Communicating

Communication skills form the basic building bricks of all human interaction, be it a simple greeting or a complex relationship. Our verbal and non-verbal messages create pictures of who we are, how we are feeling and what we like or dislike. As health care professionals the pictures that we paint can reassure people and put them at their ease or, conversely, cause stress and anxiety and make them feel very vulnerable, uncomfortable or even, on occasions, aggressive. The development of sound therapeutic communication skills is therefore vital if we are to put people at their ease and make them feel secure, confident and valued. This means paying attention
not only to what we say and do but also to how we say and do it.

Written communication skills are equally important. Clear and concise writing skills are essential not just for communicating effectively within a multidisciplinary team and ensuring consistent, quality care, but also to comply with the legal requirement to maintain comprehensive client care records.

Communication is, however, a two-way process. To communicate effectively means developing good skills at a personal level not only as a messenger, but also as a receiver. This requires us to listen attentively, be knowledgeable about the other person(s)’s abilities and perspectives as well as our own, and to develop the skills necessary to facilitate communication for those who are less able than ourselves, whatever the reason. For example, an individual with a specific learning difficulty may find it very difficult to verbalize their care needs and may need to use alternative modes of communication such as sign language to converse with us. A
child may not yet have developed an understanding of the double entendres of some of our words. Clients who may be in pain or distress or those who are newly bereaved may find it exceptionally difficult to express their feelings and may ultimately need encouragement and support to do this.

Well-developed communication skills are therefore essential tools for nurses and other health care professionals, yet there is a plethora of literature that illustrates that we are notoriously poor at this activity for a variety of reasons, not least a perceived lack of time.

The factors that affect communicating may be:
• physical arising from alteration in the structure, function or process of the organs involved in communicating, such as damage to the tongue or larynx (voice box), or nerves supplying it
• psychological such as fear, anxiety and stress
• sociocultural including language, vocabulary, jargon and gesticulations
• environmental, for example poor lighting, noise or intrusions
• politico-economic, for instance type of occupation, neighbourhood

To help you to improve your communication skills and raise your level of awareness, this chapter offers guidance in relation to assessing an individual’s ability to communicate, outlines some of the barriers to effective communication, and is followed by sections on how to respond appropriately to telephone calls, strategies to enable more effective communication with clients, and pointers for managing actual or potential violent or aggressive situations. A section on record keeping is also included.

The chapter is not intended to form a text on the theories of communication and consequently a comprehensive reading list, which includes some classic texts, is offered at the end of the chapter to help you direct your studies further. The reader is reminded that Chapter 7 offers more specific direction on how to communicate with clients who are dying and their significant others.