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Saturday 1 November 2014
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Communication - how can we improve our skills?

Communication - how can we improve our skills?

Communication is a vital skill for the nurse, but in this age of increased technology use and high-level skills, it can be forgotten. Donna Davenport calls for communication to be put back on top of all our professional agendas

A recent visit to hospital to see a close friend following surgery for bowel cancer made me think about how important good communication skills are. During the visit a nurse approached the bedside to empty his indwelling urinary catheter. As she approached she didn't make any eye contact and duly went about emptying the catheter, recorded the details on his fluid balance chart and walked away. At no time during the procedure did she speak.

It really made me think about how essential communication skills are when caring for patients. Had he wanted to ask a question the opportunity was lost. What about holistic care, wouldn't this have been a good opportunity to take a look at the patient and perhaps ask how he was feeling? Maybe she didn't want to interrupt his visiting time, as healthcare professionals often have to work around extended visiting hours.

Verbal and nonverbal communication are used by healthcare professionals every day, and we all like to think we are skilled in this area, but are we? As qualified professionals when do we update these skills or do we just learn from experience? I can recall many times as a sister in A&E having to tell relatives that a loved one had died, but how do you prepare for this, and how do you know if you did it well? Agenda for Change (factor 1) acknowledges six different levels of communication and the complexities and skills involved.1

We need to break down barriers to communication and ensure that patients feel able to discuss concerns and worries? Evidence suggests that many of the complaints received in the NHS are due to a breakdown in communication. So how can we improve this?

In this age of increasing reliance on technology and high-level skills it is easy to forget that the fundamentals of care and good communication should be at the heart of everything we do. A good consultation should start the moment you see the patient. Their nonverbal communication will tell you a lot about how they are feeling before they even speak. Listening to what they have to say about how they feel is an essential aspect of communication.

Pressures to collect data for Quality and Outcomes Framework targets, for instance, can mean that we sometimes look at the computer to see what needs doing rather than taking time to look at the patient. How do you overcome this?

Recent press coverage has called upon nurses to "smile more" and this is certainly an important aspect of communicating with patients if we are to put them at ease and gain their trust, particularly when they are feeling unwell and vulnerable. Good communication is an essential component of high-quality care if we are to ascertain the patient's level of understanding of their condition and encourage them to feel comfortable to ask further questions.

One of the pleasures of working in primary care is that we can really get to know our patients and their families and there is a wealth of evidence to support the fact that patients value their time with nurses who often explain things better and spend more time with them.

Our Health Our Care Our Say set about aiming to achieve four main goals:2

  • Better prevention services with earlier intervention.
  • More choice and a louder voice.
  • Do more to tackle inequalities and improve access to community services.
  • More support for people with long-term conditions.

Communication is at the heart of these goals and patients are being encouraged to be more involved in their care. This can only be achieved if patients fully understand what is available and feel empowered to make those choices. So next time you are talking to a patient, take time to reflect on how you think the consultation went and how it could be improved. Did you use jargon or abbreviations, and more importantly did you find out if the patient understood what had been said?

Some time ago I asked a family member about their experience of general practice and how it could be improved. He remarked that on the rare occasions he had visited the GP he had always arrived on time and yet inevitably he had been made to wait 30-45 minutes after his appointment time. Immediately I became defensive and explained that while appointment times are given sometimes patients need longer or may have attended for a routine appointment only to find something more complex on examination and therefore require longer. He replied, "Yes I understand that but why can't someone tell you that they are running over on arrival? The fact that no-one tells you what is happening makes you feel that your time is less important and you should expect to wait. At least if you knew you were going to be delayed you could contact work and let them know you are going to be late!"

Sometimes it is the little things that can make all the difference to a patient's experience!

References
1. Available from: http://www.dh.gov.uk/en/Publicationsandstatistics/ Publications/PublicationsPolicyAndGuidance/DH_4090845
2. Department of Health. Our health our care our say. London: DH; 2006.

Do you agree with Donna? Has communication suffered in order to achieve QOF points?

Your comments: (Terms and conditions apply)

"I totally agree with Donna. Healthcare communication is deteriorating drastically in the world at that. We must revamp, and enhance communication with Nurse - Patient or Doctor - Patient experience. Communication helps improve a better 'YOU' and a better environment" - Kadesh Marsh, Jamaica

"As a nurse educator for quite some time, I can say that the problem of the new nurses nowadays is they forget the very basics, I mean the fundamentals of our practice. Few to mention is that our communication. Communication is indeed a skill that we nurses should have, being a good communicator
one can assess his/her patient. Another would be, it build a strong relationship between the nurse and the patient and as well build better relationship with colleagues and other members of the healthcare team" - Glenn Gamalier, Philippines

"Having spent many years working in the public domain and knowing the importance of communication imagine my surprise when beginning my nurse training to find that communication is a real problem in some clinical areas. Paperwork, understaffing and too little time to talk to patients. It's a real shame and sets me to thinking about my own skills as a
communicator" - Lynda Lee, Lancashire

"A hundred percent agree with Donna" - Sudiati Ni Made, Indonesia

"I am a first year student nurse and I agree with Donna that communication is paramount in good care delivery. It is upsetting to see that because of short staffing levels etc, patients are not receiving the care they want from nurses. I am glad that whilst on placement I am supernumary as it
gives me the opportunity to spend more time talking to patients on my ward" - Carol Atack

"Unfortunately, yes. Having recently been at the other side my father has vascular dementia and on admission to A&E no member of staff spoke to him while they not only took blood off him but also changed his pad. As a nurse of 34 years, I was very angry that the members of staff were task-focused and did not take the time to reassure him. Communication is fundamental to good nursing care and in my father's case essential" – Christine McBride, Liverpool

"I'm a third year student nurse, I think the communication skills on the ward area is lacking as you do more of the care plans at a computer away from the patient. I feel that communication and understanding of patients' needs is getting harder to come to terms with especially when dealing with
learning disabilities in a hospital environment." - Lucinda Barwick, Durham

"I agree with Donna, basic human needs have been altered because of new technologies. Human touch and basic eye contact when talking to a patient is paramount in nursing, it should be balance technology" – JoJo, London

"Yes. I completely agree with Donna because comunication affects health outcomes." - D Ratnayake

"While targets might impact on the delivery of care there is no excuse for poor communication. Poor communication can be dangerous, impacting on patient safety and a cause for ineffeciencies. It also affects patient safistaction and generates complaints. It is time that nurses challenged the systems that impact on their capacity to provide good-quality care rather than accepting them. They have a duty to protect the patients in
their care and one would hope that the care that they provide is nothing less than they would expect themselves." - Monica Dennis, www.dignifiedrevolution.org.uk

"Yes, certainly, in the past 10 years, nurses have become too busy to chat and reassure patients due to low staffing levels and targets to be met." - Michelle Green, Northampton

"I agree that the computer age has had a great effect on communication. The only way we can find out about patients' needs is by talking. Busy and short of staff is no excuse. It only takes a few minutes." - Jeanette Hocking, Wigan

"Without a doubt. The consultation becomes more task orientated than patient focussed due to the need to tick boxes for QOF requirements. The idea of individualised patient care and time spent with patients for health promotion and education has long gone." - Julie Coupland, Corby, Northants

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