An account of communication in practice demonstrating the learner’s understanding of communication and interpersonal skills.
Reflection is a process of examination and finding explanations for your actions and to enable us to improve our skills and knowledge by finding various approaches to doing things (Howatson-Jones Lioba, 2016). This assignment is a reflection on an incident at my work area. In this context I have adopted Driscoll reflection model template (Nottingham University, no date) to reflect on my ability to communicate effectively with the service user. Communication is a phenomenon in which individuals exchange the message by using signs and symbols and interpret meaning (Donnelly. E, Neville. L 2008).Interaction between people do not take place just face to face, they take place in variety of levels. Communication help us to understand ourselves and others. The health professionals should develop and maintain effective communication skills to be successful in their profession (Donnelly. E, Neville. L,2008). This assignment will help me to meet my learning outcomes of recognize verbal and nonverbal communication, importance of self-awareness in communication, different techniques and strategies of communication which I can utilize in practice.
The first stage of Driscoll model explains what happened (Nottingham University, no date). The purpose of this reflection is to understand what happened and the reaction of myself into it and increase my confidence in effective communication. Mrs. x [name has changed for confidentiality] (NHS POLICY, 2018) has admitted to acute mental health ward under section 3, which means detaining patient for treatment (NHS,2018) with diagnosis of schizophrenia and was on clozapine titration. Schizophrenia is a mental illness in which patient struggle to differentiate what is real and what is not real, they struggle to think as normal (NHS,2016). The treatment level of clozapine in the blood in the range of 250 to 350 ng/mL is expecting for a patient with schizophrenia and treatment start at a low dose (12.5 to 25 mg/day). The continuous and systematic monitoring of vital signs before and after the administration of clozapine is inevitable to measure success of titration plan (NHS, 2018). Vital signs are core essential to identify the progress and deterioration of patient (Royal College of Nursing, 2017According to (NMC, 2010) communication is key element in health professionals and patient relationship. I introduced myself to patient and explained the procedure to get verbal consent to monitor blood pressure. Blood pressure is the force of the blood against the wall of arteries as its pumped around body by heart (NHS ,2015). Myself and other staff on duty were present on this occasion and has requested the patient to come to clinic to carry out the procedure. The patient has refused to come to clinic and walked away from us and stared at us. I have gone to patient’s room and has introduced myself and has offered drink to Mrs. X which she has refused and has been shouted at my colleague. I have requested my colleague to leave the room and to wait outside and continued to talk to Mrs. about her country and her favorite subjects. Initially patient has refused to monitor the vital signs, but however has agreed later and has monitored vital signs successfully.
I felt more confident after the successful monitoring of Blood Pressure, however, I was nervous and anxious being alone in the patient’s room while I was communicating with the psychotic patient. Psychosis is a mental health condition in which patients may suffer with hallucination, delusion, disturbed thoughts and lack of insight to surrounding and self (NHS UK, 2016). My patient was talking to the wall in her bedroom, has shouted at my colleague told him that he is not good. My patient appears in crisis stage of anger and I have adapted verbal communication, listened to her calmly and has paraphrased patients dialogue to show that I am interested and engaging in to the communication effectively. Negotiation is an important process of two way communication always based on agreement or disagreement between patients and nurses and inevitable in conflict management (Neese. B,2015). I have continued conversation with patient, given choices of place and staff on duty to undertake the procedure to solve the conflict and come to a mutual agreement. The 6C are the values in nursing to provide high standard of care (RCNi, The 6C’ of nursing, 2015). Advanced interpersonal skills, self-awareness, awareness of others are essential for an effective communication with vulnerable people in a busy health care sector (E.Bramhall, 2014). Active listening and paraphrasing are inevitable to build trust between patient and nurses (Nursing times, 2018). Anger arousal cycle explain about the importance of communication to avoid escalation of anger and we should effectively communicate at a safe point to deescalate it (Harper, 2004). I have maintained a distance from my patient due to risk and have reflected on my body language negatively. Self-awareness is a good knowledge and judgment about yourself (Cambridge Dictionary, 2018). Self-awareness is a basic skill in reflection which enable us to develop interpersonal skills and therapeutic relationship with patients (Schutz. S, Bulman.C, 2004). According to Schutz.S and Bulman. C self-awareness is unavoidable in reflection learning to engage with the service users and maintaining the right balance of positive and negative behavior. My patient was a foreigner and has past and current history of paranoia. I have not checked the individual care plan of the patient before I approached for the procedure, the care plan explains all about the triggers of agitation in my patient and about the language barrier. According to (Nursing Times, 2017) overcoming communication barrier is essential for effective communication and culture, values and believes have great influence on the communication. Mrs. X was gazing at us when we have entered in to her room. De-escalation is “transferring your sense of calms and genuine interest in what the client wants to tell you by using respectful, clear, limit setting” (PAETC Department of Family and Community Medicine,2018). I have used neutral facial expression, non -defensive body posture and appropriate eye contact to deescalate my patient to get the consent for the procedure.
Eye contact and eye gaze communicate the attitude of the patients and if any person having disturbed mood they gaze was regarded as threatening or inattentive (Williams.D,1997). I have entered to the room and have maintained a hand length distance from the patient for the safety (NHS Health and Safety Local policy, 2018) and comfort of patient and ourselves. Proximity is a core part of nonverbal communication, being too close and too far away makes the person feel uncomfortable (Skills for Care, no date). I have maintained a positive body language to make patient comfortable and to feel safe. Nonverbal communication is known as body language refers to those movements and position of head, limbs and body that convey meaning (Williams.1997).
The calm and focused tone is essential in verbal communication (Royal College of Nursing, 2016). “Verbal communication refers to the words and phrases of spoken language”(Williams.D 1997). Assertive tone and the appropriate body language have used to communicate with patient to convince her importance of the procedure. I have asked my patient gently politely and respectfully, whether she is ready for the procedure and is it ok to do it? Patient has smiled at me and shown thumb up. According to NMC (2018) it is a responsibility of nurses to inform and get consent from the patient for every procedure and the best interest should consider for the patients with lack of mental capacity.
Assertive response is a way of respecting others opinion and involving them through out to solve the problems to achieve the goal (Oxford Brookes University,2018). According to (Royal College of Nursing, 2017) the communication starts with the very first moment we meet the people and our body language shows our interest and engagement in communication. Active listening is the one of the key element in communication, an active listener listens the content, feelings of service user and show their interest by using appropriate body language (NCBI, Active listening: The key of successful communication in hospital managers,2016). I have maintained positive body language that has helped my patient to relax and has maintained eye contact with me. During the procedure I was talking to my colleague by using medical terms and I have noticed frown on patient’s face and started to bite the fingernail. Jargons are pivotal in professional communication, the complex technical words in the presence of patients is inappropriate and easy to misinterpret (Nursing Times, 2017). Culture and communication are interlinked, culture influence the way the people interpret the message (Vijai.n.Giri,2006). The nurses should provide person centered care to patients from different cultural background (NMC-Nursing associate, 2018). My patient was from a different cultural background, followed her religious faith on dressing. My patient is from high context culture and I have respected her culture, asked permission before unbuttoning her sleeves to prepare her for the procedure. “High context cultures have a preference for indirect, non-confrontational styles of communication” (Elizabeth M. S. Krause, AB, SM, 2009). “A high-context culture relies on implicit communication and nonverbal cues. In high-context communication, a message cannot be understood without a great deal of background information. Asian, African, Arab, central European and Latin American cultures are generally considered to be high-context cultures” (South Eastern university, 2018). I have explained to my patient that her readings are in the normal range and have shown thump up to convey the message correctly because of cultural and linguistic barrier in communication.
Action plan is a systematic planning and prioritizing the steps of an action to achieve a goal with in the time limit (Kent University, 2017). The reflection on this incident helps me to identify the mistake that happened during communication and the positive outcomes of my communication style. I have realized that importance of nursing process in patient care. Nursing process is a continuous action to solve the patient’s problem in a priority basis through nursing care intervention (Matthews. E, 2010). In the future I will check the care plan before I approach patient prior to a procedure. The empowerment model of care plan approach will use to help service user. The communication, observation, listening, team work, reflective practice is essential in care planning (Lloyd.M,2010). Environment is an important part in an effective communication and consideration should be given in a limited working environment (William.D2 1997). I have not considered the importance of environment at the beginning of the communication and in the future, I will make sure to provide a comfortable zone to patient in the ward before carrying out a procedure. I will consider using google translator or interpreter to communicate with patient who struggle with English language. The use of jargon should completely avoid in front of patient in the future. The de-escalation technique with appropriate body language will demonstrate for caring similar patients.
Communication is a reciprocal process and effective use of communication is inevitable in the health care sector especially when we are dealing with vulnerable group. This is a challenge for the nurses to communicate effectively in a stressful situation. The reflection has helped me to identify my strength and weakness in communication. The skills and knowledge I have learned from this reflection can apply in to my practice to provide high standard person-centered care.
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