NURS1005 Nursing Case Study

Introduction Of NURS1005 Nursing Case Study

Communication is fundamental to the delivery of quality patient care and it is an essential prerequisite to understanding patients and their needs as well as to promoting effective interpersonal relationships. According to The Department of Health and Social Care (2010), communication is defined as the significant sharing of information, which includes opinions, facts, needs, thoughts, and feelings, between two or more individuals.

Person - centered care means providing care according to requirements of individual. This essay, I will explain general communication techniques like OARS and SURETY, analyse potential communication difficulties and outline some professional, legal and ethical standards of nursing. The case study of Helen Jackson, a 73-years lady who is diagnosed with dementia and hearing impairment will be analyse and illustrate the application of these principles. Furthermore, this paper will emphasize the significance of effective communication in relation to positive patient outcomes through person-centered care.

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Communication Strategies in Nursing

In nursing, effective interpersonal interaction requires verbal and non-verbal tactics tailored for each patient. OARS communication techniques is both verbal and non-verbal and need to be adapted to the unique circumstances of each patient. OARS - Open-ended questions, Affirmations, Reflection, and Summarizing—is another effective communication method leads to more in-depth conversations ((Miller and Rollnick, 2012).The Open-ended question in OARS technique will enable the nurse to gain a better understanding of patients' experiences, this will encourage Helen to express herself and articulate her concerns regarding her husband's absence, leading to meaningful dialogue, fostering a stronger rapport and effectively assessing her needs. However, this can overwhelm individuals with cognitive challenges, such as Helen. It’s important to exercise caution when encouraging conversation, as Helen may struggle to process complex information; Simplifying questions and allowing for pauses can help Helen process the information more effectively (Bourgeois, 2006).

Affirmation and Reflection – The Nurse can affirm statements made by Helen including positive statement, reinforcing her feelings and experiences. For example, the nurse might say, “It sounds like you miss your husband very much.” Reflection – Statement about what Halen has said can be offered as statement and not as a question by the Nurse as a way of reflection. involves paraphrasing or restating what Helen has communicated, which encourages her to clarify her thoughts. In doing so, the nurse validates Helen's feelings and demonstrates active listening. Summary- This will offer the Nurse an opportunity in the course of the conversation to let Helen know that she has been following, listening and tracking what is being discussed and periodically offering a brief summary of what is been discussed so far will serves as a useful tool for both Helen and the nurse to reflect on the conversation and steer future dialogue and conversation in a constructive manner.

In addition, SURETY is another proficient communication strategy that aids in furnishing person-cantered care. SURETY stands for Sit at an angle, Uncross legs and arms, Relax, make Eye contact, touch and intuition (Stickley, 2011). It is a non-verbal communication strategy effectively used in person-cantered care. Surety helps foster a mutual understanding, allowing for care to be tailored to the needs of patients (Wyble, 2018).

In Helen’s case, the nurse’s non-verbal signals can significantly influence the quality of communication. Sitting at an angle and maintaining relaxed posture can create a welcoming atmosphere. Additionally, mindful use of touch, such as gently placing a hand on Helen's shoulder, can help gauge her emotional state. However, it is essential to bear in mind and navigate the complexities around physical contact, considering personal boundaries, cultural differences, and the potential for psychological discomfort (Hawkins et al., 2016). Understanding and respecting individual preferences around physical contact is essential for creating a safe and comfortable environment as well as conforming to the NMC code (2018).

Barriers to Effective Communication

In patient interactions, environmental noise can obstruct effective communication. The Shannon and Weaver Model (1949) illustrates that noise can be a barrier to communication and represents any form of interference that can occur in distorting or hindering the transmission of the message from the sender to the receiver. Noise can arise at various stages within the process of communication, it can be physical, Psychological, Semantic and Physiological Kate Norman, (2019). The Transactional model emphasises that communication hurdles can occur at any time and require both parties to adapt (E. Salterio et al., 2021). To reduce these barriers, healthcare providers must create a conducive environment for conversations. Helen’s hearing impairment and cognitive challenges necessitate specific strategies to ensure effective communication. If Helen uses hearing aids, it is imperative that they are functional and available during interactions. The nurse should speak clearly, use simple language, and utilize visual aids when appropriate to facilitate understanding.

Overcoming noise as a barrier to communication with hearing impairment as well as cognitive challenges faced by Helen requires a combination of various qualities such as patience, empathy and communication strategies. The student nurse should assist Helen to a quiet environment, which has no background noise helps Helen focus on the conversation. The environment should also support the maintenance of confidentiality to conform with Nursing and Midwifery council (NMC) code 2018.

Clinical communication is impeded by time constraints. Limited interaction time between Nurses and patients can lead to misunderstandings, particularly for patients with complex communication needs like Helen (Ali, 2018). This ultimately affecting the quality of care provided. Kumar, S., & Kaur, R. (2020). Establishing a dedicated timeframe for interactions, in busy environments, will allow nurses to better understand patients' concerns, ultimately enhancing care quality West E, Barron DN, Reeves R. (2005). In the case of Helen for the nurse to fully engage and gather information and provide Helen with the right information due to the fast pace of healthcare environment. It is vital to address Helens concerns timely and establishing a dedicated timeframe for interactions, even in busy environments, allows nurses to better understand patients' concerns, ultimately enhancing care quality.

Professional, Legal, and Ethical Frameworks

Nursing practice is based on professionalism, ethics, legality, and ensuring safe and fair treatments of patients. Delivering safe, equitable, and dignified care requires nurses to embrace professional, legal, and moral norms. The Mental Capacity Act (2005) serves as a guide and it is essential for fair patient treatment, protecting individuals who might not have the mental capacity to make decisions about their care. It is vital to remember that confusion does not equate to a lack of capacity; assessments should be made on a case-by-case basis and respecting Helen’s preferences. The Mental Ability Act promotes good decision-making while enhancing the quality of life for people with dementia, advocating for their personal interests and independence

Patient dignity, informed permission, compassion and professional conduct are all emphasised in the NMC Code of Ethics 2018. Section 1 of the NMC Code 2018 states that patients are treated as individuals, and their dignity is always upheld. The Code helps develop trust among Nurses and patients like Helen and protect her rights throughout her care. Adhering to the Code, enables nurses to uphold the professional standard that prioritises the rights of patients, fostering patients' rights. The Nurse should encourage Helen to an office or an area in the care home where others will not hear of the conversation. Seeking a private discussion by the Nurse will uphold or maintain Helen's privacy, dignity, and confidentiality. This approach is essential in establishing effective therapeutic relationships and enhances the overall care provided, ensuring that patients like Helen feel respected and valued.

The Equality Act 2010 requires patients to be treated equally no matter what impairments, or physical challenges they face. This legal Act underpinning the requirements guarantees respectful, personalised treatment that supports patient autonomy and rights. requires patients be equally treated regardless of age, handicap, or intelligence, Legislation.gov.uk, (2010). Since Helen has dementia and hearing impairment, the nurse must make appropriate adjustments to her care. The nurse should make sure Helen has hearing aids if they are provided or adjust the method or way of communication to meet her needs. Proper use of hearing aids significantly enhances the ability to engage in conversations (World Health Organisation, 2018). These adjustments are necessary to ensure Helen receives the identical care as other patients in the care home and also maintaining the Equality Act's, equality and inclusion principles enshrined in it.

As the core of ethic in nursing practice, the principles that nurses follow are: autonomy, benefice and non-maleficence as per Beauchamp and Childress (2001). It also takes into account the dignity of Helen, who still maintains the right to participate in decision making about her care despite her occasional confusion. Meanwhile, the nurse has to make decisions that would benefit Helen (beneficence) and avoid doing her harm (non-maleficence). Issues may range from the pursuit of honouring Helen's autonomy with the responsibility of protecting her from herself, should her condition force her to make decisions that are potentially detrimental to her health. Solving such ethical concerns calls for compassion, or even extra perception, and full comprehension of the patient's needs.

CONCLUSION

In conclusion, effective communication is vital for delivering high-quality, patient-cantered care in nursing. By exploiting established communication frameworks like SURETY, and OARS nurses can address their patients, connect with patients like Helen who face both cognitive and hearing impairment. This paper has dived into the significance of adapting communication strategies to address individual needs while adhering to ethical and legal guidelines. The complex nature of engaging patients with communication difficulties and complex medical needs demand creativity, adaptability, and a commitment to ethical practice from healthcare professionals. Cultural safety indeed encompasses the delivery of care which is patient-centred and free from prejudice but within the constraints of the NMC Code (2018) and the Equality Act 2010. Exploring the practical application of these principles can aid nurses in establishing care environments centring on the patient, ensuring that healthcare is respectful of and responsive to patient health beliefs, practices, cultural and linguistic needs of diverse patients, compassion and upholding dignity.

REFERENCE LIST

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• Hawkins, G., Linton, M., & Neale, M. (2016). The impact of touch in communication: Issues of consent, boundaries, and cultural differences. *International Journal of Health & Social Science*, 3(2), 73-80.
• Kumar, S., & Kaur, R. (2020). "Impact of Time Constraints on Quality of Nursing Care." *International Journal of Nursing Studies*, 105, 103-112. doi:10.1016/j.ijnurstu.2019.103112.
• McCabe, C. (2004). The role of communication in the therapeutic relationship: The nurse-patient relationship in healthcare settings. *Journal of Clinical Nursing*, 13(1), 19-26. https://doi.org/10.1046/j.1365-2702.2003.00856.x
• Miller, W.R. and Rollnick, S. (2012). Motivational interviewing: Helping people change. 3rd ed. [online] London; New York: The Guilford Press. Available at: https://ebookcentral.proquest.com/lib/acu/reader.action?docID=1034770.
• Norman, K. (2019). COMMUNICATION SKILLS: for nursing and healthcare students. S.L.: Reflect Press Ltd.
• Nursing and Midwifery Council (2018). The Code Professional Standards of Practice and Behaviour for Nurses and Midwives Nursing and Midwifery Council. [online] Nursing and Midwifery Council. London: Nursing and Midwifery Council. Available at: https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf.
• Stickley, T. (2011). From SOLER to SURETY for Effective non-verbal Communication. Nurse Education in Practice, [online] 11(6), pp.395–398. doi:https://doi.org/10.1016/j.nepr.2011.03.021.
• West E, Barron DN, Reeves R. Overcoming the barriers to patient-centred care: time, tools and training. J Clin Nurs. 2005 Apr;14(4):435-43. doi: 10.1111/j.1365-2702.2004.01091.x. PMID: 15807750.

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