NURSE-PATIENT COMMUNICATION

It was gobsmacking to find the following quote in a paper by McCabe about nurse-patient communication.

“…in contrast to the literature that suggests that nurses are not good at communicating with patients…”

It seems that late last century there was a view in academia that nurses weren’t up to the skills of other health professionals in communicating with patients.

However, the paper then went on to describe how the development of a positive nurse-patient relationship is essential for the delivery of quality nursing care.

And the path to a positive relationship was using a patient-centred approach.

Patient-centred communication is where the nurse invites and encourages the patient to participate and negotiate in decision-making regarding their own care.

The fly in the ointment was the health care organizations.

They do not appear to recognize or value the importance of nurses use of a patient -centred approach in delivering quality patient care.

No surprises there!

The organizational culture has an impact on the way nurses communicate with their patients.

Traditionally ward or hospital management did not encourage or support nurses in establishing a therapeutic relationship with patients.

One reason given was that it was to protect nurses from difficult emotional situations.

Another study said that

“nurses have the necessary skills to communicate well with patients but choose not to because of the lack of organizational support and encouragement.”

The outcome of the lack of support led to the idea that patient-centred communication should be discouraged because it was unsupported by hospital management.

Without proper communication with their patients, the end result was the nurses made assumptions about what nursing care a patient needs or wants because patients are not asked about what they want.

This then leads to a nursing focus on tasks and a lack of focus about the patient.

Patients have excused the lack of communication with them as the nurse was “too busy.”

Interestingly, nurses tend to view the availability of time as a key determinant of quality communications.

Communication that is perceived as relationship building with patients is viewed by nurses as time consuming.

In contrast, task-oriented communication with patients was not viewed the same way.

But patient-centred communication does not need to take up more of the nurses’ time or require extra resources.

A commitment by nurses to providing patient-centred care and a change in individual, professional and organizational values are sufficient to provide high quality nursing care.

What do patients say when they have spoken to nurses?

McCabe outlines four views about how patients perceive nurse communication with them.

The first is that nurses do not provide enough information.

And that nurses were more concerned with tasks rather than with talking to them.

Patients were reassured when nurses used a personal approach with them.

The second patient view was about attending behaviour of nurses.

This describes the non-verbal communication that nurses use with patients.

Patients look for nurses to give them their attention and show concern.

They wants nurses to regularly monitor their physical condition and their psychological and emotional well being.

Also patients valued open and honest communication and the use of language that they understand.

Nursing staff that are genuine is very important to patients.

Thirdly, patients expect nurses to be empathetic.

Sympathy about the patient’s predicament and circumstances is important, whether it is through verbal or non-verbal means.

Nurses are not expected to “fix” everything but they are expected to alleviate anxiety and uncertainty.

Nurses who behaved in this manner were trusted.

Finally, patient’s appreciated nurses who were friendly and had a sense of humour.

McCabe said that

“…humour appeared to improve the participants’ self-esteem when they could make others laugh and when they could laugh with the nurses. It seemed that the nurses who used humour appeared more approachable to the participants..”

To learn more about patient communication:

McCabe, Catherine. “Nurse–patient communication: an exploration of patients’ experiences.” Journal of clinical nursing 13.1 (2004): 41-49.

O’Hagan, Sally, et al. “What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients.” Journal of advanced nursing 70.6 (2014): 1344-1355.