According to Argyle (1978) Non-Verbal Communication is 5x more effective on a person’s understanding of a message than the use of words.

For this task, I will be comparing two journals both talking about Non-Verbal Communication within a care environment. My aim is to summarise each journal first and then compare the two to see any similarities or differences.

The first Journal is:

Non-Verbal Communication with patients by Patrick Davies.

This journal looks into how Non-Verbal Communication (NVC) affects the behaviour between a Nurse and thier patient and how it can influence the quality of care that is given.

Signals can be easily misinterpreted, therefore messages are misunderstood.

Davies looks into 5 different types of NVC that would help create and improve the relationship between the two roles.

Intimate Interaction

Nursing can often require an intimate interaction with patients. As we intimately interact with patients, our eye contact often decreases. This is a sign of an intimate avoidance.

For example, a patient has just been admitted to the ward. As part of the admission, we may often have to interview the patient to get relevant information that would help provide a more patient centred care. In almost all cases, the questions that need to be answered are often intimate and can be very personal to the patient. Patients are not often comfortable in answering these questions to someone who they have only just met and have no relationship with. This can often be mislabelled by saying that the patient is ‘difficult’ and that they are non-compliant.

Patterson (1976) Arousal Model, states that a small level of intimacy will go unnoticed and will not affect a change in behaviour. However, a sufficient amount of intimacy, will be noticed.

Facial Movements

Elkman (1972) says that there are 6 primary human emotions:

Surpise, Fear, Anger, Disgust, Happiness and Sadness.

Elkman believed that emotions can be recognised  in many different cultures. In nursing, it is often quite difficult to stay neutral and avoid showing negative NVC towards the patient.

For example, in a situation when you are changing a Stoma Bag and the smell often can be quite offensive. It can be difficult to hide the face of disgust, even though you are capable of changing the Stoma, it is still hard to show a neutral face. These kind of cues can be very easily picked up by anxious patients and can have a negative impact with their behaviour.

Eye Contact

Eye contact is used to observe Non-Verbal cues and used to regulate and synchronise conversation. Eye contact, along with other NVC, can often help a Nurse to tell is the patient is complying with their care or not.

Altschul (1972) suggests that failure to maintain eye contact can mean a lack of attention/interest.

Body Posture

Ekman and Friesen (1972) both argued that gestures can often substitute speech.

For example, Patient who are in pain and require analgesia often do not verbally say and can verbally refuse the medication. However, their gestures and body language may say otherwise.

A study by Conboy-Hill (1986) shows that Nurses and their patients are more aware each other’s non-verbal cues than we often thought.  This study focused on a Terminal patient who is unaware of their diagnosis and their nurse.

(In this Journal, it states that Doctors have the power and authority to tell the patient of their newly found diagnosis and was not the Nurses’ responsibility.)

It became clear that the Nurse had difficulty communicating with the patient and continuously giving out hollow reassurances that can be generalised and not patient specific. The Nurses’ Body Gesture can be easily read by the patient. In the study that was done, the patient in question then developed anxiety as a consequence inadequate information and reassurance. Along with an increase in pain, nausea, vomiting, weight loss and a change in behaviour of relatives allowed the patient to hazard a guess that everything was not all okay. Conboy-Hill referred to it as Closed Awareness.

Touching

Tactile behaviour is a basic human response. Deux and Wrightsman (1984) believed that touching can be used in many different ways in terms of Nursing.

There is a research carried out by Whitcher and Fisher (1979) which highlights the affect it had on patients who were touched by the opposite gender. Their study involved a Nurse professionally touching a patient, which resulted with a positive link. It was seen to be bring reassurance and comfort to the patient and was proven due to the lower blood pressure and anxiety rating of the patient. However, all patients are all unique indiviudals and the same result may not show on all patients.

The second journal is, “Non-Verbal Communicaiton; the importance of listening.” by Lynn Kacperek.

This article revolves around the authors’ perspective and on her ability to practice nursing after losing her voice. She believed that the patient/nurse relationship bond was stronger and that patients were responding better with the non-verbal approach. It suggests that effective communication rely on the ability of the individual to listen and use NV Skills.

Kacperek identifies some keys factors that personally helped her improve her Nursing practice without the use of verbal communication.

Personal Reflection

“Reflective personal knowledge is the most substantive form of knowledge and should properly constitute the body of knowledge of a practice discipline.” – John (1995)

Kacperek used a reflective model in order to reflect on her personal experience. By doing so, it enabled her to methodically describe, analyse, evaluate and develop her understanding from her practical experience.

Whilst reflecting on her actions, Kacperek has also identified several problems she had come across with communication.

Ley (1988) states that interpersonal communication is key to all aspects of care. He suggests that problems associated with patients’ non-compliance could be prevented by improving communication skills.

Listening

Effective communication requires the use of many different interpersonal skills, including listening to patient’s.

Adair (1994) found that interviewing patients and listening to their experience of care gave a valuable insight which can be used to improve the quality of care.

Listening requires for the individual to understand the verbal, non-verbal and paralinguistic features of the message. To get the best result and to understand the message and build the patient/nurse relationship, is done by actively listening. This is often achieved by remaining and quiet and not interrupting the person talking, and occasionally, responding with short encouraging statements such as “yes”, “go on” etc.

In the authors point of view, it was quite difficult to remain quiet and interrupt the patient as soon as an idea came across her mind. However, due to Kacpereks’ circumstance, she was unable to use any verbal communication.

Silence

Silence combined with a relaxed approach allowed patients time and space to think.

Davidhizar and Newmangiger (1994) pointed out that many nurses feel quite uncomfortable with silence during their interaction with their patients. Which can often lead to verbal interruption.

Porritt (1990) states that silence can often cause the listener to feel anxious.

Touch

The use of touch is an effective method of responding to patient, which can have a positive effect towards patient care.

Touch can signify a level of understanding and can show empathy towards patients.

Both Journals have strong key points towards Non-Verbal communication. Both have praised and evidence have been provided with the effectiveness of the use of NVC in nursing care.

For example, In Kacperek’s article, all the experience spoken about, was relived and practice by the author itself. She has been able to research and study the theory behind it and also apply this into practice.

Both sets of key points, interlaces each other and sets some sort of framework of how to become more effective with NVC. With the evidence provided for both journals, it was clear that it was very well thought about.

Davies’ article was more theory based. Even though both showed evidence of references, I feel that Kacpereks’ article can be slightly biased. This is because the article itself is about ther own experience with nursing care. Even though the article itself is correctly referenced, as a third party reader, I feel like that contents of the article itself is biased as it focused on her own experiences. It does not quite show any limitations to Non-Verbal Communication. This could be due to the author not wanting to portray a negative image about her to the readers.

With Davies, the key point and some how “steps” to effective NVC was more straight forward than Kacperek. Even though both articles share some similar traits, I felt that Davies’ is more reader friendly and a lot more easier to understand.

During our time in the skills lab, we will be touching upon 3 clinical skills.
1) Preparing a trolley for a patient in isolation.
2) Theory of Cannulation and How to re-dress.
3) Aseptic Non-Touch Technique.

In this blog, I will be review Aseptic Non-Touch Technique (ANTT) through my own experience. I will be using Gibbs’ Reflective Cycle (1988) to evaluate my experience with the technique.

I have chosen to use Gibbs’ Reflective cycle due to its in depth step-by-step process. The cycle that Gibb’s has created enables the individual to think methodically. Each step in the cycle has it own criteria. It simplifies the situation which enables for the user to think and evaluate in more detail.

Aseptic Technique is used to prevent and minimise the risk of contamination.  an example for when this technique is used could be when performing major/minor surgical procedures, dressing a deep tissue wound etc.

In the Clinical Skills session, we undergone a scenario where we have to change a wound dressing using ANTT. from previous experience, I have used the Technique in the past during placement, but not used it enough to regularly practice the skill.

So to follow the 6 steps of Gibbs’ Reflective Cycle:

Description – The we were given was to remove and re-apply a new dressing on a simulated wound using the Aseptic Non-Touch Technique. As a group, we we’re shown how to perform the task using the technique. As a group, we we’re shown how to perform the task using the technique with a set of guidelines taken from the Royal Marsden 2015. 

The procedure involved the following steps:

• Explain the procedure to the patient and gaining consent.
• Perform Hand Hygiene.
• Clean Trolley.
• Gather relevant equipment.
• Perform Hand Hygiene.
• Put on Apron and NON-STERILE gloves.
• Remove current Dressing and Assess the wound.
• Remove PPE and perform Hand Hygeine.
• Open Wound Dressing pack and unravel using the corners of the sheet.
• Arrange the items using the plastic bag in the pack.
• Attach the plastic bag on the trolley. This would then be used for any clinical waste.
• Using the Clinel wipe to wipe the Saline packet before opening and pouring into the pot.
• Perform Hand hygiene and apply apron and STERILE gloves.
• Put sterile towel under and over the wound, leaving an opening to access the wound.
• Clean the wound and apply a clean dressing.
• Dispose of the clinical waste, clean the trolley and perform hand hygiene.

Feelings – Coming into the practical, I felt confident that I can perform the task well as I have had prior knowledge and experience with ANTT. During demonstration, there were certain specific tasks that was done differently than what I was originally taught. This then made me question which one is the correct technique to use. It did bring my confidence down slightly and made me question, ” Have I been doing this wrong this whole time?”.

During the practical, I did not feel as confident as I taught I did. Bear in mind that I have not performed this task for a while, I will bound to have some sort of mistake. However, I was making more mistakes than I thought I would have made. I stayed calm and carried on with the task. With the guidance from my tutor, I was able to pick up the pieces and manage to get myself back on track. And having the opportunity to perform the task a second time really help with my confidence and I was able to think of a rationale for each step of the technique.

Evaluation – an advantage for in this practicaly is that I have had experience in ANTT in the past. I have used the technique before in different scenarios and have a general knowledge towards the process.

However, in contrast, there are some minor issues that i have found whilst doing the practical. Even though I have previous experience using the technique, I do not regularly practice the skill on my current job. Another downside to this is that, as mentioned before, I have been shown different techniques to use in the past which is different to what we have been taught this time round. Even though the principal of ANTT is essentially the same, it has thrown me off with the way I was previously taught. This then led to a lack of self confidence.

Analysis – in the midst of practical, I was able to come up with a rationale to why it is neccessary to do certain steps in ANTT. It enabled me to utilise my critical thinking. The use of ANTT in tge practical session is very simple and straight forward, however in a real situation, wound care could be even more complex and ANTT is not just used to redress wounds.

This Unit is called Introduction to Communication and Person Centred Practice.

Communication is key in all aspects of life. We communicate constantly with others in many different ways. Whether is be through using your voice, body language and more commonly through the use of technology. Communication helps us to connect and build a strong bond with others.

There are also many factors to think about when you are trying to get your point across. This is a very individualised matter as you all know, every single one of us is unique and all have our own advantages and disadvantages.

My experience in communication grew through constant contact with other people. In Nursing, you get the opportunity to meet a variety of different people. You get the chance to see how others communicate differently.

In this week 2 Lectures, we looked at different theories of communication and how it is implied in a more practical setting and having touched on briefly with active listening.

For a lot of people active listening can come quite naturally to others. Personally, I find this to be a sign of respect. No matter whether the subject of conversation may not be of any interest, but showing that your are listening to others can often mean a lot, especially from a ‘patient to nurse’ perspective.

This a very good skills to have and something we can show through our OSCE assessment. Not quite looking forward to the assessment, but then again, who wouldn’t be nervous being filmed for an assessment. But we shall see what the outcome will be.

We have two ears and one mouth so that we can listen twice as much as we speak. – Epictetus

Thanks for joining me!

Good company in a journey makes the way seem shorter. — Izaak Walton