The Language of Actions: Unveiling the Dynamics of Non-Verbal Communication in Nursing Practice

This reflective essay aims to carry out critical analysis and reflection on my professional development about non-verbal communication. Montague et al (2013) defines non-verbal communication as the way in which individuals communicate making use of their body language. This includes posture, eye contact, tone of voice, and facial expression. This assertion agrees with Borg (2013) who highlighted that, other body language can also include factors such as communication through messages, their appearance, and the layout of a room. Royal College of nursing (RCN, 2021) states that, it is important for health professional including student nurses to engage in reflection especially on care delivery to improve their practice.

This reflection will place an emphasis on the use of touch as the main non-verbal communication which was carried out. It will be used to make a comparison and contrast regarding my experience that occurred in various Crossfield areas which include Midwifery, Mental Health, Children as well as Learning Disability. I made the use of touched as a form of non-verbal communication to provide care (Hess, 2016). Based on this, it was my realisation that touch is a representative of a communication tool which is effective and important and that it maintains openness in communication and assist in the creation of rapport. This is supported by Stonehouse (2017) who indicated that within health and social care touch is a form of therapeutic tool which allows compassion and humanity to be brought to nursing care and improve patient experience. The names used within this reflection is pseudonyms to maintain confidentiality. (The Nursing and Midwifery Council (NMC, 2018).

One of the experiences that I will draw upon is Michelle a 35-year-old woman who had a vaginal delivery but was assisted with the use of forceps and ended up with episiotomy wound. According to (Webster et al., 2018).

During my observation, I realised that Michelle seemed to be worried, tearful, and anxious about the episiotomy. The (NMC, 2018) suggests there is a need for nurses to make the identification when patients are anxious or distressed and will also need to respond in a compassionate and polite manner. I approached her gently and offered my hand for her to hold which with consent and she accepted where I comfort her. This shows that, touch is not only a part of psychological care, that is dignity, privacy, and respect but also it is regarded as part of relational care such as compassion and empathy (Nist et al., 2020).

National Institute for Health and Care Excellence (NICE, 2021) attest that, patients experiencing significant medical event, might require emotional support from the healthcare professional. By doing this, a positive therapeutic relationship was developed, and she managed to open up to me in a more relaxed way (Kornhaber et al., 2016). Stonehouse (2017) conforms that, in nursing practice the use of touch aids in showing compassionate care thereby minimising anxiety and promoting continuity of care. The study is a review of the existing information on the topic of touch as a therapeutic relationship. However, the way facts in the study is collected is not clarified and the sample size used is not mentioned. The reliability of the study could not be ensured because logical correlation among different set of results could not be attained.

Other research has illustrated that, the use of touch help reduce anxiety (Anderson et al (2015). The study is qualitative research in which information are gathered by performing interview of 25 nurses in a multi-hospital health system. The study is reliable because more than one researcher is available to measure and corelate the data to provide in-depth explanation of the facts mentioned in the study. Burkholder et al (2010) reinforces the feeling of touch also provides calmness, empathy, trust when that support is being provided. The study is a phenomenological research in which 10 students and faculty are interviewed to gather information. The study is reliable because it explains real experiences of student nurses regarding the nature of touch to be considered nonerotic during counselling. I do believe that touch in this situation was essential for Michelle, as I realised that this has resulted in outcomes which are positive as her anxiety levels started to decrease.

Similarly, I was able to make use of touch as an effective non-verbal communication tool during my encounter with a younger patient named Eric, He was 7 years old and had Asthma and was showing anxiety being alone. By his bedside, I held Eric’s hand in way to show empathy and to provide him with reassurance (Stonehouse, 2017). My reaction of softly holding Eric’s hand was to ensure that he was not only comforted but also calm him down. This agrees with (Durkin et al., 2021) who indicates that compassionate care and empathy to be provided to the patient helps to build a therapeutic relationship with patient and the family. The fact is established in the study by interviewing 12 participants among which 4 are nurses and 8 are patients. The facts presented are reliable because there was stability in response from the nurses as well as patients which is evident as information from both of them regarding touch leading to show compassion was ensured without any conflicting views.

NMC, (2018) states that, nurses should prioritise people and respond compassionately and politely to those that we recognise are in distress and anxious. Hess (2016) added that, touch is a form of showing compassion and intervention which healthcare professionals could make use in helping to relax others and reduce anxiety. By staying with Eric, I made sure he was safe, monitored his condition and lesson any risk. His condition can escalate if left not monitored (Stonehouse, 2014).

Henry is 78-year-old elderly patient with Alzheimer’s disease. Alzheimer’s disease is a form of dementia that influence one’s behaviour, memory and thinking (Alzheimer's Association, 2016). He is somewhat frail and have experienced a few falls. As Henry was experiencing behaviour changes, withdrawal, confusion, and mood swings, which was a challenge to communicate with him. In one instance, during my shift, I spent some time with Henry and tried to have a conversation, but I realised that he was asking questions over and over. This became very awkward, and I did not know whether to continue or bring up a new topic to discuss. I decided to immediately change the conversation, but I realised he was getting irritated, and he begun to raise his voice. In order to help calm him down and to indicate that I was sorry for my actions, I approached Henry and tried to touch his shoulders to try and comfort him positively. This was however, rejected by Henry. The use of touch to convey empathy and to apologise to patient has been supported by Ellis and Astell (2017) who indicated that when communicating with a patient living with Alzheimer’s, touch plays a critical role.

Focusing on communication, professional health staff has a responsibility to communicate well with patients (NMC, 2018). Hence, communicating with Henry was essential so that he could have felt that there was some amount of understanding of the situation, reducing his irritation and confusion which can be caused from suffering from Alzheimer’s disease and shows good quality care. On reflecting on situation with Henry, I realised the importance of touch when providing care for him as having Alzheimer’s disease can have an impact on his mental health and affect communication (Currie, 2018).

According to Walton (2014), patients in mental health institution can misinterpret the use of touch and this can lead to attachment issues. The facts in the study is reliable as adequate existing articles are used to refer and support the facts. However, bias may have been raised due to influence of belief of the researcher in explaining the fact in their own words in the study from existing reviewed articles. Glesson and Higgins (2009) however highlight that the use of touch can minimise the risk when it is done with care. The study is an exploratory qualitative research with descriptive content which is performed by executed semi-structured interview of 10 psychiatrist nurses. The study is reliable because it is developed on the basis of a strong research design with appropriate explanation of the choice of methods for gathering information for the study. This assertion is supported by Walton (2014) who state that the use of touch should always be carried out with consent. Therefore, I should have ensured that I asked Henry if it was okay for me to touch him since I was the source of his irritation but also to know that within mental health care, touch is only therapeutic to clients when it is used judiciously. That is, with the use of other effective interpersonal skills (Gleeson and Higgins, 2009). As I had not done this with Henry, the use of touch in this situation was not effective nor therapeutic.

In contrast to my previous experience the care I gave to Sandra did not meet my expectation. Sandra is diagnosed with learning disabilities and was admitted unto the ward as she had suffered a fall, a cut on her forehead, broken her hand and it was recommended that she would stay in hospital overnight for observations.

As part of my responsibilities, I was assigned to Sandra to assist her with personal care. During my interaction with Sandra, I introduced myself as a student nurse and told her I would be assisting her with personal care which she consented with a head nod. Based on the code (NMC, 2018), I also ensured that her privacy was maintained during the interaction, making sure that the curtains were closed. As Sandra had a broken hand and to ensure that her autonomy was maintained, I asked her if she wanted to carry out her own personal care in areas that she could reach to which she agreed.

I realised she was tearful during the personal care, and I asked if she was okay. Sandra nodded to indicate yes however, when we got to her leg, I realised that she had a cut. Sandra started to scream and pushed my hand away. I stopped immediately and asked her if she was feeling pain which she said yes, very much. Before calling the doctor to attend to Sandra, I wanted to finish the personal care so that she would be dressed to see the doctor, I tried to touch Sandra’s hand to which she pushed my hand away and would not let me touch her any further.

Based on this situation, I realised that I did not make effective use of touch when Sandra indicated that she was in much pain. Although, the use of touch in this situation was to help in making her feel comforted and not to cause distress. However, in trying to get help for her and get her ready for the doctor, I may have rushed the situation causing more discomfort to Sandra. Public Health England (PHE, 2017) have highlighted that many individuals who have learning disabilities will tend to have difficulties in communication (PHE, 2017). This can result in it being harder for them to seek help when they are experiencing pain. In realising that Sandra was experiencing distress, I offered to touch her hand in a bid to show empathy, but this was not accepted by her. This agrees with Atkinson (2012) who said that physical contact can be inappropriate when communicating with patient if it involves pain. Gale and Hegarty, (2013) carried out research which indicated that nurses who work with people who have learning difficulties will often use therapeutic touch to enhance patient quality of life and emotional wellbeing. The study is a observational non-participative research in which the routine care of adults with disabilities is observed by the researcher in mentioning the information. The reliability of the study could not be ensured because observational studies show random presence of error due to misinterpretation by researchers. I realised that it was important that I had focused on the patient and develop an understanding as to her behaviour by looking at her facial expression when she was crying as this could be an indicative of her experiencing pain (Mencap, 2018). This shows that I should have been more attentive in the non-verbal communication needs of Sandra when providing her personal care.

Looking back, I realised that it was important that as a healthcare professional prior to beginning any kind of care and support for patients with learning disability to ensure that I enquire about the hospital passport which would have been received from their next of kin (Mencap, 2018; Petty et al., 2020). This would have helped me to have a better understanding of how Sandra likes to communicate which could have been useful in the interaction process.

In conclusion, this essay has highlighted the importance of the use of touch within the four Crossfield areas which are other fields of nursing. Also, I have been able to acknowledge strengths and weaknesses which include using touch as a means of improving care and compassion. Furthermore, I will do more research on the use of touch appropriately to convey message to patients so to minimise stressors and not sending wrong messages.

References

Alzheimer's Association (2016). What Is Alzheimer’s? [online] Alzheimer’s Disease and Dementia. Available at: https://www.alz.org/alzheimers-dementia/what-is-alzheimers.

Anderson, J., Friesen, M., Fabian, J., Swengros, D., Herbst, A. and Mangione, L. (2015) Examination of the Perceptions of Registered Nurses Regarding the use of Healing Touch in the Acute Care Setting. Journal of Holistic Nursing [online]. 34(2), pp.167-176.

Asthma UK (2019). What is asthma? | Asthma UK. [online] Asthma UK. Available at: https://www.asthma.org.uk/advice/understanding-asthma/what-is-asthma/.

Borg J (2013) Body Language: How to Know What’s Really Being Said. Harlow: Pearson Education.

Burkholder, D., Toth, M., Feisthamel, K., & Britton, P. (2010) Faculty and student curricular experiences of nonerotica touch in counselling. Journal of Mental Health Counselling, 32(2), 168-185.

Currie, L. (2018) Adaptive interaction as a method of non-verbal communication in individuals with dementia. Practice Nursing [online]. 26(4), pp.176-180

Durkin, J., Jackson, D. and Usher, K. (2021). The expression and receipt of compassion through touch in a health setting; a qualitative study. Journal of Advanced Nursing, [online] 77(4), pp.1980–1991. Available at: https://pubmed.ncbi.nlm.nih.gov/33559877/.

Ellis, M., and Astell, A. (2017). Communicating with people living with dementia who are nonverbal: The creation of Adaptive Interaction. PloS one, 12(8), e0180395.

Gale, E. and Hegarty, J.R. (2013). The Use of Touch in Caring for People with Learning Disability. The British Journal of Development Disabilities, 46(91), pp.97–108.

Gleeson M, Higgins A. (2009). Touch in mental health nursing: an exploratory study of nurses' views and perceptions. J PsychiatrMent Health Nurs, May;16(4), pp. 382-9.

Hess U. (2016). Nonverbal Communication. In: Howard S. Friedman (Editor in Chief), Encyclopedia of Mental Health, 2nd edition, Vol 3, Waltham, MA: Academic Press, 2016, pp. 208-218.

Kornhaber, R., Walsh, K., Duff, J. and Walker, K. (2016). Enhancing adult therapeutic interpersonal relationships in the acute health care setting: an integrative review. Journal of Multidisciplinary Healthcare, [online] Volume 9(9), pp.537–546. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5072574/.

MayoClinic (2019). Alzheimer’s and dementia: Tips for better communication. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/healthy-lifestyle/caregivers/in-depth/alzheimers/art-20047540.

Mencap (2018) Communicating with people with a learning disability [online]. Available from: https://www.mencap.org.uk/learning-disability-explained/communicating-people-learning-disability [Accessed 30th September 2021]

Mencap (2018) Hospital passport [online]. Available from: https://www.mencap.org.uk/advice-and-support/health/health-guides [Accessed 29th September 2021]

Montague E et al (2013) Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. Journal of Participatory Medicine; 14: 5, e33.

National Health Service (2018) Learning disabilities. NHS [online]. Available from: https://www.nhs.uk/conditions/learning-disabilities/going-into-hospital/ [Accessed 30th September 2021]

NICE (2012). Patient experience in adult NHS services: improving the experience of care for people using adult NHS services. London: NICE

NICE (2017). National Guideline Centre Final Version Asthma Asthma: diagnosis and monitoring of asthma in adults, children, and young people NICE guideline NG80 Methods, evidence, and recommendations. [online] Available at: https://www.nice.org.uk/guidance/ng80/evidence/asthma-diagnosis-and-monitoring-of-asthma-in-adults-children-and-young-people-pdf-7079863936.

Nist, M.D., Harrison, T.M., Tate, J., Robinson, A., Balas, M., and Pickler, R.H. (2020). Losing Touch. Nurs. Inq., 27 (e12368)

Nursing and Midwifery Council (2018) Read the Code online. NMC [Online]. Available from: https://www.nmc.org.uk/standards/code/read-the-code-online/#second [Accessed 27th September, 2021]

Petty, S., Dening, T., Griffiths, A., &Coleston, D. M. (2020). Meeting the Emotional Needs of Hospital Patients with Dementia: A Freelisting Study with Ward Staff. The Gerontologist [online]. 60(1), 155–164.

Royal College of Nursing (2021). Revalidation requirements: Reflection and reflective discussions. RCN [online]. Available from: https://www.rcn.org.uk/professional-development/revalidation/reflection-and-reflective-discussion [Accessed 30th September 2021]

Royal College Of Obstetricians and Gynaecologists (2020). Assisted vaginal birth (ventouse or forceps). [online] Royal College of Obstetricians & Gynaecologists. Available at: https://www.rcog.org.uk/en/patients/patient-leaflets/assisted-vaginal-birth-ventouse-or-forceps/.

Stonehouse, D. (2017) The use of touch in developing a therapeutic relationship. Healthcare Assistants [online]. 11(01), pp. 15-17.

Stonehouse, D. (2014). Communication and the support worker. British Journal of Healthcare Assistants, 8(8), pp.394–397.

Suval, L. (2014). The Surprising Psychological Value of Human Touch. [online] Psych Central. Available at: https://psychcentral.com/blog/the-surprising-psychological-value-of-human-touch#1 [Accessed 15th October 2021].

Walton, M. (2014) Person- and Family-Centred Care. British Journal of Nursing [online]. 23(17), pp.949.

Webster, S., Morris, G., and Euan Kevelighan (2018). Essential Human Development. Chichester, West Sussex; Hoboken, Nj: John Wiley & Sons, Ltd.

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