Journal Number Two:

An important primary goal of nursing is to facilitate the development of trust and to build upon a therapeutic relationship between the patient and members of the health care team. Demonstrating the skill(s) of effective communication is key. Assessment of a patient’s ability to communicate includes gathering information about the ‘contextual factors’ that influence communication itself. A context includes all the factors that influence the nature of communication and interpersonal relationships. This includes the patient’s internal factors and characteristics (psychophysiological) the nature of the relationship (relational) and the situation prompting communication (situational).

Psychophysiological context refers to the patient’s internal factors and characteristics. First, monitoring some of the even basic physiological status such as pain, hunger and weakness. Second, paying attention to one’s emotional status and treating/preventing conflicts with anxiety, anger, hopelessness and even euphoria. Last but not the least, the growth & development status of the patient; simply not only looking only age but to the developmental tasks as well, perceptions/personality and the patient’s self-concept and self-esteem all play a vital role in communication itself.

Relational context refers to the nature of the relationship between the participants. Is the relationship social, helping or working? As a nurse, I must pay close attention and factor in all three in my skill set. The level of trust and the balance of power & control also are important. Situational context is a relative of relational context in that it too refers to the reason for the communication. Often it’s not simply a game of information-exchange, but rather setting goal achievements, problem resolutions and simply the expression of feelings.

As a nurse, it’s important to continually be assessing the factors that can/do influence communication. Many altered health states and human responses can limit communication. Often, it can be an easy fix such as checking for hearing aids and or eye glasses; however, quite often, unfortunately it’s not this easy. As a result, a comprehensive review of the patient’s medical record helps provide relevant information about his/her ability to communicate. Throughout the health history and physical examinations, the health care team documents not only physical barriers to speech, but neurological deficits and pathophysiological conditions such as hearing and/or vision as well etc. For example, patients with aphasia after a stroke or late-stage Alzeimer’s disease often cannot understand or form words, nor can dementia patients often cannot make sense of what is being said. Other mental illnesses such as psychoses or depression can cause the patient to demonstrate ‘flight of idea’ where words do not keep up to rapidly changing thoughts, rambling of the same single word or phrase, loose association of ideas or even slowed speech pattern. Patients with severe anxiety sometimes are unable to perceive environmental stimulus or hear explanations and unresponsive or heavily sedated people cannot send or respond to vernal messages. Reviewing the patient’s medication record is also as important, as opiates, antidepressants, neuroleptics, hypnotics, or sedatives may cause a patient to slur words or use incomplete sentences. Finally, the nurse’s progress notes often also reveal other factors that may contribute to the effectiveness of communication. For example, quite often the family members can provide vital information about a confused patient, thus, the absence of family makes it that much more difficult for the health care team to build upon often what little information that they may have on a patient.

Over the next few weeks, I will be progressively adding to my communication skill set by gaining a better understanding of the psychophysiological, relational and situational contextual factors that quite often can have a heavy influence on the nature of communication and interpersonal relationships between the nurse and the patient. In turn, this will help myself as a nurse in making sound decisions during the therapeutic communication process between not only the patient and myself but between myself and my fellow health care colleagues as well.