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Nurses Role In Conversing Effectively In Clinical Practice

The purpose of this article is to discuss and analyse the nurse's role, with regards to communicating effectively in professional medical practice. To explore this area completely an example taken from a medical practice will be outlined, in accordance to the NMC (2008) confidentiality guide lines. To follow after will be how exactly we learn to talk, what communication is and the obstacles that prevent effective communication. A nursing component by the name of Egan (SOLER) that is especially made to help nurses develop communication skills will be discussed in relation to the clinical practice example. Another nursing module from Roper, Logan and Tierney in addition has been briefly reviewed and related back again to the medical practice example. Ideal conclusions will be used to bring this matter to a closure.

In accordance to the Medical and Midwifery Council (NMC) 2008, the patients name has been altered in order to protect their identification. Alex is a male patient, in his overdue forties and is currently being cured for on the mental health ward. To communicate with Alex a trusted relationship had to develop first, as he suffers from paranoia schizophrenia. His average day would contain being huddled into a ball in a tiny arm couch anxiously alert to everyone and everything around him. I aimed to be sure that I approached Alex in the same manor every shift in order to develop a trust between us, so that i possibly could offer assist with him if needed. On the position period the trusted relationship between Alex and I had started to form and he now trusted me enough to help assist him to the dining room to give food to him, where as normally the food was taken to him because of his nervousness and nervousness around large groupings.

In order to converse effectively you must understand the aspects involved with communication. The fundamentals start with oral and written communication skills trained to us from a young age, in order to achieve in life. Oral communication is a continuous learning skill throughout life, by observing and practising. A similar can be said for written communication. Both communication aspects should equally complement one another, as fragile or poor oral/written skills can lead to disagreements between individuals, poor paperwork, and waste materials of time for resources. Whilst mastering the art work of effective oral communication other factors now enter into play such as, using wide open and sealed questions to improve a conversation and also the facilitators/obstacles to communication. Aswell as being able to speak and write accurately, other learning functions are also educated from a young age by watching others, and are also included in our continuous learning curve through life, these include listening, understanding, becoming self aware also to the ability to maintain confidentiality. Without these important extra factors no further improvement in my opinion or professionally would be able to happen. If unable to pay attention and understand dental communication/instructions catastrophic outcomes could appear, especially in the field of nursing.

Effective communication is necessary in order to understand the individual's viewpoint on their health problems and to shoot for empathy. The nurse's job does not only involve looking after the physical demands of the individual, but also to try and build-up a therapeutic relationship between them.

Oral communication is composed mainly of two divisions called verbal and non verbal, that they both strand off and explore the many different characteristics between them.

'Verbal communication pays off close focus on the accents, pitch, build, volume, rate and context. ' (Arnold, 2001, p. 41)

Referring back to the scientific example above, before I began to communicate with Alex I politely asked him what terms he spoke or preferred to use, Alex explained that British was his only terms.

The Nursing and Midwifery Council (2008) states that, 'You must finances for it to meet people's terminology and communication needs'. (NMC code 2008, p. 3)

Communication was one of the barriers that influenced Alex then effective verbal communication was vitally important to my patient for him to maintain his social connections skills and memory space handling (Mason and Whitehead 2003) By nearing Alex frequently throughout each move I tried to keep as much public interaction as it can be to help him conquer his timid social skills and to keep some kind of normality to his everyday living on the ward. Conversing with Alex would often be a one way dialogue due to the insufficient response when connecting with him; some trained health care professionals would spend less time with him, for the feeling of being overlooked. When actually socialising with the patients is a restorative activity and can help with the healing process.

Mason and Whitehead claims that, 'Thus, medical can be viewed as a communal action and also as a kind of therapy in itself'.

I attempted to talk with Alex in a manner that I hoped would reassure to him i brought no harm, by slowing my talk and speaking quieter and softer than normal. The purpose in doing so was that speaking in less tone to Alex became more effective and calming for him, which overall provided a much better response in chat. If you were to instantly ask Alex a question, without considering your self-awareness and interpersonal skills first, it would startle him and sometimes cause an outburst of unsettlement.

Whilst looking to keep sentences brief and simple for easier understanding, to help expand the conversion I made a mindful work to ask wide open questions that could prompt more of an answer apart from yes or no. The reason in doing this was to try and help with Alex's sociable skills and build up his autonomy self-confidence. Questions such as 'what visitors have you acquired today' or 'who got you out of foundation this day' would help to establish a tiny conversion whilst trying to set up building blocks to further the discussion.

To start a chat off with one of the next words who, what, when, where, why and how, help to approach an open ended question and also dwelling address specific symptoms. (Sheldon L. K, 2009. )

'While non verbal communication looks more at the paralinguistic's such as, body gestures and movements, facial expressions, proximity, attention contact and good posture. ' (Arnold, 2001, p. 41)

Referring back to the specialized medical example above, non verbal communication needed as much attention because Alex would sit with his knees pulled in securely to his upper body, with his forearms twisted around them and his mind bowed down. By showing these finished gestures, Alex was indicating his need for self safety, and that he was sense vulnerable. To be able to start his body language and communicate with Alex small and gestures had to be used such as, attempting to maintain eyeball contact throughout enables you to establish a connection and initiates communication whether verbal or non verbal, it also helps to engage with your patient and help with attentiveness. (Gupta, 2008)

Before I sat down or made an approach, I made sure that I educated Alex what I was going to do.

Uys and Middleton suggest, 'When moving towards the patient, inform him/her verbally of what your actions signify'.

By tugging up a couch to be seated next to Alex lowering the proximity between us i tried out to show friendliness, good care and understanding, by inserting my arm slowly but surely and delicately on his arm of the seat, instead of standing up over him and sounding as superior. (Boyer, J. M 1992)

Proximity between Alex and I'd differ from day to day, sitting near him in a chair may be okay some days and on others you would need to permit significant body space. By judging his non verbal communication such as cosmetic expressions and vision contact, you consciously knew the distance he'd appreciate. (Uys and Middleton, 2004)

To offer assist with Alex and make him for moving off his security setting up and into the dining area for food, I'd verbally and non-verbally describe to Alex what the plan was and how we were going to access the dining room. I would indicate specific details in your day room and explain it could only take three steps or five steps to the next point, to encourage activity. Whilst pointing around the area I'd show my hands instead of directing my index finger. The reason for showing my hands was that directing at something can be misinterpreted as an invasion, whereas a hand is more available and patient, ready for stimulating small movement at a time. Showing points in the room to where we would walk to first, would make the voyage to the dining area appear less intimidating and also never to cause any extra stress and anxiety for him, as some restless and panicky patients need reassurance about the option of support (Uys and Middleton, 2004)

Other day's small gestures would be all it got for Alex to start his body language, such as keeping a happy, wide eyed appearance around him, exhibiting which i was still available if he desired some reassurance.

The work of Egan (1986) has been attracted upon thoroughly by nurses as the foundation for active listening, as this skill is a simple aspect required by nurses to provide enough good care, and by recommending that non verbal skills can demonstrate to the patients that you will be hearing what he or she is saying. The body work is labelled by the name of SOLER, and is an acronym from the term squarely. It induces the nurse to be seated squarely facing your patient so that you may indulge them fully; this is especially helpful when speaking with Alex as it showed I was ready to talk to him. In addition, it mentions about adopting an open pose to show stimulating and helps patient appearance. Alex displayed closed off gestures, by implying openness I tried to facilitate effective communication whilst also being aware of my body language, pose and movements. To lean just a little forward showing attention and interest was not always a good position to hold, to be so near Alex would marginally unnerve him and make him feel intimidated. Soler also suggests maintaining good eyeball contact, which again shows interest. In relation to Alex retaining good eyes contact was essential for encouragement and progress when helping to the dining room, by showing a wide eye, happy manifestation I directed for encouragement and reassurance. The past part of Soler, Egan argues that it's imperative never to fidget and to feel at ease and calm (Stretch out, 2007) again this part played a significant factor when helping Alex to the dining room.

There are also many barriers that prevent effective communication between your nurse and patient's such as, stereotyping. Nurses must try to avoid culturally stereotyping patients, and really should check with patients regarding worth, beliefs, tastes and cultural id first. (Boyer. J, M, 1992)

Other obstacles include perceptions, prejudgements, environmental factors and nurse's keeping away from subjects or speedily changing the topic if the nurse seems uncomfortable within the nurse/patient situation. The explanation for distancing themselves was to avoid discovering an area which could do more damage than good to the patient. Over time this process has been assessed and communication is currently regarded as a vital aspect for better better care and attention and a more therapeutic nurse-patient romance. (Walsh and Crumbie, 2007)

Roper, Logan and Tierney collaborated to refine the Roper models (1980) as a means of introducing start students to think about nursing practice. It's been used thoroughly within the uk as a shape work for nursing care, practice, instructing and learning.

The module is divided up into two parts, the component of living including the sixteen activities of living (ALS) and the component for nursing including twelve further activities of living that arrived to action after an extended question in 1996.

Starting off with the module of living Roper et al grouped this section into three organizations, 'essential' talks about the physical needs of everyday living, 'increase quality of living' gives close focus on the social aspect of daily living, and 'mortality' looks at the dying level of life. Another twelve 'activities of living' are related to particular individuals needs and have natural basis to them, whereas the sixteen activities of everyday living have communal and cultural determinants. (Aggleton and Chalmers, 1986) (Holland et al, 2003)

The concentrate of the theory model is aimed at reliable nurse/patient communication to be able to achieve a good living end result for the individual. It shows empathy, non judgement and value to the patients needs by recognising that, people require medical episodically which nominal disruption to a person's lifestyle should be preserved.

As mentioned previously with Alex, communication with him on the ward was to keep some sort of normality to his daily living, whilst being looked after.

Roper, Logan and Tierney states that, 'Different strategies should be carried out on an informed basis and not in accordance with previous precedent. ' (Aggleton and Chalmers, 1986, P. 31)

One of the new strategies tried out with Alex was to aid him to the dining room for food, alternatively than bringing the food to him where he sensed secure in his couch. The reason in doing so was to encourage and seek responsibility for self-care, to promote dignity also to raise Alex's self-confidence.


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