The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [144]
Patients from different ethnic backgrounds will often take a family member to health-related appointments. The family member is there to assist in the dialogue between the patient and the medical/nursing practitioner. Macdonald (2004) discusses the fact that communication is a two-way process and suggests that for it to be effective, the information provided needs to be patient focused. The process of translation and interpretation is never without potential problems, however, and it is important to try to find more effective ways of ensuring that the information provided is not misunderstood or misinterpreted.
In addition to the written word, there are also a number of reputable telephone helplines that can facilitate the translation from one language to another. It is good practice that these services be utilized rather than relying on family or friends of the patient (MacDonald 2004). The reason for this is because the latter may not fully understand what they are being asked to translate, or might misconstrue or misrepresent what is being said (Macmillan Cancer Relief 2004).
Competencies
Communication is such an essential aspect of the role of anybody in healthcare that the Knowledge and Skills Framework specifies the competencies in communication expected at different levels (Table 5.1). Nurses are expected to be competent as a minimum to level 3. This is a baseline and much work has been done in developing programmes to advance communication skills further.
Table 5.1 Knowledge and Skills Framework: four dimensions of communication competence
The consistency of the success of training interventions has been widely discussed (Chant et al. 2002, Heaven et al. 2006, Schofield et al. 2008). The NHS ‘Connected’ programme (www.connected.nhs.uk) has been developed initially to develop further the skills of key members of multidisciplinary teams in cancer care (Fellowes et al. 2003).
Ongoing development of communication skills should include learning how to negotiate barriers to good communication in the clinical environment, tailoring and individualizing communication approaches for different patients, conflict resolution and negotiation skills (Gysels et al. 2005, Roberts and Snowball 1999, Schofield et al. 2008, Wilkinson 1991).
Courses with a behavioural component of communication training, that is, role playing situations in the classroom, are preferable as this is indicated to influence effectiveness (Gysels et al. 2005).
If an issue appears to be beyond the scope of practice of the nurse, it is essential that further advice and help are sought to manage a patient’s psychosocial needs.
Supporting yourself and using supervision are key factors in being able to support other people. This means having a balanced lifestyle, knowing when you are under pressure and putting structures in place to support yourself. Make use of colleagues and friends who understand the burdens of the type of work you do. Sharing support issues and developing a good team spirit are good practices. Try to establish for yourself where and who you can go to for debriefing after distressing experiences. Do not ignore your own needs.
Preprocedural considerations
Time
In an acute hospital environment time is always pressured. For effective, supportive communication to take place, the patient needs to know that they have the nurse’s attention for a set period of time. It is therefore essential to be realistic and proactive with the patient to negotiate a specific conversation for a prescribed length of time at a prearranged point in the day. It is important to be realistic but also to keep to the arrangement, otherwise there is the potential for the patient to consider that their psychological needs are not important (Towers 2007).
Environment
Conversations in a hospital environment can be very difficult, especially if privacy is sought. However, there are still actions that can be taken to make the environment as conducive as possible to enable supportive communication to take place (Towers 2007) (Box 5.4). This preliminary