Communication in Nursing
Introduction (500)
The excellence of communication between healthcare professionals and patients plays a significant role in boosting patient outcomes. The role that communication plays can promote such aspects of patient care as health, education, compliance with prescriptions, and satisfaction (Silverman, Kurtz, & Draper, 2005, cited in O’Hagan et al. 2014). Effective communication skills are a crucial facet of patient care given that nurses have an essential role in meeting patients’ communication needs (Candlin & Candlin, 2003). To support the successful communication skills of the nursing staff, a superior understanding of useful nursing communication is requisite.
Indeed, effective communication is essential if quality and safety are to be achieved in healthcare (Kourkouta & Papathanasiou, 2014, cited in Henderson, Barker, & Mak, 2016). Henderson, Barker, and Mak (2016) argue that not should communication behavior be of high quality, but also transferable to facilitate collaboration between nursing staff including nurse students, in varied circumstances and cultures. Sealey, Burnett, and Johnson (2006) assert that knowledge of the differences in foundational values offers the premises for intercultural communication in clinical practice. Intercultural communication is “a communication that occurs where cultural differences between the relevant individuals affect the communication exchange in ways which would have been insignificant had those differences not existed” (Arasaratnam, 2012, p. 136). Based on Arasaratnam (2012), people who share cultural beliefs and principles communicate with each other within the context of common assumptions, while people from diverse cultures do not share assumptions which is often a likely source of misunderstandings. Therefore, having significant knowledge of a range of cultures mitigates the tendencies of clinicians toward stereotyping (Jeong et al., 2011). Various research studies have investigated the communication skills of nurse students within the context of diverse cultures. Taylor et al. (2011) found that students and professionals alike did not perceive that they did not have adequate practical experience in solving cultural issues in a safe learning environment. Similarly, Plaza del Pino et al. (2013) identified language barriers, prejudices, and social stereotyping as major challenges hindering the provision of appropriate care.
Henderson et al. (2016) argue that linguistically and culturally diverse students can face challenges in negotiating expectations of the clinical setting. The difference in cultural values is often a source of misinterpretation of students’ and clinicians’ activities. For instance, a student from a culture in which leaders are not questioned may be judged from a Western perspective as unassertive and lacking in initiative (Barker & Mak, 2013). Conversely, questioning and critiquing leaders may be perceived as rude and having poor attitudes from the viewpoint of a culture that esteems respect for seniors. The stress of clinical learning settings and classrooms can increase such cultural differences (Hunter Scheele et al., 2011).
Besides cultural and linguistic orientations, confidentiality is an equally important issue in nursing communication. In fact, preserving the confidentiality and privacy of patients has constituted an ethical mandate for nurses (American Nurse Association, 2001 cited in McCullough & Schell-Chaple, 2013). According to McCullough and Schell-Chaple (2013), navigating the nuances of information about patients to share and with whom at the same time while keeping patients’ significant others informed of the development regarding caring for their loved ones always has confounded nurses, especially students. This essay patchwork describing my experience in a culturally diverse healthcare setting, highlighting the challenges I experience in communicating with colleagues and nurse facilitators. It describes my Strengths, Needs Opportunities, and Barriers (SNOB), and gives three specific experiences during my placement with a local hospital.
SNOB Analysis
Strengths
I have previously worked as an accountant, which means that I have good mathematical skills. I also have care experience working in a nursing home for 9 years. In addition, I have good communication skills and I am comfortable talking with patients besides enjoying caring for them.
Needs
As a nurse student, I need to improve my communication skills with patients, and professional workers including doctors, nurses, and other healthcare practitioners. I particularly need to improve my interpersonal skills with regard to patients and professionals of different cultural and linguistic orientations. My needs were also reflected in the study conducted by … my needs were typical of nurse students. I needed to master clinical skills for adequate nursing practice and adjust to nursing practice at the hospital. These needs relate to the challenges I faced.
Opportunities
My placement in the hospital presented many opportunities for my development as a nurse. Specifically, I met with new professional nurses who have many years of experience in my specific area of nursing. These people are qualified and I was privileged to have a few as my mentors in helping me horn my practice skills. They particularly helped me improve my communication skills: how I communicate to and with patients, my colleagues, and my leaders, including those with administrative mandates. The experienced nurses taught me how to interact with people from different cultures and linguistic. I learned that respect for other peoples’ values and beliefs is pivotal to effective communication with and to them. Brislin and Cushner (1997) stressed respect as a critical principle of communication with people of different cultural, religious, and linguistic orientations.
Barriers
During my attachment at the hospital in Wales, I encountered many barriers, the main one being the inability to speak and understand Welsh. I could not maintain communication with the local patients who came for appointments at the hospital past mere greetings. Therefore, I easily lost confidence when addressed by patients and nurses, as well as other healthcare professionals, especially physicians. The other challenge that experienced in the attachment was the lack of adequate access to facilitator nurses one of whom volunteered to mentor me through the attachment. Ball and Pike (2005) observed that lack of time coupled with the pressure of competing clinical responsibilities could hinder mentors from coaching nursing students. I experienced difficulties becoming part of the different teams I was assigned. This particular challenge was attributed to the language barrier, as I lacked confidence in talking with my teammates. Therefore, I isolated myself most of the time, which my colleagues depending on their culture judged as submissive and primitive. Some of them even bullied me, so I felt cut out from the team except for my mentor who tried to encourage me to interact freely with them. However, I had very little access to him.
Patch 1
In my first community placement, my mentor and I met a patient who was deaf due to an accident he was involved in. Despite this handicap, he could read the lips and speak sign language. I greeted him and introduced myself as a student on attachment. The first thing he asked me was where I am from, as in, what is my nationality. Perhaps something I did provoked that question or he was just curious, or it was the nature of Welsh people to inquire about where someone was from. I think people often inquire about the home or nationalities of others to assess if they share any connection. This often would lead them to clarify any stereotypes associated with the stranger’s culture.
He did not ask me the question verbally; instead, he wrote it down in a notebook he carried with himself and by his bedside. I found it amusing; he could tell that I am a foreigner by reading my lips, which he said were moving strangely. It struck me that I needed to learn a few words in sign language to avoid prejudgment by the people I interact with, especially the patients because they must start developing attitudes. Driven by this desire, I decided to learn a few words in sign language. So, in my next out visit, I started speaking in sign language, which does disclose the user’s accent as foreign or native. My patient found it funny and laughed. It was a good surprise for him. This experience highlighted the importance of none verbal communication. I learned that non-verbal communication has more weight than actual verbal communication. Mastering the skills of nonverbal communication is crucial in effective nursing. Nonverbal cues or signs speak volumes about the person. It betrays the emotions and feelings of the communicator to the audience (Wright, 2012), in this context patients and colleagues. The experience with the deaf patient clarified this assumption. Therefore, I resolved to improve my non-verbal skills by enhancing my non-verbal skills by increasing awareness of my body language. In addition, I can better interpret and read the physical and emotional signs of patients, while reflecting on my own verbal communication.
According to research studies, 55% of all communications comprise non-verbal cues or signs (Holland, 2012). This means that positive body language is important to nursing communication due to the existing patient-nurse professional relationship that must be therapeutic, goal-directed, and intended to help the patient heal. Our facial expressions communicate our feelings to patients and fellow staff. For instance, during one of my rounds, one of my patients asked, “Are you upset with me? You look angry.” I was absolutely not angry with the patients, but I was rushed and had ignored my facial expression while in the room, such that, I had let my disagreement with one of the nurses spill over onto the patient. From this experience, I learned that patients as well as fellow nurses could see our hearts through our eyes.
Patch 2
In the community office, the Phone fax is ringing constantly. The community nurses are very busy and no one seems to be concerned about answering the fax. Then one of the sisters interject and said, looking at me bewildered, “Could you please answer the phone!” suddenly, I felt very nervous as if a wave of panic flashed through my body. My face turned red and my heartbeat increased, as I was frightened by the thought of answering the phone. So, I gathered enough courage and took the call, anyway. The sister retorted, saying “I don’t know why all student nurses are afraid of answering the phone fax once it rings!!!” Her observation was accurate. In the following three weeks of my attachment, I kept off that area with the phone-fax, because I did not like a repeat of that experience.
Nevertheless, my desire to learn all the relevant skills necessary to make me a good nurse overcomes my fear of answering the phone fax. Perhaps, the fear was because I did not want to embarrass myself by failing to communicate effectively. Also, I thought that my different accents may cause the patients and other nurses to disconnect from me and make fun of me. Nevertheless, I decided to be brave and professional since that is required of all nurses. Answering the phone to interact with patients and know their urgent needs is part of the nursing job description.
Through this experience, I learned the importance of understanding a health facility’s telephone infrastructure. According to NHS Practice Management Network, (n.d.) the telephone system is the first point of contact that patients have with a professional practice including nursing. Certain patients’ experiences with telephone systems are negative and should be avoided. These experiences are getting an engaged tone every time the patients attempt to contact providers, especially nurses, a ringing phone that nobody answers, going through to an answering machine instead of staff, and a system with complex options. I think that the sister who requested that I answer the phone was trying to avoid it. The patient would otherwise have been affected adversely, leading to patient dissatisfaction. I now understand why she was assertive that I answer the call. The purpose of nursing is to attend to the needs of patients. So, vowed to learn all the communication infrastructures to gain skills in dealing with them and ensuring quality of care and patient safety. Because phone fax is the means through which patients contact nurses when they are in distress, it is crucial to respond as soon as possible, because you never know you may save the situation. New technology allows nurse supervisors to see what is going on in the wards. Detecting a quire behavior of the patient in a specific ward may warrant an immediate response from the nurse facilitator. I thought of the need to learn how to observe patients for weird behaviors in order to send a nurse to check out in the ward.
Patch 3
In my second placement, my nurse facilitator and I were in the admission and recovery unit to learn the activities and skills pertaining to that section. Once in the unit, I did a lot of observations related to every patient that came to the reception. Every time I greeted them, “Good morning! My name is …. I am a student nurse.” My accent and my name will give away the cultural identity that I was a foreigner. This was always followed with the same question, “Where are you from?” Most of the patients find my accent and perhaps sometimes my name amusing and they would always smile away. Sometimes, it seems like they forget the reason they came to the community hospital.
At this point, I contend that my communication problems with native patients, staff nurses, physicians, and other staff have reduced. It means that I have improved my communication skills and have gained enough experience. Even my accent, which at first, I thought will be a major barrier, was not a major barrier after all. I learned that it did not matter the accent I used, so long as I expressed kindness and happiness by smiling, others will respond positively. Indeed, smiling is a very vital nursing communication style.
Smiling and being cheerful is an important indicator of good nursing (Ford, 2009). I learned this lesson from my experience at the attachment. This perspective is consistent with the findings of a research study conducted in the United States found in the Critical Care Nurse journal. Patients esteem nurses’ interpersonal skills and caring practices more than they do technical skills. These aspects constitute the overall nursing skill. Without one, a nurse does not qualify as completely skilled, wherefore he or she must possess interpersonal skills besides technical skills. Wysong and Driver (2009) interviewed 32 patients receiving treatment in progressive care unit in a hospital in the United States. The responses to the interviews were an eye-opener to policy-makers in the area of clinical nursing. The study revealed that patients valued the interpersonal skills of nurses more than their technical skills. Patients perceived those nurses who are friendly, caring, compassionate, kind, and good listeners as skilled nurses because this behaviour indicates confidence. One patient in the study stated that “A friendly nurse seems like they know everything” (Wysong et al., 2009, p. 29). On the contrary, patients could tell nurses who are nervous by reading their body language, stammering, and stuttering as skill deficiency. Other patients consider nurses they have difficulty understanding due to their accent as lacking in skills (Wysong & Driver, 2009). A similar Australian study identified the most important aspect of nursing care as evoking a sense of being engaged with the patient in an open dialogue, appreciating the patient as a unique individual, being available, having a friendly warm personality, and having gentle touch (Kralik, Koch, & Wotton, 2003).
SNOB Analysis
Strengths
I would generally say that I have come out of the attachment stronger than before. In particular, I have learned some Welsh and sign language. I have also taught myself about reading the lips of people to be able to guess what they want. I have learned the skills to interact with people of different cultures, especially the power of nonverbal communication, such as smiling and being compassionate with patients.
Needs
I have succeeded in satisfying my need for gaining skills to use in my nursing practice in the future. I also believe that I have satisfied my need to learn a foreign language and have effective interaction with patients of different cultural orientations and religions. Besides, I have increased my practical skills in general nursing practice. I have understood the principles of caring for patients.
Opportunities
The attachment provided me with the chance to apply the theories and training I have received in school in a real-world setting. I applied my nursing knowledge to solve some problems in the community facility. In addition, I have met with many professionals with many years of experience in nursing who helped mentor me. Overall, the attachment has helped me build my resume.
Barriers
I overcame the barriers that I perceived would hinder my progress during the attachment, although I contend that it took hard work on my side to transcend them. The first barrier was a language barrier, my foreign accent automatically evoked assumptions and stereotypes from the native patients and nurses. However, I learned the skills necessary to make patients trust my nursing skills and develop confidence in my practice. I learned that smile make softens the heart of others and make them put aside their stereotypes and work with you. Being friendly towards patients and nurses increases your chance of being accepted as a foreign nurse student and staff nurse.
When I reflect on my progress during the attachment, I admit that I started at a low level in terms of interpersonal and technical skills. However, I have learned that the way a student or staff nurse interacts with patients and other nurses overrides the technical skills he or she has. However, both skills are essential for effective nursing.
Generally, the attachment exposed me to the real events and demands of the field of nursing practice. To improve on my interpersonal skills, I will search in the library and online about the challenges experienced by foreign nurses and the techniques to overcome those challenges. Specifically, I would search the literature for intercultural interaction between patients and foreign nurses and look to identify evidence-based practice to maneuver through such a setting. On the field, I would always approach a more experienced nurse and ask for his advice on dealing with patients with regard to my foreign culture. The mentors are often helpful in helping foreign nurses overcome the challenges posed by the language barrier. In summation, seeing progress is very encouraging and adds some level of confidence in the way a nurse student approaches his or her assignment during the attachment.
Conclusion
The patch assignment has helped me understand the importance of performing SNOB analysis to assess one’s progress at work or attachment. The patchwork essay style was useful in helping stress the main elements of my nursing practice. The important things that I need to know about effective nursing care were also emphasized. The patches helped me understand my needs and weaknesses regarding implementing the concepts and theories I learned in class. Specifically, patches helped me understand in theory the various forms of knowledge that would inform my practice. For example, knowledge about effective communication with patients will help me apply the principles of communication to deliver quality care to my patients in the future, as well as cooperate with nursing colleagues in teamwork. Patchwork allows nurse students as well as other students explore and debate their experiences in inter-professional learning groups. Patchwork assignment allows students, such as me, to harness the independence of thought, reflexivity, and creativity pivotal to their professional growth (Lesley & Winter n.d.).
The snobs were useful because they helped me understand myself as a nurse and what the field demands from me. The strength facet of SNOB helped me understand my strengths and their relevance to the nursing practice. The other components of SNOB equally helped me put my needs, opportunities, and barriers into perspective. This facilitated me to improve my practice and identify the best principles that promote care quality and safety. With my SNOB analysis, I could know where I started from in terms of my potential as a nurse and where I am after the attachment. The SNOB helped me identify opportunities for improving my nursing non-technical skills. The B component of SNOB helped me understand the barriers I should expect in a new work setting characterized by cultural diversity. Once I understand the barriers, I will be able to identify the methods to use to overcome them. Thus, SNOB has helped me know myself in relation to my profession and delivery.
My experiences of communication on placement taught me crucial lessons about communicating effectively with others of different cultural backgrounds. I learn that patients use our nonverbal cues to assess our competencies and decide whether to trust us. I also learned that being friendly and smiling increases the confidence of the patients in the nurses with regard to providing professional care. I also learned that in a multicultural setting, accent plays a key role in nursing communication, as it determines whether the audience understands the message. Some patients prejudge foreign nurses as unskilled because of the accent the care provider uses.
In the future, I will always ensure that my nonverbal cues do not portray me negatively. I will always smile at patients and nurse staff to express confidence on the job. I will also be friendly to the patients under my care and express interest in their lives. This approach will help smooth any tension between two foreigners.
References
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McCullough, J., & Schell-Chaple, H. (2013). Maintaining patients' privacy and confidentiality with family communications in the Intensive Care Unit. CriticalCareNurse , 33 (5), 77-80.
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