Posted at 12.16.2018
Describe a good example of communication from your recent clinical experience and discuss the factors that contributed to its outcome
"A lot of people have thought anger and helplessness at not being listened to when declaring something important. Also the extreme frustration to be misinterpreted. . . " Ellis, RB. (2003). Defining Communication. In: Ellis, RB, Gates, B, Kenworthy, N Interpersonal Communication in Medical. 2nd ed. London: Churchill Livingstone. p3.
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I have been recently on 7 week placement in a medical home for the elderly. It had been a personal home but also experienced a little dementia unit where patients with mental health problems were taken care of. This experience has educated me that interacting with seniors patients with dementia can be extremely difficult due to their loss of storage, language skills, insufficient attention and basic disorientation. In certain circumstances however the patients mentioned that they wished my attention I came across it hard to comprehend what they required scheduled to these communication obstacles.
In my article I get started by outlining what dementia is, what communication is and exactly how important verbal and non verbal communication is to victims of dementia. Presently in the united kingdom it is estimated that 700, 000 people are suffering from dementia (BBC information)
Dementia is a disorder that is linked with an ongoing decline of the brain and its capabilities. It really is generally induced by damage to the framework of the mind and is most frequent in people over the age of 65. Thinking, terminology, ram, understanding, and judgement are all affected in someone who has Dementia. Sufferers could also have problems in managing their emotions and behavior when in communal situations. Due to this their personalities may appear to improve.
There are 4 varieties of dementia. Alzheimer's disease, Vascular dementia, Dementia with Lewy body and Leading or temporal dementia. These 4 varieties were all within patients in the dementia device, where I put in 7 weeks; however I will be concentrating on Alzheimer's.
Communication is often thought as "the imparting or interchange of thoughts, thoughts, or information by speech, writing, or indicators". Although there is such a thing as one-way communication, communication is normally a two-way process in which there is an exchange and progression of thoughts, thoughts or ideas towards a mutually accepted goal or understanding.
Communication is a process whereby information is imparted by way of a sender to a device via some medium. The device then decodes the message and provides the sender a responses. All types of communication need a sender, a note, and a receiver. Therefore communication takes a common medium. There are auditory means, such as conversation, song, and modulation of voice, and there are nonverbal means, such as body gestures, sign terminology, touch, attention contact, and writing. (Undiscovered Author (2000). Communication. Available: http://en. wikipedia. org/wiki/Communication#Communication_Modeling. Last accessed 2 Jan 2010)
All varieties of communication verbal and non are being used by a medical worker. With dementia sufferers, good non verbal communication is essential. (Argyle, 1978) believes that non verbal communication can have five times the maximum amount of influence on a person's knowledge of a message compared to the verbal communication at the time.
Chomsky calls the take action of talk (verbal communication) 'performance' and the knowledge of the dialect 'competence'. People perform the difficulty of conversation daily but haven't any real understanding of why or how they came to be able to. Talk allows us to hold interactions, ask question, give instructions, conceal the reality, build routines & most importantly speak about interactions in which we are participating (Argyle, 1978).
Berlo has produced the following model of communication. It really is stated below, extracted from Berlo, D. K ( 1960) The Process of Communication: an intro to the idea and practice. New York. Holt, Rinehart and Winston.
Berlo believed that the most effective tool for successful communication is at the relationship between the communicator, known as the Encoder or Source, and the listener, known as the Recipient or Decoder. He presumed that common factors must exist between the encoder and decoder for successful communication to occur; as well as an arranged format of communication, known as a Route.
Berlos' SMCR model identifies the communication process into four components: Source, Note, Channel and Reciever.
Berlo states that the source and recipient must discuss the same group of fundamentals in order to own successful communication. He argues that just how people communicate relate to their position within the socioethnic system - whether they are educated or noneducated, prosperous or poor. He boasts that it is these factors that impact both Source and Receiver and in turn, influence the communication process. Both Source and Device have to have got the next elements:
Communication skills: Both Source and Receiver have to use the same language or code in order to converse. There is also to talk about the same usage of indications, words and imagery.
Berlo states that there are five verbal communication skills that are categorized as this category. The first four are extracted from the ShannonWeaver model; two encoding skills being speaking and writing and two decoding skills - listening and reading. The fifth skill is the most crucial as it pertains to thought and reasoning. Take say for example a highly skilled linguist who's fluent in various languages. As the linguist trips overseas, he succeeds in speaking and connecting with the natives of the country but fails to comprehend the codes of etiquette or gestures. In doing so, the receiver's thoughts and opinions of the foundation alters whilst the foundation is unaware of this mishap; resulting in a changed relationship between the two.
Good communication skills are extremely important for health workers. It is vital for a medical worker to understand a patient's needs and individual requirements in order to ensure best care and patient well-being and ensure that the patient feels respected, valued and is cured with dignity. Many of these considerations donate to patient health care. If an individual cannot be realized properly it is very hard to provide appropriate care. If there is good communication between an individual and healthcare staff member, it will reduce the patients' anxiety. Research shows that patients are at threat of high degrees of anxiety and disappointment if communicative attempts don't succeed. (Finkee, Erin HMS 2008). Communication helps the carer and patient get to know the other person better, it can help them to connection which usually results the patient feeling able to express why is them happy or annoyed, what foods they like and moreover any problems these are experiencing. A good connection can be hard to achieve with an individual with dementia as short-term memory is often lacking so previous discussions can be forgotten. Strategy towards patients with dementia is vital, facial expressions, tone of voice, uniform and how exactly we present ourselves can say a whole lot about us and our frame of mind to the patient.
When communicating with older people residents easily were to raise my voice within an aggressive way they could feel threatened and frightened by me, but if I speak to them in a pleasant tone of voice the then the resident is much more likely to feel at ease around me. Eye contact was very important particularly when trying to activate a disorientated patient. I possibly could then start gaining trust and understanding between myself and the resident. Whenever a patient has dementia they can not speak by the ultimate stage. Finished questions are usually far better by this stage. You will discover 2 types of questions, available and closed. Open questions leave the response open to reply with a lot of information or a little. Closed questions are the ones that a patient has nod or shake their head to or use other areas of the body such as thumbs up or down. Finished questions such like "Are you ok?", "Are you hungry?" allowed the patient to communicate with us without having to construct a word. These kinds of closed down questions are a kind of non verbal communication. (Berlo's communication route) It was often very hard to work with verbal communication with Alzheimer's patients because there short-term memory is bound so they quickly lost the thread of the dialogue. Nevertheless it is vital to talk to dementia sufferers in order not and then care for them but to provide comfort and reduce the fear and isolation associated with the disease. On several situations during the placement I drew on the communication skills I had formed learned from looking after very young family such as my more radiant brothers. Using game titles and shut down questions to activate them, opening discussions on items around them that have been precious to them such as images or ornaments. Allowing them to discuss the overall game or thing. However I had been careful to never push these to recall remembrances as this may have brought on them distress particularly if they could not remember specific things like where they were created. (In Berlo's model I was seeking to ensure a channel)
Even using closed questions one sometimes needed to explore further than one answer. I observed a female patient who was simply certainly agitated. When questioned she suggested that yes she'd like to go to the toilet. When the duty nurse attempted to assist her she became greatly distressed to the idea of hysteria. Even after she have been to the toilet she remained annoyed. After some time it became visible through much questioning that although she needed assistance she had not desired it from the male obligation nurse. Bearing in mind the actual fact that the patient was a very elderly female and also require been raised with certain attitudes to propriety this incident might have been avoided with more effective communication. (This is apparently an incompatability between the rules of te two individuals making communication impossible. The nurse understood the words of the lady for the reason that she wanted the toilet but performed understand the cose/ etiquette of her upbringing)
According to Argyle (1990) in a dialogue, words make up only 7% of a message; firmness, tempo and syntax constitute to 38% and body gestures makes up to 35%. Non verbal communication can be portrayed by our cosmetic motions, gaze and eyeball contact, gesture and body motion, body position and body contact, use of space and time and how exactly we dress. (Henley 1977) says that how powerful we feel in an relationship can be indicated non- verbally. Our unspoken communication can be shown through our body language. Coming in contact with patients is definitely an essential tool for a nurse. It may offer support and understanding, comfort and security. It gives extra interpretation to the spoken expression. Often a patient would simply ask me to remain or stand with them or keep their palm. Although this looked a very simple form of treatment it was often very emotional for me but appeared to be of great benefit to the individual. I have considered if at such moments the patients were being disorientated and the simple act of someone trustworthy being close seemed to lessen their stress and anxiety for some time. It had been my experience a laugh when appropriate often initiated an effort to communicate. Macleod and Clark (1991) claim that most touch between nurses and seniors patients is related to practical procedures, satisfying a practical rather than an mental purpose. However i came across this not to be true, when i pointed out often i patient would just want you to carry there side for emotional comfort. Care workers are not always able to spend as much time with specific patients as they might like. This sometimes led to a mismatch between verbal and non-verbal communication. Patients acquired upset with care workers who although they were conducting a helpful task searched tired or impatient possibly for their workload however, not because they didn't service. Some patients want care personnel to sit with them during meal times but this could not always be achieved and on occasion such patients did not eat their food. It really is well accepted that supplying nurses the time to listen and be attentive assist patient well-being. Contrary to this were the occasions when patients refused to consume or drink either because they did not want to consume or drink or because these were neither hungry nor thirsty or they didn't like the meals or drink. These thoughts were communicated non-verbally by patients refusing to open their mouth area, spitting food out. The inability to clarify verbally was a significant hurdle to communication. Personnel in turn needed to ensure that their verbal and non-verbal communication did not cause further obstacles e. g. impatient tone of voice, facial manifestation or body gestures.
Where patients could converse verbally obstacles still existed to ensuring full understanding especially where insufficient concentration was a concern. Background noises, e. g. noisy radios or television sets, people around speaking as well as us, this can confuse and offer distraction patients. Turning the tv down whilst having a discussion with a patient can help. Speaking clearly in a vocabulary, style or accent understood by the individual increases verbal communication. Speaking evidently and providing simple instructions also helps patients understanding but tuning in is by very good the main verbal communication in understanding patients' needs. It's important to learn patients brands and use them. This helps catch the attention of and carry patients attention and more importantly recognizes them as an individual with specific needs and not an individual.
Working in the dementia device was very emotional. Patients were often distressed and unsatisfied and hardly ever happy. Irrespective the patients were inviting and often willing to engage on differing levels. I endeavoured to keep up a good attitude and outward appearance, to pay attention and be alert to my body terminology. Although I endeavoured to show empathy somewhat than sympathy it is impossible to essentially understand how terrible it must be to lose our communication skills so considerably but most nurses make every effort to ensure maximum two way communication with patients, utilising different method of communication. A nurse can also ensure that she/he obtains a full understanding of the problems dementia victims face and help with professional best practice.
The following case study from my recent scientific experience illustrates communication and the factors that contributed to its result.
Mr. Jones was taken to the nursing home by his kid. He is 88 and has experienced from dementia for several years however in the past time Alzheimer's has progressed rapidly and the need for round the clock care has kept his son struggling to look after him. Mr Jones's symptoms include major confusion, withdrawal from culture, delusions and extreme feeling swings, he often gets extremely furious. He needs carers for several normal activities needed for daily living such as finding the toilet, supporting him on with his clothes and generally seeing over his throughout the day. Some of his needs may also be credited to his age group; he has problems with his ability to move so requires a carer to the not just due to the Alzheimer's.
My mentor asked me to invest some time with Mr Jones, speaking with him and striving to develop a rapport with him. Your day before my mentor experienced given me some leaflets on the subject of dementia and Alzheimer's to prepare me and present me a much better understanding.
When I first sat down with Mr Jones he just seemed like a 'normal' seniors gentleman of fine health for his years, however when i began talking with him I came across quickly how advanced his Alzheimer's was. It had been quite upsetting for me as I had never experienced that situation before. In the first 20 minutes of speaking to Mr. Jones he had asked me the same question and we'd the same dialog around 5 times. I came across this rather uncomfortable as I was unsure whether to keep with the repetitive conversation or try to change the subject as I was not sure if either of the would cause Mr. Jones to be distressed. I decided to continue to listen to Mr Jones demonstrating involvement in his chat. Eventually Mr Jones was able to extend that particular conversation little by little revealing more of the storyline. Mr Jones pointed out if you ask me that he was the homes Gardener. Baffled by this I visited my mentor who guaranteed me that was a delusion he had thought was real since his boy moved him into the home also to just 'leave him to it'. I had not been able to talk with a dementia expert about them but I did so question if this 'delusion' was an expression of a very pleased man's need to be self-employed and a company. Perhaps it was a coping strategy at the idea of being put into a home. I therefore chose to discuss gardening with Mr. Jones. I had been very careful not to ask any questions about this gardening he performed at the home for fear of causing embarrassment or confusion. Of these conversations one would not need known that these were based on a delusion and Mr Jones remained calm at all times.
I discovered that after the first week of my working there Mr Jones accepted my face, he still sustained to ask me the same questions such as 'where do your home is?', 'do you understand my son?' and tell me about his gardening job but he would bear in mind by name. The outcome of being attentive and being attentive during our discussions had empowered Mr Jones to remember my face and with time he might have associated my name with my face. Would this have provided some sense of continuity in his life?
The thing that bothered me the most however was that Mr Jones would ask me when he was going to get his pay cheque. The other staff explained to tell him 'next week'. I found this shocking and an inadequate answer. I sensed that easily have as the other staff told me this might just reinforce the delusion and so I when he asked me the next time I advised him the truth. This however made him very distressed and annoyed. The NMC (2002) advises that people must not add extra stress or distress to a patient by our activities. I will have asked my coach for a conclusion of her advice. I've now read further about dementia and by revealing him 'next week' it allowed him to avoid worrying about it in those days and empowered us to improve the subject to 1 we could talk about or even to engage in a task like a board game. Telling him 'next week' was using his short-term memory to prevent distress.
This experience has shown me that I have insufficient knowledge in my own communication skills; I had formed focussed too much on my morals and be anxious that I was being untruthful with him when infact perhaps reinforcing his view would have induced him less displeasure. I hadn't considered his other needs like his wishes or dreams and I had not gathered enough personal information about him beforehand to know this - maybe he liked gardening. ( It would appear that we (Mr Jones the foundation and me the encoder were speaking the same language but were not on the same cultural channel which led to poor communication for the reason that neither of us understood others message)
This experience was very annoying and upsetting and highlighted the necessity for me to improve my communication skills and ensure better understanding of patients' conditions and needs before attempting any other thing more than basic needs communication e. g. are you starving?
I tried never to communicate my frustration, lack of understanding and mental problems to Mr. Jones by being attentive, asking appropriate questions and using wide open, non agitated body gestures ( promoting empathy in the form of my body language to market active listening (Egan 2002) until the moment in time he became distressed at which point I did not have the required communication skills to deal with the problem positively
I should have allowed additional time to understand what Mr. Jones was thinking and sense by maybe asking him peaceful questions such as have you any idea what your location is, how long are you here? As well as perhaps he would have come to a gradual realisation by himself. I now appreciate that my concerns about the value of real truth (the fact is always the best plan) were not compatible with his health care needs.
when taking into account Berlo's model, when one factor is absent the communication fails. Inside the example given, the source and the recipient experienced a common route but the concept was interpreted differently, there is no common understanding of the message. I hope with further training i'll develop a better knowledge of communication. Rowe (1999) talks about a person must identify their weaknesses as an initiative for becoming self-aware. I am going to take all of this into account when on my next positioning and through the others of my medical career.