COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page i Communication and Interpersonal Skills for Nurses COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page ii Series Editor: Shirley Bach 1 2 Transforming Nursing Practice – titles in the series 3 4 Communication and Interpersonal Skills for Nurses ISBN 978 1 84445 162 3 5 Law and Professional Issues in Nursing ISBN 978 1 84445 160 9 6 Learning to Learn in Nursing Practice ISBN 978 1 84445 244 6 7 Nursing and Working with Other People ISBN 978 1 84445 161 6 8 Nursing in Contemporary Healthcare Practice ISBN 978 1 84445 159 3 9 What is Nursing? Exploring Theory and Practice ISBN 978 1 84445 158 6 10 1 2 3 4 5 6 7 8 9 20 1 2 3 4 5 6 7 8 9 30 1 2 3 4 5 6 7 8 9 40 1 2 3 To order, contact our distributor: BEBC Distribution, Albion Close, Parkstone, Poole, 4 BH12 3LL. Telephone 0845 230 9000, email: [email protected]. You can 5 also find more information on each of these titles and our other learning resources at 6 www.learningmatters.co.uk 7111 COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page iii Communication and Interpersonal Skills for Nurses Shirley Bach and Alec Grant COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page iv 1 2 3 4 5 First published in 2009 by Learning Matters Ltd 6 All rights reserved. No part of this publication may be reproduced, stored in a 7 retrieval system, or transmitted in any form or by any means, electronic, 8 mechanical, photocopying, recording, or otherwise, without prior permission 9 in writing from Learning Matters. 10 1 © 2009 Shirley Bach and Alec Grant 2 3 British Library Cataloguing in Publication Data 4 A CIP record for this book is available from the British Library 5 ISBN: 978 1 844 451 623 6 7 The right of Shirley Bach and Alec Grant to be identified as the authors of this 8 Work has been asserted by them in accordance with the Copyright, Designs and 9 Patents Act 1988. 20 1 Cover design by Toucan Design 2 Project Management by Diana Chambers 3 Typeset by Kelly Gray 4 Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall 5 Learning Matters Ltd 6 33 Southernhay East 7 Exeter EX1 1NX 8 Tel: 01392 215560 9 E-mail: [email protected] 30 www.learningmatters.co.uk 1 2 3 4 5 6 7 8 9 40 1 2 3 4 5 6 7111 COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page v Contents Foreword vi Acknowledgements vii About the authors viii Introduction 1 1 Nursing, caring and interpersonal communication 8 2 Key concepts 24 3 Evidence-based principles 44 4 Safe and effective practice 61 5 Understanding potential barriers 76 6 The learning and educational context 100 7 The environmental context 124 8 Population and diversity contexts 141 Glossary 168 References 171 Index 179 v COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page vi Foreword As someone who supports students in clinical placements, I am struck by how often it is the subtle intricacies around how we communicate and interact with patients, families and colleagues that present us as nurses with the greatest intellectual and emotional challenges. Numerous dilemmas, confusions, misunderstandings and anxieties arise as we try to tease out what we bring to the game as individuals, what we encounter in our roles as students and nurses, and what are complex aspects of the patients, relatives, professionals and organisations we engage with. It is in this light that I welcome this excellent book, in which the authors span a breadth of interesting, pertinent and at times refreshing array of topics that are important in considering communication and interpersonal skills in all fields of nursing. In places, rather demanding concepts are explored, but it is worth the effort as the authors illuminate nursing practice by drawing on core evidence from nursing and then venture outside the traditional stomping ground to pull in research, theories and ideas belonging to other fields. This lateral approach promises to stimulate nursing students and others to explore how best to make sense of the complexities and challenges of communication and interpersonal relationships. The book looks at some of the typical stumbling blocks many of us encounter as we strive to learn how to communicate and interact safely and effectively, and offers ways to anticipate and engage with the potential barriers that often lead to emotional struggles for students in practice. Practical can-do exercises within these pages offer students scope to reflect on their personal and clinical experiences and relate these to the focus of a particular chapter. Many of these interactive elements could prove to be prize material in class-based teaching and learning. The chapter on the learning and educational context should be valuable to many students and mentors as it provides a wholesale exploration of how the student experience, both in university and practice, fits within a broader educational framework. The results of engaging with this should be a more empowered student who takes greater ownersh ip of their education and mentors that can better appreciate how the sum of the parts fits together. The last two chapters shed a bright light on the social-cultural settings within which nursing practice, interpersonal interactions and communication take place. These rich, thoughtful and wide-ranging sections scrutinise the challenges of providing effective healthcare across the lifespan within a constantly evolving, diverse society. I came away from reading this book with new concepts and understanding that will inform my work with students and qualified nurses for years to come. It is with great pleasure that I commend it to you. Dr Alan Simpson Senior Research Fellow and Lecturer Vice-Chair, Mental Health Nurse Academics (UK) City University, London vi COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page vii Acknowledgements The authors and publisher would like to thank the following for permission to reproduce copyright material: Arnold, E and Boggs, KU, Interpersonal Relationships: Professional communication skills for nurses. Copyright © 2006, Elsevier, London. Adapted Table 5.1, ‘Comparison of social and professional relationships’, p77, reproduced with kind permission of Elsevier, London. Dai, DY and Sternberg, RJ (eds) Motivation, Emotion and Cognition. Copyright © 2004, Lawrence Erlbaum, Mahwah, NJ. Adapted Theory Summary, p89, reproduced with kind permission of Lawrence Erlbaum, Mahwah, NJ. DeVito, JA, The Interpersonal Communication Book. Copyright © 2007, Pearson Education Inc., Upper Saddle River, NJ. Adapted table in Activity 5.3, p85, and Relationships and proxemic distances box, p82, reproduced with kind permission of Pearson Education Inc., Upper Saddle River, NJ. Hargie, O and Dickson, D, Skilled Interpersonal Communication. Research, Theory and Practice. Copyright © 2004, Routledge, London and New York. Adapted Types of Self box, p84, reproduced with kind permission of Routledge, London and New York. Kreps, G and Kunimoto, EN, Effective Communication in Multicultural Health Care Settings. Copyright © 1994, Sage Publications, London. Adapted Figure 8.1 ‘Iceberg model of multicultural influences on communication’, p149, reproduced with kind permission of Sage Publications, London. Narayanasamy, A, The ACCESS model: a transcultural nursing practice framework. British Journal of Nursing, 11(9): 643–50. Copyright © 2002, British Journal of Nursing. The ACCESSm odel, p154, reproduced with kind permission of the British Journal of Nursing. Rose, D and Pevalin, DJ (2005) The National Statistics Socio-economic Classification: Origins, development and use. Institute for Social and Economic Research, University of Essex. Basingstoke: Palgrave Macmillan. Crown copyright © 2005. ‘Social class based on occupation’, p156, ‘Socio-economic groups’, p157 and ‘Operative categories of the National Statistics socio-economic classification (NS-SEC)’, p158. Reproduced under the terms of the Click-Use License. Every effort has been made to trace all copyright holders within the book, but if any have been inadvertently overlooked the publisher will be pleased to make the necessary arrangements at the first opportunity. vii COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page viii About the authors Dr Shirley Bachis Head of the School of Nursing and Midwifery at the University of Brighton and also the Series Editor for Transforming Nursing Practice. In the past, she designed curricula for nurses that integrated interpersonal relationship skills and communication studies, before specialising in health psychology and the application of psychology to health and illness settings. She has written a study guide in psychology for nurses, and researched and developed a model for psychological care. She has also led programmes that promote the professional practice of nursing and midwifery, especially in the area of advanced nursing practice. Most recently, she has developed an interest in new learning technologies and has drawn upon her understanding of both communication and pedagogic theories to publish in this area. Dr Alec Grantis Principal Lecturer in the School of Nursing and Midwifery at the University of Brighton and is a Registered and Accredited Cognitive Psychotherapist. With a background in, originally, mental health nursing, and more latterly psychotherapy, social science and psychology, he is now a course leader for the M.Sc. in Cognitive Behavioural Psychotherapy. He has taught, researched, practised and written about communication and interpersonal skills – and related areas such as clinical supervision – in the caring profession since the mid-1970s. viii COM & INTER SKILLS PT_gk.QXD 17/7/09 10:12 Page 1 Introduction Who is this book for? This book is primarily intended for students of nursing, whether on a diploma or degree pathway, starting their Common Foundation Programme or equivalent. However, as communication and interpersonal skills (CIPS) develop throughout the course as different contexts and situations are faced, the relevance of the topic will still apply in years two and three. The focus is not to develop knowledge for any one specific branch (Adult, Child, Mental Health or Learning Disabilities) but to support development for progress into any branch and beyond. Therefore, there may well be value for those who are studying on branch programmes and those on continuing professional development modules. It may also be of interest to experienced nurses who wish to develop their leadership roles. The Nursing and Midwifery Council’s (NMC) Standards of Proficiency for Pre-registration Nursing Educationare a foundation for the book. However, the content is not narrowly defined by them. Why communication and interpersonal skills for nursing? Because we have learned since birth how to express ourselves within our family and friendship groups, we all believe we are good at communicating. We have also been honing our relationship skills, often through trial and error or role modelling, and we think there is no need to consider very deeply about how we do it. It has become second nature. There are times, though, when we experience situations where we consider that an interaction did not go smoothly; perhaps we were misunderstood or a friend reacted differently to how we expected. At times like these, we may think that we could have said something differently that would have improved the reactions and responses of ourselves and those around us. So, while we have developed expertise, we can always learn and improve when it comes to human relationships, mainly because there are so many factors that influence how we respond in various situations. If we shine the spotlight on healthcare situations, where there are many complexities that are often similar to our everyday lives but enhanced by factors such as healthcare policy, environment, hierarchies of responsibility, physical discomfort, anxiety, sadness and fear, we have an even more complicated set of circumstances to deal with than when we communicate or interact with family or friends. Healthcare interactions are with patients, carers and peers in often demanding and stressful circumstances, which inevitably lead to further demands on our abilities to communicate effectively. Therefore, it is important that students take time to learn in more detail about communicating in healthcare settings in order to interact as effectively as possible. This means becoming more aware of oneself as well as others. Unfortunately, there is ample literature to suggest that we do not communicate as well as we might in healthcare settings. In this book we will be exploring the many 1 COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page 2 n factors that impact on our abilities to communicate ideas to one another in these 1 o cti settings. We will try to rise to the challenge of improving CIPS interactions in our 2 u d different spheres of practice. 3 o r nt 4 I Learning features 5 6 We will draw on evidence from the nursing literature, theories of nursing, social 7 psychology, sociology, communication studies and contemporary issues for twenty- 8 first-century living to provide you with insights on improving your CIPS. There will be 9 activities to engage you with the ideas by utilising self-assessments, case studies and 10 scenarios. Some of these will be activities you undertake as self-reflection, while 1 others may involve discussion with your fellow students. There will also be practical 2 activities and references to further reading or websites for you to explore. We have 3 included a glossary of some terms that we also hope will help explain ideas and 4 concepts covered in the chapters (glossary terms are bold in the text). 5 6 Book structure 7 8 In Chapter 1, ‘Nursing, caring and interpersonal communication’, we introduce the 9 subject and examine the issues facing today’s nurses in achieving effective and safe 20 CIPS. We explore the fundamental concepts of communication and of interpersonal 1 skills and differentiate between the two. This is done through the lens of the caring 2 domain of nursing as a context for improving CIPS. The final section of the chapter 3 describes a systematic framework for CIPS in nursing. 4 5 In Chapter 2, ‘Key concepts’, the crucial need for effective and sophisticated 6 interpersonal communication in modern healthcare organisations is discussed. The 7 key concepts in CIPS are defined, and explained, together with the underpinning 8 theories. This discussion will help students to understand and justify why good 9 interpersonal communication makes a significant difference to nursing practice. The 30 chapter differentiates between CIPS in nursing and in counselling and psychotherapy. 1 The case for an evidence base for CIPS in nursing is outlined and the nursing, and 2 related, theories underpinning interpersonal communication in nursing are explored. 3 Finally, the organisational basis for healthy interpersonal relating in nursing is 4 discussed. 5 6 In Chapter 3, ‘Evidence-based principles’, we explore key issues in the historical 7 development of research in CIPS in nursing. The effectiveness of research into CIPS 8 teaching and experiential learning is discussed. The chapter articulates the problems 9 around a sole reliance on humanistic counselling/psychotherapy models of 40 communication. We evaluate the reasons for the importance of good interpersonal 1 and organisational climates in the practice of nursing CIPS. Patient/client first- and 2 second-level forms of communication are explored to provide a deeper 3 understanding. The meaning behind ‘blip cultures’ and the forms of communication 4 appropriate to such cultures is considered in relation to evidence-based practice. 5 Chapter 4, ‘Safe and effective practice’, aims to increase understanding of the 6 importance and relevance of a process for communicating safely and effectively. The 7111 2