Nursing communication skills for NESB nurses (II)

Using speech functions while performing nursing tasks

  When you read the sample dialogue you probably identified the six significant speech functions. Of course, not every nursing task will involve using all these stages as part of  your oral interaction with the patient and some tasks may involve other speech functions not covered here. However, it is a good idea to know how to use these common ones.

  1. GIVING INFORMATION

  Eg. 'We do this to make sure that your temperature, pulse, respiration and blood  pressure are OK while you』re here in hospital.'
    Other ways of framing this speech function include:
  

• This is to ...
  
• We need to...
  
• We do this because ...
  
• This is important because...
  

  2.  EXPLAINING PROCEDURE
  Eg. 'I』m just going to wrap this cuff around your arm and pump some air into it so that I can read your blood pressure'.
  Other ways to frame this speech function include:
  I just want to...
  Now I'd like to...
  Now I'm going to...
  3. SEEKING COOPERATION FROM THE PATIENT
  Eg. 'Could you just roll up your sleeve?'
  Other ways to frame this speech function include:
  

• I'd like you to...
  
• If you could just...
  
• Would you mind...
  

  4.   OFFERING ENCOURAGEMENT
      Eg. 'Yeah, that's fine.'
  Other ways to frame this speech function include:
  

• That's good
  
• Well done
  
• OK / Right / Great      !
  

  5. OFFERING REASSURANCE
  Eg. 'Don't worry, it won't hurt you'
  Other ways to frame this speech function include:
  

• It won't take long
  
• It might feel a bit      strange/funny at first
  
• You've had this done before,      haven't you?
  

  6. GIVING FEEDBACK
  Eg.'Yes, it's quite normal'
  Other ways of framing this speech function include:
  

• Everything's OK
  
• There's nothing to worry about
  
• Your temperature's up a bit but      it's nothing to worry about at his stage.
  
• Your blood pressure's a bit      high, so I'll let Dr Lee know when she comes in.
  

Sample dialogue

  When performing nursing tasks you need to remember to communicate with patients at the same time. You do this to:
  

• exchange information or to keep      them informed about what is happening
  
• to involve them in their own      care
  
• to show respect for them as      patients and
  
• to reassure them that      the task is proceeding well.
  

  Read the following dialogue between a patient and her nurse. The nurse has just admitted the patient and she is taking her vital signs (i.e. monitoring temperature, pulse, respiration, and blood pressure). Taking vital signs is also called 『doing observations』 (or obs).
  

  

  N: Now Mrs Morrelli I need to take your vital signs. We do this to make sure that your temperature, pulse, respiration and blood pressure are OK while you』re here in hospital.
  P: Oh. … I see.
  N: I』m just going to wrap this cuff around your arm and pump some air into it so that I can read your blood pressure. Could you just roll up your sleeve a bit?
  P: Right. (P. rolls up sleeve.) Like this?
  N: Yeah, that』s fine. (N. attaches cuff and starts pumping.)
  P: It feels a bit funny.
  N: Don』t worry. It won』t hurt you.
  P: Is it OK?
  N: Yes. It』s quite normal.
  

  

  Now read the dialogue again and this time try to identify different stages in the interaction which linguists call 『speech functions』. See if you can distinguish where the nurse is:
   

• giving information to the      patient
  
• explaining the procedure to the      patient
  
• seeking cooperation from the      patient
  
• giving encouragement to the      patient
  
• offering reassurance to the      patient
  
• giving feedback to the      patient.
  

                                                
                       
Responding to patients

  Don』t forget that communication is two-way and that patients may also ask you questions while you』re performing nursing tasks. For example, while you』re doing a dressing you may need to be prepared for questions on a variety of topics such as:
  

• Will this      hurt?
  
• Is my      wound looking better today?
  
• When』s      lunch coming?
  
• Have you      ever been in hospital?
  
• Where are      you from?
  
• Do you      live with your family?
  

  Pause now and plan how would you answer these questions...
  Sometimes patients have worries or complaints that they express to you. Think about how you would respond to these concerns :
  

• I』m in a      lot of pain at the moment.
  
• I』d really      like to have my shower before my visitors come.
  
• I don』t      like the lunch I』ve been given.
  

  In the instances above, you can probably offer some help with the patients』 problems, but what about the following concerns?
  

• I』m really tired of waiting for      the doctor to come.
  
• I』m      worried because my wife said that she was coming to visit me an hour ago      and she』s still not here.
  
• I just      feel like I』m never going to get better.
  

  In these cases you may need to clarify what the patient is feeling by:
  

• 'reflecting      back' what they have said by paraphrasing their statements e.g .'So you're concerned about your wife because      she's late...'
  
• asking some 'open-ended',      follow-up questions  eg ''What are some of      the reasons why she might be running late?' OR 'How was she travelling here to the hospital today?'
  
• listening attentively to the      patients' answers
  
• paraphrasing the answers to      show that you』ve understood
  
• using open, positive body      language.
  
  

Social Conversation
  To establish rapport with your patient you will need to engage in casual or social conversation at times, for example, when you go into the ward first thing in the morning. (Of course this depends on the circumstances, for example, you obviously wouldn』t make chit-chat with a patient who was in pain!) A common conversation opener would be to ask a patient the following :
  

• Did you have a good night』s      sleep?
  
• Did you sleep well?
  
• Did you have a good night?
  
• How are you feeling today?
  

  These greetings in English are 'formulaic' which means that, to a large extent, they are predictable. However you will still need to listen closely to the patient's answer (eg.'Yes, I had a great night' OR 'No, I slept very badly') so that your next response is appropriate.)
  After this sort of exchange, patients will sometimes ask you questions like:
  

• What』s the weather like today?
  
• What』s it like outside?
  
• What sort of a day is it?
  
• Have you just come on this      morning?
  

  To initiate further conversation with patients you may like to respond to cues around the room such as flowers, 『Get Well』 cards, photos or books. If you don』t know the patients very well you might make a comment or give a compliment such as:
  

• What a lovely card!
  
• I like your flowers
  

  If you feel you have established rapport with the patient you might follow this up with a question:
  

• That』s a lovely photo. Are they      your children/grandchildren?
  
• That book looks interesting.      What』s it about?
  

  If you want the conversation to continue (and you have the time), you could share some information about yourself with the patient:
  

• I like this TV show too
  
• My son is also 13
  

  To keep the conversation going you can use some communication strategies such as:
  

• non-verbal encouragement (nods, smiles,      leaning towards the speaker)
  
• back channel cues ( mhmm, uhuh,oh )
  
• verbal encouragement (really?, you did?,      goodness!)
  

  *Next time you're in a crowded space such as a bus, listen to how people use these strategies to keep conversations going. Social interaction is also important in building up relationships between team members so don't forget that you can also use these strategies when making social conversation with staff members on your placement.