A nurse with good communication skill is someone who really listens to the patients, understands their problems and queries and answers in a way the patients will understand. Communication in nursing profession can be a complicated process, and the possibility of sending or receiving incorrect messages frequently exists. It is important to know the key components of the communication process, how to improve the nursing skills and the potential problems that exist with errors in communication. In this case, we take a nurse as an example. A nurse who can explain in a simple manner to a sick man why a particular diet is very useful to get well soon, is said to have good communication skills. Both verbal and non-verbal communication plays a very important role in communication in nursing.
For most patients, the nurse becomes the primary contact in the medical world. The nurse serves as the liaison between doctor and patient. She must understand the doctor’s instructions and the patient’s concerns. Her communications skills focus on both giving and receiving information as well as creating an environment of confidence.
The relationship between nurse and patient should be a therapeutic nurse-patient relationship. According to Pullen and Matthias (2010), a therapeutic nurse-patient relationship is defined as a helping relationship that is based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patients physical, emotional, and spiritual needs through your knowledge and skill. In other words, a therapeutic nurse-patient relationship focuses mainly on the patient.
Today, it is sad to say that there are many nurses who fail to grasp the importance of good communication between the nurses and the patients and therapeutic nurse-patient relationship. They neglect their duty to keep the needs of the patients as their first priority.
Poor communication is dangerous as misunderstandings can lead to misdiagnosis and even medication errors.
This area is also one of the main sources of complaints made to the health service ombudsman every year and some believe that a separate module for communication should be used in nursing training instead of being subsumed into the general curriculum.
The barriers to good communication skills are many and include time pressures (nurses are so busy ad may not be able to get time to sit and talk with patients); lack of privacy; skills mix on the wards can mean there is a shortage of qualified nurses who are available to talk to patients; lack of training; and different languages.
There are also several useful things to remember in having good communication including being prepared and know what you are going to say; having the right information to give when patients ask questions; maintain eye contact and observe the patient’s body language; listen properly; pick up on the non-verbal signs as well as the verbal ones; avoid the use of medical jargon; and in cases of breaking bad news, be emotionally prepared, try to find the right environment, and be sensitive, honest and compassionate.
In this assignment, however, I will only discuss on factors that lead to poor communication in nursing.
1. Problem Statement
The problem statement for this research is ‘To determine the factors that lead to poor communication skills in nursing’.
Poor communication skills in nurses are a major problem today and can be widely seen in most hospitals and clinics. There are many cases where the nurses speak rudely to the patient and ignore any questions asked by them. They are more concerned with their own welfare than that of the patient and many nurses hesitate and feel embarrassed to ask questions when there are things they do not understand. Their ignorance and poor communication skills can be due to several factors such as emotional stress, language barriers, overworking, fear and education or experience gaps.
This problem of poor communication, if it is not dealt with at its earlier stage may lead to the destruction of the delicate relationship between the patients and the nurses. The patient will no longer trust the nurses and this may not only give a bad name to the nurses but also to the hospital.
I believe that, when the root of this poor communication in nurses has been identified, we can take immediate action to correct and improve the current communication between the nurses and the patients.
In this research, our scope is within the Miri General Hospital. The nurses in the hospital act as a mediator between the doctor and the patients. Nurses are the group of hospital staff that are the eligible to explain any queries of the patients and give comfort to patients. This is the main reason why good communication skill is a compulsory trait that all nurses must possess.
It is from this research that I hope, we will get a better understanding of the cause of poor communication in nurses and from there, and we will be able to take necessary steps to overcome this problem.
2. Research Objectives
(a) To understand the importance of good communication skills in nursing.
The best relationship between a nurse and her patient is the therapeutic nurse-patient relationship. Therapeutic nurse-patient relationships are based on mutual trust, nurturing, and sensitivity to the patient’s needs. In this research, we wished to determine why good communication is very important in the nursing field. What are the advantages of good communication in nursing and what are the drawbacks of poor communication in this field.
(b) To determine if overworking is the cause of poor communication in nursing.
Nurses today have more responsibilities compared to nurses of previous times. Today, nurses not only are responsible for the welfare of their patients but their paperwork load has increased. Nurses also need to ensure the cleanliness of the ward especially if the housekeeping staffs are not around. They need to be able to fix the machineries if the technicians are not available. All these additional responsibilities lead to the overworking of nurses and thus leads to them not having the time to communicate and interact well with the patients.
(c) To determine if shortage of nurses is the cause of poor communication in nursing.
With each passing year, there are more sick patients that require a lot of time and attention from the nurses. But due to lack of nurses, there is only very limited things a nurse can do for each patient. The nurse allocates a very short while to attend her patients, not having time to talk or listen to the patient’s questions or doubts. This will make the patient feel neglected and unattended to. This high nurse to patient ratio may also be a reason that contributes to the poor communication between nurses and patients and also degradation of therapeutic nurse-patient relationship.
(d) To determine whether language barrier is leading to poor communication in nursing.
Language plays an important role in communication. The inability to understand a language can lead to misunderstanding and miscommunication, worst still, misdiagnosis. In nursing, it is very important that the nurse should understand what the patient tries to convey to them and vice versa. If both the nurses and the patients cannot understand each other due to use of different language, it will lead to many problems and misunderstandings. Language may also be a factor that leads to poor communication in nursing.
(e) To determine if fear is one of the contribution to poor communication in nursing.
One common reason for poor communication is that it has to do with a nurse having a lack of comfort or fear in communicating with another nurse or doctor. These type of issues usually occurs when a nurse feels threatened by a co-worker, fears the possibility of making a mistake and doesn’t say anything to avoid judgement or lacks confidence in her abilities as a competent nurse.
(f) To determine if education and experience gaps leads to poor communication in nursing.
An education or experience gap can occur when a less educated/experienced nurse works with another senior nurse who is much more educated and/or experienced and the junior nurse has trouble understanding the concepts, procedures and/or medical terminology used by the more experienced nurse. These types of gaps can lead to confusion, misinterpretation, inaction and errors due to the inability to communicate effectively and fully understand what is being communicated.
(g) To determine whether emotional stress leads to poor communication in nursing.
Nurses who are experiencing a lot of emotional stress or a trauma may have difficulty focusing or expressing or communicating their feelings, perceptions, beliefs and attitude towards certain situations. This can lead to mistakes being made and/or reduce the amount of attention they are able to put towards their work, patients and co workers.
3. Hypothesis/ Research Questions
I have come to believe that modern day nurse-patient relationship is undergoing serious strain due to poor communication between the nurses and the patients. There are several factors that might contribute to this problem.
Firstly, the modern nurses are being overworked, causing them to lack in their communication skills. When nurses work long shifts for extended periods of time it can cause fatigue, which lowers their focus, effectiveness and ability to communicate effectively with patients and staff. Today, nurses must spend an inordinate amount of time completing redundant documentation in several different places, hunting for supplies, wearing multiple hats and performing other tasks. For instance, if the need for a cleanup arises and the housekeeping staffs are not present, nursing staff must address it. If the remote control is not functioning properly and the maintenance staffs are nowhere to be found, the nurse is usually the person who must try to resolve the issue.
The next reason is due to shortage of nurses. Every year there are more sick patients that require much of the nurses’ time. This leaves them with very limited time with other patients. The nurses may be doing their job but they fail to form a relationship with the patients. We take for example, a nurse approaching the bedside to empty a patient’s indwelling urinary catheter. As she approached she didn’t make any eye contact and duly went about emptying the catheter, recorded the details on his fluid balance chart and walked away. At no time during the procedure did she speak. This example shows how essential communication skills are when caring for patients. Had he wanted to ask a question, the opportunity was lost. At this time, it would have been a good opportunity to take a look at the patient and perhaps ask how he was feeling. Poor non verbal communication also leads to poor nurse-patient communication.
Poor communication also occurs when the nurse and patient speak different first languages. Idioms and frames of reference can carry shades of meaning in one language that may not exist in another. Mispronunciation or incorrect signing may be misleading to the nurse or patient, causing the patient to lose his trust on the nurse. This problem usually occurs among the elderly patients and also the foreign patients. Due to the difference in language, both the nurses and the patients fail to convey each message to another. Especially in Malaysia, a country full of different races and languages, it is impossible for the nurses to be able to understand and speak all these different languages. There are also some patients, especially those who live in the interiors; they are not able to speak the national language but only their one native language. This phenomenon also leads to poor communication skills.
Poor communication also tends to evolve out of the level of power within hospitals. The presence of hierarchies in hospitals tends to increase the likelihood of poor communication developing at some level or another within the vertical power structure. The main cause of this communication failure is due to fear but hierarchical organization of power in hospitals is not a bad thing-it just means that it can lead to poor communication to develop discrimination within the medical hierarchy. One of these places is between physicians and nurses. Nurses frequently hesitate from asking physicians potentially “obvious” or unimportant questions. As both physicians and nurses are very much involved in the care and support of patients, major communication breakdown between them could lead into serious medical difficulties for their patients. For example when a physician instructs a nurse to convey important medical information to patients but the nurse does not fully understand the information and due to fear, she does not ask for further explanation from the doctor and gives the wrong information to the patient. Poor communication between physicians and nurses also often develop when physicians fully rely on written orders to convey instructions to nurses. They will write important details into patients’ medical files- including crucial instructions for nurses, for example when to administer a particular treatment. If nurses happen to miss checking patients’ medical files, they will also miss the important instructions that were written in them. Although this raises the crucial question of why doctors continue to use this indirect mode of communication to the extent they do, and nurses don’t object to it, does not suggest that written communication should be prohibited, but that written communication is a poor substitute for direct verbal communication. One reason why written communication remains is that nurses fear questioning what they might consider to be a standard practice among all doctors. Here again it can be seen that the reluctance to question the practices of superiors may lead to a communication breakdown-or, more seriously, to a complete communication failure.
As nurses usually feel inferior to the physician in charge, so do junior nurses feel inferior to the senior or more experienced nurses. The younger nurses hesitate to ask questions to the senior nurses in fear of being labelled as not well educated. Sometimes, the senior nurses explains a certain procedure or information to the junior nurses, but due to lack of experience, she may not fully understand it and hesitate to ask any questions after that. The senior nurses also take for granted that the junior nurses understand all that has been explained. Miscommunication as such is very dangerous as it will affect the patient.
Nurses are the backbone of any healthcare unit. The pressures of overtime and long working hours create a work leads to stress, which will affect the health of the nurses. All nurses have to do shift work or attend emergencies at night and this stress of shift work can also worsen the nurse’s health conditions leading to depression, low morale, and low motivation. Other factors such as long commuting hours and long traffic adds to their stress affect the employee’s efficiency and effectiveness. All these can affect the nurse’s relationship at home as well as on the job. Home stress contributes significantly to the stress faced by nurses. Their home life is disturbed due to night shifts, overtime, transportation problem, and difficulty in getting leave. They constantly worry about their children and their studies not being properly supervised. Nurses have to look after the home, cooking and cleaning as they cannot afford domestic help. This can have a negative influence on their physical and emotional health and lead to psychosomatic disorders. Psychosomatic illness is a disorder that affects the body and the mind. These illnesses have emotional origins causing physical symptoms. Some examples are acidity, anaemia, backache, and stiffness in the neck and shoulders. Sometimes, in the absence of doctors, nurses are on the front line and have to face verbal abuse from patients and relatives for issues that may not be directly connected to their work. Physical violence and aggressiveness is also on the rise in patients and their relations. Demanding patients and their relatives can cause conflict and lead to more stress. Another cause of stress is economic loss to the organization due to errors, wrong decisions, wrong choice, lack of attention, and injury. All these stress factors demotivate the nurses causing them to slack in their communication skills.
Communication in nursing is specifically used to identify the nurse-patient relationship amongst other things; some of the ways include translating, getting to know you and establishing trust to ensure the patient receives the best treatment (Fosbinder, 1994).
In a place where an individual’s health and well-being is largely determined by the level of cooperation amongst nurses and other medical professionals who are assisting them, there are things that are more important than education, training and open communication.
Poor communication often leads to big mistakes such as prescribing the wrong medication, improper diagnosis of a patient ailment or medical condition, administering the wrong treatment plans and in some cases even death of a patient due to misdiagnosis due to lack of communication.
We also know that nurses and physicians are trained to communicate differently. Nurses learn to communicate by being descriptive, detailed, and narrative while physicians learn to summarize, diagnose, mend, and repair. This makes nurses the best mediator between the physician and the patient as nurses are taught to explain and give information in the most understandable manner to the patient.
Communication is at the heart of these goals and patients are being encouraged to be more involved in their care. This can only be achieved if patients truly understand what is available and feel empowered to make those choices.
Therefore, when talking to a patient next time, take time to reflect on how you think the consultation went and how it could be improved. Determine whether you use jargon or abbreviations that the patient might not understand, and more importantly did you find out if the patient understood what had been said.