In this task I will be analyzing, evaluating and explaining a few methods of interpersonal

communication- the way in which these methods work in a nursing setting. In task one (a) I will
firstly be looking at body language. Secondly, I will be working on personal contact. Lastly, I will
focus on signing. In task one (b) I will exhibit how factors affect communication.

TASK 1A

Body Language

Body language means communication through gestures, postures, and facial expressions by
which a person manifests various physical, mental, or emotional states and communicates
nonverbally with others (American Heritage 2013). However in nursing, body language is viewed as
the way in which our bodies communicate our own or a character's attitudes- for example
maintaining eye contact as you converse with a patient, lets the patient know that you are listening
and interested in hearing what they have to say. Nurses view body language as a benchmark for-
revealing clues to unspoken intention or feeling; reinforcement or emphasise through physical
behaviour. Kinesics includes facial expressions, body posture, gestures, eye movement, touch and
the use of space. Thurman (2011) state, "Although you may think that you do most of your
communicating by speaking, in fact over 90 percent of what you communicate to others is done
without speaking a word." Through facial expression, a nurse can tell if a patient is happy, sad or
scared for example a client is admitted due to her being assaulted and threatened. The police have
come to speak to her but her body language suggests that she is frightened and does not want to
speak to the officers.

Personal Contact

Nagar(2006) cites Sommer's (1969) definition of Personal space as "an area with invisible
boundaries surrounding a person's body into which intruders may not come in.' For example; a client
in a nursing home will refer to their bedroom as their personal space therefore the room is
personalised with family pictures and items that make patients feel at home. However in nursing,
patients value their personal space and feel discomfort, anger, or anxiety when their personal space
is encroached so when entering their space it's imperative to knock before entering. When providing
care, distance, body space, consent, touching, culture, posture, professional boundaries and
proximity are seen as essential part of caring. The NMC (2008) maintains that a care provider must
maintain clear professional boundaries, when providing care for a patient. Consequently personal
space in care must be invaded to provide the appropriate care needed especially when feeding or
changing patients. According to Encyclopaedia of Management (2009), "While this body language is
generally well understood in each culture, there are major cultural differences in nonverbal
communication." Thurman (2011) says in some Hindu communities, folding your arms is assign of
humility whereas in Western cultures this could be a sign of stubbornness or aggression.

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 Signing

Signing is a language which uses manual communication and body language to convey
meaning, as opposed to acoustically conveyed sound patterns (Dictionary.com 2015). Thurman
(2011) states that, "signs from British Sign Language (BSL) have been used in several vocabularies
specifically for people with learning disabilities such as Makaton and Sign-along." However, this has
helped communication in patients with learning disabilities. For example a patient is admitted with
multiple impairments by using sign language the care giver can determine the patients' needs and
emotions. It's important when caring for a patient to recognise their needs. As a result the NHS
provides resources such as picture books, signers and the lite writer enabling communication to be
effective."Signs are to eyes what words are to ears."- Ken Glickman (1999). When caring for patients
with hearing impairment nurses should make sure that patients are wearing hearing aids as well as
using other methods to communicate. BBC's Mr Tumble, teaches by saying the word, showing a
picture and then signing it. Whereas the method of signing is different for deaf and blind person as
use tactile signing, figure writing and braille- despite the differences communication is effective as
patients are provided with the right equipment- signers.

B: Communication barriers affect the way we communicate on a day to day basis.

Recognising those barriers has a positive impact on the care given to patients. For instance, a
refugee family comes into a Primary Care Trust the wife is pregnant, hysterical and requires
treatment but speaks no English. Establishing what language she speaks is crucial then it is
essential to assess the patient and care can be given. Communication is very important in care work
as it goes hand-in-hand with the development of excellent relationships with service users (Michie
2004).

When communicating with patients, who come from a different background or ethnic group,
it is imperative to familiarise yourself (as a care giver) with the important cultural values and
religious beliefs. For example, Somalian children are taught not to make eye contact with adults
when they are spoken to, whereas in Western cultures lack of eye contact is viewed as a sign of
deceitfulness (Thurman 2011). Another example- a Chinese patient has died, in their culture money
is placed in the patient's mouth and a letter on a scroll is placed in the hand- the patients journey to
the other life is paid and the letter serves a passport upon arrival as no person makes a journey
without these two things.

Personal space is an invisible bubble carried around with us that defines how we approach
others and how close we are willing to allow people to approach us. To some degree it is how we
involve with others through unhindered relationships formed in society or due to culture (Bach
2009). Depending on the situation personal space may differ. Constitutively infiltration of personal
space is potentially exasperating depending on the context and personal appraisal which are critical
aspects when maintain a patient's health (Hall 1996) for example when entering a patients room it is
right to gain consent by knocking before entering. Badging into the patients room without consent
means that you don't respect their space and dignity (NMC 2008).

Distance when caring for patients will vary on the setting but it must be accurately judged.

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Geriatric patients usually require a vast amount of attention and to provide effective care their
personal space would need to be invaded. Whereas when caring for a patient in a mental institution
a care giver would need to keep their distance for safety reasons as the behaviour of mental health
patient can be erratic. Similarly when caring for cancer patient's distance must be maintained as
patients have a low immune system.

Task Two

In this task there are three components I will be looking at. Firstly I will be looking at the
communication cycle. Secondly, I will be working on why communication was ineffective in my case
study. Finally I will be explaining how communication could have been more effective.

A: (http://www.buzzle.com/articles/communication-cycle.html) [Accessed on 29/12/14]

The communication cycle enables us to achieve contact with others and being understood.
The process involves conveying messages through sending and receiving between persons. My
understanding of the communication cycle according to Argyle's theory is- an idea manifests, it is
coded and put through the right medium; the message is sent and is then received by the intended
person; the message is then processed by the receiver and understood, finally a response is given
and the cycle repeats itself. Communication is fundamental to our everyday life which enables us to
reach out- being personal and intimate or formal and informal.

B: In the case study it clearly shows that communication is ineffective and a number of
factors can contribute to this outcome. Primarily, English is not the patient's first language
indicating that there are also cultural differences- this interferes with the patient's ability to receive
and understand the message for example maintaining eye contact (Hale1999). NMC (2008) states
that patients should be treated with dignity, respect, they must be treated as individuals and must
not be discriminated against. Due to this the patient may he been left feeling discriminated as her
cultural needs were not met. In turn this makes the client endure a mixture of emotions such as:
isolation, frustration, agitation and exclusion- this can lead to confusion. Another factor why
communication failed could be due to the nurse's negative body language when she prised her off
her arm. She did not apply the communication cycle by- not listen actively or reflectively; giving
feedback to the patient or wait for a response. Therefore her communication skills did not portray
empathy or demonstrate she understood exactly what point the client was trying to bring across.

Finally, the nurses' tone of voice may make the patient feel that she is an irritation and the
nurse is angry or exceptionally busy to deal with her (White2005). On the other hand pace of speech
is inseparable from tone of voice and this normally reciprocates body language in an angry manner-
living the patients unsure as they're constantly looking back at you the care giver.

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 C: Communication could have been more effective in this situation if the nurse took a little
bit of time to understand the patient's needs and making sure the needs were met by putting the
patients' interest first as this would enable the patient feel to feel secure in her time of vulnerability.
This could have been achieved by adopting a sympathetic approach- making certain that the patient
feels comfortable and by showing respect. With the use of active listening, reflective listening and
giving feedback the patient would have felt that she had the nurse's undivided attention. At that
point the patient would view her concerns, worries and wishes with the hope that her needs would
have been met at some point- the nurse would have gained the patient's trust. The nurse should have
ensured that the time and place was right for conversation to take place for example changing the
environment by taking the patient into a cubicle to reduce the noise levels from the busy ward. It
was important for the nurse to try very hard to find and an appropriate method for interactive
communication by- speaking clearly and slowly, also through clarification or repetition. This can also
be achieved through: the use of interpreters and right body language- showing the patient you are
willing by smiling; showing empathy for example by using eye contact. Finally, being sensitive to
what the patient was saying, feeling; thinking and showing meant the nurse showing: respect and
protecting the patients' dignity and rights.

Task 3

Commonly in a nursing setting patients do suffer from different emotions. For example a
child is brought into the doctor's surgery for vaccination due to the fear of needles she being to
suffer with anxiety. It's the care provider's job to distract the child in order to calm him/her so the
vaccination can be administered. On the other hand when treating someone from pain and
discomfort a holistic approach must be taken as; pain can be physical, emotional, social and spiritual
(Nolan 2011). A midwife at all times must be confident in her setting portraying the right body
language and facial expression; opposite to this will only make the patient nervous and more
frightened. Most times fear of pain can make the feeling worse; causing additional pain through
anticipation. For instance, a woman has been admitted as she is in labour, it's obvious that she is in
pain and most probably scared. It is best to observe and assess the patient. It is essential to
acknowledge the patients feelings, emotion and respecting their dignity (NMC 2008) through
showing empathy and telling her everything will be ok. Using physical methods patient will need to
be reassured through offering comfort in a compassionate way by massaging her hands. Personal
space will be breeched to provide comfort. It is imperative that the midwife stays calm and focus as
that also keeps the patient calm. Pain can be managed with self-help methods for example
encouraging the patient to go for a walk or by having a warm bath. Finally using drugs for example
an Epidural can be administered if the patient is in agony or is distressed.

Task 4

Nurses and careers are supported in a variety of ways involving their interactions with

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patients. Firstly, there is the NMC code which guides the care that is provided to patients. The NMC
is also the body that governs the practice, well as the well-being and stability of the care giver.
There are policies and procedures by the trust, this encourages team building skills. Working with
colleagues is one of the most effective ways to care for patients. Communication aids are also
provided for example symbol and picture books, also the light writer for patients with severe
impairments.

Carers are provided with communication channels such as computers to aid with quick
research. We live in a multi-cultural society so as a result advocates are brought in the help care
givers for example interpreters are used to tackle language barriers as some patients have a
preferred method of communication - their native language.

Training such as C.P.D (continuous professional development) and all mandatory training:
manual handling, health and safety, infection control, basic life support and vital signs are provided
so carers can obtain the skills needed to perform effectively at the task at hand. By law carers are
taught safe guarding dealing with patients' record keeping; this can be done electronically or
manually on patient's care plans. With the use of clinical supervision carers identify their weakness,
which is improved with appropriate training, the aid of ward managers and senior staff-improving
the care givers confidence and keeps them motivated to continue their job.

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