Communication Skills Reflection: Patient Interaction

Communication Skills Reflection Patient InteractionThis essay exit exa tap the interaction surrounded by myself and the mother of a child who has recently been diagnosed with diabetes mellitus (Mrs X). Before examining the interaction in specific detail I would like to consider some of the more(prenominal) general elements that are relevant to the topic of discourse between health care professionals and their patients.There are galore(postnominal) translations of communicating and Wilkinson polish offers unmatched definition which describes a complex process of both sending and receiving messages in different formats (both vocal, non verbal or more comm only when a mixture of both elements). This interchange typic aloney every(prenominal)ows for an exchange of information, feelings, inquires and preferences. Typically the dickens protagonists in a communication exchange will encode and decode messages in a cyclical pattern. Each making an analysis and response to the pre ceding gambit. (Wilkinson SA et al. 1999)Bugge enlarges on this definition by putting it in a context of use of professional breast feeding and suggesting that its purpose is generally manifold but will let in the stiffs of establishing a mobilise active-patient relationship, to be a tool for expressing concerns or inte ride out in the patients circumstances, to burn information relevant to the patients condition and to provide healthcare information. (Bugge E et al. 2006)It is an necessity part of the whole process of successful communication that both parties achieve a shared collar of misbegottening. This is validated by the process of feedback description which indicates if the actual meaning of the message was interpreted as it was in the first place intended. (Coiera E et al. 1998)In this essay I should note that communication empennage be considered on many different levels. In this instance we are specifically considering the mechanisms of information exchange b etween a healthcare professional and a client which, in the broadest sense will ultimately determine many of the parameters of intercession (and also by chance patient compliance) (Stewart M 1995). Although we are specifically considering one interaction here, this does not mean that the other elements of communication are ignored. Hogard (E et al. 2001) writes extensively on the importance of communication between healthcare professionals which stooge cause huge problems in terms of patient management if they are anything less than optimal. I would rely that any information that I would be able to glean from a patient could be communicated to the rest of a multidisciplinary healthcare team efficiently so that suspend management decisions could be made.If we consider an overview of a typical communicative interchange it laughingstock generally be categorised by both guinea pig and level. In the specific context of nursing, the various levels could be considered as Social whi ch is considered to be safe and non-contentious, organise, which is typically utilised for steads of teaching and patient interviews and Therapeutic which has the characteristic of being specifically patient focussed, businesslike and generally time limited. (DAngelica M et al. 1998)Heinmann-Knoch (et al. 2005) considers the process in greater detail. If this initial interaction is successful it feces develop further characteristics such as the nurse amazes to regard the patient as a uncommon individual and begins to understand their motivations, and the patient develops a trust in the nurse. It is within this communication context that the nurse is generally able to accent to provide care and, more importantly in some instances, encourage patient identify, resolve, or adapt to health problemsWe will also briefly consider the elements of both verbal and non-verbal communication.Verbal communication requires, by definition, the conscious use of the spoken or written word. The nature, grammar and syntax and context of the words chosen are important in that they can reflect the patients genial age, their education, their culture and in some cases their mental state and feelings of the moment. In a clinical context inferences can be made from the way the words are delivered such as their choice, their tone or mea authoritative of delivery. The characteristics most favourable for efficient and effective communication are that the words should be simple, brief, clear, well timed, relevant, adaptable, liable. (Philipp R et al. 2005)Non-verbal communication by contrast, relies on the interpretation of facial expressions, hand gestures, and body language. This can be an extremely subtle means of communication and can give credence (or otherwise) to the spoken word. In the nursing context, non-verbal communication can be manipulated to the nurses advantage to help to elicit information that whitethorn otherwise not fix been forthcoming. It has been estimated that non-verbal communication accounts for up to 85% of information transfer between communication adults. In the professional nursing context it requires both opinionated observation and careful assessment and interpretation to derive the full meaning of what the patient wishes to convey. Most importantly, the nurse should be aware of incongruity between the verbal message and the non-verbal cues. The patient who smiles while describing a terrible pain is one such example. (Musselman C et al. 1999)Specific examplesIf we now consider elements of communication from the transcript. Clearly at that place is no evidence of non-verbal communication on the transcript but I was very conscious of the mothers initial reticence in her opening exchanges with me. She initially sat in a closed position and largely avoided eye contact. As the conversation unfolded she clearly became more relaxed and trusting. She adopted a more open and relaxed posture and started to express herself with appro priate hand gestures. (Hulsman R L et al. 1999) I particularly recall the jabbing gestures she made to emphasise a order relating to big(a) injections.I throw away to observe that the environment that was used for the interview was very unreal and I moot that this may gestate had an influence on both myself and the client. I think that, in a real situation I would be able to allow the conversation to be farthest more fluid and relaxed.I can analyse some of the techniques used to elicit or reinforce informationDuring the interview I purposely made a point of training open questions to try to draw out the clients responseSo it sounds as if, it has obviously upset you..?It sounds as if you were almost blamed yourself for it as well..?Generally its quite a healthy family as well..?From the terminology youre using there is sounds as if you know what youre talking about, you sound quite confident..?Mrs X. was clearly at ease after a while and even when closed questions were asked she would answer them Yes or No and and then go onto both expand what had been said and volunteer other information.I had varying degrees of success in eliciting the information that I was after. Trying to establish whether it would be difficult to get the patient to comply with his nourishment I touched on the subject of diets and Mrs X clearly has a major psychological bar in coming to terms with her own diet. I allowed her to express her views about her obesity before try to bring the conversation back on track. After Mrs Xs outburst about her life-threatening morbid obesity I made three attempts to both empathise and sympathise with her feelings in battle array to gain her trust by asking supportive and non-contentious questions before returning to the point relating to injections with the questionSo how did you feel with the injections, because obviously for me that was quite a scary experience, seeing someone so young giving an injection to themselves..?Phrasing the ques tion in this way appears to show considerable empathy for Mrs Xs situation and allows her then to offer her opinion. (Richards T 1999)There were salwaysal instances where I needed to summarise what was said in order to be sure that I had understood the thrust of Mrs Xs comments lite to understand, em, there was no panic mongering in them and things like that. If Id control looked on the websites, I cogency have found some information I didnt want to see at this stage. So I was advised not to look and I didnt.So would you be a bit. . So if you enounce something that was branch of like false information or mis-information that scared you a footling bit, is that what youre move to say?It probably would have scared me because its my child, but I wouldnt have been into representation about it, I would have been probably saying well that. problems.Paraphrasing was a useful technique to train that I had understood what was being said.Yes, and you know, instead of buying biscuits an d things for the biscuit tin in the house, Ill be buying fruit, huge varieties of fruit, and thatll be their options now.So you say youre red ink more toward the healthy life style and keeping, would you,?Direct questioning helped to elicit specific answersProdigy websites?Off the websites, yes, they were very good because they were no nonsense.Do you mean they were slowly to understand?Easy to understand, em, there was no panic mongering in them and things like that. If Id have looked on the websites, I might have found some information I didnt want to see at this stage. So I was advised not to look and I didntOn occasions it was useful to reflect on the implications of Mrs Xs answers and to try to elicit further information from herSo it sounds as if, it has obviously upset you..?Does that it sounds as if you were almost blamed yourself for it as well..?Empathising is a useful technique particularly when dealing with difficult issues such as the problems with diets. (Stewart M . 1995) oddly being teenagers, its all.. They eat chocolate, they eat crisps and all things that are spoilt for them and if theyre restricted in what they can eat it lists them want it more in a way. I know if I couldnt have chocolate or sweets..On reflection I believe that I made a reasonable attempt in the circumstances to get as much information from Mrs X as I could. By the end of the interview Mrs X was getting tired and losing concentration so I believe that it was correct to terminate the interview at this time. (Wilkinson S et al. 1999)I am aware that I a great deal asked incomplete questions or stopped in the middle of a sentence. This may be an indication that I was not in control of the situationThis whole exercise has been a useful analytical and nurture experience for me. I believe that I shall have gained a great deal of experience from the installment and will use that to further inform my practice in the future.References Bugge E and I. J Higgins on (2006) mit igative care and the need for education Do we know what makes a difference? A limited systematic review. Health Education Journal, June 1, 2006 65 (2) 101 125.Coiera E and Vanessa Tombs (1998) Communication behaviours in a infirmary setting an observational study. BMJ, Feb 1998 316 673 676.DAngelica M, Kathy Hirsch, Howard Ross, Steven Passik, and Murray F. Brennan (1998) Surgeon-Patient Communication in the Treatment of Pancreatic Cancer. Arch Surg, Sep 1998 133 962 966.Heinmann-Knoch, Korte, Heusinger, Klunder Knoch (2005) Training of communication skills in stationary long care homesthe evaluation of a model project to develop communication skills and transfer it into practice. Z Gerontol Geriatr. 2005 Feb 38 (1) 40-6.Hogard E and Roger Ellis (2006) Evaluation and Communication Using a Communication take stock to Evaluate Organizational Communication. Eval Rev, Apr 2006 30 171 187.Hulsman R L, Ros W J G, Winnubst J A M, et al. (1999) Teaching clinically experienc ed clinicians communication skills a review of evaluation studies. Med Educ 1999 33 655 68Musselman C and C Tane Akamatsu (1999) interpersonal communication skills of deaf adolescents and their relationship to communication history. J. Deaf Stud. Deaf Educ., Winter 1999 4 305 320.Philipp R and P. Dodwell (2005) meliorate communication between doctors and with managers would benefit professional integrity and reduce the occupational medicine workload. Occup. Med., Jan 2005 55 40 47.Richards T. (1999) Chasms in communication. BMJ 1999 301 1407 8Stewart M . (1995) Effective physician-patient communication and health outcomes a review. CMAJ 1995 152 1423 33.Wilkinson S, Bailey, J. Aldridge, and A. Roberts (1999) longitudinal evaluation of a communication skills programme. Palliative Medicine, June 1, 1999 13 (4) 341 348.AppendixSelf in blue italicsMrs X in shadowy printHow has xxxx diabetes since coming into hospital?Well its come as a terrible jerk obviously, that hes got diabetes, because hes a healthy boy. Its still a shock. I think the lag have tried to help us over it as much as they can.Do you feel as if theyve given you profuse information about diabetes..?I think weve been make full with information, I think that it was good that one particular member of staff dealt with us mainly, and they listened very about to what we had to say. Weve had a lot of conflicting information but ultimately it all meant the same thing which caused a little bit of confusion.And did you feel as if that that was a bit of overkill? Or a bit too much information too soon?Probably, but between the bits of information that we run off the PC, off the..Prodigy websites?Off the websites, yes, they were very good because they were no nonsense.Do you mean they were easy to understand?Easy to understand, em, there was no panic mongering in them and things like that. If Id have looked on the websites, I might have found some information I didnt want to see at this stage. So I was advised not to look and I didnt.So would you be a bit. . So if you read something that was sort of like false information or mis-information that scared you a little bit, is that what youre trying to say?It probably would have scared me because its my child, but I wouldnt have been into histrionics about it, I would have been probably saying well that. problems.YesI had a little bit of friendship about diabetes before this happened, but sometimes a little bit of knowledge is a more dangerous thing.Is that because of the work that youre doing?Yes, and you know, what Ive actually learned now . had diabetes, so.And do you think how its sledding to change your lifestyle?Definitely going to change the lifestyle. Having a big family its going to mean that..How many people in the house sorry?In the house theres 6. Cooking Sunday dinner yesterday, there were 11 of us for Sunday dinner yesterday..Thats a lot of people..Yes, and you know, instead of buying biscuits and th ings for the biscuit tin in the house, Ill be buying fruit, huge varieties of fruit, and thatll be their options now.So you say youre going more toward the healthy lifestyle and keeping, would you,Yes, yesWould you all the bad things, would you keep them out of the house or will you still buy them in for..I wont be buying them because my children will need to make their own decisions about that. I usurpt have small children who are going to feel deprived if they go intot have a chocolate biscuit. Theyre old enough to make a conscious decision, okay silents given us that, but I fancy this so Im going to go and buy it. Theyve got their own resources so they can go and do it themselves.And theyre quite able about that are they?Yes, and theyre happy, apart from one, about the healthier way of cooking things if you like and em, wasnt a terribly bad diet in the first place.Have they all agreed to sort of, give their responses to diabetes or are they sort of displace back about it? T hey seem quite laid back..They are very laid back. Theyve even, I mean it sounds absolutely terrible but theyve even been quip jokes about it. Three of my children have got asthma and I mean he was joking well mines worse than yours and ..So theyre all quite light hearted about it and taking it in their stride.Yes. Matthew, my eldest boy, was, because hes a Nurse I think, he was absolutely devastated but he is better about it now. But in the first instance he was absolutely gutted. I mean xxxx he was gutted obviously..Well this is it, he seems quite calm about it from what Ive seen and a very relaxed family in general.Yes. I mean if we were any more laid back wed need .. on a wickedness to keep us going because we dont really let things bother us.So it sounds as if, it has obviously upset you..?Yes, very much. I kicked right off. I didnt kick off in antecedent of him, but when I got home I kicked right off to perpetuallyybody and anybody that would listen. I even had texts from f riends that didnt even know, and I was ranting to themDoes that it sounds as if you were almost blamed yourself for it as well..?I did wonder, you know, initially I wondered if it was because theyve always been allowed to have sweets. Ive never made sweets into a fix or a treat, you know, theyve always been an passing(a) matter of fact, because I didnt want them to grow with my problems, obesity problems, because they werent allowed sweets. I didnt ever want them to ever think sweets were something really special. Because theyre not, theyre just some other thing that, theyre a foodstuff, and theyre a bad source of..Especially being teenagers, its all.. They eat chocolate, they eat crisps and all things that are bad for them and if theyre restricted in what they can eat it makes them want it more in a way. I know if I couldnt have chocolate or sweets..Well thats just my life experience you know, being denied things and then departure home at 16 and take all of that stuff and bec oming at one point seriously morbidly obese I dont want that for my children. Obviously they might have a predisposition to do that. I dont want that to happen so, lets not make sweets and biscuits em, a reward or a treat so they never have been. So then I wondered if possibly theyd had too much. None of them are overweight, none of them are fat, none of them have got bad teething and cavities and things. None of them has ever had a filling.Generally its quite a healthy family as well..He hasnt seen a doctor for 7 years.So it must be a complete shock for you that this has perfectly happened.. and changed everything that has been happening in your home. So how has the rest of the family been coping, have they been..?Very supportive, except for one..Ah, except for one, is that the elder one or the younger one?Hes 18 just turned, and hes got an terrible diet, all I can do is advise him. I can put his meals in front of him and if he chooses not to eat them and go and buy rubbish the n, all I can do is advise him.So how did you feel with the injections, because obviously for me that was quite a scary experience, seeing someone so young giving an injection to themselves..I knew he could do it. Of all of this, thats the bit that doesnt faze him.Does it faze you at all?It doesnt faze me. Em, when I was asked to give him an injection here, and staff knew I could do it said you might not be able to do it because hes your son.. But its not like that is it? If he goes into a hypo and he needs me to inject him, Im not going to start you know, oh my god his life depends on it, get him injected, how..From the terminology youre using there is sounds as if you know what youre talking about, you sound quite confident.Yes. I am. I mean.but, at the end of the day its your child and youre not going to, going to, you wouldnt hesitate, just get on with it, you just do it.And do you feel that thats the attitude that youre whole familys going to have as well?Yes. Theyre all, you kn ow, when hes doing his bloods theyre all there watching, hovering over him, when hes sticking a needle in theyre ooh, where are you going to stick it now? you know. Nobodys squeamish, nobodys terribly bothered by it, I think theyre all pretty pleased because its not them thats got diabetes. But at the end of the day .but be supportive, cant ask any more really.Yes. Can you see yourself coming in regularly to see all the diabetes nurses? Even if hes in complete control of his diabetes will you still come in and visit just to make sure everythings alright?Yes, as long as he wants me to come with him, then I will come with him. I mean, when he turns 18 if he wants me to come to the diabetes clinic with him then Ill come with him.Is he independent anyway?Very. Fiercely independent. Still like, on the holler its still like mamma So when you go away today do you think youll feel as if youre going to have everything that you need for the next, lets say two weeks, or week, to be happy wi th..Yes I still need to ask about when I should make an appointment for .. him to see his GP. I still need to ask little questions.. When he turns 18 is the insulin free, or does he have to pay for it like everybody else, with the prescription chargesYes .. arent they? Its quite expensive as well isnt it?Well asthmatics dont get their inhalers free, they have to pay..When you think about it youve got your insulin, your sticks you.Its the keytones as well, they havent been completely explained to us.Theyre in the leaving pack anyway whichI mean I understand what the keytones are, butWhat are they? Because I dont fully understand, I know theyre a by-product ..Keytones are a turn back product that your kidneys filter out of the blood and pass out in the water. Obviously theyre in your blood for your kidneys to pull them out, filter them out, but if his blood sugars are high and remain high you should try on his urine for keytones. There are sticks to test his urine. If there are a l ot of keytones in his urine then he should probably do a test on his blood which is just another stick that goes inHave you got them?No. Then you would yell the ward. But we know we can phone the ward anytime.So you feel reassured at having that point of contact that you can phone up anytime?Absolutely, yes. Theres still going to be stuff that comes up and what can you do about that? Theres going to be stuff that comes up all the time.Im sure youre going to have peaks and troughs a little bit where youre unsure whats happening and if youre concerned hes not controlling his diabetes properly, were only a phone call away.Yes. And if its not being controlled I dont think it would be anything hes doing deliberately wrong..You said earlier, he knew about what his level was. I think at one point yyyy asked him what level do you think youre at..Yes, he was very close.Mm, very closeAnd that was only on day two or three, day three maybeHes had a couple of lows on his blood pressure as well which I think hes realised because hes felt the effect that its had on himHe knew yesterday good afternoon that he was low because he said look at me and he showed me and there was just ever such a slight tremor in his hands.Did that concern you or reassure you?It reassured me because he knew and I said, he said I need to test my blood and I said why and he said because I think its low and he said look and he showed me. For him it was low, its the lowest its been.Well thats fantasticI wasnt worried because I knew that all he had to do was have the glucose or eat something or both and em, when he goes back to trail I know that hes You take home glucose tablets as well dont you? I think you can buy them from the shops now..Yes. You can just at the supermarket so theyre easy to carry about.Very nice sweets as well. Anyway I think thats about enough so thank you for your time.I hope it helps.Im sure it will.17.04.07 word count 2,112 PDG