communication found that both the individuals and their partners recognised that they interpret the use of different communication means in relatively the same way. The study found that participants perceived the level of interaction increased during the study, as both were more familiar with different modes of communication (Rautakoski 2010).
One in four adults experiences a mental health condition in any given year (National Institute for Health and Care Excellence (NICE) 2019), many of whom also have comorbid obesity, asthma, diabetes mellitus, chronic obstructive pulmonary disease, chronic heart disease, stroke and heart failure (Public Health England (PHE) 2018). Nursing associates will encounter people with mental health problems throughout their nursing career, and they can enhance their communication encounters with people with mental health problems by:
Having a fundamental knowledge of the main mental health problems
Giving the person time with no distractions
Letting the person share as much or as little as they want to
Not making assumptions or try to diagnose
Keeping questions open ended
Talking about well‐being, for example, exercise and diet
Listening carefully and repeating what you have heard to check accurate understanding
Being aware of stigma and the negative impact inaccurate prejudices can have on communication, for example, people with mental health problems are usually portrayed as violent and aggressive in the media, but this is not typical of the majority of people with mental health problems
Knowing your limits and asking for help from other healthcare professionals if needed
Table 2.4 The 7Cs of communication.
| TERM | MEANING |
|---|---|
| 1. Clear | Avoid jargon and complex words. Focus on a specific message which makes the message understandable |
| 2. Concise | Keep it brief, avoid repetition. Highlight the main message |
| 3. Coherent | Ensure the message makes sense and is logical |
| 4. Complete | The message must be complete and contain everything it needs to so that the receiver can respond or act |
| 5. Concrete | Specific and clear, supported by facts and figures |
| 6. Courteous | Considers both viewpoints (sender and receiver) and the feelings of the receiver. The message should be sincere and polite and delivered in a friendly and courteous manner |
| 7. Correct | Uses appropriate and correct language. Check for mistakes. A correct use of language increases trustworthiness |
Dementia can also affect an individual’s ability to communicate. Dementia is not a condition in itself (Alzheimer’s Research UK 2019). It is a term which describes the symptoms that occur when the brain is affected by certain conditions which cause the gradual death of brain cells. Dementia is a progressive condition. Examples of such conditions include Alzheimer’s disease, vascular dementia, and Lewy body dementia. In the United Kingdom, there are currently around 850,000 people living with dementia (Alzheimer’s Society 2017). The speed of which cognition declines can vary from person to person and may depend on which type of dementia they have (SCIE 2015). Symptoms of dementia can include loss of memory, reduced concentration, personality or behaviour changes, reduced ability to perform everyday tasks and problems with communication and reasoning skills. These changes in communication skills can be upsetting and frustrating for the person with dementia and those around them.
As people living with dementia experience changes in communication, they may experience word finding difficulties, repeat words or phrases, have naming difficulties, for example, not being able to name a watch but knowing it is something related to time and speech and grammar may become mixed up, making conversation difficult to follow. As a result of cognitive changes, the person with dementia can experience difficulty in following, processing and comprehending what is being said to them (Alzheimer’s Society 2016). As a person’s dementia progresses, their ability to communicate by spoken word can become increasingly impaired; however, they will continue to communicate in other ways, such as gesture, body language and facial expressions. In these circumstances, a person’s behaviour becomes a way of communicating.
The nursing associate needs to ensure that they consider the changes someone with dementia may be experiencing and modify their communication to match where the person is in their dementia journey. This can include getting the person’s full attention before you start, using shorter sentences, making one point per sentence, giving the person additional time to respond, rephrasing rather than repeat and paying attention to the person’s body language as it can support what a person may be trying to verbally express. Further tips for communicating with a person with dementia are provided by the Alzheimer’s Society (2016).
The final element of the PER tool is for the healthcare professionals to reflect on whether they achieved what they set out to, if it went well and what they could have done differently (Richardson 2017). The nursing associate will be familiar with models of reflection from both their pre‐registration education programmes and revalidation requirements of the NMC. Some questions the nursing associate may want to ask themselves when reflecting on their communication experiences include:
What did I like best about my use of communication skills?
What did I like least about my use of communication skills?
If I were to do this interaction again, what would I do differently and why?
What 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