have I learnt from this interaction?
To aid effective communication further, the nursing associate should consider the 7Cs of effective communication, which are applicable to both written and oral communication (Table 2.4). The 7Cs are used in business communication and media communications to ensure that the message is accurate for the target audience, and they are applicable to the nursing associate when interacting with patients.
Barriers to Effective Communication
Nursing associates who are aware of the common barriers to effective communication will be able to anticipate and react to ensure optimal communication and patient care. There are many factors that can create communication barriers, and some of the common ones are listed here:
Environmental barriers can arise due to issues with the setting in which care is provided, be it at home, close to home or in hospital; all can impact communication due to factors such as noise, lack of privacy and lack of control over who is present.
Personal barriers can be created by healthcare professionals, including nursing associates, working in areas where staff conflict and workloads are high, resulting in lack of time or support for patients. Communication can also be impacted when the nursing associate lacks skills or strategies for coping with difficult emotions, reactions or questions.
Physiological barriers: People can experience difficulty in hearing or speech following conditions such as stroke or brain injury. Hearing and eyesight problems become more common as we age, and as the population is living longer, these issues may become more prevalent in years to come. The nursing associate needs to develop an awareness of the challenges these barriers create for effective communication and work collaboratively with the patient, their family/carers and other healthcare providers such as speech and language therapists.
Psychological barriers such as fear and anxiety can impact a person’s ability to listen to what the nursing associate is saying. Patients may worry about being judged or becoming emotional. The patient may struggle to explain their feelings and attempt to appear strong for someone else’s benefit.
Cultural barriers can impede communication especially when the nursing associate is unable to demonstrate cultural competence. Lack of understanding, or lack of curiosity, about different cultures can result in negative patient experiences. Different cultures have different beliefs about personal space, understanding of illness and acceptable treatment options. It is important for nursing associates to think about their own experiences when considering cultural differences in communication and how these can challenge patients and healthcare professionals. It is important for the nursing associates to demonstrate cultural awareness when caring for people and to ensure that their needs, priorities, expertise and preferences are always valued and taken into account (Nursing and Midwifery Council 2018b).
Yellow Flag Cultural Beliefs and Values Associated with Non‐verbal Communication
Language differences between the nursing associate and patient can cause communication errors. The nursing associate will need to work with families, colleagues and interpretation services to assist when language barriers exist. The use of jargon, acronyms and abbreviations (there are over 700 acronyms and abbreviations used by the NHS) can have a significant impact on communication, as it often results in misunderstanding. Literacy level can also significantly impact communication, and the nursing associate needs to be aware of the patient’s ability to read and write when providing written patient information.
Conflict can arise for a variety of reasons and be positive when it offers an alternative viewpoint. It becomes a barrier when it detracts from the purpose of the communication. Nursing associates aim for collaborative relationships with patients but caring for people when they are at their most vulnerable can lead to heightened emotion, and patients can react out of character, appearing rude or aggressive. Having good communication skills can help the nursing associate de‐escalate or even prevent such responses and build patients’ confidence and trust.
Difficult conversations should not in themselves be barriers to effective communication. A nursing associate can lack confidence and competence in dealing with such emotive conversations, such as complaints (see chapter 9), suicide, end‐of‐life or organ donation thereby creating communication barriers that impact the patients and their family/carers. Effective communication with relatives and caregivers can be important in determining what the patient would want. In any holistic care provision, it is important to consider the patient’s family and include family members and engender an interprofessional approach. In order to work with family members as collaborators in care, we need to understand how to communicate with them (Haddad et al. 2019). Patients’ relatives benefit from clear, accurate and consistent information about their relative’s condition delivered in a timely way in an appropriate environment (Richards & Edwards 2019). Effective communication is vital for patients and relatives when a patient is receiving end‐of‐life care. The nursing associate would need to monitor the activities of living but also engage in challenging conversations the patient or relatives may want to have. By talking about death and dying, the nursing associate is acknowledging the patients’ desire to plan and organise; it is also giving the family a clear expectation that their loved one is going to die. The nursing associate needs to consider the appropriate time and place to have the conversation, as a busy ward environment is not conducive to this type of conversation (Fitzsimons 2018). The family should be told about an anticipated death away from the patient’s bedside in a room where there will be no disruptions. For privacy, the door of the room should be closed, but with a clear path to it, as distressed relatives may want to leave the room. Everyone will be asked to sit down, so that the healthcare professional delivering the bad news is not standing over the relatives, the healthcare professional’s tone of voice will be calm and their posture open. The relatives should be allowed time to process the information and freely express their emotions; they would want to do this in private. The healthcare professional can then return to the relatives and answer any questions they may have or give them another opportunity to discuss the information they have received (Woodrow 2019).
Templeman (2019) talks about the reflective practice of healthcare professionals and how this leads to developing knowledge, skills and behaviours in effective communication. By reflecting on challenging conversations, the nursing associate can develop new perspectives on those conversations and identify in what areas they want to develop their communication skills. This process will build the nursing associate’s self‐awareness and listening skills which will, as a result, make them a more effective communicator. Templeman (2019) describes good communication as skills in common courtesy, comforting and empathy. It is the ability to listen, summarise and paraphrase, whilst recognising the appropriate use of touch and how to negotiate personal space.
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