Abstract

Communication is one of the essential factors to maintain a good quality of life because it allows humans to interact and provide comfort. In hospitals, the importance of communication becomes even more evident.  Therapeutic nurse-patient communication helps nurses to build positive relationships with patients by showing warmth, respect, and empathy.  In order to accomplish the effective communication and empower the patient, a nurse needs to identify and be aware of the patient’s physical, psychological, or social barriers.  Communication skills may be useful to overcome the barriers that inhibit nurses from building healthy patient-nurse relationship.

            Keywords: Therapeutic communication, nurse-patient relationship

I.          Introduction 

Overview of issue:

          Communication is one of the essential factors to maintain a good quality of life because it allows humans to interact and to provide comfort.  Communication includes verbal and nonverbal.  During verbal communication, there are many factors that affect the choice of words.  For example, age, race, socioeconomic status, education background, gender, place, and situation are the factors.  Nonverbal communication includes body language, facial expressions, and active listening.  The ability to classify information in ways that can be understood by self and others would be severely impaired if spoken languages were not used (Arnold&Boggs, 1999).  In hospitals, the importance of communication becomes even more evident.  Not only a lot of information is given and understood by communicating, but also a patient’s needs and feelings are mostly learned through communication.  Therefore, therapeutic communication is as important as knowledge, evidence based practice, and so on. But, often significance of therapeutic communication is forgotten.  So, the importance of effective communication should be thoroughly discussed and learned.

Importance in professional practice:

          Therapeutic nurse-patient communication helps nurses to build positive relationships with patients by showing warmth, respect, and empathy.  It also increases confidence of the nurse by enabling nurses to ask for support, open up for feedbacks, and overcome anxiety.  Therefore allows nurses to provide the best possible care for patients.  Effective nurse-healthcare provider communications assure optimal patient-centered care (Ashurst & Taylor, 2010).

Application to a patient scenario:

          BD, 85 years old male, was admitted from a nursing home with complaint of short of breath and a change in mental status.  When I assessed BD, his mental status was stabilized.  However, he was very demanding and wanted to get things done in his own way.  BD’s nurse and LNA seemed very agitated with him and did not want to communicate with him unless it was necessary.  It was a good time for me to learn how to deal with a difficult nurse-patient relationship.  However, I believe that even if a patient may be difficult to have pleasant interactions with, a nurse should never abandon or avoid communicating with the patient.

          BC, 72 years old diabetic female, was admitted with CHF.  She was a very pleasant lady, and I assumed she would not have any frustration or depression with her health and life.  However, while I was talking to her, she said “I don’t want to bug anyone, and I just want to die soon.”  I was very surprised, and at first I did not know what to say to her.  But then I asked her what made her to think that she would be “bugging” anyone and why would she want to die soon.  She told her frustration of limited mobility and not being able to do activities she enjoys.  I told her she will get better and held her hand.  However, I did not know if saying ‘you will get better’ would be a false hope and not an appropriate therapeutic communication.

     ND was admitted due to CHF and headache.  When I assessed her, I heard crackles on her base of lungs and her pain was 6 out of 10.  I notified her nurse to give the prn pain medication, but she was too busy to give the medication.  My patient hesitated with asking for the pain medication again because she felt it would be too demanding.  The nurse seemed distracted with other issues and was very stressed out, so she failed to meet my patient’s needs.  She finally did ask for the medication, but the nurse came back about 30 minutes later.  I wish I could have spoken up for my patient, but because I am a nursing student, it was hard for me to step up and talk to the nurse.  There are many barriers that distract nurses from providing better care for patients.  In this situation, stress and overload of work made the nurse draw attention away from my patient.  In addition, I believe if a nurse properly communicated with other healthcare providers and patients, positive outcomes, such as faster patient’s optimal physical and psychological health/wellness achievement, would more likely to be produced.

 

II.      Discussion/analysis of findings from your reading of the literature

Barriers

          According to Weaver (2010), in order to accomplish the effective communication and empower the patient, a nurse needs to identify and be aware of the patient’s physical, psychological, or social barriers.  Within patients, physical barriers may include sensory impairment and environment issues.  Psychological barriers could include personality or disability.  Social barriers include cultural values, religious beliefs, socio-economic status, and so on.  While nonverbal communication is almost similar among any country, verbal communication depends on cultural tradition, religious values, geographic location, and so on.  Nurses may have conflicting values, commitments, and lack of value that would affect communication, therefore leading to a failure of accomplishing patient-nurse relationship (Arnold &Boggs, 1999).

          Furthermore, nurses who participated in Sheldon, Barrett, and Ellington’s (2006) research reported the difficulties in communicating specific diagnoses and clinical situations, patient and family emotions, nurses’ emotions, triangle of nurse-physician-patient communication, and nurse coping behaviors with difficult communication.  They felt they were not educated enough to communicate with patients in difficult situations.  Therefore, education to improve communication skill is needed.

Improving Communication Skills

Communication skills may be useful to overcome the barriers that inhibit nurses from building healthy patient-nurse relationship.  The research done by Duxbury and Whittington (2005) found that while nurses thought the environmental condition and the patient’s mental illness precipitated the patient’s aggression, the patient perceived the environmental condition and poor communication as the aggression precursor.  According to Robinson and Watters (2010), communication skills can be attained and improved through practice.  Effective therapeutic communication skills gather or transmit information successfully and promote healing and recovery of the patient.  Active listening is required since hearing without actually listening may cause a problem (Jasmine, 2009).  Listening allows nurses to gain essential information, to understand patients, and to provide better care.  Egan (1990) suggested the proper body position that would help a person to effectively engage in conversation: sit squarely in relation to the client, lean slightly towards the patient, maintain open position, make reasonable eye contact, and relax.

In addition, communication should be taken in place with minimal distraction.  For example, drawing curtains and moving a patient to a private counseling room would provide less distraction.  However, changing to a quiet room may be difficult in real clinical setting due to lack of room availability or a patient’s immobility. (Jasmine, 2009)  Furthermore, patients may need some encouragement and trust needs to be established to communicate their feelings and concerns to the nurse.  Encouragement can be done through using touch, humor, and tears.

Among various communication skills, exploring is another essential skill, and “it largely involves the use of effective questioning techniques to probe deeper into the issues concerning a patient” (Jasmine, 2009).  For the better therapeutic communication, open-ended questions can be used to assist the patient to discuss and clarify what he or she is thinking, concerning, and feeling.  Then, paraphrasing conversations helps nurses to repeat and reinterpret what has been said during communication (Jones, 2009).

The communicator needs to be assertive and responsive.  In order to be assertive, one needs to have competent knowledge, confidence, and “ability to start, continue, and stop conversations” (Schuster, 2000).  Brunero and Lamont’s research showed that the e-learning package reduced stress and increased knowledge, skill, and confidence of nurses in managing the difficult nurse-patient relationship (2010).  The e-learning package used scenario based learning method.  According to the authors, it is not only cost-effective, but also easily accessible.  Moreover, a nurse educator, clinical nurse specialist, and registered nurses contributed in expanding and developing the scenario to maximize its purpose. Improvement of difficult Patient Stress Scale (DPSS) total, confidence, skill, and knowledge were statistically significant.  According to the authors, the e-learning package should be implemented and developed more since it had positive outcome, which delivers better care to patients and reduces stress.  The scenario and problem based e-learning package could improve communication skills and difficult nurse-patient relationship because the nurse has more knowledge, skill, and confidence.  As a result, patients may receive optimal care from the nurse.

III.     Summary, Conclusion and next steps based on the literature. 

          There are many barriers that disrupt therapeutic communication.  Based on my findings, I need to carefully assess at my patient’s culture, religion, education background, socio-economic status, and so on before I see my patient.  Comprehensive assessment will help me to find out what my patient’s needs are.  Moreover, I would be able to resolve barriers and to respect my patient’s beliefs.  Furthermore, I am going to carefully observe my patient’s nonverbal cues, such as facial expression, voice tone, body language, and so on to make sure if he or she has any distress or issue.  Also, when my patient wants to discuss his or her concern, or if I notice something different with my patient, I will stop what I am doing, sit down, listen, and solve the problem with the patient.  Then, I will continuously evaluate the progress until the goal is achieved.

IV.     Epilogue/reflection/learning/so what

I believe communication could represent the aesthetic part of nursing.  How I artistically present myself and communicate with my patient could influence healing processes.  Based on the literatures I reviewed, I learned to practice and focus on communicating with patients and building therapeutic relationship with my patient.  Since communication assures healthy nurse-patient relationship and promotes healing process, I will focus on the whole person rather than disease or tasks.

I learned to use appropriate therapeutic communication techniques according to the situation.  For example, making observation, asking opened question, offering self, encouraging, accepting, using silence, focusing, exploring, and so on can be used when my patient is having a difficult time or when I need to get to know about my patient.  In addition, I should never reject, tell patient what to do without discussion, ask too many questions, make stereotyped or unrelated comments, or interrupt my patient while communicating.

References

Arnold, E & Boggs, K. (1999). Interpersonal Relationships: Professional Communication Skills for Nurses. Philadelphia, PA: W.B. Saunders Company.

Ashurst, A & Taylor, S. (2010). Communication, communication, communication. Nursing & Residential Care, 12(3), 140-142. Retrieved from CINAHL Plus with Full Text database.

Brunero, S., & Lamont, S. (2010). The ‘difficult’ nurse-patient relationship: development and evaluation of an e-learning package. Contemporary Nurse: A Journal for the Australian Nursing Profession, 35(2), 136-146. Retrieved from CINAHL Plus with Full Text database.

Duxbury, J., & Whittington, R. (2005). Causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing, 50(5), 469-478. Retrieved from EBSCOhost.

Egan G. (1990). The Skilled Helper: A systematic approach to effective helping. Brookes/Cole, California

Jasmine, T. (2009). The use of effective therapeutic communication skills in nursing practice. Singapore Nursing Journal, 36(1), 35. Retrieved from EBSCOhost.

Jones, L. (2009). The healing relationship. Nursing Standard, 24(3), 64. Retrieved from EBSCOhost.

Robinson, K., & Watters, S. (2010). Bridging the communication gap through implementation of a patient navigator program. Pennsylvania Nurse, 65(2), 19-21. Retrieved from EBSCOhost.

Schuster, P. (2000). Communication: The Key to the Therapeutic Relationship. Philadelphi,PA: F.A. Davis

Sheldon, L., Barrett, R., & Ellington, L. (2006). Difficult communication in nursing. Journal of Nursing Scholarship, 38(2), 141-147. Retrieved from EBSCOhost.

Weaver, D. (2010). Communication and language needs. Nursing & Residential Care, 12(2), 60-63. Retrieved from EBSCOhost.

 

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