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3 Communication – fundamentals

Table 3.1 Examples of paraphrasing.

	Patient	Healthcare worker
Summarising	“I'm the bread winner, I'm not sure what will happen to my family.”	“You are worried about how your family with cope financially.”
Interpreting	“I'm waiting on the results. I've been waiting a while.”	“You're worried about when you're getting your results.”

Table 3.2 Clarification questions.

“So, what you're saying is…?”

“Am I correct in understanding that…?”

“So what you mean by that is…?”

“What I'm hearing is…, is that correct?”

“I'm not quite sure I follow, could you give me more details?”

Table 3.3 SOLER – a tool to build rapport Identified by Egan (2014).

S	Sit at a comfortable angle and distance
O	Maintain an open posture, i.e. uncrossing legs and arms
L	Lean forward appropriately to show engagement
E	Maintain eye contact. The healthcare professional must be aware of when this might not be culturally appropriate
R	Maintain a relaxed posture. This will help with building rapport and trust.

Background

Communication is undertaken with every social interaction and effective communication is affected by how the message is sent and how it is received (Gates et al. 2003). Communication is recognised by the Nursing & Midwifery Council as an essential skill (2018) and involves written, verbal, and non‐verbal communication, with patients/clients/service users, relatives, carers, and other members of the immediate and wider multi‐professional team.

Influencing Factors

How we communicate depends on the client group we are communicating with and can change when:

 Communicating with people from different cultures.

 Communicating with people who speak different languages.

 Communicating with those with learning disabilities.

 Communicating with children.

 Communicating with those with dementia and/or delirium and other neurological impairments.

 There is a lack of time – it will be apparent by your body language if you feel that you do not have time for the interaction. This can be mitigated by providing a more suitable time for the conversation.

Professional Approach

In nursing how we communicate will impact upon the therapeutic relationship and trust built between the professional and the patient. How we communicate should be considered at the beginning of each episode of care and must be open, honest and non‐judgemental. There are numerous factors that we must consider:

 The environment – where is the best place for this conversation?

 Physical discomfort, e.g. pain – consider giving analgesia before the conversation.

 Psychological discomfort, e.g. anxiety – adjusting body language, volume, articulation, pitch, emphasis and rate (VAPER) (Nelson‐Jones 2014) of verbal communication can help here.

 Emotional discomfort, e.g. grief.

 Physical impairments, e.g. sight or hearing impairment– consider proximity, visual aids.

 Jargon – avoid professional language the patient may be unfamiliar with as this will create an additional barrier.

Procedure: Verbal Communication

Verbal communication can be face‐to‐face, over the telephone, or through other media forms, e.g. Facetime, Skype:

 Listening – this is a key aspect of verbal communication as it shows we are attentive and interested in the message being conveyed. It also demonstrates that we receive the message, understand it, support the person we are communicating with, and thus validate the message being delivered.

 Active listening involves paraphrasing, where the key points are repeated back to show that the correct message is being received (Table 3.1).

 Active listening can also involve the use of paralanguage such as: “mmh”, “yes”, “uh‐huh”, to show that you are listening.

 Verbal communication may initially start with closed questions, such as “Were you inside or outside?”, which can be used at the outset, and open questions, such as “How did you feel when that happened?”, to build rapport and engagement.

 Open questions are then used to gain more detailed information and insight into how the person is feeling.

 When communicating verbally there are other factors to consider. VAPER can help us to reflect on our communication in the moment and adjust accordingly (Nelson‐Jones 2014).

 If you are not fully following the message it is acceptable to ask for clarification. Table 3.2 provides examples of clarification questions.

Procedure: Non‐verbal Communication

 Non‐verbal communication involves body language, our gestures, and dress (e.g. uniform), and can also be impacted by our height, gender, and scent, which some may find intimidating.

 As healthcare professionals work in closer proximity than is socially comfortable we need to be aware of our non‐verbal communication and utilise this method of communication to demonstrate our care and compassion.

 Egan's acronym SOLER (Egan 2014) can be a useful tool to use initially to build rapport (Table 3.3).

 Communication is often split into three Cs, represented as 55/38/7 (Mehrabian 1972): 55% of communication occurs through body language, 33% through tone of voice, and 7% through the actual words said. Although this is often contested, it is certainly worth considering when engaged in communication.

 In some instances, therapeutic use of silence is also required, allowing the person time to express their message.

Written Communication

 Written communication can be used where there is an impairment impacting on the verbal message being received.

 It can also be used when professionals need to communicate with each other, i.e. via emails or in multidisciplinary notes.

 Written communication needs to be clear, concise, and legible. The key points need to be emphasised, jargon must be avoided, and the patient needs to be comfortable with, and able to use, this method.

Red Flags

  New dysphasia or dysarthria.

  New or sudden onset of confusion.

  Decrease in level of consciousness.

  Changes in behaviour following injury.

References

1 Egan, G. (2014). The Skilled Helper: A Problem Management and Opportunity Development Approach to Helping, 10e. California: Brooks‐Cole.

2 Gates, B., Ellis, R.B., and Kenworthy, N. (2003). Interpersonal Communication in Nursing: Theory and Practice, 2e. Churchill Livingstone.

3 Mehrabian, A. (1972). Nonverbal Communication. Chicago: Aldine‐Atherton.

4 Nelson‐Jones, R. (2014). Nelson‐Jones' Theory and Practice of Counselling and Psychotherapy, 6e. London: Sage Publications.

5 Nursing & Midwifery Council (2018). Standards for Competence for Registered Nurses. London: Nursing & Midwifery Council.