Communication in Care: A Critical Exploration Using the Calgary Cambridge Model

Introduction

Communication is nursing is the process through which the information regarding healthcare is exchanged between individuals such as caregivers, family members, patients and physicians with the use of words, signs and behaviour. The communication is vital in nursing as it helps to develop interaction with patients to provide them information regarding care to avail informed consent from them, identify patients needs, resolve issues faced by the patients and provide care according to the demands of the patient. In this assignment, a critical review of the interaction performed between the nurse and the patient presented in the video is to be discussed by using the Calgary Cambridge model. In addition, the experience during review of the communication is to be analysed to discuss its strength and limitation. and offer the best possible insights into healthcare dissertation help.

Background

Student Context

In 2016, immediately after my graduation, I started working as a qualified nurse in the Fahad Specialist Hospital located in Saudi Arabia. During the placement, I was responsible to work in the male specialist ward for three weeks under the assistance of specialist nurse to provide proper care to the patients. The training through assistance was helpful for me to become familiar with the way effective quality care is to be provided. My role in the hospital was to assess the patients after discharge to determine their experience during the stay in the hospital. In 2017, I began to work as a nursing teaching assistance in the nursing college of Bisha University located in Saudi Arabia. The role in this job was to provide practical classes to nursing students by assessing their strength and limitation in providing care and accomplish nursing duties.

Patient Group

The patient group mainly cared for during my tenure in the hospital are elderly patients who are 65 years of age and above suffering from mild to severe dementia. The common interactions which usually take place are determining the needs and demands of care of the patients and make the patients provide informed consent regarding care through non-verbal as well as verbal communication.

Nursing Communication

The non-verbal communication skills were more important for the context of providing care to elderly dementia patients because the patients were mostly seen unable to use proper words and phrases or form legible sentences to inform their needs and demands. The dementia patients are found to be unable to make proper verbal interaction because the disease has led their significant brain cells to be destroyed making them face issues with developing language (Hung et al. 2017). Thus, the non-verbal communication skills were particularly important in this content as through facial expression along with the use of signs as a nurse I was able to understand needs of the dementia patients as well as communicate with them the care action and therapeutic intervention to be provided for them. The non-verbal interaction is significant for the mentioned patient group because it helped me as a nurse to properly assess the mental and physical state of the patients. In addition, it helped to develop interpersonal communication with the patients to show them empathy and respect their dignity during the interaction. The verbal communication was used as additional interaction method with the family members of the patients to inform them regarding the health condition of the patients as well as gather detailed information regarding the patient and access feedback for the care satisfaction towards the individuals.

The dementia patients as a result of their forgetful behaviour, inability to communicate verbally and inefficiency to perform own tasks become a burden of care for the family. This leads the family members to treat them in an inappropriate way as they are unable to understand the feeling of the patients and manage their needs (Voss et al. 2018). Thus, communication skills are mainly important for caring of dementia patients as it helps to determine the feelings and emotions of the individuals to offer them effective care. In addition, dementia is considered in some cultural communities as shame in the society due to which the dementia patients are abused and harmed which lowers their dignity and self-esteem (Stubbe, 2017). This is because their emotions and feelings are not valued as well as they are rejected to be properly respected by society. Thus, communication skills are important for caring of the dementia patients so that through effective interaction the feelings and emotions of the individuals can be valued to improve self-esteem and respect the dignity of the patient. In addition, communication skills are important in dementia care to avoid error in care (Xanthopoulou et al. 2019). This is because communication helps the nurses to determine the needs and demands of patients based ion on which the care plan is developed by the nurses, in turn, avoid delivering wrong care that does not fulfil needs of the patient

Communication Skills

The good communication in nursing is referred to relay and interpretation of information between the nurses and patients along with interprofessional to deliver satisfactory care to the service users on the basis of their needs and demands (James and Caiazza, 2018). The therapeutic communication is used by the nurses to develop effective interaction with patients. In addition, the two types of communication techniques used by nurses to establish good therapeutic interaction are non-verbal communication and verbal communication.

Therapeutic Communication

The Therapeutic communication is referred to the process of interaction which prioritises the mental, social and physical well-being of the service users. The nurses to establish therapeutic communication supports the delivery of information by maintaining objectivity and professional distance with the patient (James and Caiazza, 2018). As mentioned by Martin and Chanda (2016), accepting and affirming information shared by the patient is one of the key elements of therapeutic communication. This is because it indicates that the patient is being properly heard and makes the nurses understand the way care is to be provided specifically to the individual for its proper reception. As commented by Lanzoni et al. (2018), recognition during therapeutic communication helps to acknowledge the behaviour of the patients that at times encourages them to accept care from the nurses and build effective rapport. This is because the patient's feel that the nurses are paying proper attention to their care, in turn, making them develop trust towards the nurses.

The nurses required providing time and scope to the patients to interact with them as it is key element in building effective therapeutic communication (Schwind et al. 2016). This is because the patients feel valued due to attention and time, in turn, making them support consultation with the nurses. The proper observations and seeking clarifications during interaction is another key element of establishing good therapeutic communication (Amoah et al. 2019). This is because observations and clarifications make the patients feel they are actively listened by the nurses, in turn, feeling encouraged in making further interaction.

Verbal Communication

The good verbal communication is established by the nurses by using friendly words and phrases to make the person feel comfortable to initiate conversation (Kiani et al. 2016). This is because such expression and words make patients develop trust and feel enjoyment in making communication with nurses. As asserted by Alsawy et al. (2017), verbal communication is to be made in a clarified manner for it to be effectively established. This is because clarity in communication helps the patients have proper understanding of the information being asked or shared. The good verbal communication also requires the element of practicing humility and speaking with confidence to be followed (Azevedo et al. 2017). This is because humility helps the nurses showing respect towards the patients and speaking with confidence leads them to provide information with self-assurance making the patient’s belief the nurses. In addition, the development of good verbal communication requires nurses to deliver information in a concise manner (Payton, 2018). This is because lengthy verbal information may make the patient unable to memorise the facts and become confused to participate in further interaction.

Non-verbal Communication

A good non-verbal communication is established by the nurses by managing positive body language which includes good body posture, direct eye contact, facial expression and touch (Rytterström et al. 2019). During non-verbal communication, the nurses required to be relaxed, face the patients, stand or sit with arms closed and require adopting an open stance in front of the patient (Salehi et al. 2018). This is because such body posture indicates that the nurses are interested in communicating with the patient, in turn, making the individuals feel encouraged initiating interaction. As mentioned by McCarthy (2017), maintain good eye contact with the patients during communication emphasis that the nurses are showing interest in knowing the individual. In addition, maintaining positive facial expressions such as smiling and avoiding to rolling out eyes or yawning helps in establishing good non-verbal communication. The nurses require considering the way they touch the patients during communication as it conveys if the nurses have affection and concern for the patients (McCarthy, 2017).

Linking with the role

The dementia patients are often found to be abused and harmed in the society as a result of lack of understanding of their mental condition by the people where they regard them as weak (Swan et al. 2018). Thus, the lack of acceptance leads the dementia patients often avoid communicating effectively and remain isolated. However, the proper care and acceptance of people with dementia by nurses through therapeutic care and interaction makes them feel valued (Bayles et al. 2018). This leads the individual to develop the will to interact freely with their needs and demands. Thus, the acceptance and affirmation elements of therapeutic communication helped me in addressing the needs of the patients in my previous placement by making the patients with mild dementia cooperate to share and reveal their demands in care to be fulfilled by me. As argued by Eastham and Cox (2017), dementia patients are often not recognised by the family and allowed to share their emotions. This is because they are regarded as mentally ill people who have no understanding regarding the real world and treated as burden of care in the society. The recognition through good therapeutic communication of the dementia patients thus helped me as the nurse to make them comply in establishing interaction and accepting care as it made them feel respected and valued.

The use of good verbal communication in my previous placement helped to draw feedback from the families of the patients regarding the care provided. The good verbal communication assists to avail feedback from families of patients which is essential in care because based in the information the care for the patients is updated so that improved quality healthcare and better health condition of the patients are able to be assured (Lazar et al. 2017). The hindrance faced with verbal communication in the placement is that the dementia patients often lacked understand regarding verbal information that eventually led to create problem in care. This is evident from the study of Martinez et al. (2018) where it is mentioned that dementia patients lack the ability to frame proper speech and communication due to dysfunctioning of the brain areas. The non-verbal communication in this context helped me as the nurse to gather information from the patients as through signs and understanding of facial expression as well as gestures by the patients their needs and demands in care could be identified. As argued by Lazar et al. (2017), non-verbal communication by nurses is sometimes vague and imprecise. This aspect of the non-verbal communication is evident in creating issues in interaction as non-verbal conversation in the previous placement at times made me as the nurse provide wrong care to the patient as a result of vague indications.

Review of Interaction

Overview of Scenario

In the current communication video, it was seen that I was trying to interact with a 70-year-old male patient named Steve admitted to the hospital for treatment of bedsore present who also has high blood pressure and mild dementia. The interaction was done before dressing bedsores of the patient to gather his consent regarding the care to be provided. This is because forceful care could led the elderly patient to feel disrespected and undignified along with create objection in availing care from the nurse (Featherstone et al. 2019). The interaction was based upon the previous experience as in this case I was also ensured to care for a male patient having mild dementia which I did previously in my placement. In this case, I also used non-verbal along with verbal communication skills while interacting with Steve by maintaining direct eye contact, body language and facial expression as I did earlier to interact with other male dementia patients in my job. This is because previous experience taught me that non-verbal communication skills are essential for supporting the development of effective verbal interaction among mild dementia as gestures and expressions play a key part in making the patients remain engaged in communicating and sharing information with nurses. It is evident from the study by Judd (2017) where it is mentioned that during verbal communication positive body language as well as facial expression is important so that the patients understand they are being actively listened in turn making them engaged in executing further interaction.

Approach to analyse the interaction

The consultation models are used by health professional and nurses to analyse and determine the aspects in care being provided to the patients are wrong and required to be changed so that better quality support can be provided to individuals for improving their health (Bruen et al. 2017). In order to analyse the current consultation regarding an elderly patient with bedsore named Steve, the Calgary Cambridge model is to be used. The Calgary Cambridge model has the key focus to determine the process of consultation from the beginning of the session followed by collecting information, providing structure of the consultation, developing a relationship, provide information through explaining and planning and ending the session (Mudiyanse et al. 2016). The model is seen to have a practical approach to determine the limitation and strength of medical consultation so that changes can be made in future practices to arrange improved care consultations.

The Calgary Cambridge model is used as the approach in reviewing the mentioned consultation as it leads to determine the social, psychological and physical aspects during the interaction (Solomon, 2016). Therefore, the use of the model would help to determine the way emotions and feelings of the patients along with social perception were influenced during the interaction and the way changes in physical interaction is to be made to develop a better medical consultation by the nurse in future. The model is to be used for analysing the consultation made because it provides a systematic way of examining the progress of the interaction to determine in which stage key issues are faced that are to be changed for the betterment of the interaction (Sommer et al. 2016). Thus, it provides clear concept to the nurses and physicians regarding the ay consultation is to be made to flow smoothly.

The Interaction

Initiation of Session:

The initiation of session analyses the way rapport with the patient is built by the nurse and ascertaining the reason behind the patients have attended the consultation (Solomon, 2016). The initial session of the consultation informs that the nurse entered the ward in which the male patient named Steve with a bedsore was present and greeted him by saying “Good Afternoon” with touch and asking the way his day was to build initial rapport with the patient. As commented by Shoji et al. (2019), greeting patients in proper manner leads the nurses expresses their readiness to communicate with the individual. This is essential because it makes the nurses indicate the patient as person and avoid ignoring as a faceless visitor. As argued by Bentwich et al. (2018), inappropriate greetings make the patients feel ignored. This leads the patients to show non-cooperation to initiate communication with the nurses as they are not respected and valued. Therefore, greeting the patient was an appropriate approach by me as the nurses were appropriate to make him feel being valued.

The nurses showing empathy towards the patients and trying to understand their health complication makes the patients feel cared and valued (Digby et al. 2016). This is because the patients feel that the nurses can relate and understand their complication experienced with the health condition and would try to show positive indication to care for them. Thus, being a nurse the empathetic approach at the initiation of the consultation to understand and share Steve’s feeling regarding health with asking him the way he is feeling is positive technique to develop effective communication in healthcare. As asserted by Davies et al. (2018), availing care in the hospital may act as scary for the patients as they are not familiar with the environment. Thus, the familiar approach to greet and ask the mentioned patient regarding his day and reminding him that I am already known to him helps to ease Steve which in turn assists to build positive rapport with the patient at the initiation of the communication.

In the consultation, it was seen that as a nurse I initially accessed permission from the patient regarding if I can sit and talk with him. As mentioned by Schmidt et al. (2018), asking permission to communicate with the patients by the nurses helps to show dignity towards them. This is because accessing permission leads the patients to feel their opinion is valued by the nurses, in turn, helping to build a rapport to continue the interaction. Moreover, seeking permission to sit and talk with the patient was an appropriate approach towards smoothly initiating the interaction as it helped to determine whether or not the patient is interested to talk. The reason behind the development of the consultation was clearly mentioned to the patient during the initiation of the session. This is evident as being the nurse I informed Steve that I have come to dress his bed sores. The smiling during interaction with the patient from the initial stage helps the nurses to establish effective rapport as well as makes the patients feel at ease and develop a feeling of trust towards the nurse (Rämgård et al. 2016). Thus, greeting the mentioned patient with a smile from the beginning of the communication is important as it helped me develop trust in making further communication and build positive rapport with her. However, the continuous use of “yeah” from the initiation of the consultation was not an effective therapeutic consultation approach taken by me as the nurse.

Gathering information

In collecting information, the physicians and nurses are seen to explore the issues faced by the patient by using open and closed questions, understanding cues, determining patient’s concern and expectations and determining the further structure of the consultation (Solomon, 2016). In order to collect health information regarding Steve, I as a nurse used various open and closed questions. This is evident as initially, I asked what expect the bedsore pain that is bothering him to be shared so that I can understand the care needs of the patient. As asserted by van Dijk and Buijck (2018), using open question by nurses while interacting with the patients provides them scope to determine wider needs and demands regarding care. This is evident as being a nurse when I asked Steve what other than bedsore is bothering him I was able to determine that he is uncomfortable and not pleased with the nursing staffs continuous changing his position and is feeling pain in the back. In addition, it allowed identifying that he missed watching a favourite movie the other day which he wished to see as well as facing issues with watching things as his spectacles is not provided to him which he brought during admission to the hospital.

The determination of the proper cues of expression made by the patients and active listening through open questions helps the nurses properly explore the healthcare situation and resolve queries of the patients regarding care (Browne et al. 2019). It is evident as from Steve’s frowning expression during conversation to relate the issue of being continuously moved I was able to determine that he is uncomfortable with the condition and active listening of the information shared by the patient mentioned that he has no concept regarding bedsores. Thus, establishing on the patient’s idea I explained him the concept of bedsore and the reason behind he being continuously moved so that his wound could be healed. As commented by Chen et al. (2019), active listening to the patients is important by the nurses as it makes them feel valued and share more intricate information. This informs that active listening helps the nurses determine the bigger picture of the health condition of the patient. It is evident as active listening helped me as the nurse; in this case, understand the way Steve got his wound which eventually led to his bedsore. In addition, active listening of the patient’s perspective helped me as the nurse understand that the patient is close to his mother and cares about her well-being but my lack of clear response or any action regarding the news may make Steve feel that I was not properly listening to him.

The open statement during nursing interaction helps the nurses show they are focussed on making conversation with the patients (Bravo et al. 2018). Thus, to gather further information I used open statement by mentioning what except bed sores Steve wish to inform that are to be cared by me while offering her support. This is because it would lead him to think about the other aspects of care regarding which he is not satisfied to be taken proper care by me to ensure his good health. It is evident as the open statement made him reveal that he feels uncomfortable to be touched over his face regarding which I offered him proper explanation behind such action. In order to gather detailed information regarding the patient, it was seen that I followed the SOLER model of communication which led me to develop active listening. As mentioned by Moorley et al. (2019), SOLER model informs that during verbal communication the individuals require to sit squarely with open posture as well as lean towards the client and relax along with maintaining direct eye contact. This is because open posture along with sitting squarely and leaning towards the patient in nursing means the nurses are concerned and interested to listen to the information being shared by the patient. Moreover, direct eye contact shows that the nurses are interested in listening to the patient (Van Gelderen et al. 2016). However, in this case, it was seen that I as a nurse was unable to continuously maintain direct eye contact with the patient that may create indication that I am not actively listening to his needs. This, in turn, may make him avoid sharing further intricate details regarding his health.

In therapeutic communication, it is seen that nurses provide open statements, repeat information along with use silence so that the patient is prompted to work on their problems and have time to think the information to be asked further in the conversation (del Carmen et al. 2019). In the given case example, it was seen that I as a nurse repeated the same information to Steve regarding bed sores for explanation to his queries which were made due to forgetfulness as a result of the presence of mild dementia. This is done with the intention to resolve the queries of the patient to make him incline to ask further questions and share information to be collected regarding their health. In addition, I as the nurse allowed proper silence in between interaction to provide Steve scope to think about the way further conversation and information he wishes to make and share. This is because silence during interaction offers the patients time and space to determine the broader topic regarding her health condition to be interacted (Rice et al. 2017). During consultation, it was found that I do faced issues with mannerism which may have distracted the patient from sharing valuable information. This is because pulling of sleeves continuously in front of the patient may make him feel I am being bossy and distracted.

Explanation and planning

In explanation and planning stage, information to the patient is provided in chucks compared to great details while gathering information. This is done to determine the overall understanding of the patient regarding the consultation (Solomon, 2016). In the given case example, it is seen that chunks of information regarding the care process to be followed in stages for the bedsores is provided by me to Steve by relating to previous information mentioned for evaluating if he has actually understood the way care is to be provided. As commented by Mariani et al. (2016), effective understanding regarding care is to be achieved by the patients through communication to provide informed consent regarding care. This is because without clarified thoughts regarding care the patient would be in confusion regarding whether or not to accept the provided care, in turn, making them create hindrances or objection in accepting the care. In the case example, it was seen that Steve was provided with the opportunity to understand information and overall analysis of his thoughts are checked at the end of the consultation to plan care for him. This is evident as a nurse I asked if he understood the reason behind his pain in the back and the way the bedsores to be dressed by me to which he provided acceptance.

A shared decision regarding Steve’s care plan is made through effective interaction. As commented by Mariani et al. (2017), shared decision-making regarding the patient's care by involving the individual by the nurses makes them feel valued and achieve satisfactory care. This is because the shared decision regarding care is reached through consultation regarding the wishes and demands of the patients with the nurses. The NMC Code of Conduct also informs that nurses are to determine care plan for the patients through shared decision-making and access informed consent from the patients (NMC, 2018). In the case example, it was seen that shared decision regarding the patient’s care is taken which is evident as I asked Steve to select the side he wished and feels comfortable to be moved so that his bed sores are able to be dressed properly. In addition, I asked if he is okay with the procedure of bedsore analysis to be taken and if any changes in required to which he replied being okay with the procedure. This ensured Steve had proper explanation regarding his care which led him to provide informed consent. Moreover, the way his issue with blurred vision is to be resolved is determined through shared decision made with the help of clear interaction.

Closing

The closing of the session includes summarising the information and ensuring the care plan created is agreed by the patient (Mudiyanse et al. 2016). This is effectively followed by in ending the conversation as I politely asked the patient at the end if Steve would cooperate with me to help me dress his bedsore. The patient replied that he would cooperate in case no hurt is done by me and I assured him that I have no intention to inflict pain. This led him to provide final consent regarding the dressing of the wounds. In addition, I mentioned the patient in the summarised way the stages to be followed next for the diagnosis of the effect of treatment of his bed sores and when he could get results for the process. The summarization of the information shared through interaction with the patient during the closing of consultation leads the nurses to ensure both the parties are well known of the steps to be taken and the patients would not create further hindrances in accepting care (Ampe et al. 2017). Thus, I summarised information shared for the patient during the closing of the session so that no further issues are created during actual care.

Discussion

The overall analysis of the case example of developing consultation with the patient indicates that the interaction was success to most extent. This is evident as the patient at the end expressed acceptance of care and most of the issues faced by her was resolved. The use of the Calgary Cambridge model helps the nurses to examine their ability of communicating with patients and use proper consultation techniques for promoting shared approach for managing issues (Widyastuti et al. 2018). Thus, the use of the Calgary Cambridge framework helped me in this aspect to determine the extent of ability I have for making proper therapeutic consultation with the patient. In addition, the model helped me as the nurse to determine the techniques to be followed in consultation so that shared information can be gathered with the involvement of the patient to manage health issues. The Calgary Cambridge model also assisted me as the nurse to systematically evaluate my consultation process in the practical field to determine the wrongs done and actions to be changed to ensure better healthcare consultation with patients in future.

The impact of the consultation on the patient was that his confusion regarding the reason behind continuously being moved is resolved. This is because he was explained the need for the movement is to ensure faster healing of his bedsores. Moreover, the consultation impacts the patient to develop better trust over the nurse and share his wishes along with information regarding his family. This is evident as he expressed the wish to go to India again and the extent of love he has for his mother and the way he is concerned regarding his mother's well-being. However, it was seen that I as nurses did not provide active response to acknowledge the news which may have impacted the patient to think that I lack understanding regarding his feelings and not listening to him actively. The assurance to the patient that he would be provided substitute glasses for correcting his blurred vision impacted the individual to calm down and stop it make it an issue. The assurance that the movie which he has watched half would be arranged again through the consultation impacts the patient to become happy. The consultation does have a positive outcome for the patient as well as the nurse because the confusion regarding continuously being moved from his bedsore is resolved as well as he is made to comply with the nurse in accepting care.

Conclusion

The exercise has informed me that people with mild dementia experiences forgetfulness but continuous repetition of the information make them understand the facts. In order to initiate a successful consultation, as a nurse, the person required providing opportunity to the patient to speak by avoiding interrupting them. In addition, for successful initiations of the consultation, the nurse requires to make them patients feel ease with them, respected and dignified to develop proper rapport. The nurses to gather proper information through consultation require having active listening skill which they could develop by following SOLER communication model. Moreover, the nurses are to maintain silence so that the patients have the opportunity to think and share information regarding their health. The exercise also taught me that the for effective explanation regarding care chunks of information are to be shared by relating with previous information and the planning regarding care is to be done through shared decision. In closing the consultation, summarisation of the information shared is to be done for the client to ensure the patient, as well as the nurse, have well-understanding regarding the care to be provided.

The learning in the exercise would be applied in future to develop effective consultation with the patients who have confusion regarding their care so that they can be complied to avail the care smoothly. The learning in future would also be implemented in developing rapport with the patients through effective communication. In addition, this learning would be used for making more improved and clarified communication with patients having dementia so that improved quality care compared to the current condition can be provided. Moreover, the learning in future is to be shared among student nurses to make them experienced and have information regarding the way they are initiate and accomplish successful consultation in practical field with patients.

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