Читать книгу The Nursing Associate's Handbook of Clinical Skills - Группа авторов - Страница 40

Total communication is an approach that supports people with complex communication needs. It was developed to empower people to help them express themselves and form connections (Sense 2019). Total communication was born from the concept that when communicating, we are not just a talking head, we use non‐verbal communication through our bodies (Thomsen 2010). Total communication refers to all available means of communication, be this limited verbal speech, sounds, spontaneous non‐verbal means and low technological devices (Rautakoski 2010). This approach is reliant on a partner to facilitate and clarify the meaning in a conversation. A study by Rautakoski (2010) in the training of people with severe to moderate aphasia and their communication partners in the use of total communication found that both the individuals and their partners recognised that they interpret the use of different communication means in relatively the same way. The study found that participants perceived the level of interaction increased during the study, as both were more familiar with different modes of communication (Rautakoski 2010).

One in four adults experiences a mental health condition in any given year (National Institute for Health and Care Excellence (NICE) 2019), many of whom also have comorbid obesity, asthma, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart disease, stroke and heart failure (Public Health England (PHE) 2018). Nursing associates will encounter people with mental health problems throughout their nursing career, and they can enhance their communication encounters with people with mental health problems by:

 Having a fundamental knowledge of the main mental health problems

 Giving the person time with no distractions

 Letting the person share as much or as little as they want to

 Not making assumptions or try to diagnose

 Keeping questions open ended

 Talking about well‐being, for example, exercise and diet

 Listening carefully and repeating what you have heard to check accurate understanding

 Being aware of stigma and the negative impact inaccurate prejudices can have on communication, for example, people with mental health problems are usually portrayed as violent and aggressive in the media, but this is not typical of the majority of people with mental health problems

 Knowing your limits and asking for help from other healthcare professionals if needed

Table 2.4 The 7Cs of communication.

TERM	MEANING
1. Clear	Avoid jargon and complex words. Focus on a specific message which makes the message understandable
2. Concise	Keep it brief, avoid repetition. Highlight the main message
3. Coherent	Ensure the message makes sense and is logical
4. Complete	The message must be complete and contain everything it needs to so that the receiver can respond or act
5. Concrete	Specific and clear, supported by facts and figures
6. Courteous	Considers both viewpoints (sender and receiver) and the feelings of the receiver. The message should be sincere and polite and delivered in a friendly and courteous manner
7. Correct	Uses appropriate and correct language. Check for mistakes. A correct use of language increases trustworthiness

Dementia can also affect an individual’s ability to communicate. Dementia is not a condition in itself (Alzheimer’s Research UK 2019). It is a term which describes the symptoms that occur when the brain is affected by certain conditions which cause the gradual death of brain cells. Dementia is a progressive condition. Examples of such conditions include Alzheimer’s disease, vascular dementia, and Lewy body dementia. In the United Kingdom, there are currently around 850,000 people living with dementia (Alzheimer’s Society 2017). The speed of which cognition declines can vary from person to person and may depend on which type of dementia they have (SCIE 2015). Symptoms of dementia can include loss of memory, reduced concentration, personality or behaviour changes, reduced ability to perform everyday tasks and problems with communication and reasoning skills. These changes in communication skills can be upsetting and frustrating for the person with dementia and those around them.

As people living with dementia experience changes in communication, they may experience word finding difficulties, repeat words or phrases, have naming difficulties, for example, not being able to name a watch but knowing it is something related to time and speech and grammar may become mixed up, making conversation difficult to follow. As a result of cognitive changes, the person with dementia can experience difficulty in following, processing and comprehending what is being said to them (Alzheimer’s Society 2016). As a person’s dementia progresses, their ability to communicate by spoken word can become increasingly impaired; however, they will continue to communicate in other ways, such as gesture, body language and facial expressions. In these circumstances, a person’s behaviour becomes a way of communicating.

The nursing associate needs to ensure that they consider the changes someone with dementia may be experiencing and modify their communication to match where the person is in their dementia journey. This can include getting the person’s full attention before you start, using shorter sentences, making one point per sentence, giving the person additional time to respond, rephrasing rather than repeat and paying attention to the person’s body language as it can support what a person may be trying to verbally express. Further tips for communicating with a person with dementia are provided by the Alzheimer’s Society (2016).

The final element of the PER tool is for the healthcare professionals to reflect on whether they achieved what they set out to, if it went well and what they could have done differently (Richardson 2017). The nursing associate will be familiar with models of reflection from both their pre‐registration education programmes and revalidation requirements of the NMC. Some questions the nursing associate may want to ask themselves when reflecting on their communication experiences include:

 What did I like best about my use of communication skills?

 What did I like least about my use of communication skills?

 If I were to do this interaction again, what would I do differently and why?

 What have I learnt from this interaction?

To aid effective communication further, the nursing associate should consider the 7Cs of effective communication, which are applicable to both written and oral communication (Table 2.4). The 7Cs are used in business communication and media communications to ensure that the message is accurate for the target audience, and they are applicable to the nursing associate when interacting with patients.