Communication Skills in Nursing | Reflection

talk Skills in Nursing ReflectionThis essay provide present a reflective account of conversation skills in perpetrate whist undertaking appraisal and chronicle taking of two intensive C be tolerants with a similar condition. It give endeavour to explore altogether aspects of non vocal and verbal discourse ports and reflect upon these areas using Gibbs reflective regular recurrence (1988).Scenario A Mrs pack, 34, a passenger in a road relations collision who was non wearing a seatbelt was thrown through the windscreen contributeing in multiple facial wounds with extensive facial swelling which unavoid equal her to be intubated and sedated. She presently has cervical spine immobilisation and is awaiting a supplementary distress CT. Mr throng was similarly involved in the accident.Scenario B Mr James, 37, preserve of Mrs James, the driver of the car, was wearing his seat belt. He had minor superficial facial wounds, fractured ribs and a fractured right arm. He is alert and orientated but currently breathless and requiring high atomic number 8 concentrations.Patients who are admitted to intensifier aid are typic each(prenominal)y admitted due to serious ill health or trauma that may also incur a potential to develop aliveness threatening complications (Udwadia, 2005). These diligents are norm eachy unconscious, thrust limited movement and fork over sensation deprivation due to sedation and/or disease processes. These unfavourable conditions rely upon modern technical fight back and invasive procedures for the purpose of observe and regulation of physiological functions. Having the ability to efficiently hap with forbearings, colleagues and their fast relatives is a fundamental clinical skill in Intensive get by and key to a skilful nursing practice. conference in Intensive pull off is therefore of high importance (Elliot, 1999) to provide information and support to the critically ill enduring in order to reduce their anx ieties, stresses and preserve ego identity, self esteem and reduce social isolation (Joo 2009, Alasad 2004, Newmarch2006). wide conversation is the key to the collection of patient information, delivering quality of parcel out and ensuring patient safety.Gaining a patients narration is atomic number 53 of the most important skills in practice of medicine and is a foundation for some(prenominal) the diagnosis and patient clinician relationship, and is increasingly existence undertaken by nurses (Crumbie, 2006). Commonly a patient may be critically ill and therefore the ability to perform a timely assessment whilst being prepared to administer life saving treatment is life-and-death (Carr, 2005). Often the patient is transferred from a ward or department indoors the hospital where a comprehensive history has been taken with documentation of a full examination investigations, working diagnosis and the appropriate treatment taken. However, the patients history may not have been collected on this admission if it was not appropriate to do so. Where available patients medical notes thunder mug provide internal information.In relation to the scenarios where the patient is breathless or the patient had a reduced conscious level and requires sedation and cannulisation, effective colloquy is restricted and obtaining a comprehensive history would be inappropriate and almost surely unsafe (Carr, 2005). The Nursing tocology Council promotes the importance of keeping clear and complete records inside the Code Standards of Conduct, performance and ethics for nurses and midwives (NMC, 2008). Therefore if taking a patients history is unsafe to do so, this required to be documented.Breathing is a fundamental life process that usually occurs without conscious thought and, for the heavy person is taken for granted (Booker, 2004). In Scenario A, Mrs Jamess arrived on Intensive care and was intubated following her facial wounds and localised swelling. Facial t rauma by its self is not a life threatening injury, although it has a good deal been accompanied with new(prenominal) injuries such as traumatic brain injury and complications such as airway obstruction. This may have been caused by further swelling, bleeding or bone structure damage (Parks, 2003). Without an artificial airway and ventilatory support Mrs James would have struggled to breathe adequately and the potential to become in respiratory arrest. at bottom scenario B, Mr James had suffered multiple rib fractures causing barrier in expansion of his lungs. Fractured ribs are amongst the most frequent of injuries sustained to the government agency, report for over half of the thoracic injuries from non-penetrating trauma (Middleton, 2003). When ribs are fractured due to the spirit and site of the injury there is potential for underlying organ contusions and damage. The gist of having a flail chest is fuss. Painful expansion of the chest would result in inadequate ventil ation of the lungs resulting in hypoxia and retention of secretions and the inability to communicate effectively. These combined increase the venture of the patient developing a chest infection and possible respiratory failure and potential to require intubation (Middleton, 2003). A key component of Intensive Care is to provide patients and relatives with effective communion at all times to ensure that a holistic nursing come is achieved.Intensive care nurses care for patients predominantly with respiratory failure and over the course of studys have taken on an drawn-out role. They are expected to examine a patient and interpret their reckonings and results (Booker, 2004). In these situations patient requires supportive treatments as soon as possible. Intensive Care nurse should have the ability and competence to carry out a natural assessment and collect the patients history in a systemic, superior and sensitive approach. Effective dialogue skills are one of the m whatsoev er inherent skills involved in this role.As an Intensive Care nurse, introducing yourself to the patient as soon as possible would be the first step in the history taking process ( accessory A) and the physical assessment process. Whilst introducing yourself there is also the aim to gaining consent for the assessment where possible, in accordance with the Nursing and Midwifery Councils Code of Professional Conduct (NMC, 2008). Conducting a comprehensive clinical history is usually more helpful in making a provisional diagnosis than the physical examination (Ford, 2005). Within Intensive Care the Airway, Breathing, Circulation, Disability, characterisation/Examination (ABCDE) assessment process is widely used. It is essential for survival that the oxygen is delivered to blood cells and the oxygen cannot reach the lungs without a patent airway. With poor circulation, oxygen does not get transported away from the lungs to the cells (Carr, 2005). The ABCDE approach is a simple approa ch that all team members use and allows for rapid assessment, continuity of care and the step-down of errors.Communication reflects our social world and helps us to construct it (Weinmann Giles et al 1988). Communication of information, messages, opinions and thoughts are transferred by different forms. prefatorial chat is achieved by speaking, concentrate language, body language office and eye allude, as technology has essential intercourse has been achieved by media, such as emails, telephone and mobile technology (Aarti, 2010). There are two main ways of communication verbal and non verbal.Verbal communication is the simplest and quickest way of transferring information and interacting when face to face. It is usually a two way process where a message is sent, silent and feedback is given (Leigh, 2001). When effective communication is given, what the sender encodes is what the receiver decodes (Baron2005, Zastrow2001). Key verbal features of communication are made up o f sounds, words, and language. Mr James was alert and orientated and had some ability to communicate he was breathless due to mad fractured ribs which hindered his verbal communication. In order to help him to breath and communicate effectively, his pain must be controlled. Breathless patients may be only able to speak two or more words at a time, inhibiting conversation. The use of closed questions can allow breathless patients to communicate without exerting themselves. closed questions such as is it painful when you breathe in? or is your eupneic feeling worse? can be answered with non verbal communication such as a shake or nod of the head. Taking a patients history in this way can be time go through and it is essential that the clinician do not pip assumptions on behalf of the patient (Ashworth, 1980). Alternatively, advance patients to use other forms of communication can aid the process. Non verbal communication involves physical aspects such as written or visual of com munication. soft touch language and symbols are also acknowledged in non-verbal communication. Non verbal communication can be considered as gestures, body language, writing, drawing, physiological cues, using communication devices, mouthing words, head nods, and touch (Happ et al2000, Alasad2004). Body language, posture and physical contact is a form of non verbal communication. Body language can scram vast amounts of information. Slouched posture, or folded arms and crossed legs can portray oppose signals. Facial gestures and expressions and eye contact are all different cues of communication. Although Mr. James could verbally communicate, being short of breath and in pain meant that he also needed to use both verbal and non verbal communication styles.A patients stay in Intensive Care can start from days to months. Although this is a temporary situation and many patients will make a good recovery, the psychological impact may be long-lasting lasting (MacAuley, 2010). When caring for the patient who may be unconscious or sedated and does not appear to be awake, hearing may be one of the last senses to fade when they become unconscious (Leigh, 2000). Sedation is used in Intensive Care social units to enable patients to be tolerable of ventilation. It aims to allow powderpuff and synchrony between the patient and ventilator. Poor sedation can overhaul to ventilator asynchrony, patient stress and anxiety, and an increased risk of self extubation and hypoxia. oer sedation can lead to ventilator associated pneumonias, cardiac instability and draw out ventilation and Intensive Care delirium. Derlerium can be distressing for both the relatives andthe patient, who may have some recolection after the deleium epsiode (Mclafferty, 2007). Delirium is found to be a predictor of death in Intensive Care patients (Page, 2008). all(prenominal) day a patient spends in delirium has been associated with a 20% increase risk of intensive care bed days and a 10% increa sed risk of morbidity. The single most profound risk factor for delirium in Intensive Care is sedation (Page, 2008). Within this stage of sedation or delirium it is impossible to know what the patients have heard, understood or precessed. Ashworth (1980) recognised that nurses often failed to communicate with unconscious patients on the basis that they were unable to respond. Although, research (Lawrence, 1995) indicates that patients who are unconscious could hear and visit conversations around them and respond emotionally to verbal communication all the same could not respond physically. This emphasises the importance and the need for communication remains (Leigh, 2001). neurological posture would unavoidably have an effect on Mrs Jamess capacity to communicate in a usual way. It is therefore important to provide Mrs James with all information necessary to reduce her stress and anxieties via the different forms of communication. For the unconscious patient, both verbal communic ation and non verbal communication are of importance, verbal communication and touch being the most appropriate. There are two forms of touch (Aarti, 2010), firstly a task orientated touch when a patient is being moved, washed or having a dressing changed and secondly a caring touch holding Mrs James hand to explain where she was and wherefore she was there is an example of this. This would enhance communication when informing and reassuring Mrs James that her husband was alive and doing well. Nurses may initially find the process of public lecture to an unconscious patient embarrassing, pointless or of low importance as it is a one way conversation (Ashworth, 1980) even so as antecedently mentioned researched shows patients have the ability to hear. Barriers to communication may be caused by physical inabilities from the patients however there are many types of other communication barriers. A barrier of communication is where there is a breakdown in the communication process. This could happen if the message was not encoded or decoded as it should have been (Baron, 2005). If a patient is under sedation, delirious or hard of hearing verbal communication could be misinterpreted. However there could also be barriers in the transfer of communication process as the Intensive Care surround in itself can cause communication barriers. Intensive Care can be noisy environment (Newmarch, 2006). Other barriers can simply include language barriers, fatigue, stress, distractions and jargon. Communication aids can promote effective communication between patient and clinician. Pen and paper is the simplest form of non verbal communication for those with adequate strength (Newmarch, 2006). Weakness of patients can affect the movement of pass on and arms making gestures and handwriting frustration and difficult. Patients may also be attached to monitors and infusions resulting in restricted movements which can lead to patients feeling detain and disturbed (Ashworth, 198 0). MacAulay (2010) mentions that Intensive Care nurses are highly skilled at anticipating the communication needs of patients who are trying to communicate but find the interpretation of their communication time consuming and difficult. The University of Dundee (ICU-Talk, 2010) conducted a three year multi disciplinary study research project to develop and evaluate a computer based communication aid specifically designed for Intensive Care patients. The trial is currently ongoing, however this may become a breakthrough in quick and effective patient clinical and patient relative communication in future care.This assignment has explored communication within Intensive Care and reflected upon previous experiences. Communication involves both verbal and non verbal communication in order to communicate effectively in all situations. Researching this topic has highlighted areas in Intensive Care nursing which may be overlooked, for example ventilator alarms and general noise within a u nit may feel like a normal environment for the clinians however for patients and relatives this may cause considerable amounts of apprehension. Simply giving explanations for such alarms will easily alleviate concerns and provide reassurance. From boilers suit research (Alasad 2004, Leigh 2001, MacAuley, 2010 Craig, 2007) Intensive Care nurses believed communication with critically ill patients was an important part of their role however disappointedly some nurses perceived this as time consuming or of low importance when the conversation was one way (Ashworth, 1980). Further pedagogy within Intensive Care may be required to cleanse communication and highlight the importance of communication at all times. Communication is key to ensuring patients receive quality high standard care from a multidisciplinary team, where all members appreciate the skills and contributions that others offer, to improve patients care and the overall patient experience.Appendix 1, The History Taking Pr ocessThe questions are the key to a good interview. You need to use a mix of open ended questions and closeended questions. Open ended questions leave the door open for the patient to tell you more. Questions likewhen it this problem start?, have you had any new-made health problems?, and can you show me where ithurts? are open ended. The patient feels forgive to provide additional information. While questions like doesit hurt here?, did you have this pain yesterday?, and have you had the flu in the past month? are closeended. Close ended questions seek very specific, often yes or no responses from the patient and dontencourage the patient to provide any additional information. Good interviews are a mixture of both kinds ofquestions. (Secrest, 2009)Basic Elements1. Greetinga. Introductionb. Identification of patient and selfc. Assessment of the patients overall appearance and demeanor2. Personal historya. Ageb. Occupationc. aroused. Height / Weighte. Marital / Family statusi. Chi ldren3. Chief bursting charge (CC) or Presenting complainta. Why is the patient seeking care?b. What other problems concern the patient?4. History of present illnessa. Location and radiation of complaintb. Severity of complaintc. Timing of onsetd. Situation (setting) of onsete. distance of complaintf. Previous similar complaintsg. Exacerbating and relieving factorsh. Associated symptomsi. Patients explanation of complaint5. chivalric medical historya. Systematic questioning regarding previous adult illnessesi. Neurological/Psychiatricii. Eye, ear, nose, throatiii. Skin/Hair/Nailsiv. Musculoskeletalv. Cardiovascular/respiratoryvi. Genital-urinaryvii. GI tractb. Childhood illnessesc. Surgeries, injuries or hospital admissionsd. OB/ secondary schooli. Birth controlii. Pregnancies / Birthsiii. Menstrual periodsiv. Pelvic exams / Pap smearse. Psychiatricf. Immunizationsg. covering testsh. Allergies6. Family historya. Disease historyb. Parental healthc. Childrens health7. dose histor ya. Current medicationsi. Prescriptionii. Over-the-counterb. Drug allergies8. Lifestyle (social history)a. alcoholic drinkb. Smokingc. Recreational drug used. Sexual life style/orientatione. Reproductive statusf. Occupational issues(Secrest,2009)