not know the truth.
More issues in disclosure
If she is subsequently told that she needs further examination because of a suspected tumor, she may assume (accurately) that the nursing staff has not been entirely fair to her. This example also illustrates how important it is to be aware of the meaning of the question and not just the literal meaning of the words.
Consent
She had not been seen by any of the health service personnel in the area before. On a superficial level the answer would be yes, but for the treatment to succeed we must enlist the cooperation of the patient.
Written communication
The technical superiority of the treatment takes on a different appearance when the full effect is outlined. The incident is something that others involved in the care of the patient need to know.
Confidentiality
Let's look again at the incident mentioned in the vignette on page 147, where a patient was accidentally given the wrong dose of the correct medicine. However, in the context of nursing practice, for most purposes we can rely on implied consent to share information with others involved in the patient's care on a need-to-know basis.
Afterword
Further reading
Useful resources
Index
Edited by Sarah Kraszewski and Dr Abayomi McEwen