of Salford, UK
Chapter Aim
To explore the theories and models that underpin communication relevant to the role of a nursing associate
Learning Outcomes
By the end of this chapter, the reader will be able to:
Identify and define the components of the three models of communication
Describe contextual factors that affect communication
Understand the importance of effective communication within the role of a nursing associate
Test Yourself Multiple Choice Questions
1 What are the three key communication models?Transgression, interaction and transactionTransmission, interaction and transactionTransport, interaction and transactionTransmission, intervention and transaction
2 Which of the following is/are the result(s) of poor communication?Medication errorPoor patient outcomesLow staff moraleAll of the above
3 Which of the following terms is used to describe a communication barrier?ChannelCodeNoiseReceiver
4 Which of the following represents the contexts considered important in the Transactional Model of Communication?Psychological, social, cultural and relationalPhysical, psychological, social and culturalPhysical, psychological, social, cultural and relationalPhysical, social, cultural and relational
5 In Peplau’s interpersonal relations theory, which of the following indicates when the nurse and patient begin to work collaboratively to enable the patient to become an active recipient of treatment?Orientation phaseIdentification phaseExploitation phaseResolution phase
Introduction
Nursing associates provide safe and effective holistic patient‐centred care that is underpinned by the 6Cs of caring (Department of Health 2012). Communication, one of the 6Cs, is a complex yet critical element in all areas of nursing activity. The nursing process, the assessment, diagnosing, planning, implementation and evaluation of care, is achieved only through careful attention to interpersonal relationships, the environment and the specific skills of verbal and non‐verbal communication. Nursing associates are required to communicate with a wide variety of patients across their lifespan, including babies, children and young people, carers and families, and adults and older people. They are expected to provide prevention, treatment, rehabilitation and end‐of‐life care while working in a broad range of settings, such as at home, close to home and in hospital. They do not work in isolation and so require excellent communication skills to work effectively with not just patients and carers but also health and social care colleagues within a multidisciplinary team. Many of the people nursing associates communicate with will have communication challenges requiring them to make reasonable adjustments and adapt their style of communication.
There is a well‐established link between team communication, worker morale and patient safety. Poor team communication has been directly linked to high nurse turnover rates and low morale (Brinkert 2010). Low morale contributes to high levels of stress, burnout, poor job satisfaction and an overall poor quality of life (Khamisa et al. 2015).
Supporting Evidence
The National Institute for Health and Care Excellence (2016) has provided guidance for health and social care professionals to enhance the transition between inpatient mental health settings and community or care home settings
Poor communication is often a feature in healthcare related events (Burgener 2017) with communication issues frequently featuring in National Health Service (NHS) complaints and medication related events. Within hospital and community health services, Ombudsman data identifies communication issues as one of the five most common complaint factors in cases which were fully or partially upheld in 2018–19 (Parliamentary and Health Service Ombudsman 2019).
In recent years, a number of serious failings in healthcare provision have made national news, for example, the Francis enquiry. This public enquiry reviewed reports on poor care in the Mid Staffordshire Foundation NHS Trust between 2005 and 2009, which was believed to have contributed to the avoidable death of many patients and highlighted communication failings in sharing information and concerns (Francis 2013).
Poor communication between healthcare professionals, poor communication with patients and limited communication between primary and secondary care have all been identified as factors which influence medication errors (World Health Organization 2016). Keers et al. (2013), in a systematic review of causes of medication administration errors in hospital, also identified inadequate written communication as a factor.
Take Note
Good communication is essential in meeting patients’ needs and providing safe, quality patient care. Improvements in communication can lessen healthcare errors and make a positive impact on patient outcomes. For the nursing associate, it is important that they develop underpinning knowledge about communication as well as the skills to deliver effective communication to provide high quality care.
Red Flag
This chapter will focus on the underpinning knowledge of communication and will be followed by a series of chapters that will examine the specific communication skills required by the nursing associate. The Nursing and Midwifery Council (NMC) (2018) standards of proficiency for nursing associates require, at the point of registration, the nursing associate to communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges; this is closely related to platform 1, that is, being an accountable professional.
The World Health Organisation (WHO) defines communication as ‘the transfer of information, ideas or feelings’ (World Health Organization 2009, p.16). More recently, communication has been described as ‘the exchange of information between people by sending and receiving it through speaking, writing or by using any other medium’ (Sibiya 2018, p. 20). Effective communication means that information is conveyed clearly between people. To be an excellent nursing associate requires communication skills to engage effectively with patients using two‐way communication. Failure to recognise this two‐way communication could lead to negative conclusions, negative attitudes and dissatisfaction. The nursing associate must, therefore, continuously try to improve their communication skills to ensure high quality patient‐centred care.
Models of communication help us to consider the processes involved when communicating in several arenas with a variety of people. They provide