Communication To Patients In
Different Age In Nurse Practice
What can studying communication skills
offer us as medical practitioners?
Increased nurse Job Satisfaction
Decreased Conflict Within The Consultation
More Accurate And Efficient Interviews
Better Clinical Hypothesis Generation
Increased Patient Satisfaction
Increased Patient Understanding And Recall
Improved Compliance And Disease Outcome
Decreased Medico Legal Complaints
Actual Savings In Time
More Structure And Control Of The Difficult Consultation
Treatment Outcome:
Effective diagnoses and treatment depends not only on
identifying physical symptoms of illness, but also on the
nurse’s ability to detect and respond to verbal and nonverbal cues, to elicit all relevant information (physical
and psychosocial), relevant to diagnoses and treatment.
Patient’s Adherence:
A poor communication skill is related to poor compliance.
Communication skill training has a positive influence on
patient compliance with prescribed medication. Effective
communication enables nurses/Nurse and other health
professions to pass on relevant health information, and
to motivate patient to pursue healthier lifestyle. This is a
very important part on health promotion.
nurse’s Competence & Self-Assertion:
Research has also shown that better nurse’s patient’s
communication can also contribute to the clinical
professional and personality (self-confidence) aspects.
Patient’s Satisfaction.
Many researches have also shown a significant
relationship between the clinician’s interpersonal skills
and patient’s motivation and satisfaction. When the
nurse dominates the interview, verbally and emotionally,
the result is always leads to dissatisfaction of the
patients and their relatives. This may also be related to
the patient’s expectation about the role of the nurse.
Patient’s satisfaction plays a major role in assessing
quality medical care in the newly adopted health system
(manages care) in the USA.
Cognitive Satisfaction: How satisfied is the patient with
their understanding of the diagnoses, treatment, and
prognoses. This is related to the nurse’s Verbal
Behavior.
Emotional Satisfaction: This is related to the nurse’s
non-verbal behavior. The ability to show care and
concern by tone of voice, eye gaze, facial expression,
body movement and posture.
INTERVIEWING
CORE COMMUNICATION
SKILLS: Core communication
AND
skills covers three
dimensions:
COMMUNICATION
• nurse -patient interpersonal
skills
SKILLS
• Information gathering skills
• Information giving skills and
patient education
Advanced Communication
Skills
• Skills for motivating patient
adherence to treatment plans
• Other applications of core
communication skills in
specific situations.
Information gathering skills
A critical part of all nurse-patient interactions involves
eliciting information from patient. The core skills which
are needed to facilitate the process of information
gathering are skills which help to facilitate the patients’
involvement in the medical interview in away that
enables the nurse to arrive at an accurate diagnosis of a
patient’s problem or symptoms.
Using an appropriate balance of open to closed
questions
Open questions invite an extended answer, not a
“Yes/No” response. Generally questions such as “Please
tell me about your pain” are better at eliciting information
than closed questions such as “Is it a stabbing pain?”.
Open questions are particularly useful patients are being
asked to describe their problem; which they should be
allowed to do minimal interruption early on in the
consultation.
Silence
You need to learn to use silence appropriately as a way
to encourage express themselves more fully, raise
difficult topics and remember important
Clarifying patient expectations about the consultation
You need to clarify with the patient what their
expectations are consultation, and should avoid making
premature conclusions about the reason person’s visit to
the nurse. This may helps to reveal cases where the
symptom the patient is not in fact the patient’s main
concern, and will also help to avoid inaccurate diagnosis
of the patient’s complaints.
Clarifying the information given by the patient
You need to clarify the meaning of what the patient is
saying and the nurse perceives from the patient’s nonverbal communication in order to he/she understands the
patient fully.
Sequencing of events
After eliciting a broad description of the patient’s
situation, students need to help the patient to sequence
events and experiences in order to develop a logical of
the patient’s situation.
Directing the flow of information
While it is important that patients be allowed the
opportunity to communicate at the same time the student
needs to learn to maintain control of the interview, by
guiding the interview content towards a diagnosis of the
problem.
Summarizing
Since a lot of information can be exchanged in
consultations, you should be able to summarize the main
issues raised during the consultation and should ensure
that a shared understanding of these.
Information giving
skills and patient
education
The medical interview usually involves the nurse in providing
information to the patient about their illness or problem, and when
appropriate the nurse will give inform and advise about the proposed
treatment plan or treatment options.
Providing clear and simple information by monitoring jargon, and by
checking the patient’s understanding before (“What do you know
about asthma?”) and during (“Have I made myself clear?”) the
explanation process.
Using specific advice with concrete examples. Abstract or general
advice/inform should be exemplified in terms that make sense to the
patient “Don’t use acidic foods for example steer clear of fried
things”.
Putting important things first. Research suggests that what is said
first is remembered. A nurse should say first what it is most
important for the patient to recall
Using repetition. Repetition should be used carefully to a
level appropriate to patient. Often it is best to recycle
information using slightly different words, in case the
formulation has been only partly understood.
Summarizing. This is an important interview-closing skill
(see above). Sum should be brief, and repeat the main
points agreed in language, which is unambiguous clear.
Patients may also be invited to repeat the nurse’s
instruction to ensure that they shared understanding.
Categorizing information to reduce complexity and aid
recall. Where the information to be conveyed is complex,
or where there is a lot to be said, it should be clearly b
down into manageable units which are clearly signaled
to the patient, using markers s “there are three things we
need to think about ... firstly/secondly/thirdly etc”.
Using tools: Complex information could well be
accompanied by a series of heading and
diagrams. Some nurses offer tape recorders of
their consultations to patients where the
information has been intellectually demanding
and psychologically distressing.
Checking patient understanding of what has
been said. Repeating instructions, using
diagrams, written instructions, and sometimestechnical aids to explain difficult concepts are
useful. The student must be competent in
summarizing the information given and in
checking patient understanding by asking the
patient to repeat what heard and understood.
Skills for motivating
patient adherence to
treatment plans
The list below includes skills for the promotion of behaviour. Realistic
compliance with treatment plans may require patients to make
significant changes in their diet, lifestyle or daily routine on a short term
or long term basis.
Providing a rationale for behavior change
Providing examples of role models
Allowing opportunities for verbal rehearsal of the details of the
treatment
Feedback (positive reinforcement of constructive behaviour changes
already achieved since earlier consultations)
Finally, nurses should be aware about the clincial, communication and
interpersonal skills that are required when dealing with difficult
patients,(e.g., overdependent, dramatizing and exaggerating,
aggressive, and antisocoial personalit.
Children who are either “neglected” or “rejected”
Children who have problems making friends, those
who are either “neglected” or “rejected” sociometrically,
often show deficits in social skills. One of the most
common reasons for friendship problems is behavior
that annoys other children. Children, like adults, do not
like behavior that is bossy, self-centered, or disruptive.
It is simply not fun to play with someone who doesn’t
share or doesn’t follow the rules. Sometimes children
who have learning problems or attention problems can
have trouble making friends, because they find it hard
to understand and follow the rules of games. Children
who get angry easily and lose their temper when
things don’t go their way can also have a hard time
getting along with others.
Social competence deficits and peer
rejection
Exclusion from a normal peer group can deprive rejected
children of opportunities to develop adaptive social behaviors.
Evidence compiled from studies using child interviews, direct
observations, and teacher ratings all suggest that popular
children exhibit high levels of social competence. They are
friendly and cooperative and engage readily in conversation.
Peers describe them as helpful, nice, understanding,
attractive, and good at games. Popular and socially
competent children are able to consider others’ perspectives,
can sustain their attention to the play task, and are able to
“keep their cool” in situations involving conflict. They are
agreeable and have good problem-solving skills. Socially
competent children are also sensitive to the nuances of “play
etiquette.”
They enter a group using diplomatic strategies, such as
commenting upon the ongoing activity and asking permission
to join in. They uphold standards of equity and show good
sportsmanship, making them good companions and fun play
partners.
Children who are
rejected by peers often
have difficulties focusing
their attention and
controlling their behavior.
They may show high
rates of noncompliance,
interference with others,
or aggression (teasing or
fighting).
Peers often describe
rejected classmates as
disruptive, shorttempered, unattractive,
and likely to brag, to start
fights, and to get in
trouble with the teacher.
Aggressive children
Not all aggressive children are rejected by their peers.
Children are particularly likely to become rejected if they
show a wide range of conduct problems, including
disruptive, hyperactive, and disagreeable behaviors in
addition to physical aggression.
Socially competent children who are aggressive tend to
use aggression in a way that is accepted by peers (e.g.,
fighting back when provoked), whereas the aggressive
acts of rejected children include tantrums, verbal insults,
cheating, or tattling. In addition, aggressive children are
more likely to be rejected if they are hyperactive,
immature, and lacking in positive social skills.