8 Communication within medical placements
• To explore communication within multidisciplinary teams within medical placements
• To explore why communication is so important for the medical patient’s wellbeing
• To determine the importance of accurate record keeping
• To identify learning opportunities to develop communication skills within placements
Introduction
Wherever you are in your medical placements and regardless of your field of nursing, you will have learning outcomes that require you to demonstrate competence in communication and interpersonal skills (Nursing and Midwifery Council (NMC) 2010,). Your NMC-approved programme based on the 2010 Standards and Competencies has a generic competence for communication and interpersonal skills alongside the NMC Essential Skills Clusters for ‘care, compassion and communication’ (NMC 2010). The NMC states that ‘all nurses must use excellent communication and interpersonal skills. Their communication must always be safe, effective, compassionate and respectful’ (NMC 2010, p. 15).
Some of you will be achieving competencies with the NMC (2008) Standards, which also have a significant number of competencies related to effective communication skills. As well as engaging with different sets of competencies, your curriculum documentation will be different for each university, but all of your programmes will incorporate the NMC Domains and Essential Skills Clusters. Some of you may have skills-based outcomes, activities and reflections in addition to these, and it is important that you are aware of what you need to achieve in relation to communication and interpersonal skills within your placements. You will need to adapt your communication strategies depending on who you are speaking to and where you are placed.
There are four key areas for you to focus on during your medical placement:
1. The relationship with the patient and their significant others.
2. Professional relationships with colleagues and the multidisciplinary team.
3. What information to give at handover or patient reporting period.
During the theoretical component of your course, you will have been taught about the NMC Code (NMC 2008). Now that you are in your placement, think about how this is put into practice. You could consider the following:
1. Think about why it is important to maintain and regulate professional standards.
2. Are you able to think about examples from practice? How is confidentiality maintained? What records are left by patients’ beds? How are patient records accessed and who can access them?
3. How do you answer the phone and what information are you allowed to give? Observe and listen to how other members of the nursing team deal with telephone queries.
4. Are patients asking you difficult questions? How can you answer them in a professional manner? How do other members of staff answer these questions?
With regards to record keeping, the NMC (2009) produced very comprehensive guidelines, but it is important to remember that records at the end of a bed could be looked at by anyone visiting and should contain nothing that provides demographic data or diagnosis.
Reflective practice is now part of nursing and many of your learning outcomes will require you to reflect about your practice. There are many models of reflection that you will have been introduced to at your university (Johns 1996, Gibbs 1988). Nursing involves situations that are complex and we need to make sense of these situations in order to build on the relationship between practice and theory. Whatever model or framework you use for reflection, they normally contain the following considerations (Gibbs 1988):
• Description of the experience/event – what happened?
• Feelings – what were you thinking and feeling?
• Evaluation – what was good and bad about the experience?
• Analysis – what sense can you make of the situation?
• Conclusion – what else could you have done?
It may help you to read the following articles about reflection and the student nurse:
O’Donovan M (2007) Implementing reflection: insights from pre-registration mental health students. Nurse Education Today 27(6):610–616
de Sales T, Beddoes L (2007) Using reflective models to enhance learning: experiences of staff and students. Nurse Education in Practice 7(3): 135–140
Professional relationship with colleagues and the multidisciplinary team
• Multidisciplinary team forums – care planning meetings.
• Participating in ward rounds – usually a consultant will have set days and times for ward rounds. Ward rounds take place by the patients’ beds and a registered nurse, consultant and a team of doctors with other healthcare professionals discuss with the patient how they are progressing. A clinical assessment and examination are often made by the consultant and actions to be taken are discussed with the patient and documented.
• Making referrals under supervision of your mentor on behalf of patients to clinical nurse specialists, district nurses, discharge coordinators and others.
• Spending time with the clinical nurse specialists who link with the medical placement.
• Liaising with social workers, physiotherapists, occupational therapists, bed managers and site nurse practitioners.
In Chapter 4, patient journeys and examples of learning pathways were explored. This is an ideal opportunity for you to speak with your mentor to ensure that you are accessing all the learning opportunities possible with regard to understanding about the work of other health and social care colleagues.
You will see that you will have some learning outcomes that require you to communicate with other disciplines and to have some understanding of their role. This was one of the actions from several high-profile healthcare investigations in the UK which criticised staff for not being able to communicate effectively, such as the Bristol Royal Infirmary Inquiry (2001), the Climbie case (Department of Health 2003) and the case of Baby P (Laming 2009).
that your mentor is not a mind reader and it is up to you to be open about what your learning needs are and, most importantly, those you have to achieve as part of your practice assessment expectations.
The kinds of information you may gain during one of these meetings might be the following:
• A member of the medical team might have spoken about the current health status of a patient.
• The physiotherapist may have discussed the mobility needs of the patient.
• The occupational therapist may have provided information regarding their ability to self-care, the assistance they require and the condition of their home environment.
• The social worker may have discussed the resources available to support the person at home.
• The nurses will have discussed how the patient is managing their activities of daily living on the ward.
• The views and wishes of the patient and their family/significant others will have been provided either by the patient and family themselves, if present, or by any member of the team who has discussed this with them.
• A member of the team will have taken the role of record keeper to ensure that all decisions are documented.
• The outcome of the meeting will usually be plans for discharge, goals that need to be met prior to discharge and referrals to any other members of the team not present.
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