Effective communication is a key determinant of patient satisfaction, compliance and recovery. Good communication allows nurses to help patients, families and other care workers to manage emotional crises, pain of physical, mental and even facilitate patients’ treatment plans (Denier et al. 2010; Sirota 2008).
Nurses are continually associated with patients care, and are a vital link between patient, family, physician and other care providers (Denier et al. 2010). Hence, nurses have the responsibility to build a therapeutic relationship with patients. Denier et al (2010) stated that to establish the nurse-patient interrelations, nurses are required to be open and have effective communication skills.
Active listening is one of the fundamental skills in patient-centered care. It is an interactive process to facilitate the understanding and be understood (Adler & Rodman 2009). Active listening requires the suspension of the nurse’s other thoughts and a shift in focus to the content of the patient’s message. Five essential tasks are required; this essay will discuss each of these categories.
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Attending is the primary element in active listening. Nurses have to draw attention to vocal noises and give appropriate responses. It requires the nurse to use eye contact, body language, facial expression and vocal tones to show they are remain attentive to the patient.
However, too much eye contact can be threatening and therefore suitable head nodding or say “uh-huh” at intervals can evidence of being present. An important attribute is the ability to create a sense of freedom and safety, so that the patients can express their thought and experience without fear (Bryant 2009).
Bryant (2009) described that stay in front of the patients and lean slightly forward, having good eye contact, with hands still and look directly at the patient can acknowledge the patients that the nurses are listening. While giving 2 minute full attention to the patients before head nod or turning the head down to note important information can provide a gentle and warm environment that the nurses are remain interested to their topics.
The importance of openness and attentiveness attitudes to the patient and the family, by showing approachability and attainability can gain the trust from the patients (Denier et al. 2010) which help to form the patient-centered therapeutic relations.
In some cases, the nurse requires to understand messages that may not be verbally expressed, including tone of voice and body language, hence careful observation skills are needed. This refers to the gestures, physical attitude, behavior, and eye contact that adopt when conversing.
Nurses can also convey their interest and concern by leaning forward slightly, using an open posture, with hand gestures and facial expressions to match the emotional message, such as surprise, shock, worry, support, joy. An underrated form of body language is smiling. Webb et al described all behavior, whether verbal or non-verbal, intentional or unintentional, is a form of communication.
However nurses should avoid giving one message verbally, but give another message accidentally through body language. For example, in a prolonged communication nurses should respect to the patient and avoid yawning, looking around the room or off into the distance (Weger Jr, Castle & Emmett 2010).
Some patients may have defensive postures such as folded arms, facing away or poor eye contact indicated that person is feeling anxious or threatened in some way. In some cases, patients may have an impaired ability to talk, such as suffered from stroke. Hence, nurses should provide supportive and compassionate care during all the events and identify what the patients perceive as threatening, and provide interventions to alleviate anxiety and facilitate communication (Denier et al. 2010; Sirota 2008; Weger Jr, Castle & Emmett 2010).
When questioning a patient, nurses often develop a sense of the patient’s ability to convey information. Some patients are shy and need more directed questions to help them to respond; others may ramble or be vague. With the use of, open-ended questions that cannot be answered with yes or no, this can encourage the patient to provide more information and expand on the subject in a comprehensive way. These can also lets the patients know that the nurses are care for them and be able to listen to their needs (Lang, Floyd & Beine 2000; Paans, Muller-Staub & Nieweg 2013).
Examples of open-ended questions include the use of “what”, “why”, “where” and “how”. Such as “What do you thing causing your problem?”, “Why is this element the most important aspect…?”, “Where might this rule not necessarily hold true?” and “How else could this situation be explained?”. Sometimes it may be necessary to rephrase the questions to give the patient more thinking time and further opportunities to raise information.
Closed-ended questions usually elicit short answers either yes or no. An example of a closed-ended question is, “Are you allergic to any medicines?”. This type of questions is useful in gathering factual information and summarizing what has been said (Jasmine 2009; Paans, Muller-Staub & Nieweg 2013).
Balancing the use of open- and closed-end questions can enables nurses to analyze patients’ experiences, feelings, and perceptions about their disease and prognosis and may help target the assessment of specific issues.
Paraphrasing and summarizing
One way to show the patients that the nurses are listening is to use paraphrasing. Paraphrasing is simply restating and summarizing what the patients said. This tells the patients that the nurses are listening and understood what they are trying to communicate, thereby confirming the patient’s experience as valid and significant (4,5).
It also enables the nurses to ensure their interpretation and understanding of the information received is correct which can increases in conversational satisfaction. Examples of paraphrasing statements include: “I’m not sure I’m with you but…”, “If I’m hearing you correctly…”, “It appears to you…”, “Listening to you it seems as if…”, “So, as you see it…”, “The thing you feel is most important is…”, “To me it’s almost like you’re saying…” and etc
Although, one may argued that paraphrasing may not necessary associated with increases in conversation satisfaction or feeling understood by the patients (Weger Jr, Castle & Emmett 2010); however, the beneficial effects seems to overwhelm the disadvantageous of summarizing the patients words. Paraphrasing offers an opening for the patients to determine whether the nurses complete understood their information and has provided an opening for modification and the reaching of the understanding (Bryant 2009).
Reflection of feeling
The final communicative attitude is the embodiment of trust worthiness by using reflective response technique. This is a way of helping the patients explore their meaning. This technique involves reflecting back to the patient that the nurse thought and believe, in order to verify their understanding and to encourage the patient to continue elaborating on their point of view.
Patients occasionally deny concern, or attribute fears to other family members when they feel anxious about a perceived threat. Such expressions should be seen as form of direct emotional expression.
Patient: “My mother is coming to see me this afternoon” whilst sighing and looking away. Nurse: “Oh, you don’t seem very excited about this, is everything ok”? In this case, the patient may deny the nurse concern, however, if the nurse continue to express the feeling by saying “I am concerned…” or “that really bothered me”. Then it will often yield the patient’s underlying concerns.
Kagan (2008a, p.61) found that the perception of feeling listened to is “freeing and healing”, and provides the patient’s with a sense of well-being and acceptance. When necessary, a comment, or encouragement would be helpful in the conversation. Sometimes, even silence can show the respect for painful feeling. Hence, combined with the expression of serenity and tranquility, it allows nurses to be supportive and establish an emotional connection with the patient and the family (2).
Based on the above description of active listening, I recognized myself as a dissatisfactory listener. One of the main reasons is because my current occupation is a scientist which I don’t have chance to communicate with lot of different people.
Even if I speak to a person, I found myself doesn’t have the patience to hear other people saying and always jump from subject to subject, therefore I have had a poor focusing skills. In some extends I have a poor body language; this is because I lack of socializing skills.
Whereas, I’ve got good observations, questioning, paraphrasing skills and reflection of feeling skills, this is because of the nature of my job that made me to observe scientific changes and keep asking question and summarized other people published work.
In order to improve my communication skills, I will attend more social sessions and community work in order to talk to more strangers and practice my communication skills. I will also focus and listen to the speaker and follow their topic. For my body language, I will try to deep breathe, relax and control my hands and making eye contact to each person that I am speaking to.
Listening is the foundation of all interpersonal relationships; it is a critical component of all aspects of nursing care and is necessary for meaningful interactions with patients. Kagan (Kagan 2008) (2008) reported that people desire to be listened to more than anything else during their experiences with health professionals. And good communication is essentially important for creating peace, because it mitigates unclarity and ignorance. As such, it can prevent distress, commotion, panic, anger and misunderstandings (Denier et al. 2010).
Thus, nurses should try to interact with patients by using the full range of communication skills such as listening, observing, questioning, paraphrasing and reflecting of feeling, to help patients realize that physicians are there to help as much as they possibly can, both physically and psychologically. By using active listening skill nurses can create the rapport for a real partnership with patients who have been heard and affirmed.
Adler, RB & Rodman, GR 2009, Understanding human communication, 10th ed. edn, Oxford University Press, New York ; Oxford.
Bryant, L 2009, ‘The art of active listening’, Practice Nurse, vol. 37, no. 6, pp. 49-52.
Denier, Y, Gastmans, C, De Bal, N & Dierckx de Casterle, B 2010, ‘Communication in nursing care for patients requesting euthanasia: a qualitative study’, J Clin Nurs, vol. 19, no. 23-24, pp. 3372-80.
Jasmine, TJX 2009, ‘The use of effective therapeutic communication skills in nursing practice’, Singapore Nursing Journal, vol. 36, no. 1, p. 35.
Kagan, PN 2008, ‘Listening: selected perspectives in theory and research’, Nurs Sci Q, vol. 21, no. 2, pp. 105-10.
Lang, F, Floyd, MR & Beine, KL 2000, ‘Clues to patients’ explanations and
concerns about their illnesses. A call for active listening’, Arch Fam Med, vol. 9, no. 3, pp. 222-7.
Paans, W, Muller-Staub, M & Nieweg, R 2013, ‘The influence of the use of diagnostic resources on nurses’ communication with simulated patients during admission interviews’, Int J Nurs Knowl, vol. 24, no. 2, pp. 101-7.
Sirota, T 2008, ‘Speak up for good communication’, Nursing, vol. 38, no. 7, p. 6.
Weger Jr, H, Castle, GR & Emmett, MC 2010, ‘Active Listening in Peer Interviews: The Influence of Message Paraphrasing on Perceptions of Listening Skill’, International Journal of Listening, vol. 24, no. 1, pp. 34-49.
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