Introduction

Through a variety of activities and case studies, a variety of communication strategies will be examined to equip you with a greater understanding of the range of responsibilities you have as a student nurse, particularly with regard to communication.

The NMC identifies communication and interpersonal skills (NMC Standards: Domain 2) as one of the core competencies for entry to the register, and state that:

Communicating with clients and carers

Communication is an interactive process, which consists of the significant exchange, through verbal or non-verbal means, of important information that may include thoughts or emotions; this can include the written word as well as face-to-face interactions. Communication skills are essential to develop rapport with the client and to facilitate comprehensive data collection with the intention of developing an appropriate schedule of care to meet the client’s needs (Webb 2011). Developing a therapeutic relationship to achieve this requires a variety of communication skills such as the ability to initiate discussion, listen and respond appropriately, reassure, reduce anxiety, empathise. Effective questioning is also a skill which helps to determine the client’s perception of the problem, facilitating questions from the client is also essential to provide an opportunity to explore their concerns. Careful observation of body language such as facial expression and the professional’s awareness of body language and the therapeutic use of touch are also essential components of effectively communicating. Remember that communication is two-way, the client is also reading the body language of the practitioner. Good communication skills are also essential in the facilitation of liaison with other professionals and services and in the promotion of continuity of care (Webb 2011).

The report refers to a ‘theme of poor communication’, which appears within most of the case studies; examples of this include lack of communication with relatives of the seriousness of their loved one’s condition; failure to inform relevant personnel about discharge arrangements; and failure to establish patients’ concerns.

Similar to most first nurse–client interactions, one of the aims of the first encounter is to develop a rapport. You may have mentioned friendliness and calmness to portray this. It is important to have time: the first visit, if possible, should be planned taking this into account. You may have referred to the commencement of the interaction as the ‘introductory’ phase, where the practitioner introduces themselves and in the community context, this will also include how the practitioner is invited into the person’s home. An example of this interaction is given in Chapter 3.

Once the introductory aspects of home visiting are addressed, the next stage includes questioning and listening to find out the client’s immediate problem, concerns and expectations. It is important to listen to the client’s ‘narrative’ about their experiences. This requires the practitioner’s skills to initiate discussion, to listen effectively and then to summarise the key issues (Miller & Webb 2011). The skills of questioning will be required again to gather more data in relation to the client’s needs; this will usually include general observations about the client and if required, clinical examination. Once this has been achieved, information can be reviewed and checked with the client and in collaboration with the client, a plan of care with achievable aims and objectives can be devised. The way you conclude your first home visit is important and can determine future visits. This is an opportunity to summarise the plan of action following the visit, to give information regarding the time and purpose of the next visit and to give contact details should the client or carer need to get in touch before the next visit.

Good listening skills are an essential component of the practitioner’s communication skills and are particularly significant when attempting to plan appropriate individualised palliative care. Listening to the clients’ personal wishes and beliefs to develop understanding of their perspective regarding their situation will greatly assist in the development of appropriate care. Reaching a satisfactory plan of action from the client’s perspective will only be achieved by listening, discussing and negotiating.

Hamilton and Martin (2007) have developed a framework for effective communication skills practice, this includes the following:

Hamilton and Martin (2007) also summarise the communication skills of the nurse using the acronym EDUCATE:

Information giving

Within the context of managing long-term conditions, community practitioners are often required to communicate multifarious information to patients. Such information may include factors related to treatment regimes, advice regarding diet, rest and exercise or instructions regarding medication – often this information is delivered in a face-to-face meeting. This kind of interaction with the patient provides the practitioner with a valuable opportunity to gain feedback from the patient, to review and check the patient’s understanding and to encourage and support them. To ensure effective information giving, it is important to also consider where and when the information is delivered and also what family members, relatives, carers need to be involved.

Reflecting on your communication skills

Collaborative working

The skills of collaboration, co-ordination and communication are often referred to within the management of long-term conditions. Collaboration is about working together to resolve issues and achieve common aims. The significance of collaborative working is referred to by the Department of Health (DH 2003) and the Nursing and Midwifery Council (NMC 2010). The Healthcare Quality Strategy for NHS Scotland also emphasises the importance of professionals working collaboratively. The benefits of working collaboratively include the following:

Effective record-keeping to promote effective communication

Good record-keeping is an essential professional requirement of all healthcare practitioners and is an essential part of your learning and achieving competence (NMC Standards: Domain 2: Competency 2.7).

Comprehensive records help to facilitate effective communication between agencies to enhance continuity of care and can also assist in the process of clinical supervision and audit. Patient records can provide valuable evidence to defend and support the actions of healthcare staff if legal action is instigated. You may only visit a patient once, yet your record of that visit is significant and is often a valuable aspect of that patient’s overall care.

Good record-keeping is identified as Competency 7 within Domain 2 of the NMC Standards for Entry to the Register:

Most health records are now held electronically; this facilitates the provision of up-to-date, significant health-related information about clients to relevant healthcare professionals and is particularly useful when urgent medical care is required and the GP surgery is closed or if the client is admitted to A&E. Some community nurses will record their visits on their rounds using laptops or even assist patients to use new technology in their home (see the Queen’s Nursing Institute Report: Smart New World: Using technology to help patients in the home, at: http://www.qni.org.uk/docs/smart_new_world_final_web.pdf). However, within some practice areas, written records may still be utilised, it is therefore important that you review your responsibilities to ensure comprehensive and thorough records.

The importance of accurate written record-keeping: an example

Reference was made earlier in the book to the use of the Liverpool Care Pathway, which can be implemented within the advanced stages of terminal illness to enable the provision of appropriate end-of-life-care. The documentation is completed by healthcare professionals every time they make a visit to the patient’s home. This is to enable communication on every aspect of care between all the professionals who are involved with the patient and family. This document also includes contact details of all the services involved with the patient’s care, which can be used by the family or by different members of the care team. Contingency medication can also be documented in case there are any changes in the patient’s condition. At weekends, staff who visit may not have previously met the patient and family it is therefore imperative that all documentation is completed comprehensively to communicate care need.

The following summary of common errors in record-keeping is discussed by Dimond (2005):

Good records normally include factual, clear, accurate and comprehensive information.

Good record-keeping practice includes the following:

Writing and preparing for a case conference

Case conferences are often conducted in relation to aspects of care involving children and their health or care of the older adult in residential care. This is an opportunity for all professionals working with a specific client and family to meet to clarify roles and responsibilities. It is also time to review progress with the patient/client and carer or family in order to make an informed choice about future care.

Activity

With your mentor, it may be possible to attend a case conference to observe the written information required for such an event; or you could also discuss the issues of report writing with, e.g. the public health nurse or school nurse within your placement area who may be involved in writing for case conferences related to child protection. You may like to refer to RCN (2010; www.rcn.org.uk), which provides guidance for nursing staff in ‘Safeguarding children and young people – every nurse’s responsibility’; this document contains some useful guidelines for report writing within this specific area of care. You can also discuss report writing for case conferences with the GP, community psychiatric nurse or district nurse within your community learning placement.

Additional website resources to help you:

1. Scottish Border Child Protection Procedures: http://www.online-procedures.co.uk/scottishborders2012/contents/what-to-do-if-you-have-concerns-about-a-child/case-conference/preparing-for-case-conference (accessed July 2012)

2. An NHS Trust Guideline: http://www.oxfordshirepct.nhs.uk/about-us/documents/260Non-ClinicalGuidelinesforCaseConferenceReportsforChildrenandYoungPeopleDecember2010.pdf

3. Angus Adult Protection Multiagency Guidance: http://www.aapc.org.uk/professionalscaseconf.cfm

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