Communication unites people by concepts of words and actions. As a healthcare practitioner therapeutic communication is an essential part of nursing interventions such as health promotion, treatment and rehabilitation (Kourkouta & Papathanasiou, 2014). It is necessary feature of a nurse’s ability to stipulate possibilities for patients to understand their options to support them to create informed decisions regarding their treatment (Williams et al., 2008). Communication in this context refers particularly to face to face oral communication. For the purpose of this paper, communication skills will be critically analysed through an interview between a nurse and a patient. In the scenario, Geoff an Oncology patient was presented to the hospital for chemotherapy education.
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It is significant to consider the location of the interview as much as possible to avoid crowded and noisy environment. Arrangements should be made as it is important to maintain the patients’ privacy specifically when discussing sensitive issues (Jones et al.,2011). I began the interview by introducing my name to the patient, to be able to form rapport. Kourkouta & Papathanasiou (2014), mentions that to be able to generate the right relationship with the patient the initial moment is important. The verbal and non-verbal qualities of communication were observed during the first and second interactions. Verbal communication techniques involve the use of open-ended questions, positive responses and the use of empathy (Schofield et al., 2008). I have asked Geoff an open- ended questions like “Can you tell me your knowledge about the treatment that you are going to have?”, “how are you coping up?” and “who provides you support?”. With these kinds of questions, it seeks to gather more information from the patient to gain more understanding of the patients’ level of knowledge (Flannagan, 2007). Non-verbal cues were able to express by actively listening, maintaining good eye contact and using empathetic gestures through head nods and warm facial expressions (Koukouta & Papathanasiou, 2014). Moreover, non-verbal cues in communication permits the patient to feel relaxed and shows that I am focused on listening to him. Applying silence within active listening in the interview gives the patient to express what he wants to convey (Sheldon, 2011).
Throughout both scenarios with Geoff, I made it certain that he is comfortable and the environment that is noiseless with no interruptions will stimulate confidence for him to express his concerns (Kourkouta & Papathanasiou, 2014).
Although not executed in this interview, the use of touch can also be done which can show support and reassurance when needed (Albardiaz, 2014). This aspect of communication was not indicated for this particular situation as Geoff appeared to be comfortable expressing his concerns and I am trying to avoid any feeling of awkwardness that can cause any form of distress (Albardiaz, 2014).
During the interview Geoff mentions that his feeling of frustrations about his diagnosis and concerns about his wife, children and grandchild. A study analysing “supportive care needs” recognised that patients who had their psychosocial issues addressed in addition to their physical problems were more positive of their care (Jones et al., 2011). According to Jones et al., 2011, most men are more hesitant to initiate conversation involving to their emotional issues. I recognised that Geoff had increased anxiety and concerns in the second scenario. As his nurse, I mentioned about “family meeting”to be able to know everyone’s concern (Kissane et al., 2012). I encouraged Geoff to liaise with any support when needed. It is essential to encourage patients that they know that they are not alone in confronting their trials and they are aware to obtain help or assistance when needed (Jones et al., 2011). It is significant that there are means that support the discussion of sensitive issues in order to tackle the patients’ needs holistically (Jones et al., 2011).
Patient-centred approach is directed at a corresponded acceptance and plan of care, and for the patient to feel that he has a sense of control over his condition (Williams et al.,2008). The patient should be informed of their options and encouraged to actively participate in decision making (Williams et al., 2011). With the effects of good communication, it can straightforwardly affect their survivorship experience and promote oncology care (Song et al., 2012). The fundamental objective of a patient is to successfully manage their own health status and to be able to participate in their own healthcare plans (Rosenberg & Gallo-Silver, 2011).
Overall, the aim to be able to deliver a good therapeutic communication with Geoff has been achieved. The use of open-ended questions primarily motivated the dialogues, although, the first scenario needs to use more of it to be able to express more of his concerns. In consideration of the first scenario, I believe that I could have improved the skill by asking more open-ended questions in order to get a better response, hence, the after-effect of the interview will be enhanced (Flannagan, 2007). The use of non-verbal communication was observed, listening attentively, good eye contact and empathy were practiced. These characteristics is appreciated by patients due to confirmation of their feelings and having someone showing they care. According to Cripe & Frankel (2017), most patient does not demand for an extended consultation, but they desire to have accuracy and empathy by attentive listening regarding their concerns of their illness. Recognising Geoff’s emotional cues and replying in timely manner should be enhanced. Every patient has different pace of opening up in communicating particularly if the subject is difficult to talk about (Kourkouta & Papathanasiou, 2014). I was attentive and silent to make sure that I will not be distracting him from what he was saying. As I have acknowledged that Geoff’s had increased anxiety and emotional distress in both circumstances. By active listening, maintain eye contact and minimal responses I was able to be aware of Geoff’s concerns (Kourkouta & Papathanasiou, 2014). It has been found that minimal responses, can be beneficial in patient centred communication. The responses include the use of saying “yes” and “hmmm” (Jansen et al., 2010).
As I continue to discuss the potential side effects during the first interview, I have noticed that Geoff’s facial expression and avoiding eye contact by looking down to the ground. There is a possibility that he felt overwhelmed with all the information. It might be possible to alter the pre-chemotherapy education by giving some education materials and information for support. Flannagan, 2007, mentions that patient will be able to comprehend the information given if the details are simple to understand, patient’s presence of mind and not in distress. Clarification method has been used to developed good communication skills by reflecting to what is Geoff’s main concern. In this instance, the patient will feel that the healthcare provider is listening and empathetically supporting him.
During the second interview, I have noticed that Geoff’s is on the verge of tears. Silence was practiced being able express his emotions. I have not offered any tissue as it may give him the connotation that I am trying to hold him from his emotions (Flannagan, 2007). Support provided by discussing the problem and finding possible solution (Flannagan, 2007). I have identified during the interview that there were many problems confronted by Geoff. The feedback that I should have done is to narrow it to be able to prioritise which should be able manage. Kissane et al., 2012, reported that effective communication happens if the apprehensions are understood by comprehensive care plan that can follow by adherence to treatment and better health outcomes.
At the end of the interview, the both scenarios have not completed the discussion appropriately due to the time restrictions and even if Geoff’s concerns were acknowledged proper solutions were not entirely discussed. This will be my learning curve in the near future to prioritise and to allow myself to identify on how to communicate empathetically. Flannagan, 2007, reported that a nurse should always remember the acronym NURSE which stands for Name, Understanding, Respect, Support, and Explore, to be able to distinguish what is fixable problem to what is not.
References
Albardiaz, R. (2014). Teaching non-verbal communication skills: an update on touch. Education for primary care. 25(3), 164-170. DOI: 10.1080/14739879.2014.11494268
Cripe, L. D., & Frankel, R. M. (2017). Dying from Cancer: Communication, Empathy, and the Clinical Imagination. Journal of Patient Experience, 4(2), 69–73.
DOI: https://doi.org/10.1177/2374373517699443
Flannagan, P.E. (2007). Communicating with Oncology Patients about Palliative Care. Modern Medicine Network. 21(4). Retrieved from https://www.cancernetwork.com/palliative-and-supportive-care/communicating-oncology-patients-about-palliative-care/page/0/2
Jansen, J., Van Wert, J.C.M., De Groot, J., Van Dulmen, S., Heeren, T.J., & Bensing, J.M. (2010). Emotional and informational patient cues: The impact of nurses’ responses on recall. Patient education and counselling, 79(2), 218-224
Jones, R., Regan, M., Ristevski, E., & Breen, S. (2011). Patients’ perception of communication with Clinicians during screening and discussion of cancer supportive needs. Patient education and counselling, 85(3), 209-215
Kissane, D. W., Bylund, C. L., Banerjee, S. C., Bialer, P. A., Levin, T. T., Maloney, E. K., & D’Agostino, T. A. (2012). Communication skills training for oncology professionals. Journal of clinical oncology: official journal of the American Society of Clinical Oncology, 30(11), 1242–1247. doi:10.1200/JCO.2011.39.6184
Kourkouta, L., & Papathanasiou, I.V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65-67. Doi: 10.5455/msm.2014.26.65-67
Schofield, N.G., Green, C., & Creed, F. (2008). Communication skills of healthcare professionals working in oncology – Can they improved? European Journal of Oncology Nursing, 12(1), 4-13
Sheldon, L. K. (2011). An evidence-based communication skills training programme for oncology nurses improves patient-centred communication, enhancing empathy, reassurance and discussion of psychosocial needs. Evidence-based nursing, 14(3), 87-88.
Song, L., Hamilton, J. B., & Moore, A. D. (2012). Patient-healthcare provider communication: Perspectives of African American cancer patients. Health Psychology, 31(5), 539-547. Retrieved from: http://dx.doi.org/10.1037/a0025334
Rosenberg, S., Gallo-Silver, L. (2011). Therapeutic communication skills and student nurses in the clinical setting. Teaching and learning, 6(1), 2-8.
Williams, S. W., Hanson, L.C., Boyd, C., Green, M. Goldmon, M., Wright, G., & Corbie-Smith, G. (2008). Communication, Decision making, and cancer: What African Americans want physicians to know. Journal of Palliative Medicine, 11(9), 1221-1226.
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