Nursing Therapeutics 1

Nursing Therapeutics 1 – Assignment (3093 words)

The following essay aims to explore various aspects of verbal and non-verbal communication with reference to an interaction between two mental health nurses; (Colin and Susan), recorded on video. Collins English Dictionary (2000) defines the term ‘communication’ as: “the imparting or exchange of information, ideas, or feelings”. The ability to communicate effectively is a required skill in all aspects of human contact (Alcock, 2002); furthermore, it is a skill, which is considered to be an “essential” tool in the field of nursing (Egan, 1994). Brown (1997) reiterates this, stating that for nurses, the skills required in order to communicate effectively and sensitively are “crucial”.

Communication is expressed both verbally and non-verbally (Caris-Verhallen et al, 1999), and according to both Burnard (1994) and Alcock (2002) it is an activity in which all humans participate. Dexter and Wash (1991, p.35) describe communication as a “constant and continual” phenomenon, adding that “non-communication is impossible”; all humans communicate, whether intentional or not (Burnard, 1994).

Dexter and Wash (1991) and Caris-Verhallen et al (1999) both state that the term ‘non-verbal communication’ pertains to every manner and form of communication which does not use or entail the use of spoken language. Brown (1997) elaborates on this, adding that non-verbal communication can comprise the use of both body language, and non-verbal vocal cues that include; crying, laughter, sighing, groaning, and volume and tone of voice. These non-verbal vocal cues are referred to as ‘paralanguage’ (Eysenck and Flanagan, 2001), and are illustrated on the video, by both Colin and Susan, (examples of this are evident during lines 15 and 16). According to Dexter and Wash (1991, p.35) these cues are often used alongside verbal communication “adding to, or even changing, the literal meaning of what is said”; this is also shown on the video (lines 63 and 65), where the emphasis which Colin places on his words changes the meaning of his verbal communication from what could have potentially been a question asked due to confusion in an attempt to seek clarity or understanding, into a remark which illustrates incredible defensiveness.

Non-verbal communication usually accompanies spoken language (Antai-Otong, 1999b), however Bush (2001) emphasises that communication which occurs non-verbally, is just as significant as that which is expressed verbally. However, it is highlighted by Antai-Otong (1999b) that verbal and non-verbal communication do not always match up, referring to this as ‘incongruence’. Burnard (1994) states that if what is being communicated is to appear genuine, then both verbal and non-verbal communication must match. Dexter and Wash (1991) and Sommer and Sommer (2002) both support this notion, reporting that in order for communication to be as effective as possible, it must also be congruent. This is reinforced by Burnard (1994) and Antai-Otong (1999b) who both suggest that the likelihood of a misunderstanding of communication occurring is considerably less if verbal and non-verbal communication are congruent with one another; such confusion would present a significant barrier to effective communication (Alcock et al, 2002). However, the processes involved in non-verbal communication are described by Antai-Otong (1999b) as being “natural, spontaneous, and often unconscious”; consequently, Brown (1997) reports that it is widely accepted that when communication is incongruent, it is the non-verbal expressions, rather than the verbal ones which are “more accurate” and “more reliable” indicators of how a person really feels; implying that due to the occurrence of the unconscious transmitting of non-verbal messages, non-verbal communication can be more reliable than verbal communication, adding that non-verbal messages have the ability to “reveal the true feelings” which underlie the spoken word.

Antai-Otong (1999a) states that the majority of all communication is expressed non-verbally, and it is reported by Brown (1997) that non-verbal communication is a mode of communication which is used by all humans, without exception; evidently this remains an “ever-present” constituent of human communication and interaction (Miller, 2002), powerful enough to convey “all human emotions” so accurately that at times spoken language is “unnecessary” (Brown, 1997). This clearly has significant implications for mental health nurses, and implies that a good understanding of non-verbal communication can be invaluable when assessing and monitoring the mental state of a patient; a view which Brown (1997) supports, reporting that the most substantial advantage for nurses of acquiring a versatile understanding of non-verbal communication is improved “accuracy” when assessing the mental state of their patients. Dexter and Wash (1991) report that our innermost feelings and thoughts can be transmitted through the slightest of movements and gestures; therefore, a good awareness of non-verbal communication, for nurses, is an asset, which will help them to ascertain and gain insight into the needs of their patients (Burnard, 1994). Additionally, it is argued by Caris-Verhallen et al (1999) that nurses must be good communicators, not only in order to accurately assess the needs of patients, but also in order to provide ‘patient-centred’ care, which is “tailored to the individual”.

However, it is highlighted by Antai-Otong (1999b) that our “cultural background” can affect the ways in which we communicate. Therefore, one can assume that in order for communication to be efficient and effective it is important to take cultural issues into account (Burnard, 2003). Pearce (2003) reinforces this, stating that between cultures, differences in “customs and etiquette” can bring about “all manner of misunderstandings”; adding that speaking a common language is not necessarily enough to guarantee good communication. Miller (2002) elaborates on this, reporting that as well as culture; the age, gender, ethnicity, education and health of an individual will all impact upon the way they communicate. Burnard (1994) highlights that it is important to bear this is mind, so as not to interpret different styles of communication inappropriately; no two human beings share entirely the exact experiences, knowledge and background, and this must not be overlooked (Miller, 2002).

It is also argued by Miller (2002) that the environment in which communication takes place can impact upon the capability of people to “lead or sustain” that communication. Ironbar and Hooper (1989) support this, stating that unsuitable and inappropriate environmental conditions can be distracting, and are not conducive to good communication; factors such as temperature, smells, lighting and noise can impact upon the detail and success of communication (Johnson, 1997). Furthermore, Dexter and Wash (1991) state that a complex environment can potentially distort the messages we are conveying, which is likely to cause or create misunderstandings, or even cause the communication to be ignored. The environment, as shown on the video, in which Colin and Susan are communicating is a quiet and well-lit area with two chairs (where Colin and Susan are seated), and a coffee table placed between them. This also appears to be a private, ‘staff only’ area of the ward; an environment such as this, which is both private and quiet is, according to Sommer and Sommer (2002) likely to significantly improve communication in comparison with environments, which present distractions, such as those with high levels of background noise.

Wilkinson (1999) highlights that increasingly the ability to communicate effectively is, for nurses, recognised as a “core clinical skill” and an “essential component of clinical competence”, which Cowin et al (2003) state is central in ensuring the provision of therapeutic care. According to Caris-Verhallen et al (1999) communication is required in the development of good interpersonal relationships; furthermore, good communication facilitates the development of relationships (Miller, 2002), and is reported by McCabe (2004) as being a critical factor in the growth and development of a “positive nurse-patient relationship”; this is important as, according to Welch (2005) the therapeutic relationship is regarded as a “cornerstone” of mental health nursing. Furthermore, Buresh and Gordon (1996) suggest that poor non-verbal communication has the potential to “unwittingly” weaken and detract from the status and prestige of the nursing profession; therefore, one can assume that a good command and understanding of non-verbal communication skills is an essential commodity for all nurses, who wish to help maintain and improve the public image of their profession.

According to Bush (2001) effective communication between nurses and their patients begins with ‘active listening’; “paying undivided attention to what the client says and does” (Wilson and Kneisl, 1996). Deering and Cody (2002) report that active listening is conducive to, and aids good communication. Susan displays a key element of good active listening on the video, in the form of ‘paraphrasing’ (lines 189-190); the process where an individual expresses their interpretation and understanding of the content of communication, allowing them to clarify the accuracy of their comprehension (Best, 2005). Bush (2001) states that nurses should ask their patients to paraphrase significant information, and then do the same in return; suggesting that this will reduce occurrences of misunderstanding and miscommunication. However, it is suggested by Antai-Otong (1999a) that the skills required for active listening involve, and place demands on all senses; emphasising that active listening necessitates more than simply a keen pair of ears.

At the start of the video, good active listening skills are again demonstrated by Susan, when she adopts the ‘SOLER’ position (Egan, 1994); she is facing Colin “squarely” with an “open” posture, conveying her involvement and availability; she is “leaning” slightly towards Colin, signalling that she is both interested in him and paying attention; “eye” contact is also maintained appropriately by Susan, which again indicates that she being attentive and also reaffirms her interest; in addition she also appears to be relatively “relaxed”, which is likely to help Colin feel more at ease. Antai-Otong (1999a) explains that active listening involves both verbal and non-verbal communication, adding that for active listening skills to be used effectively, one must be “attentive to both kinds of cues”. Here, Susan is clearly aware of these implications, and she is using her entire body to communicate appropriately and effectively. During this time, Colin appears to be imitating or ‘mirroring’ the position displayed by Susan; this behaviour, according to the Holistic Health Network (2006) may be exhibited to help Colin to build a rapport with and relate to Susan more wholeheartedly.

Despite this, the body language displayed by Colin is rather different, and not as convincing as that which is shown by Susan. During the beginning of the video, his avoidance of eye contact (evident during lines 10 to 26) may be an indication that he is disinterested in his interaction with Susan (Caris-Verhallen et al, 1999). Whereas, Dexter and Wash (1991) suggest that the lack of eye contact displayed by Colin may be revealing inner feelings of insecurity, uncertainty and unease; furthermore, Brown (1997) reports that this may also undermine his verbal communication, as this broken eye contact could convey that Colin is not being entirely truthful. This notion is reinforced by the fact that Colin is clenching his hands and hiding them from view, as, according to Brown (1997) this is also implicit that “the exact truth is not being told”; adding that, conversely, displaying open palms is a signal of sincerity. However, Dexter and Wash (1991) also suggest that the tense and rigid posture held by Colin, with his arms crossed into his lap could convey that he feels anxious, adding that the clenching and rubbing of his hands may communicate feelings of anticipation; a view supported by Fiske (1991) who reports that posture is a good indicator of the levels of both tension and relaxation that a person is experiencing. His speech is slightly agitated, with numerous paralinguistic cues, including a stutter (line 11); he appears tired in his appearance, with drooping shoulders.

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