Foundations for Professional Practice

Therapeutic Communication

The person-centred care model is the one which has been implemented in recent times which is distinctly different from the older thought of paternalistic care (Wilberforce et al. 2017). In paternalistic care, all the decisions regarding the medical decisions of a patient as about the doctor or the care providing medical team. Now the school of thought is that the patient knows him the best and he should be included in his care process so that the best level of care is provided which is safe and appropriate. In person-centred care model, the patient is at the centre of the care process which is based on his preference, values and needs which are related to the planning of the care process and the delivery of care (Burton et al. 2017). This communication is named therapeutic communication and it is utmost important that there are a good level and transparent communication between the two. 

Therapeutic communication is essential for the care providing team so that there can be an accurate assessment of the current condition and understanding of the needs of the patient (Brownie et al. 2016). The needs of the patients are required for the understanding of preferences and values so that the care plan can be made accordingly and there can be positive health outcome.

Nurses are the healthcare professionals who work closely with the patients and are in most contact with the patient and have a major role in the assessment of the patient throughout the care process (Real et al. 2017). Communication is required for the same and therapeutic communication is an art which is the type of communication in which the patient feels the level of comfort with the nurse such that there is an open flow of information from the patient to the nurse (Arnold 2019). Establishment of therapeutic communication is such that there are effective listening and questioning techniques which will help in this (Gilligan and Eddy 2017). Along with verbal communication, there should be non-verbal communication. They are an important component so that the patient can feel comfortable which is required. Empathetic and active listening is important along with supportive body language which invites confidence. Empathetic listening is the one in which the healthcare professional understands what the patient is going through (Mudiyanse 2016). After listening they should repeat what they understood by repeating it to the patient to confirm is active listening (Silverman et al.2016). While talking to the patient the body language should be such that there is open stance like leaning towards to patient and not detached or cold (Kuhnke 2016).

Inter and Intra-Professional Communication

Healthcare is a dynamic field which changes continuously according to the needs of patients. For the care of the patient, the healthcare team consisting of various healthcare professionals like a general practitioner, doctor, specialist doctor, psychiatrists, and nurses (Eggins and Slade 2015). When the patient is shifted from one ward or specialization to others for example from the emergency department to the cardiovascular department it is required that the chain of communication is maintained. Also, when there is a change of duty of the nurses and other healthcare professionals as in a healthcare facility the professionals usually work in a rotatory shift manner. The chain of communication should be maintained between different healthcare professionals at all the levels as well as when the same professional visit the patient at two different times (Australian Commission on Safety and Quality in Health Care 2014). These are respectively called inter-professional as well as intra-professional communication.

One such method to maintain the chain of communication is during clinical handover. Clinical handover can be defined as the transfer of professional responsibility of the patient which the healthcare professional can be held accountable for the care process. It is essentially a communicative event (Salem 2019). Two major things are followed in a clinical handover and they are verbal as well as written both of them are equally important as former can give subjective information while the latter gives subjective and objective information. Patient identification is one of the most important components of the clinical handover and the first thing that is done so that the healthcare professional on both the ends can make sure they are catering to the same patient (Spranzi and Norton 2020). In the clinical handover of the emergency department, there are four important structural components: antecedents, behaviour and interactions, content and delegation of ongoing care (Redley et al. 2017).

One of most commonly used structures for clinical handover in the written form is ISBAR that is the identification of the patient, situation, background, assessment and action and response and rationale (Chiew et al. 2019). For the verbal clinical handover, SOAPIE can be used which is subjective, objective, assessment, plan, implementation and evaluation (Campos and de Beltrán 2017). According to the national safety and quality standards for the healthcare of the patients the chain of communication by the clinical handover should follow the patient at all points (Australian Commission on Safety and Quality in Health Care 2014). This will help in effective inter/intra professional communication. It is required for the appropriate care for the patient which is safe so that there can be positive health outcome.

Communication Barrier

Effective communication barrier is a vital component of healthcare of the patient and it should be present at all the aspects of the healthcare as well as at all the levels. The communication should be complete and transparent between the healthcare team and the patient as well as different personnel involved in the caregiving process. There can be potential barriers to effective communication between the patient and healthcare professional and between the various members of the healthcare team (Ali, 2017). The communication barrier that can be present between the patient and healthcare professional can be due to various things.

First, it can be attributed to constraints of time- it can be seen when there are many patients it often causes that the time given to one patient is reduced (Cubaka et al. 2018). Second, can be due to less privacy the patient might not be comfortable sharing some aspects in the presence of many people (Origlia Ikhilor et al. 2018). Third, sometimes the physical condition of the patient like being in intense pain can prevent the flow of communication or if the patient is embarrassed about his condition like the presence of venereal disease might be a cause of barrier (Bor et al. 2018). Medical jargon is for the communication between healthcare professionals but if it is used much in communication with the patient can cause communication barrier as the patient might not understand what is being spoken to him or her (van Rosse et al. 2016). Fifth, if the patient is from a different cultural or social background there can be the presence of communication barrier due to linguistic or it can be due values and beliefs of the patient (Ali et al. 2017; Li et al. 2017). Lastly, being in hospital can be scary for the patient and he or she might be receiving more information which is not possible to be perceived in a short period can be one of the potential barrier (Ali, 2017).

The communication barrier that can be present between healthcare professionals in the team can be due to various things. One of the most important barriers to communication is if the flow of patients is high and the healthcare professionals are relatively less it can be a barrier to communication (Graves et al. 2018). Another barrier can be a lack of training and inadequacy in the education provided. Communication in healthcare is a multi-dimensional and multi-factorial which is complex and the environment of people play an important role as a barrier (Norouzinia et al. 2016). It is required that the barriers to the communication are identified and measures are taken to address them so that the patient care is safe and appropriate.

References for Foundations for Professional Practice

Ali, M. (2017) Communication skills 2: Overcoming barriers to effective communication. Nursing Times, 114(1), 40-42.

Ali, P.A. and Johnson, S. 2017. Speaking my patient's language: Bilingual nurses’ perspective about provision of language concordant care to patients with limited English proficiency. Journal of Advanced Nursing73(2), pp.421-432.

Arnold, E.C. 2019. Developing patient-centered communication skills. Interpersonal Relationships E-Book: Professional Communication Skills for Nurses, p.68.

Australian Commission on Safety and Quality in Health Care 2014. NSQHS Standards.

Bor, R., Lloyd, M. and Noble, L. 2018. Discussing sensitive topics. Clinical Communication Skills for Medicine, p.49.

Brownie, S., Scott, R. and Rossiter, R. 2016. Therapeutic communication and relationships in chronic and complex care. Nursing Standard31(6), p.54.

Burton, C.D., Entwistle, V.A., Elliott, A.M., Krucien, N., Porteous, T. and Ryan, M. 2017. The value of different aspects of person-centred care: A series of discrete choice experiments in people with long-term conditions. BMJ open7(4).

Campos, E.A. and de Beltrán, A.P.A. 2017. Effectiveness of the program “Annotations, that speak for you” in the knowledge, attitudes and practices of nursing professionals in nursing annotations according to the SOAPIE model in the hospitalization services of the Hospital II Vitarte, L. Scientific Journal of Health Sciences , 10 (1).

Chiew, L., Bakar, S.B.A., Ramakrishnan, S., Cheng, P.L.C., Karunagaran, Y. and Bunyaman, Z.B. 2019. Nurse’s perception and compliance on identification, situation, background, assessment and recommendation (isbar) tools for handoff communication in tertiary hospital, Dammam. Malaysian Journal of Medical Research3(4), pp.26-32.

Cubaka, V.K., Schriver, M., Cotton, P., Nyirazinyoye, L. and Kallestrup, P. 2018. Providers’ perceptions of communication with patients in primary healthcare in Rwanda. PloS One13(4).

Eggins, S. and Slade, D. 2015. Communication in clinical handover: Improving the safety and quality of the patient experience. Journal of Public Health Research4(3).

Gilligan, C. and Eddy, J. 2017. Listening as a path to psychological discovery: An introduction to the Listening Guide. Perspectives on medical education6(2), pp.76-81.

Graves, M., Doucet, S., Dubé, A. and Johnson, M. 2018. Health professionals' and patients' perceived barriers and facilitators to collaborating when communicating through the use of information and communication technologies. Journal of Interprofessional Education & Practice10, pp.85-91.

Kuhnke, E. 2016. Body language: Learn how to read others and communicate with confidence. John Wiley & Sons.

Li, C., Son, N., Abdulkerim, B.A., Jordan, C.A. and Son, C.G.E. 2017. Overcoming communication barriers to healthcare for culturally and linguistically diverse patients. North American Journal of Medicine and Science10(3).

Mudiyanse, R.M. 2016. Empathy for patient centeredness and patient empowerment. Journal of General Practice, pp.1-4.

Norouzinia, R., Aghabarari, M., Shiri, M., Karimi, M. and Samami, E. 2016. Communication barriers perceived by nurses and patients. Global Journal of Health Science8(6), p.65.

Origlia Ikhilor, P., Hasenberg, G., Kurth, E., Stocker Kalberer, B., Cignacco, E. and Pehlke‐Milde, J. 2018. Barrier‐free communication in maternity care of allophone migrants: BRIDGE study protocol. Journal of Advanced Nursing74(2), pp.472-481.

Real, K., Bardach, S.H. and Bardach, D.R. 2017. The role of the built environment: How decentralized nurse stations shape communication, patient care processes, and patient outcomes. Health communication32(12), pp.1557-1570.

Redley, B., Botti, M., Wood, B. and Bucknall, T. 2017. Interprofessional communication supporting clinical handover in emergency departments: An observation study. Australasian Emergency Nursing Journal20(3), pp.122-130.

Salem, M. 2019. An Educational Intervention to Improve the Caregivers’ Understanding of the SBAR Tool used for Patient Handover during Hospital Transfer Processes. Advanced Practice Nursing4(157), p.2.

Silverman, J., Kurtz, S. and Draper, J. 2016. Skills for communicating with patients. Crc press.

Spranzi, F. and Norton, C. 2020. From handover to takeover: Should we consider a new conceptual model of communication?. British Journal of Midwifery28(3), pp.156-165.

van Rosse, F., de Bruijne, M., Suurmond, J., Essink-Bot, M.L. and Wagner, C. 2016. Language barriers and patient safety risks in hospital care. A mixed methods study. International Journal of Nursing Studies54, pp.45-53.

Wilberforce, M., Challis, D., Davies, L., Kelly, M.P., Roberts, C. and Clarkson, P. 2017. Person‐centredness in the community care of older people: A literature‐based concept synthesis. International Journal of Social Welfare26(1), pp.86-98.

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