Communication
... is: Berlo's S-M-C-R Model (1960)- This is a more complex Dyadic – Two way process, which takes into account the many variables in the communication process. (Underwood.M. 2003. URL) According to Berlo there are four elements to take into account, each with five sub-categories: Source: Communication skills - Knowledge - Social system - Culture - Attitudes. Message: Elements - Content - Structure - Treatment - Code. Channel: Seeing - Hearing -Touching - Smelling - Taste. Receiver: Communication skills - Knowledge - Social system - Culture - Attitudes. The two schools differ in their understanding of what constitutes a message. The process school (Shannon and Weaver), sees a message as that which is transmitted by the communication process. In the semiotic school (Berlo), the message is a construction of signs, which, through interacting with the receivers, produce meanings. In the context of this scenario, I felt the semiotic school of though most accurately describes how communication was carried out. I would have been extremely ineffective for the student nurse to simply state to the patient that her Husband was away at a hospital appointment and expect that to resolve the situation, bearing in mind, the patient has impaired understanding and communication skills due to her condition. A given source may have a high level of skill not shared by one receiver, but shared by another. We cannot predict the success of the source from her skill level alone. (Berlo.D. 1960) taken from (Underwood.M. 2003. URL). Non-verbal Communication- Often in this kind of situation, we rely more on forms of non-verbal communication to get our message across, paying particular attention to facial expressions, eye contact and touch (which we will explore under concept/values). I would say that these non-verbal influences played the biggest part in aiding the student nurse in calming and reassuring the resident. A kindly smile, nodding of the head and speaking in a calm soft tone of voice to gently reassure, can be just as effective as straightforward verbal communication. “Body language, or non-verbal communication, is an ever-present component of our communications with others. Human communication especially face-to-face communication is largely non-verbal according to Caris-Verhallen et al (1999). (Millar.L.2002.p47)”. Discipline and Knowledge: In this section we will look at: Concepts and values – Values/beliefs: Broadly defined as to what we think is good, right or just, they are basically standards by which we judge people, ideas policy’s etc. determining whether we think they are good, bad desirable or undesirable. In nursing we need to have a particular standard, stance or model, which will underpin the values of the profession. 1. The beliefs/values on which nursing is based, relate to: a) The person b) Health c) The environment 2. The goals of practice or what the practitioner aims to achieve. 3. The Knowledge and skills the practitioner needs to develop in order to gain theses goals. (Pearson.A, Vaughn.B & Fittzgerald.M. 1996.Fig.2.2) Concepts: Nursing can be looked on as a collection of concepts encompassing the things that are thought of as being important to nursing. As nurses we need to know about these concepts developing and adding to with theories of our own. Some of the most important concepts in nursing are: The concept of care: “Care is the essence of nursing and the central, dominant, and unifying focus of nursing” (Leininger.M 1991. p35). Leininger has defined caring as, people assisting, supporting or carrying out actions to or for another person or persons, with obvious needs to improve their condition . From a psychological point of view, it could be said that caring is learnt through role models, imitation and observing also through solving problems, making decisions and reasoning. Another viewpoint is that of altruism, which is a selfless caring for others. Some people believe we are born with the ability to care, which drives certain individuals into professions such as care work and nursing. This concept is central to all aspects of nursing; it is necessary to ‘care’ in order to care. The concept of touch: Non-verbal communications, such as touch are a natural addition to verbal communication, and can considerably enhance the task of communicating particularly when the party you are trying to communicate with is unable to express or understand verbal communication fully, due to illness or learning disability etc. As long as the correct manner of touching is employed, and there is no way it could be seen as being inappropriate. A patient’s personal and cultural beliefs should also be taken into account in order to avoid any insult or distress. “The health professional should be mindful that people are picking up signals conveyed by his or her manner of touching…Patients will be much more aware of this touching that the health professional, who has become used to touching patients The health professional probably has so firm a concept of his or her good intentions that the question of inappropriateness or improper familiarity never arises.” (Portilo.R. 1990. pp145-146) This approach proved to be particularly useful in the context of this scenario, due to the resident’s medical condition (Alzheimer’s). The student nurse had observed that the resident was in the habit of holding her husbands hand almost all of the time, proceeded to take the residents hand and lead her away from the main populated area, for privacy, then sitting with the resident, the student nurse put her arm around the residents shoulders to comfort her as she was upset at this point. Once the resident was calmer the student nurse began to reassure her whilst holding her hand, ensuring good eye contact and talking in a gentle calm tone. Concept of Reassurance: Reassurance is shown to patients by appropriate communication and interpersonal skills. In the instance of this scenario it was one of the main objectives, which was necessary to enable the resident to calm down and relax until the return of her Husband. In Fareed’s study of reassurance in 1996 (In the Journal of Advanced Nursing) from a patient’s perspective he found that for effective reassurance: o The patient needed to feel they were in good hands. o The person reassuring them was in tune with them. o They were given accurate understandable knowledge. o Nurses were available and accessible. o There was good use of communication skills i.e. nurses knowing when to use verbal and non-verbal methods appropriately. o There was a good trusting relationship present between nurse and patient. o The feeling of being cared for, nurses having a caring attitude towards them. o Encouraged to have an optimistic outlook. o Nurses were Kind, cheerful and helpful. The majority of these conditions were present in the situation of the scenario, which enabled an effective outcome. Professional and Ethical Practice Ethical theory Deontology The term deontology is from "deon," Greek for obligation. Therefore, "deontological" refers to the theory or study of moral obligation. This is a kind of pure viewpoint of ethics. Deontological theories identify various duties and rights. Duties and obligations have been classified under several categories including o Duties to God, o Duties to oneself, and o Duties to others which include: o Duties to family, o Social duties, and o Political duties. The basic rights include life; liberty and the pursuit of happiness are considered to be natural, universal, equal, and undeniable. The focus of deontological theories is on moral duties or obligations rather than on moral value or goodness. Intentions play a significant role in determining whether an act is ethical according to deontologi...