Healthcare nursing practices and professional development

Nursing: Patient-Centric Communication

There are probably no skills that are as critical in nursing as are communication skills. The nurse is generally responsible for giving the patient instructions on medications, follow-up and other very critically important care information. Ineffective communication may result in poor outcomes for patients and in the most severe of cases even death to the patient. This study will examine literature of a peer-reviewed nature relating to this subject supporting effective communication skills in the nursing practice. To understand the scarcity of the literature on the nurse communication with patients one must only do a simple search online at the PubMed website using the key words for search: "nurse-patient communication." The first study reviewed in this study is an example of negative communication skills of nursing staff and will be followed with case studies that identify positive interactions in communications between nursing staff and patients.

REVIEW OF THE LITERATURE

In the study of Tfouni, LV; de Carvalho, EC; Scochi, CG (1991) Discourse, institution, power: an analysis of the nurse patient interaction. The work of Tfouni, de Carvalho, and Scochi (1991) was a study conducted for analysis of nurse-patient interaction. The study is composed of approximately 20 dialogues among five nurses and twenty patients in which the 'mechanics of conversation were analyzed. The results of this study showed "an asymmetry in the interaction, a fact that qualifies the nurse-patient interaction as one of control, domination and effacement of individuality. These factors show that ideology of the hospital institution with respect to the patient is characterized by imposition of authority and alienation."

Carol A. Williams and Monette T. Gossett (2001), in the work entitled: "Nursing Communication: Advocacy for the Patient or Physician" state that: "Communication among nurses, patients, and physicians is a key component of effective health care. In addition to communication with patients, nurses directly or indirectly influence physician-patient communications." (2001) The study of Williams and Gossett was a secondary analysis that made examination of the interactions of registered nurses with."..simulated patient[s] regarding what the physician had told the patient about the reason for hospitalization." (Ibid) The findings of the study state that: "Nurses mediate and clarify communications between the patient and physician." (2001)

The work of Mendes, Trevizan, Noquiera, and Hayashida (2000) states that: "Nursing is a profession committed to the promotion of human beings." It is held by these authors that:."..communication plays an important role within the nursing process and its results, and it is also a fundamental component of the treatment." (Mendes, Trevizan, Noquiera, and Hayashida (2000)

The work entitled: "Patterns of Medical and Nursing Staff Communication in Nursing Homes: Implications and Insights From Complexity Science" states that: 'Complexity science teaches that relationships among health care providers are key to our understanding of how quality care emerges." (Colon-Emeric, 2006) This study was conducted with a focus on comparison of the difference in patterns of "medicine-nursing communication on the quality of information flow, cognitive diversity, self-organization and innovation in nursing homes." (Colon-Emeric, 2006) Participating in what was a six-month study were two facilities. The method of case study research was through field observations, shadowing and depth interviews. In the first facility the pattern of communication found to be dominant was a "vertical chain of command between care providers characterized by thin connections and limited information exchange. This pattern limited cognitive diversity and innovation in clinical problem solving." (Colon-Emeric, 2006) The second facility was characterized by an "open communication patterns between medical and frontline staff." Findings of the study state there were higher levels of "information flow, cognitive diversity, innovation and self-organization in the second facility."..although tempered by staff turnover." (Colon-Emeric, 2006) The study concludes that: "The patterns of communication between care providers in nursing facilities have an important impact on their ability to provide quality, innovative care." (Colon-Emeric, 2006)

The work entitled: "Nursing Advocacy: How is it Defined by Patients and Nurses, What does it Involve and How is it Experienced?.states that: "Advocacy is an integral part of nursing. However, there is a scarcity of empircal evidence on nursing advocacy process and most of that evidence concerns nurses' view on the care of certain vulnerable patient groups in acute care settings. Before nursing practice can truly adopt advocacy as an inherent and natural part of nursing, a clearer understanding is needed of how it is defined and what activities are needed to accomplish advocacy." (Vaartio, 2006) The study states that in the nursing practice "the abstract concept of nursing advocacy finds expression in voice responsiveness, which integrates and acknowledges professional responsibility for and active involvement in supporting patients' needs and wishes. (Vaartio, 2006)

Jarrett and Payne in the 1995 work entitled: "A Selective Review of the Literature on Nurse-Patient Communication: Has the Patient's Contribution Been Neglected"? states that: "Previous research has been critical of the quality and quantity of nurse-patient communication, describing it as brief and superficial. Nurses are depicted as controlling and restricting the course and topics of conversations with patients. Communication skills training for nurses have been advocated as a solution for this apparent deficit." (Jarrett & Payne, 1995) It is held by Jarrett and Payne that earlier research overemphasizes the communication of the nurse and minimizes the patient's contribution to the content of the communication. (1995)

The work entitled; "Explanation in Consultations: The Combined Effectiveness of Doctor's and Nurses' Communication with Patients" states that the study being reported was a comparative study of "doctors and nurses' communication with patients in multidisciplinary health care..." (Collins, 2005) The sessions were videotapes and qualitatively analyzed with findings that state: "Distinctive features of explanations in nurses' and doctors' consultations with patients were identified. These can be understood by reference to patterns of communication. Nurses' communication was mediated by patients' contributions; doctors' communication gave an overarching direction to the consultation as a whole. While nurses' explanations began from the viewpoint of a patient's responsibility and behavior, doctors' explanations began from the viewpoint of biomedical intervention. Their consultations lent different opportunities for patients' involvement." (Collins, 2005) The communications of doctors and nurses have their own individual and unique features which allow "distinct contributions" of each which is stated to have "implications for policy, for practice and for interprofessional education." (Collins, 2005)