The Nursing Associate's Handbook of Clinical Skills. Группа авторов

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

       In some eastern European cultures, a smile denotes happiness and would be seen as inappropriate in a situation of when caring for someone who is seriously ill (Leifer 2019). Whereas in other cultures, a smile is used to reassure. Similarly, with the use of eye contact – some cultures interpret direct eye contact as a sign of engagement, and others consider this to be disrespectful. In western cultures, nodding of the head can be seen as understanding or agreement, while an inclined head can indicate that the person is listening (Richardson 2017). Nursing associates need to have an awareness of personal space, as the nurse who frequently invades someone’s personal space can be seen as rude, whereas someone who is deemed reluctant to enter that personal space to offer comfort may be seen as ‘cold’ (Leifer 2019).

      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.

The ability to communicate effectively, with sensitivity and compassion, is paramount to the provision of high‐quality person‐centred care (NMC 2018a, 2018b). The competencies, within the nursing associate standards, must be demonstrated in a wide range of health and social care settings and adapted to meet the needs of people across their lifespan. Nursing associate’s need a diverse range of communication skills and strategies to ensure that individuals, their families and carers are kept informed and supported to be actively involved in their own care wherever possible. Other chapters in this text will consider in more detail specific communication skills for nursing associate’s.

      Orange Flag Communicating with Older People with Cognitive Impairment

       Confusion or disorientation in older people can be caused by a variety of factors such as infection, delirium or dementia. Older people with cognitive impairment are more at risk of developing delirium. Delirium is characterised as restlessness, agitation or aggression (hyperactive delirium), or being sleepy, quiet or withdrawn (hypoactive delirium). People generally present with a mixture of hyperactive and hypoactive delirium (National Institute for Health and Care Excellence 2014). Communication with people who are disorientated or confused can be challenging. Haddad et al. (2019), suggest that a healthcare professional should not maintain the confusion, but they should re‐orientate the person, unless doing so would result in deep agitation or violence. Politely listening with interest will enable the healthcare professional to determine how deep the confusion is and from this can decide the best course of communication. Richardson (2017) talks about a humanistic approach to communication, that is, being empathetic and non‐judgemental. The nursing associate should remain professional when in challenging situations and allow a moment before responding to an angry or distressed person. It is important that the nursing associate responds in calm manner and ascertains what is causing that distress or anger. Moving on from this point, the nursing associate needs to demonstrate empathy. In order to demonstrate empathy, the nursing associate needs to utilise their skills in non‐verbal communication and should respond to the patient’s experiences, not their own (Richardson 2017).