Importance Of Non-Verbal Communication In Emergency Nursing

Challenging Experience with a Laboring Patient

You will be required to critically reflect on your experience of taking a health history from one patient. Please note this does not have to be a comprehensive health history as outlined in this module.

An interview with a patient on health history draws many interpersonal skills and one has to take time for reflecting on one’s own values, biases and assumptions to every encounter. Self-reflection is a process that is continuation of professional development in clinical settings. This imparts personal awareness while working with patients being one of the most rewarding patient care aspects (Asselin and Fain 2013). In the following discussion, Gibb’s reflection cycle provides an opportunity to reflect on my personal experience to work with a patient in labor for data collection. The reflection will also reflect on the important communication aspects in collecting data on patient history.

During my placement, I was assigned on the maternity ward in the hospital to assist my mentor as an emergency nurse. The nurse on the day shift was absent and my mentor asked me to assist the patient, ABC. She was in pain and her husband was present in the ward. My mentor tried to communicate and placate her however; she was anxious and had limited English proficiency. Due to labor pain, she was looking worried and looked at her husband to comfort her. However, her husband also did not understand English and was looking helpless. My mentor assigned me with the patient, asked to communicate with her and get her medical history. As she was in excruciating labor pain, it was extremely difficult for me to communicate with her and fetch details. I was unable to comfort her and describe the process to the patient. It was getting difficult for me to communicate with her in getting her medical history as she was gasping in pain. I was unable to support her as was in immense amounts of pain and unique compassion that was required to deal with her and as a result, I was unable to collect the necessary information from her.

Initially, when I was assigned with this particular task, I was feeling privileged that I will be working with patients through the most vulnerable and special experiences of her life. My energy was captivating as there were waves of calm followed by surges of emergency and chaos in labor and delivery. I was in extreme tension and stress and mixed feelings of joy.

The Role of Non-Verbal Communication in Emergency Nursing

At first instance, I was nervous as the patient was grimacing in extreme pain. I was trembling with fear on how to support the patient and comfort her. I empathized with ABC and her husband as they have limited English proficiency and communication was getting difficult for me. She was worried about her baby’s wellbeing and was getting impatient, irritated with me on asking questions. I could not help in that aspect and tried to build a good rapport with her. In that particular situation, it was getting difficult for me to ask questions to the patient about her past health history and course of pregnancy. I approached her again, but she was not willing to answer and I felt that I left my mentor and myself down.  However, I tried again and felt that non-verbal communication with her during that time could be helpful in gathering the necessary information from her. I listened and responded to her concerns and felt that she was convinced by my gestures and touch.  

After I touched and listened to her empathetically, I was able to connect to her to some extent and communicate with her. I was standing close to her line of vision and maintained eye contact and gradually she started responding to me. However, I felt that I could have dealt her more empathetically and demonstrated effective communication skills in collecting data from her. The incident was challenging for me as it encountered communication difficulties as one of the biggest complaint while trying to interact with the patient in labor pain. I was feeling guilty that I failed to complete the task assigned to me and could not support the woman during her most difficult situation.

After the incident, I felt that caring is reflected through a nurse’s communication skills and I tried my best to communicate with the patient by exhibiting nonverbal communication skills rather than communication skills. At first, I was unable to support my patient and develop caring role so that they interact with me in providing their personal information. However, gradually I gained the confidence to approach the woman again and tried to comfort her.

I think my approach lacked effective communication skills and I was unable to connect with my patient at first instance. As stated by Kourkouta and Papathanasiou (2014) non-verbal communication expressed by laboring women are essential cues that nurses should recognize in order to provide appropriate care and gathering data history about their course of pregnancy. I should have been more compassionate and warmth in my approach as it would have indulged my patient to talk to me. I focused on technical aspects rather than the aspects of pain that made it difficult for the patient to communicate with me about her past medical history and labor progress.

Cultural Diversity and Effective Communication in Emergency Nursing

According to Dahlberg and Aune (2013) communication (verbal and non-verbal) can affect the birth outcome and satisfaction in mothers with their birth experience. I was unable to communicate and comfort her that resulted in increased stressor during her labor pain. Another study conducted by Negron et al. (2013) stated that during childbirth process, the type of perceived support that a woman gets greatly affects her satisfaction. Empowerment of laboring women by nurses can be achieved through maintenance of free flow of information considering the nonverbal and verbal cues during interaction (Iravani et al. 2015). During obstetrics, words are powerful as what is being spoken to a woman during labor provides cues for issues of control and power for them (Schölmerich et al. 2014). The woman was experiencing critical pain and high anxiety adding stressors to the birth process. At the same time, I would have been more compassionate and demonstrated therapeutic communication skills, and then I would have been successful in gathering data from her. I should have improved my non-verbal communications during the incident in getting necessary information what was needed in that challenging situation.

The incident taught me that my communication skills were important at that moment while I was caring for the patient. I should have understood that non-verbal communication is important in instances of interacting with patients from other cultural background. The lack of compassionate and caring attitude hindered communication between us that made the patient more anxious and irritated. I was unable to gather relevant data from the patient about her pregnancy and most importantly, support her during labor pain. These consequences led to further discomfort and frustration in the patient. I should have demonstrated effective nonverbal communication skills.

During emergencies, communication is complex and nurses are expected to understand their patients especially from culturally diverse backgrounds (Savery 2015). Inadequate communication forms the basis for patients stress and complaints and failure to understand the importance of language during health-related issues can lead to low quality of care (Okuyama, Wagner and Bijnen 2014). Due to lack of effective communication skills, I was unable to support the woman during labor pain. A large body of research suggests that nature of support received by women during labor is identified as ‘essential support’ for a positive life experience (Dahlberg and Aune 2013). I became anxious in that critical situation and that resulted in conveyance of negative attitudes to the laboring patient and her husband. However, this incident was good as it contributed to my experience. It gave me confidence to manage women with labor pain and help them during the most difficult times. There are two main responsibilities of an emergency nurse in labor pain to establish a therapeutic relationship and provide emotional support through caring attitude, calming and positive non-verbal expressions (McConnell, Slevin and McIlfatrick 2013).

Developing a Therapeutic Relationship in Providing Emotional Support during the Intrapartum Period

Conclusion

From the above situation, I concluded that I could have acted differently and these circumstances could have been avoided. I could have conveyed more optimism and confidence in her ability to give birth and comforted her during labor pain. Non-verbal communication is the best approach during stressful situations when the patient faces difficulty in communicating verbally (O’hagan et al. 2014). This non-verbal communication could have been important in this situation to understand the patient’s concern and comfort her. I should have demonstrated the ability to ask questions to the patient with kindness so that she felt comfortable, gained interest and trust and as a result, this would have supported her during labor pain. The stressful situation made me feel nervous and I failed to comfort the patient as well as gather past medical history from her. Touch is also way to communicate that covey affection and concern to the patients. It communicates reassurance and acceptance providing emotional and physical support to the laboring women (Montague et al. 2013). It was my duty to ask the patient whether she is benefitted or not.

From this experience, I learned to develop my therapeutic communication skills, critical thinking skills, observation, comfort promotion, compassion and empathy as an emergency nurse in supporting patients with labor pain. Intrapartum support is important, as it is a psychosocial event and has an impact on the childbearing woman as well as childbirth outcomes (Lyndon et al. 2015). Professional support is expected during labor pain as it reduces the risk for emergencies or medical interventions. During labor pain, both verbal and non-verbal communication skills are important like touch, eye contact and focus on attention (Khadivzadeh et al. 2015). The nurse should provide a clear intention for communication reassuring the woman in labor pain through nonverbal cues influencing her experiences (Ricci 2013). There is a need to develop trust, rapport and effective communication between healthcare professionals and childbearing woman that is important for positive childbirth experience (Henderson and Redshaw 2013). From the incident, I concluded that I lack non-verbal communication and active listening skills. Listening is important during intrapartum nursing and requires concentration of mobilization and attention of all senses for non-verbal and verbal messages emitted by the patient. It was my responsibility to assess the situation and her problems as it would have enhanced her self-esteem and comforted her during labor pain.

Interpersonal communication skills are also important as it demonstrates the ability of nurses to ask questions with kindness and get relevant information without scaring patients. Moreover, good personal relationships also create trust, feelings of acceptance, interests and harmonious relationships during intrapartum period (Afaya et al. 2017). This therapeutic relationship is pre-requisite to effective communication between patients and healthcare professionals not only convey messages rather get adequate information from the patients (Arnold and Boggs 2015). I was unable to demonstrate effective interpersonal communication skills and lacked the ability to express sincere concern for the care of patient and in collecting medical history from her.  Therefore, I need to improve my interpersonal communication skills and critical thinking skills to meet the patient’s needs and take help from interpreter in cases when I am unable to understand my patient.

My action plan for my future role as an emergency nurse in maternity ward includes development of interpersonal communication skills, problem-solving skills, lack of empathy or understanding, active listening skills, and assertiveness. These skills will help me to deal such situations in a better way in the future within a time of six months.

Skills need to develop	Goals	Strategies
Interpersonal communication skills	To develop active listening skills	Short courses like soft skill classes for one month can be helpful for improving my active listening skills. Feedback from peers can also be a method to assess my listening skills. Direct observation is another method that can enhance my active listening skills through attending social gatherings, meetings and seminars (Henry, Holmboe and Frankel 2013).
Therapeutic communication skills	To improve my communication while interacting with patients	Communication courses are long duration courses of 3 months that offer proper education and training to work efficiently during critical situations. Strategies like listening, questioning, empathetic communication, noticing, establishing and incorporating patient care can be helpful in enhancing therapeutic communication potential (Bramhall 2014). By looking for patient cues, asking open and directive questions about feelings, using silence and pauses, use of minimal prompts and clarification can be helpful in enhancing effective communication skills.
Problem solving skills	To develop problem solving skills to work under critical situations	This can be developed by discussing my strengths and weaknesses with my peers for honest feedback. Collaborative approach like attending seminars, projects, workgroups or tasks that demand negotiation can be helpful in discovering my strengths and weaknesses while working on it.
To develop compassionate and empathetic care	To develop good team spirit, cooperation to work under crisis conditions	During communication, make eye contact and give uninterrupted attention while talking to the other person. Workplace education programs can also be useful in practicing effective communication during critical incidents.
Critical thinking skills	To develop clinical judgment and reasoning into a clinical situation.	This can be achieved through simulation-based learning. Problem-based learning with the help of case studies, in-depth briefing of clinical experiences, critical incidences discussion, concept mapping can be helpful in developing critical thinking skills.
Active listening skills	To understand patient’s concerns and preferences	This strategy includes seven steps- Reflecting, acknowledging, summarizing, empathizing, making guesses, paraphrasing and checking that help to verify the understanding of the situation. This would help to understand patients and their feelings. Non-judgmental attitude can help to avoid arguments that can ruin trust as critical comments can frustrate patient and limit their understanding. This also helps in providing understanding and care to the patient without any judgment regarding their choices and preferences. The SAGE & THYME model foundation workshop can also be useful in providing a framework for structured conversation with a patient who is in pain or distress. Setting-  Be aware of the setting Ask- ask the patient about their concerns Gather- In this stage, gather and analyze their concerns Empathy- After analysis, respond sensitively to their concerns. Talk- Therapeutic communication can be helpful in talking and supporting the patient’s concerns. Help- Asking patients if they need help You- critical thinking skills is required to think what strategies would help the patients. Me- Asking the patient if they need any additional help End- The last step involves summarizing and closing the conversation. This workshop helps to increase competency, perceived confidence and willingness to understand patients’ emotional concerns. The time is two months. This also provides evidence-based communication skills training to nurses in dealing with patients’ concerns (Connolly et al. 2014).
Assertiveness	To develop assertive communication skills, relieves nervousness and enhance trust in nurses in advocating for their patients.	Educational programs that involve conceptual knowledge help to overcome communication issues. Reflective practice can be another way to examine one’s experiences and actions with the outcome of enhancing one’s clinical knowledge and developing nursing practice. In this practice, one can make sense of different situations in improving care (Lauren Caldwell 2013).

From the above discussion, it can be concluded that effective communication is important in nursing for improving patient safety. During critical situations, professional support and interpersonal communication are hampered that influences patient safety. Therefore, it is important to enhance one’s interpersonal and therapeutic communication skills to provide best quality of care to patients. For this, reflective practice and action plan can be helpful in getting a better understanding of one’s actions and developing professional skills.

References

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