How can the nurse evaluate the effectiveness of communication with a client?

Communication skills are a necessity when you need to speak to a wide variety of people. Learning how to improve communication skills will make you a better nurse by enabling you to better understand your patient’s needs. Communicating effectively with your patients will make accomplishing your daily nursing tasks much simpler by minimizing the barriers to mutual understanding.

Effective Patient and Family Communication               

Considering your patient’s perspective is key to preventing encounters that resemble any kind of conflict, and sometimes the best way to achieve that is to, quite literally, get on their level. Not only does effective communication reassure patients and their families, but communication can have an impact on patient care and health and streamline processes in the day-to-day work of a nurse. It shows the humanistic side of the nurse (or any healthcare professional), building trust and happy healing.

1. Assess Your Body Language

Have your body at the same level as the patient to prevent distraction and ensure that your sole focus is on them. If necessary, sit in a chair so that you can be face to face and making eye contact, versus leaning over or squating. And, always face the patient while speaking.

2. Make Your interactions Easier for Them

When communicating with a patient, keep your sentences and questions short, stay on one topic at a time, and explain difficult concepts in clear terms. Even though nurses are well-researched and knowledgeable, it’s important to speak in Layman’s Terms and simple concepts unless otherwise requested by the patient.

3. Show Them the Proper Respect

Accommodate you patient’s requests as much as is safe and prudent. Rather than speaking in commands, offer them choices and if needed, provide redirection. Strive to help them maintain their dignity. This is especially important if you’re working in a skilled nursing facility.

4. Have Patience

Depending on your patient’s age, illness, or cognitive difficulties, they may move and speak more slowly than you do. Give them time to move at their own pace. Positive patient communications need not be rushed. It’s helpful to think about putting yourself in their shoes and imagine how you would want to be treated with respect and compassion.

5. Monitor Your Mechanics

Expanding on the concept of making the interactions easier for the patients, it’s important to speak clearly and slowly, louder than you usually do, but without yelling. Enunciate complex words carefully and use simple language as much as possible.

6. Provide Simple Written instructions When Necessary

Use graphics where possible.

Patients coming out of surgery or trauma are less likely to remember everything you’ve told them. In fact, it may be challenging for even a family member to remember the advisement you provide when emotions come into play. An easy-to-follow list of the basic concepts you’ve discussed will help to ensure compliance with their plan of care. Writing is a more permanent form of communication and may spark questions once the patient reads and digests the information.

7. Give Your Patients Ample Time to Respond or Ask Questions

Not rushing through instructions or responses will help your patients feel like a valued partner in the management of their own health and make communicating effectively more likely. Asking questions builds rapport because the patient has the opportunity to provide information  from their end or offer their own opinions.

Communication Barriers in Nursing

A study featured in the Global Journal of Health Science shared that according to the patients in their study, the most dominant communication barriers were gender differences between nurse and patient, the nurse’s reluctance for communication, a hectic environment of the ward or facility, and the patient’s anxiety, pain, and physical discomfort.

On the flipside, the most frequent communication barriers from the nurses’ viewpoint in this study were as follows: differences in colloquial languages of nurses and patients, nurses’ being overworked, family interference, and the presence of emergency patients in the ward.

Importance of Patient and Family Communication

Based on patient and nurse experience, the communication barrier could be conquered through compassion and patience. Distractions and emergencies never cease, and the workload never dwindles. It’s important for nurses to not only follow this list of communication tools, but to also avoid conveying their burdens or stress to their patients in order to achieve harmony.

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Nurse communication skills should center on the patient experience, patient education, and building connections beyond supplementary health IT.

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February 14, 2022 - In healthcare facilities, nurses can be found nearly everywhere—at patient screenings, in nursing stations, and, most importantly, with the patient in the exam room or at the bedside. Nurses are on the front lines of patient care, making nurse communication skills essential to a positive patient experience.

On a pragmatic level, nurse-patient communication is important because it is one of the primary domains on which CAHPS surveys are scored. Patients answer questions about whether the nurse treated them with courtesy and respect, listened to them carefully, and explained concepts clearly.

High CAHPS scores are important for an organization’s reputation and some reimbursement models.

The communication components of CAHPS scoring highlight the two main goals in nurse-patient communication:

• Creating a positive, warm, and compassionate patient experience
• Creating meaningful patient engagement and delivering patient education

However, meeting these goals isn’t always easy, especially as new technologies infiltrate the nurse-patient relationship. Although health technology provides many advantages to patient care, it can also detract from nurse-patient relationships.

Meanwhile, workforce issues and labor shortages make it hard for nurses to spend enough time to forge deep relationships with their patients. That can contribute to both lower patient satisfaction as well as nurse burnout.

But using targeted communication strategies, nurses may overcome these barriers. Particularly, nurse communication skills should focus on:

• Interpersonal connection
• Patient education
• Patient engagement technologies

Using nurse communication strategies that emphasize those points can help healthcare professionals both meet the clinical and emotional needs of their patients while fulfilling their other job demands.

MAKING PERSONAL CONNECTIONS

Nurse-patient communication is anchored by strong interpersonal relationships. Meaningful relationships will allow nurses to carry out their clinical jobs more easily while keeping patients engaged in their care.

But being a nurse isn’t easy, as nurses face full patient loads and crowded workflows. It may be challenging for nurses to find time to build interpersonal patient relationships between their clinical duties and other job demands.

“Everybody wants to do that,” said Christy Dempsey, MSN, CNOR, CENP, previously the chief nursing officer at Press Ganey and now the chief experience officer, during a previous interview. “The pushback is always about not having the time. Nurses say, ‘you must be joking if you can think I can spend 15 to 20 minutes with every patient.”

However, some research has indicated that small changes to existing workflows can help circumvent those time constraints.

Making physical connection

Sitting next to a patient while talking, even for a brief period, can help improve patient satisfaction scores, for example. A 2017 study found that nurses who asked to sit beside their patients while talking improved hospital patient satisfaction scores from the 9th percentile to the 43rd percentile.

Finding common ground through patient communication

Dempsey has boiled her own communication strategy down to about 56 seconds, a timeline all nurses should be able to follow, she said.

Dempsey begins by asking patients what they prefer to be called, about their family, and about what they enjoy doing in their daily lives. By gathering anecdotal information about her patients, Dempsey can nearly always make a connection.

“In truth, there aren’t even six degrees of separation between us,” she said. “We can always find something in common that will make a personal interaction. When I’m ready to wrap up that interaction, I always conclude with that connection.”

Using active listening to tailor patient care

Nurses and other healthcare experts have been looking for the key to a quality patient encounter that also fits within busy workflows. At the University of Virginia, researcher Claudia Allen, JD, PhD, developed the Background, Affect, Trouble, Handling, and Empathy (BATHE) method, designed to only take five minutes.

BATHE uses open-ended conversations between patients and nurses to build strong relationships that can often go beyond clinical needs. Understanding who the patient is as a person helps the nurse connect with the patient and make her feel more comfortable during a potentially tumultuous care encounter.

“The intervention invites the patient to talk about whatever is important to him or her,” Allen and colleagues wrote in an article in Family Medicine.

Understanding patient needs and concerns allows nurses to target their communication and clinical strategies toward specific patient preferences.

“In outpatient settings, BATHE has been found to improve patient satisfaction without significantly increasing time spent per office visit,” the research team added.

Using communication to support patient safety

Being an attentive clinician is important to the overall patient experience because it is instrumental in reducing avoidable patient harms and support patient safety.

When a nurse is a good listener and frequently checks in on her patients, she is able to reduce both physical and emotional distress.

For example, a nurse who conducts regular rounding can check in with a patient who just underwent hip surgery and needs something from across the room. The nurse can get the object for the patient rather than risk the patient falling.

Similarly, a nurse who is attentive in her listening can understand an underlying reason for a patient’s concerns and fears about a procedure. The patient might be resistant to the hip replacement because she is nervous about adverse side effects, for example.

When a nurse can identify patient worries, she can help alleviate fears and create a better experience.

USING COMMUNICATION SKILLS TO SUPPORT PATIENT EDUCATION

In addition to forming connections with patients, nurses are in charge of ensuring patients understand, and therefore are engaged in, their care plans. In 2018, the American Academy of Nursing reaffirmed patient education as a core part of nursing work.

“Health literacy is a precursor to health and achievement of a culture of health,” the group wrote in its policy brief that year. “Patient empowerment, engagement, activation, and maximized health outcomes will not be achieved unless assurance of health literacy is applied universally for every patient, every time, in every health care encounter, and across all environments of care.”

And data has confirmed nurse-led patient education has its benefits. A 2019 literature review in the journal The Gerontologist revealed that nurses who spearhead patient education efforts among older adults can support better patient satisfaction and better clinical quality outcomes.

Nurse communication strategies should account for these patient education responsibilities.

Utilizing patient teach-back for patient education

Patient teach-back is a leading patient education strategy. During patient teach-back, nurses should ask patients to repeat a concept, set of instructions, or other health information in their own words. This helps patients synthesize the information and helps providers confirm whether patients truly understood the exchange.

Organizations can begin to develop teach-back skills by creating a leadership team or identifying an initiative champion, the Agency for Healthcare Research and Quality (AHRQ) said in a guidebook on the topic.

Next, organizations should begin staff training. Training should highlight the goals for patient teach-back as well as example prompts for the strategy (i.e. “Just to be safe, I want to make sure we are on the same page. Can you tell me...” or “I want to make sure that I explained things clearly. Can you explain to me...”).

Organizations must also educate patients about the teach-back tactic. Nurses should emphasize that the strategy is not a test or a judgment of the patient. Instead, patient teach-back is a tool to gauge patient understanding and to help nurses determine where they need to better explain a concept.

“Effective communication is a clinician’s first step to helping a patient with a health problem,” AHRQ said in the guide. “The evidence-based, low-technology teach-back technique can be the gateway to better communication and better understanding, and ultimately it can improve patient outcomes.”

Teach-back is also an important part of family and caregiver education. Nurses need to make sure family caregivers are well-educated about patient health needs to better assist the patient after discharge.

Considering patient health literacy in communication

Nurses, like other clinicians, must also make sure they meet patients at the appropriate health literacy level when discussing health concepts. Bearing in mind a patient’s comfort level with health concepts will help the nurse better gauge how she should talk to the patient.

According to a Bradley University guide on patient education, best practices include:

• Using basic language – provide explanations for complex medical terminology.
• Speaking at a measured pace. Speaking too quickly could prevent patients from following the conversation and disrupt patient questions.
• Asking the patient questions. This means utilizing patient teach-back or simply asking where the patient has questions.
• Taking the time to ask the patient if she has questions about the information relayed, instead of leaving it up to the patient to speak up.

Nurses may also refer to any available printed or digital patient education materials. Increasingly, healthcare organizations are also investing in online patient education resources to which nurses may refer patients.

Navigating nurse communication and health IT, telehealth

Health IT plays a significant role in supporting strong nurse-patient communication. The use of bedside tablets, digital nurse call buttons, and digital rounding tools have helped nurses come to the aid of patients in need.

Digitizing patient education systems has also been helpful at streamlining and enhancing the nurse-patient relationship.

But the insurgence of telehealth, which saw its biggest boom at the start of 2020 during the COVID-19 pandemic, has also thrown a wrench in that relationship. Like other healthcare providers, nurses have had to explore how they can build the same rapport via telehealth as they do during in-person care encounters, developing a “webside manner,” so to speak.

That webside manner builds on the interpersonal skills they have always used to connect with patients in person, according to Jessica Dudley, MD, the chief clinical officer at Press Ganey.

“I actually think that the ability for clinicians to connect with patients in some ways is often easier in the telehealth setting than in the in-person setting,” Dudley said during an interview.

“Clinicians really do leverage their communication skills and they have to focus on that and be more intentional because they are going to lose any of the subtle body language cues that they would get in an in-person setting,” she explained.

For example, nurses have learned to look at the webcam, not the image of the patient on their screens, when they want to emphasize eye contact. Non-verbal cues to show they are listening, like smiling when appropriate or nodding the head, have also been effective.

And of course, dressing the part has been key to establishing that good rapport even over virtual care options.

Some nurses may encounter hiccups when patients do not want to turn their cameras on during the telehealth encounter. Many patients have technical reasons for not turning on their cameras, like wifi or device limitations.

“Otherwise, the biggest barrier that we've seen for patients not wanting to turn on their camera is they're not excited to show what's happening in their home setting to anybody else,” Dudley explained.

Coming from a place of empathy, clinicians who feel they have an established baseline of trust and rapport with patients can explain why having the camera on helps improve the clinical care they can provide.

“At the end of the day, this comes down to the relationship between that provider and the patient,” Dudley advised. “If they can, providers can encourage patients to turn on their camera, to say, ‘I'm here to really support you and do everything I can. And I can do that better if I can see you, if that's possible, or you show me your medications.’”

Nurses have been able to use telehealth to their benefit, too. Notably, increased telehealth use has helped nurses and other healthcare providers to see their patients in the context of their own homes and even uncover some social determinants of health, look food security, diet limitations, or housing problems.

Nurses should not necessarily solicit a look in a patient’s pantry or at the home gym, but rather they should wait for the patient to let them into this part of their lives.

Considerations for other health IT barriers

Although telehealth is the latest technology consideration for nurse communication skills, healthcare professionals may find themselves confronted with some of the same legacy challenges. The presence of the EHR and digital documentation, for example, could still limit a strong interpersonal connection.

After all, some studies have indicated that nurses who are distracted by EHR documentation may see lower patient satisfaction scores, although those findings may be less salient now that the EHR has become a mainstay in practice.

Nevertheless, nurses should continue educating patients about why the EHR is in the room and how it improves care. Additionally, maintaining eye contact and sharing the EHR screen can help the patient feel incorporated in the care encounter.

Technology is likely to continue challenging the interpersonal nurse-patient relationship, but the nature of those challenges is likely to evolve. As telehealth continues to become an integral part of patient care access, patients and nurses may become accustomed to building relationships across a computer screen, just as they became accustomed to the EHR in the exam room.

What is not likely to evolve is the importance of a good patient relationship and healthcare experience, and nurses are integral to that. With nurses on the frontlines of patient care, it will be essential that they understand how to deliver that positive experience through good communication.

Nurses will need to balance compassion, clinical expertise, and technology demands in order to create a quality care encounter that supports both patient health and emotional needs.

How can a nurse have an effective communication with a client?

How can you ensure that you are communicating effectively with patients?

Which nursing intervention would help in effective communication?