This is a reflection essay on my professional communication. The reflection will be focused on a two twenty minutes’ communication interactions. A self-analysis tool will be used to breakdown the interactions. It will help in analyzing the key communication skills. These will enable me to identify both my positive and negative attributes in communication. there will be an explanation on how to improve my communication skills so as to develop myself in the profession. Relevant nursing communication theories will be used as support evidences on effective communication skills. An action plan on how to improve and develop my communication skills will be developed. The essay should demonstrate the following: one, the importance of effective communication in the patient assessment. Two, the current policies and practices in the health care sector on communication. Three, demonstrate patient centered care. show an understanding of the patients need. Four, should demonstrate awareness of my limitations and strengthens in communication and its development. Five, the essay should demonstrate that I have an understanding of the importance of developing a professional behavior and conduct through effective communication strategies. Discuss on the nurse-patient relationship. There will be a conclusion to summarize all the above.
Reflection of my communication/interaction with PD. She is elderly with dementia. The tool T was used to analyze my communication and the interpersonal essential skills. One, I was able to create a good rapport with the patient. I was able to convey empathy, warmth, genuineness and positivity which made her develop trust in me. Two, I was able to communicate fluently with the patient. I used the appropriate tone and pace considering that the patient had dementia and was elderly. Three, on reflection, paraphrasing and clarification I did not perform accordingly. My skills on reflection, clarification and paraphrasing are inadequate. This led to missing important information from the patient. Four, I was empathetic to the patient’s condition/situation. This made me to be sensitive to her responses, emotions and feelings. Five, I was able to act accordingly to the communication cues she hinted to me. For example, at some point the patient started answering my questions with one word answers. She also didn’t answer some questions. This was an indication of either she wanted to terminate the communication or she wanted to change the direction of the questions I was asking. Six, I was able to use the summary reflection so as to mark the end of the communication. I also allowed the client to give me feedback on their point of view. Seven, the patient was old and had dementia, therefore, her level of concentration was lowered, she had memory impairment and also due to her age she has physical discomfort. These are barriers to effective communication. I ensured I removed them by: ensuring she was comfortable and making the conversation interesting and short. From the above reflection it is clear that I need to improve on my reflection, paraphrasing and clarification and also on active listening. My strengths were seen in verbal fluency, empathy, being sensitive and in overcoming barriers in communication.
The second reflection on my communication and interpersonal essential skills will be analyzed from the interactions I had with patient MW. A pregnant teenager with HIV. Being a pregnant teenager is faced with a lot of stigma and challenges and adding HIV on top makes it even worse. Using the tool T the following information was obtained. One, I was able to create a good rapport with the client. It was not easy. At first she was reluctant to talk to me but after identifying myself to her and to her condition she conversed with me. I was able to create a positive and unconditional positive regard with a lot of genuineness, empathy and warmth. Two, I used the correct tone and pace while talking to her. I did not judge or condemn her. this made it easier for her to open up to me. I was verbally fluent which made communication so easy. Three, on the active listening, it was inadequate. I got distracted most of the time which made me loose so important information. Four, I had insufficient skills on reflection, clarification and paraphrasing. This prevented me from digging deeper to get more information. Five, I was empathetic, this made me sensitive while interacting with her. Six, just as mentioned above I was able to know when she doesn’t want to talk about certain topics and also when she wanted to terminated the conversation. For example, in some instants, she remained reluctant to answer my questions. This was an indication that she was not comfortable with the line of the questions. This made me change the direction of the questions. Seven, I used summary reflection to conclude the communication. this ensured that the client received a feedback on their point of views. Eight, our communication faced no barriers as I ensured that the client was physically comfortable. From the above it is clear that I need to improve on my active listening and the reflection, clarifications and paraphrasing skills. It is also clear that I am verbally fluent, empathetic and sensitive. It is also clear that I can overcome communication barriers and I can be able to use summary reflection to conclude my conversation.
De Vito (2011) defines human communication as a set that consist both sending and receiving of non-verbal and verbal messages between two or more persons. Balzert-Riley (2011) defined communication as a reciprocal process in which the messages are sent and received between two or more persons. Petrie (2013) further described interpersonal communication as a series of the messages/ information that one sends out to people and the message that one receives from other people through hearing, seeing or touching one another.
In nursing communication is very different when compared to other health care professionals. Its uniqueness is not as a result of the communication skills that are required but as a result focus and the emphasis that are put on the communication in this professional practices. The nurses are the corner stone/key when it comes to health care services delivery. The nurses spend most time with patients than all the other health care providers. This time is usually spent in explaining, coordinating and delivering patient care using the therapeutic communication. communication involves interacting and developing relationships, living together and working together. It is practically unavoidable. Nursing is all about helping people. This makes communication an integral part in nursing as it involves sharing information and feelings with the patient and also with other health care providers (Timmins and McCabe 2015).
There are different models of communication, the linear model, circular and the skill model (Arnold, Underman and Boggs 2011; Baiteson 2010; Berlo 2016) Miller and Nicholson 2013). The linear model is limited to communication that is unidirectional so cannot be used in nursing. Nursing needs a multidimensional communication model. The remaining two models are applicable in nursing as they help in explaining the components and the process of interpersonal communication that is required in nursing. The models are important as they help in translating the information being given or explaining or/and instructing a patient. it is useful in ensuring the conversations are friendly, there is use of humor and personal sharing (Timmins and McCabe 2015). The models also help in establishing trust. This is usually as a result of the confidence that the patients have on the competences of the nurses. It is well established by anticipating the needs of the patients. Lastly the two models allow the nurses to go an extra mile. The nurses become friends with the patients and they do more than is required.
Morse et al., (2012) came up with a communication model that focused on the emotional engagement of the patient and the nurse. Two key characteristics were identified from this model. The nurse can either be patient focused or nurse focused. The other characteristics was whether the communication is first level that is spontaneous or second level is the learnt communication. The patient centered with first leveled communication are usually emotional communication that are unconsciously done and are culturally conditioned. This communication usually has aspects of pity, consolidation, sympathy, compassion, reflexive reassurance and commiseration this is considered normal, superficial and in most cases it is undervalued. The most preferred is the patient centered with second leveled communication. This one involves confronting, comforting, sharing self and informative reassurance. It involves talking about the personal life of the patient using humor. This helps in creating a relationship with the patient and alleviating the hospital boredom (McMahon 2012; Mc Dowall 2010; Timmins and McCabe 2015)
As mentioned earlier nurses plays a major role in patient’s coordination through communication. Quality patient care requires therapeutic relationship between the nurse and the clients. Therapeutic communication/interaction is a curative or healing nurse-client interaction (Timmins and McCabe 2015). This is a well mastered concept in nursing so as to ensure there is effective nurse-client communication. therapeutic communication forms the basis for an interactive relationship. It involves establishment of rapport, having an understanding of the patient’s experience, making the care to be patient centered and ensuring there is optimization of the health care resources. Establishment of rapport leads to therapeutic interactions. That allows the client to express their feelings, communicate their thoughts, uncertainties knowing that the environment is safe, accepting (no judging) and supportive (Timmins and McCabe 2015; Burnard, 2014; Bensing, 2011).
Therapeutic nurse-patient relationship requires trust, empathy, warmth and mutual respect. The patient has to believe that the nurse understands, cares and is concern about his or her problem/situation/condition (Goble 2012). A safe and caring environment enables the nurse to value and embrace both the internal and the external experiences of the clients. It strengthens decision making and in formulation of individual care. The following techniques helps in creating a therapeutic interaction: active listening, clarification, focusing, questioning, silence, summarizing, reflection, assertiveness, humor, negotiation and conflict resolution (Timmins and McCabe 2015; Burnard, 2014; Bensing, 2011).
Two key limitations to effective communication were identified; lack of active listening and inability to reflect, clarify and paraphrase. As seen above these two are very important when creating a therapeutic relationship with the client. Therapeutic interactions help in making the patients care to be patient centered/focused. It also helps in knowing identifying the patient’s needs. Therapeutic communication ensures that the patient receives high quality care (Becker, Heimberg and Bellack, 2012).
Active listening is a selective attentiveness and interactive process which involves all the senses, mindfulness and comprehension so as to assess the verbal and the non-verbal communication. It is the cornerstone to all interactions. Many people are poor listeners although they appreciate good listeners (Timmins and McCabe 2015; Burnard, 2014; Bensing, 2011; Becker, Heimberg and Bellack, 2012). For one to assess the needs, concerns and the wishes of the client, one has to be a good listener. Active listening entails more than just hearing. It includes having an understanding and interpreting what is being said accurately. Listening is more than just remaining silent. It is a dynamic and interactive process (McMahon 2012; McDowall 2010). Development of active listening requires self-control, genuine interest, patience, concentration and vast energy. Active listening helps the client in setting the tone and being more direct. Active listening leads to establishment of an environment that is safe. It also fosters trust. It enables collection of relevant information which allows one to make the correct diagnosis. Active listening is important in decision making and in formulation of the patient care (Timmins and McCabe 2015; Burnard, 2014; Bensing, 2011; Becker, Heimberg and Bellack, 2012.
As explained above, there are barrier that are hindering me to listen actively. These barriers include; asking or challenging the client by asking “why”. Introduction of irrelevant information. Interrupting the client, completing client’s sentences giving advices, asking closed ended questions, being closed minded, and using medical jargons (Timmins and McCabe 2015). I can become an active listener by maintaining eye contacts, giving full attention to the client, that is both mentally and physically, reducing the barriers that hinders active listening, avoiding interruptions, responding to the emotional and content component of what the client is communicating, conveying evidences of active listening through paraphrasing, reflection and asking for clarification (Karmark, Peterman and Raynor 2015; Timmins and McCabe 2015; Burnard, 2014; Bensing, 2011; Becker, Heimberg and Bellack, 2012).
Reflecting, clarifying and paraphrasing are techniques very important in therapeutic communication. Reflecting is restating or paraphrasing or/and validating what was communicated (Tomm, 2013). They are used when the nurse ought’s to glean from the patient’s statements and emotions. Clarification is a technique that is used by the nurses so as to validate the verbal and the non-verbal communication so as to determine the accuracy of hat the client is saying. They enable the nurse to get more information from the patient therefore, correct diagnosis. It is also important in decision making and in formulation of patient care to be delivered (McDowall 2010; Goble 2012).
Reflection, paraphrasing and clarification are the most difficult skills/ techniques in communication (Tomm, 2014; Petrie, 2013, Oliver, 2010). For one to be able to use them they must be active listeners. They are all used to confirm client’s assumptions and assertions. The problem I have in reflecting, clarifying and paraphrasing originates from the factor that I am not an active listener. To be able to curb this problem I should tackle the problem I have in listening. The strategies to remove solve this are just as the ones highlighted above.
As seen earlier I excel in establishing rapport. Rapport is the mutual comfortable relationship that is based on objectivity, respect, trust and safety (Tomm 2014). It is important in therapeutic communication as it is the basis to therapeutic communication. I’m fluent in verbal communication. This ensures that the patients set the tone and the pace (Szasz and Hollander 2017; McCray 2011). I am empathetic. This means am able to put myself into the patient’s situation. This enhances my understanding of the patient. Empathy can be translated to being sensitive. I am able to use summary reflection so as give feedback to the clients. This means that I am able to integrate and synthesize the key points that arises in a client-patient discussion. This is important in creating an understanding of the patient’s condition (Tomm 2014; Thompson 2016). Lastly am able to overcome barriers to communication and also I can detect when the patient needs to change in the conversation topic or need to terminate the conversation.
Conclusion
In conclusion, it is clear that for quality patient care, there should be therapeutic communication/interaction between the client and the nurse. Therapeutic interactions ensure that the care is patient centered. This translates to having patients’ needs catered for in a timely manner. Therapeutic communication contributes to decision making and in formulation of interventions. It is also clear that I was unable to create a create therapeutic interactions due to insufficient active listening and lack of reflecting, paraphrasing and clarifying. As seen above these problem can be dealt with by becoming an active listener. An active listener avoids distractions, concentrate keenly and pay attention. My strengths were identified in creating rapport, summarizing, being sensitive, empathetic and being able to overcome barriers in communication.
References
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