Activity 2.1: Reflective practice
Think of occasions when you have assessed a person’s needs and planned their care. Reflect on examples where:
- Your assessment went well.
- Your assessment did not go so well.
- What factors seemed to make the difference to these encounters?
Development of good communication skills will always drive forward improvement in your assessment and planning of care. Most nurses can remember their first efforts at assessing a patient’s needs, and how long it took to work through all of their activities of living, and the issues that arose from them. Although this may have been a slow process, there were advantages to this. The time spent with the patient enabled you to build a good rapport with them, and start to understand their values and expectations.
As you gain experience in nursing, your ability to hone in on the important issues will get better. Where this helps in efficiency and time-management, the danger is that more experienced nurses may gloss over what they might consider to be minor issues in care, focusing solely on the areas which require the most immediate attention (particularly from the point of view of a demanding care environment). An opportunity to get to know the patient can be lost, as well as the time for a patient to express themselves properly, and discuss issues important to them.
This danger is offset somewhat by the development of advanced communication skills. The nurse becomes adept at picking up cues, both verbally and non-verbally, and reading a situation accurately within quite a short period of time. Many put this down to an innate intuition, and although there may be something to this, mostly this ability is a learned skill reflecting a raft of personal capabilities. The establishment of good interpersonal relationships is centrally important to the therapeutic relationship, enabling the nurse to develop the skill of ‘personal knowing’ (Schwind et al. 2014).
In terms of person-centred care (PCC), training healthcare staff to promote shared decision making in clinical consultations has been shown to develop their communication skills (Dwamena et al. 2012).
Dwamena, F., Holmes-Rovner, M., Gaulden, C. M., Jorgenson, S., Sadigh, G., Sikorskii, A., . . . Olomu, A. (2012). Interventions for providers to promote a patient-centred approach in clinical consultations. Cochrane Database of Systematic Reviews, 12. Article No: CD003267.
Schwind, J. K., Beanlands, H., Lapum, J., Romaniuk, D., Fredericks, S., LeGrow, K., . . . Crosby J. (2014). Fostering person-centred care among nursing students: Creative pedagogical approaches to developing personal knowing. Journal of Nursing Education, 53(6), 343–347.