Communication in nursing and a clinical example

Communication in delicacy and a clinical exampleThis assignment is a reflective account of my relationship and communicating with a plastered broad-suffering during my first clinical stead in a nursing kinsperson.All names in this text ache been changed, to respect the confidentiality of the forbearing role and other healthc atomic number 18 professionals (NMC 2002). IntroductionMost state deject throttle of entangle choler and helplessness at non world listened to when saying some social function completely-important(a). Also the intense frustration of being misunderstood Ellis, RB. (2003). defining Communication. In Ellis, RB, Gates, B, Kenworthy, N Inter in-person Communication in Nursing. 2nd ed. capital of the United Kingdom Churchill Livings tactile sensation. p3.I obligate recently been on 7 week placement in a nursing photographic plate for the decrepit. It was a residential home entirely also had a sm alone derangement unit in which patients with men tal health problems were acquiren c atomic number 18 of. This last has taught me that communicating with elderly patients both with and without dementia weed be extremely tight. In certain circumstances I fix it hard to understand what some residents wanted due to these communication barriers.In my essay I will be describing to the reader, what dementia is, what communication is and how important literal and non communicatory communication is to sufferers of dementia.What is hallucination? madness is a common condition. In England alone, at that place ar soon 570,000 wad living with dementia. That number is expected to double over the adjacent 30 years. Dementia. Available//www.nhs.uk/conditions/dementia/Pages/Introduction.aspx. Last accessed 20 Dec 2009.Dementia is a condition that is connected with an ongoing decline of the brain and its abilities. It is generally ca apply by damage to the structure of the brain and is nearly common in people over the age of 65. T hinking, speech, memory, consciousness, and judgement are all stirred in someone who has Dementia. Sufferers may also have problems in imperative their emotions and behaviour when in social situations. Due to this their personalities may appear to change. on that point are 4 kinds of dementia. Alzheimers dis liberalization, Vascular dementia, Dementia with Lewy bodies, where and Frontotemporal dementia. These 4 kinds were all precede in patients in the dementia unit, where I spent 7 weeks hitherto I will be concentrating on Alzheimers.ALZHEIMERS ISWhat is communication? Communication is ingrained for human inter propelion it is the process of passing on in motleyation form one person to another. Both verbal and non verbal communication is subroutined by a health cathexis worker however for a dementia sufferer non verbal communication is essential. ( argyle, 1978) believes that non verbal communication abide have five fourth dimensions as much effect on a persons brain of a message compared to the verbal communication at the time.Chomsky calls the act of speech (verbal communication) performance and the intimacy of the language competence. People perform the complexness of speech daily but have no real knowledge of why or how they came to be able to. Speech allows us to hold conversations, ask question, take a leak instructions, hide the truth, build routines and most signifi enduretly confabulation some interactions in which we are involved (Argyle, 1978).Why is communication important? Communication is extremely important in the healthcare indus decide. In arrangement (as a healthcare worker) to understand your patient and vice versa, there essential be good, clear communication. This will help the patient receive amend care. If a patient standnot be understood properly it would be in truth hard to give appropriate care. If there is good communication betwixt a patient and healthcare worker, it will ease the patients anxiety Patients are a t risk for high Levels of anxiety and frustration if communicative attempts are unsuccessful. (Finkee, Erin HMS 2008). Communication helps the carer and patient get to know each other better, it helps them to gravel and learn what makes the patient happy or upset, what foods they corresponding and more importantly when theres a problem the patient is more uniformly to turn to the carer if there is a good bond there. A good bond back end be hard to achieve with a patient with dementia as of a sudden term memory is often lacking so earlier conversations can be forgotten. Approach towards patients with dementia is very important, facial expressions, tone of vocalisation, uniform and how we mystify ourselves can say a lot approximately us.When communicating with the elderly residents if I were to raise my voice in an self-asserting guidance they may feel threatened and scared by me, but if I speak to them in a pleasant tone of voice the then the resident is more likely to fee l at ease around me. I can then origin gaining trust and understanding between myself and the resident. When a patient has dementia they cant speak by the final stage. Closed questions must be used by this stage. thither are 2 types of questions, absolved and unlikeable. Open questions leave the answer open to oppose with alot of information or a little. Closed questions are those that a patient has nod or shake their head to or use other organic structure parts much(prenominal) as thumbs up or down. This style of questioning is appropriate to use on someone in the final stage of dementia. Closed questions are such like ar you okay?, Are you hungry?. This allows the patient to take place with us without very saying anything. These types of closed questions are a type of non verbal communication. As I have mentioned earlier there are two types of communication, verbal and non-verbal. Verbal Communication public lecture to the patient and them responding with speech. It can really be very difficult to use verbal communication with Alzheimers patients because there short term memory is limited to they forget easily whats been said. According to Argyle (1990) in a conversation, language make up only 7% of a message tone, tempo and syntax make up to 38% and body language makes up to 35%. Non verbal communication can be expressed by our facial movements, gaze and gist connexion, motion and body movement, body posture and body contact, use of space and time and how we dress. (Henley 1977) states that how powerful we feel in an interaction can be expressed non- verbally. Our unspoken communication can be shown through our body language. touch patients can be an essential tool for a nurse. It can disco biscuit support and understanding, comfort and security. It adds extra meaning to the spoken word. Macleod and Clark (1991) suggest that most touch between nurses and elderly patients is related to applicatory procedures, fulfilling a practical rather th an an emotional purpose. Facial expressions and tone of voice can go what youre severe to say. If youre frowning or looking sad, this can cause patients to get angry and upset, but if youre smiling at patients, this can raise their mood. perceive and attending are both also very important aspects of communication. Patients who can speak freely approximately their ideas and feelings fatality a little encouragement so that they can explore these ideas a little further, such as saying Mm or Aha. In the mental health infirmary that I was on placement at, most of the clients had Alzheimers disease, so it was very difficult to communicate with all of them as the majority of them couldnt found it difficult to communicate certain issues at some times. It was hard for me to know their needs as they couldnt tell me what they wanted, the only way I could help them was if I asked them closed questions like Do you want something to eat?, or do you need to go to the toilet?. This gave the patients the opportunity to give me a yes or no nod or use their eyes to tell me what they wanted. Another way I noticed if patients were agitated was if they were walking around fiddling with everything and trying to get out of the hospital , I knew something was wrong, commonly it was because they were constipated or needed the toilet, other times was because they were thirsty and needed a drink. If I was feeding the patients and they wouldnt open their mouth to eat the food or storm against the spoon I would know that they werent hungry. Sometimes patients would spit their tea out, this was usually because it was too hot. Barriers to communicating and how to overcome them the biggest barrier to communicating with a patient with Alzheimers disease is the fact that some of them cannot speak. But when we speak to them, there can be barriers so that patients cant hear or understand us, these entangle Background noises, e.g. the radio playing loudly, or the television too loud, pe ople around reprimanding as well as us, this can project patients even more. Turning the television down whilst having a conversation with a patient can help. The way we speak, if we are mumbling they wont be able to understand us, or if we have an unfamiliar accent that they dont sleep with or understand they wont be able to respond to us. utterance clearly and giving simple instructions helps patients understand us better. If we are feeding patients and talking to them at the similar time, clients will get all confused and defeated. Or if we are eating or chewing something ourselves whilst talking to a patient, this can affect our speech and make it difficult for the patient to understand what were saying. Taking time to concentrate on one proletariat at a time avoids confusion. Calling clients by their name can draw their attention better rather than honorable talking to them just away, because otherwise they might ignore us because they dont know that were talking to them. Providing the patients with the words they might want to say can help us set up their needs because perhaps they might dispirit something but then start mumbling, listening carefully to them will make things much easier for us to respond and help them. Conclusion Before going on placement, I matte up very nervous and anxious on what it was going to be like operative with patients who I knew couldnt communicate with me. I kept cerebration about how hard it was going to be to know how to take care of them and try to reach their needs in the best possible way, the only thing that helped me through the experience was the fact that I had a great smokestack of empathy and patience which helped me communicate better with the patients so I didnt get frustrated or angry when they couldnt respond to me. Before I went to work on the ward, I had read up and researched Alzheimers disease, to have a greater understanding on what to expect, and to be able to deal with the environment i n a more professional manner. I used verbal and non-verbal communication and body language e.g. touching, feeling, smiling and speak clearly. This helped me communicate much better with the patients as a majority of them couldnt reply to me verbally, so they used eye contact and touch to help me know what they wanted or needed, e.g. if a patient took my hand and lead me to the direction of the toilets, I knew they needed the toilet.Mr. Jones was brought to the nursing home in the Flintshire area by his son. He is 88 and has suffered from dementia for a number of years but in the past year Alzheimers has progressed plum quickly leaving his son unable to care for him. Mr Joness symptoms include major confusion, withdrawn from society, psychotic beliefs and extreme mood swings, he often gets extremely angry. He needs carers for certain normal activities essential for daily living such as finding the toilet, helping him on with his clothes and generally ceremony over his throughout t he day. Some of his needs may also be due to his age he has problems with his mobility so needs a carer for that not just due to the Alzheimers. My mentor asked me to spend some time with Mr Jones, talk to him and build up a rapport with him. The day before my mentor had given me some leaflets on the subject of dementia and Alzheimers to prepare me and give me a better understanding.When I first sat down with Mr Jones he just seemed like a normal elderly gentleman of bonny health for his age, however as I began speaking to him I found quickly how advanced his Alzheimers was. It was quite upsetting for me as I had neer been in that situation before. Within the first 20 minutes of speaking to Mr. Jones he had asked me the same question and we had the same conversation around 5 times. I found this rather awkward as I was unsealed whether to continue with the repetitive conversation, create a new one or whether if I did so it would end in the same way. Mr Jones also mentioned to me that he was the homes Gardener. Confused by this I went to my mentor who assured me that this was a delusion he had thought was real since his son moved him into the home and to just leave him to it.I found that after the first week of me working there Mr Jones recognised my face, he still continued to ask me the same questions such as where do you live?, do you know my son? and tell me about his gardening job but he would find by name. So knowing my name had clearly gone into his long term memory.The thing that worried me the most however was that Mr Jones would ask me when he was going to get his pay cheque. The other staff told me to tell him neighboring week. I found this shocking and an insufficient answer. I felt that if I did as the other staff told me this would just reinforce the delusion and so I when he asked me the next time I told him the truth. This however make him very di showed and upset. The NMC (2002) outlines that we must not add extra stress or discomfort to a patient by our actions. This has proved to be a hard role to follow as either pickax would have added discomfort to him.This experience left me feeling very self-conscious and inadequate in my role. I tried to understand why he had manifested this delusion and came to the answer that perhaps it was a coping technique at the thought of being coiffe into a home. I felt anger and frustration and helplessness that there was nothing I could think to do to help this delusion fade away.Although this experience was very frustrating for me and credibly the patient, it has highlighted the need for me to improve my communication skills.It appeared to me that Mr. Jones delusion was not only a psychological disorder caused by his condition, but a way for him to put his mind at ease. Critical analysis of this experience has pointed to the fact that I have inadequacies in my skills I had focussed too much on my morals and worry that I was being untruthful with him when perhaps reinforcing his placement would have caused him less displeasure. I had not considered his other needs like his wishes or desires and I had not gathered enough personal information about him beforehand to know this maybe he liked gardening. I had been unsure about what to say or do to ease Mr. . unvarnished anxieties and had adopted what Watson Wilkinson (2001) describe as the blocking technique. By continuing my actions to bind on with the meal, I was cutting short the patients need to communicate a problem. I was influenced in this decision because I felt obliged to be seen to reduce his anxieties, knowing my actions would be judged by an audience of other care workers and patients on the ward. I did not respond efficiently to reduce his scathe and this pressure led me to deal with the situation inadequately and for that I felt guilty (Nichols 1993). I should have allowed more time to understand what Mr. Jones was thinking and feeling by maybe asking him calm questions such as do you know w here you are, how long have you been here? And perhaps he would have come to a gradual realisation by himself. I could have shown more empathy in the form of my own body language to promote active listening (Egan 2002) instead of just worrying about his mind wandering to an untruth.Gould (1990) cited by Chatham Long (2000) have suggested that many of the non verbal behaviours we use to reassure patients, such as close proximity, prolonged eye contact, clarification, validation, touch, a calm and soothing voice, the effective use of questions, paraphrasing and reflecting thoughts and feelings and summarising are all sub skills with the totality of empathy. There is an abundance of information about communication, oddly for nurses because it is considered by many as the core component to all nursing actions and interventions. Lack of effective communication is a problem that still exists because the learn process that leads to a skilled level of ability may take years of experience to develop (Watson and Wilkinson 2001). It has been quite difficult for me to admit my inadequacies in communication, but Rowe (1999) explains that a person must identify their weaknesses as an porta for becoming self-aware. Only with acceptance of ones self, can a person begin to acknowledge another persons uniqueness and build upon this to provide holistic care. I know the knowledge I have gained through reflection of my experience will not always ensure that I will treat patients with unconditional positive regard, simply because of the diversity in the nature of us as individual human beings and the environment surrounding us. I have gained a new perspective on my practice which is to set myself personal goals in facilitating effective communication between the patient and myself, should the situation present itself again.BERLOS MODEL