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Different Reasons People Communicate in Dialogue

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While predominately vocalised, people can communicate through other mediums such as gestures, written words, pictures and behaviours. As to why communication occurs, it’s a way of one entity expressing or sharing something with another. It may be used to express needs, desires, emotions, to inquire, socialise or inform. I have cared for patients with varying degrees of Schizophrenia where communication and its effectiveness are potentially subject to the intensity of the unseen stimuli they may be experiencing. While talking may be difficult, said patient may gesture they are hungry by lifting their hand to their mouth, or express discomfort by their body language and behaviour, such as restlessness, irritability or aggression.

In my position, communication has to be adaptable due to varying degrees and methods of understanding. For example, patient A with learning difficulties may understand and communicate better with a behaviour chart, where patient B may communicate better vocally. In my area of occupation, Communication should have a centralised focus on the care and treatment of a patient’s well-being and rehabilitation.

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The dynamic of the relationship may influence the nature and content of the communication, for example the information shared from a patient to a HCA may be personal and sensitive information that should not be shared with another patient or a member of the public in any capacity. However, that information can be shared with a co peer or nursing authority as it may influence the nature of care that patient receives.

Communication between a patient and staff can build and strengthen a therapeutic relationship to develop beneficial change for the patient. In my particular environment, I work on a rehabilitation ward. The majority of the patients have capacity to communicate verbally, consistently. As part of their rehabilitation plan, addressing their socialisation and communication skills are very important. I try to communicate as often as possible with my patients while maintaining strict personal boundaries and societal norms to prompt a dialogue; this will not only set guidelines for a patient, but will enable me to partially gauge their mental state in that moment and offer feedback into their notes for future development.

Patients talking to other patients can be a great practicing ground for building relationships and the essential skills it requires. There is not the same social divide as there is when interacting with a healthcare provider and so, may help them overcome certain barriers of communication. This may present a degree of risk depending on the nature of the patients, however, facilitating their understanding of this is a more ethical (but not always successful) approach than limiting their interaction for a time, unless mental deuteriation and or potential physical aggression becomes a considerable probability as a result.

Communication and openness between work colleagues is an essential component to maintaining ward safety/care for both patients and staff. Given the potential stress of the environment and the dependency you can have on your colleagues to carry out certain tasks (restraints, medical intervention, personal care) and the unification under your duty of care, working relationships will develop. It’s a healthy aspect of working in my environment, given that it is shift work, you can spend around ten hours five times a week with your colleagues.

For my given work setting, the ways in which you would manage a situation greatly depend on what the challenge is. On the whole, least restrictive practice is one of the cornerstones of the duty of care myself and other healthcare employees have. Furthermore, each patient has their own positive behaviour support (PBS) plan, which may highlight a different approach to the same type of challenging behaviour.

If I experience verbal agitation of verbal aggression from a patient, I would try to communicate as clearly and openly as possible without raising my voice to not further escalate. I would use their name and eye contact early to establish my attention is focused solely on them. I would use no harsh body language or hasty movements to not only portray a sense of calm but to also not prompt a potential physical reaction from the patient. I would try and establish what the escalation or challenging behaviour is regarding, whether it could be something tangible or delusional etc. I would incorporate what I know from their PBS plan into my approach. For example, it’s written to not challenge or be dismissive of patient A’s delusions as they have increased risk of hostility, opposed to patient B, where we should give their delusions no credence what so ever.

I would try and turn the challenging behaviour into a two-way communication, and if possible, reflect their agitation through the ensuing dialogue. This would show the respect of having listened, while hopefully working toward a peaceful resolution. However, there may be times were any attempt at communication further agitate a patient, even if someone is considered to have a good therapeutic rapport. I find this to be particularly common in-patient C, who suffers from Bipolar. When they become agitated and verbally aggressive, any communication seems to escalate their challenging behaviour. In accordance to the RAID (Reinforce Appropriate Implode Disruptive) approach, unless it would be unsafe or uncaring to do so, it may be best not to engage with the patient and let the events run their length with the condition that their positive behaviours are reinforced.

There are the unfortunate circumstances where challenging situations may be physical in nature. If you are the intended target of physical aggression its normally best to further limit your involvement as you may be a factor in continuing their behaviour. In regard to physical aggression, it may result in restraining the patient, however, this should always be supported by vocalisations of the intention and will only continue forward after the patient has been warned but continues to be aggressive. Even during a restraint, the aim is to disengage as soon as possible, so there will be a staff member dedicated to communicating calmly to the patient in order to decrease the risk they pose to others or themselves.

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