The concept of communication is an essential component of nursing practice. It is a lifelong learning process, in which nurses “make an intimate journey with clients and their families from the miracle of birth to the mystery of death”, while building therapeutic communications that are necessary along the way (Potter & Perry, 340, 2009). There are many essentials to this phenomenon that create what is considered to be a good nurse. We, as nurses, must treat each patient as an individual, and learn and understand what their needs are specifically so that they are given the best care possible in the end. In order to do so, effective communication must be achieved. According to the literature, there are five elements of communication; courtesy, the use of names, trustworthiness, autonomy and responsibility, and assertiveness (Potter & Perry, 2009). The purpose of this paper is to discuss the meaning of these elements and to apply them to nursing practice. In order for adequate communication to be attained, the nurse must use all of these elements for each unique case.
As previously stated, the nurse must individualize the plan of care for each patient. “The patient’s interests should serve as the primary focus of concern for the nurse”, which requires detailed understanding of each patient’s personal perspective, and ordinarily entails effective nurse – patient communication (Carnevale et al, 2009). It is the nurse’s job to get to know their patient’s and understand and acknowledge their feelings, opinions, concerns, etc., in order to deliver a better quality of care. A perfect example of when communication is essential to the quality of care is V.R.
V.R. is a six year-old boy with Angelman’s syndrome that I have gotten to know over the past eight months. He has a five year-old sister (also with Angelman’s), a three-year old brother, and two amazing parents. He was assigned to my care when I joined an organization called Autism Respite Resource Outreach (ARRO). This group was founded in order to provide better care to children with autism, getting to know individual families and their unique situations. Angelman’s syndrome, a specific kind of autism, is very different from what I had expected. Kids with Angelman’s syndrome are very interactive with others, very loving, affectionate, and need attention from those around them. However, this does come with some behavioral issues. For instance, when V.R. does not get the attention he wants, he will throw items around him, strike out toward others, or scream and shout. My responsibility in his care is to understand more about what he needs from others and cater to those needs, while also learning new ways to keep these behaviors under control.
The first element of communication is courtesy. As nurses, we should always say hello and goodbye to patients, knock on doors before entering, and introduce ourselves in a kind manner. Also, nurses should state their purpose and say please and thank you to the people around them. If a nurse does not use these little cues of communicating with their patients and peers, they may be perceived as being rude or insensitive, which ultimately sets up a barrier between nurse and patient and alters the communication between the two (Potter & Perry, 2009). In reviewing the literature, it is known that a proper tone of voice and body language when speaking with a person goes a long way. Children from one of the studies I reviewed have stated that a good nurse speaks in a “nice, calm, relaxed, cheerful, kind tone of voice and sit down with them smiling and with smiling eyes” that they respond well to (Brandy, 2009). Both these verbal and nonverbal communication skills are helpful in opening up the relationship and getting to know the individual.
In V.R.’s case, much of this courtesy is done between myself and his parents. Whenever I enter their home, I make sure that I say hello to everyone and see how everyone is doing. I usually listen to the mother while she tells me some exciting stories about what the kids did that day, how things are going, etc. The children are always so excited to see me pull up into their driveway, and I always have a big smile on my face and open arms for hugs when I see them. Opening these lines of communication with the mother and her children from the start lets her know that I am genuine in caring about her family’s position and that I am willing and happy to be there for all of them.
Use of Names
The second element of communication is the use of names. Introducing yourself, making eye contact, and smiling at others gives them recognition, letting them know that they have been acknowledged and that you are committed to their care. Addressing others by name also gives them a sense that you respect them as a person and honor their uniqueness as an individual (Potter & Perry, 2009). Nurses should not refer to patients by their room number, diagnosis, or other inappropriate ways, as this sends the message that the nurse does not care enough to know that patient as an individual.
With V.R. and his family, I first called all of the children by their first names and the parents by their last names, such as “Mr. or Mrs. R.”. Shortly afterward, I was calling the children by their cute nicknames that their mom and dad had made up for them, and the parents told me to call them by their first names. This let both me and the parents know that the relationship had progressed, and it gave me a better understanding of how they viewed my role in the care of their son.
The third element of communication is trustworthiness. “To foster trust, the nurse communicates warmth and demonstrates consistency, reliability, honesty, competence, and respect” (Potter & Perry, 348, 2009). The patient must be able to rely on the nurse and know that he or she will help without even thinking twice about it. If a patient cannot count on their nurse, the relationship will not progress and the communication will be hindered.
When demonstrating that I am a trustworthy person in V.R.’s family, I do everything I can for them. I go out of my way to create fun learning activities for all of the kids to be a part of, I stay late or come early if the parents need my help, and I am always there when I say I will be there. This lets them know that they can trust me and they know that their family is important to me. I care about the entire family’s well-being, and my actions show them that this is true.
Autonomy and Responsibility
The fourth element of communication is autonomy and responsibility. This is the ability to be independent, accomplish goals, and advocate for others. Nurses make choices and accept responsibility for the outcomes of their actions, as well as communicate in a manner that reflects the importance and purpose of the conversation (Potter & Perry, 2009). In order for nurses to meet these requirements, they need good communication skills to assess the patient’s needs and provide care that is tailored to the individual. They need to create a good interpersonal relationship in which there is room for socializing, affection, and empathy (Caris-Verhallen, Kerkstra, and Bensing, 1999).
V.R. and his family need me there to help with his care. They expect me to advocate for him when they are not there to do so, and they expect me to be able to help out with his daily activities, such as eating meals, playing outside, hygiene, etc. I set goals for myself, and for V.R., every day before I see him in order to prepare myself for the day. I socialize with the family, whether we are just in the house or out for the day on a trip together. Being able to spend quality time with all of them gives me a better understanding of what they need from me, and what I need from them in return. It is my responsibility to be there for all of them and to do my job properly in order to provide V.R. with the best quality of care and the best experience for the family.
The fifth and final element of communication is assertiveness. This element allows nurses to express their feelings and ideas while also conveying respect for those people they are speaking with. People appreciate open, honest communication, which opens up a whole new level of comfort in the relationship with that person. If nurses lead by example with this assertive communication, it is expected that the patients will follow. This would open a better patient-centered communication approach, in which they are “invited and encouraged to participate and negotiate in decision-making regarding their own care” (McCabe, 2004).
I believe that I have this attribute when it comes to my quality of care. I always give my honest opinion about particular issues regarding V.R.’s development and how he should be cared for, and the family respects me for that. They trust in me enough to know that I am only looking out for what is best for him and the rest of them, and they believe in my ability to give adequate information to move forward in V.R.’s care.
Findings and Nursing Implications
After reviewing the literature, I have found that communication is essential in the care of the patient. It is a skill that nurses must develop in order to provide patients with the best information possible based on their individual needs. The elements to communication are all pieces to one whole: all are needed in order for the nurse to achieve the appropriate bond. Showing them respect, acknowledging them as unique people, and showing them that they can trust and believe in us are just the start of a new, and hopefully growing, relationship. V.R. has received the best of my abilities as a provider, and he will continue to receive it in the future.
In my opinion, nurses do not always give us the best examples of what good communication is with patients. Some are very skilled at taking the time to get to know their patients and to understand where they are coming from in order to give them the best care possible, but others take the easy way out. They do just enough to keep the patients quiet, without really knowing who they are caring for. As nursing students, it is up to us to take the lead. We must be the new examples for everyone to follow in order to create a better environment and more memorable experiences for others.
Brandy, M. (2009). Hospitalized Children’s Views of the Good Nurse. Nursing Ethics, 16(5). Retrieved from Academic Search Premier.
Caris-Verhallen, W., Kerkstra, A., Bensing, J.M. (1999). Non-verbal behavior in nurse-elderly patient communication. Journal of Advanced Nursing, 29(4). Retrieved from Academic Search Premier.
Carnevale, F.A., Vissandjee, B., Nyland, A., Vinet-Bonin, A. (2009). Ethical Considerations in cross-linguistic nursing. Nursing Ethics, 16(6). Retrieved from Academic Search Premier.
McCabe, C. (2004). Nurse-patient communication: an exploration of patient’s experiences. Journal of Clinical Nursing, 13. Retrieved from Academic Search Premier.
Potter, P.A., Perry, A.G. (2009). Fundamentals of Nursing. St. Louis, MO: Mosby Inc.
Rankin, S.H., Stallings, K.D., London, F. (2005). Patient Education in Health and Illness. Philadelphia: Lippincott Williams and Wilkins.