Table Of ContentCOM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page i
Communication and
Interpersonal Skills
for Nurses
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Series Editor: Shirley Bach 1
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Transforming Nursing Practice – titles in the series 3
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Communication and Interpersonal Skills for Nurses ISBN 978 1 84445 162 3
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Law and Professional Issues in Nursing ISBN 978 1 84445 160 9
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Learning to Learn in Nursing Practice ISBN 978 1 84445 244 6
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Nursing and Working with Other People ISBN 978 1 84445 161 6
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Nursing in Contemporary Healthcare Practice ISBN 978 1 84445 159 3
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What is Nursing? Exploring Theory and Practice ISBN 978 1 84445 158 6
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To order, contact our distributor: BEBC Distribution, Albion Close, Parkstone, Poole, 4
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COM & INTER SKILLS PT_gk.QXD 17/7/09 10:07 Page iii
Communication and
Interpersonal Skills
for Nurses
Shirley Bach and Alec Grant
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First published in 2009 by Learning Matters Ltd 5
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All rights reserved. No part of this publication may be reproduced, stored in a 7
retrieval system, or transmitted in any form or by any means, electronic, 8
mechanical, photocopying, recording, or otherwise, without prior permission 9
in writing from Learning Matters. 10
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© 2009 Shirley Bach and Alec Grant
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British Library Cataloguing in Publication Data 3
A CIP record for this book is available from the British Library 4
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ISBN: 978 1 844 451 623 6
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The right of Shirley Bach and Alec Grant to be identified as the authors of this
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Work has been asserted by them in accordance with the Copyright, Designs and
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Patents Act 1988.
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Cover design by Toucan Design 1
Project Management by Diana Chambers 2
Typeset by Kelly Gray 3
Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall 4
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Learning Matters Ltd 6
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Contents
Foreword vi
Acknowledgements vii
About the authors viii
Introduction 1
1 Nursing, caring and interpersonal communication 8
2 Key concepts 24
3 Evidence-based principles 44
4 Safe and effective practice 61
5 Understanding potential barriers 76
6 The learning and educational context 100
7 The environmental context 124
8 Population and diversity contexts 141
Glossary 168
References 171
Index 179
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Foreword
As someone who supports students in clinical placements, I am struck by how often
it is the subtle intricacies around how we communicate and interact with patients,
families and colleagues that present us as nurses with the greatest intellectual and
emotional challenges. Numerous dilemmas, confusions, misunderstandings and
anxieties arise as we try to tease out what we bring to the game as individuals, what
we encounter in our roles as students and nurses, and what are complex aspects of
the patients, relatives, professionals and organisations we engage with.
It is in this light that I welcome this excellent book, in which the authors span a breadth
of interesting, pertinent and at times refreshing array of topics that are important in
considering communication and interpersonal skills in all fields of nursing. In places,
rather demanding concepts are explored, but it is worth the effort as the authors
illuminate nursing practice by drawing on core evidence from nursing and then
venture outside the traditional stomping ground to pull in research, theories and ideas
belonging to other fields. This lateral approach promises to stimulate nursing students
and others to explore how best to make sense of the complexities and challenges of
communication and interpersonal relationships.
The book looks at some of the typical stumbling blocks many of us encounter as we
strive to learn how to communicate and interact safely and effectively, and offers
ways to anticipate and engage with the potential barriers that often lead to emotional
struggles for students in practice. Practical can-do exercises within these pages offer
students scope to reflect on their personal and clinical experiences and relate these to
the focus of a particular chapter. Many of these interactive elements could prove to be
prize material in class-based teaching and learning.
The chapter on the learning and educational context should be valuable to many
students and mentors as it provides a wholesale exploration of how the student
experience, both in university and practice, fits within a broader educational
framework. The results of engaging with this should be a more empowered student
who takes greater ownership of their education and mentors that can better
appreciate how the sum of the parts fits together.
The last two chapters shed a bright light on the social-cultural settings within which
nursing practice, interpersonal interactions and communication take place. These rich,
thoughtful and wide-ranging sections scrutinise the challenges of providing effective
healthcare across the lifespan within a constantly evolving, diverse society.
I came away from reading this book with new concepts and understanding that will
inform my work with students and qualified nurses for years to come. It is with great
pleasure that I commend it to you.
Dr Alan Simpson
Senior Research Fellow and Lecturer
Vice-Chair, Mental Health Nurse Academics (UK)
City University, London
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Acknowledgements
The authors and publisher would like to thank the following for permission to
reproduce copyright material:
Arnold, E and Boggs, KU, Interpersonal Relationships: Professional communication
skills for nurses. Copyright © 2006, Elsevier, London.
Adapted Table 5.1, ‘Comparison of social and professional relationships’, p77,
reproduced with kind permission of Elsevier, London.
Dai, DY and Sternberg, RJ (eds) Motivation, Emotion and Cognition. Copyright ©
2004, Lawrence Erlbaum, Mahwah, NJ.
Adapted Theory Summary, p89, reproduced with kind permission of Lawrence
Erlbaum, Mahwah, NJ.
DeVito, JA, The Interpersonal Communication Book. Copyright © 2007, Pearson
Education Inc., Upper Saddle River, NJ.
Adapted table in Activity 5.3, p85, and Relationships and proxemic distances box, p82,
reproduced with kind permission of Pearson Education Inc., Upper Saddle River, NJ.
Hargie, O and Dickson, D, Skilled Interpersonal Communication. Research, Theory
and Practice. Copyright © 2004, Routledge, London and New York.
Adapted Types of Self box, p84, reproduced with kind permission of Routledge,
London and New York.
Kreps, G and Kunimoto, EN, Effective Communication in Multicultural Health Care
Settings. Copyright © 1994, Sage Publications, London.
Adapted Figure 8.1 ‘Iceberg model of multicultural influences on communication’,
p149, reproduced with kind permission of Sage Publications, London.
Narayanasamy, A, The ACCESS model: a transcultural nursing practice framework.
British Journal of Nursing, 11(9): 643–50. Copyright © 2002, British Journal of
Nursing. The ACCESS model, p154, reproduced with kind permission of the British
Journal of Nursing.
Rose, D and Pevalin, DJ (2005) The National Statistics Socio-economic Classification:
Origins, development and use. Institute for Social and Economic Research, University
of Essex. Basingstoke: Palgrave Macmillan. Crown copyright © 2005.
‘Social class based on occupation’, p156, ‘Socio-economic groups’, p157 and
‘Operative categories of the National Statistics socio-economic classification (NS-SEC)’,
p158. Reproduced under the terms of the Click-Use License.
Every effort has been made to trace all copyright holders within the book, but if any
have been inadvertently overlooked the publisher will be pleased to make the
necessary arrangements at the first opportunity.
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About the authors
Dr Shirley Bach is Head of the School of Nursing and Midwifery at the University of
Brighton and also the Series Editor for Transforming Nursing Practice. In the past, she
designed curricula for nurses that integrated interpersonal relationship skills and
communication studies, before specialising in health psychology and the application
of psychology to health and illness settings. She has written a study guide in
psychology for nurses, and researched and developed a model for psychological care.
She has also led programmes that promote the professional practice of nursing and
midwifery, especially in the area of advanced nursing practice. Most recently, she has
developed an interest in new learning technologies and has drawn upon her
understanding of both communication and pedagogic theories to publish in this area.
Dr Alec Grant is Principal Lecturer in the School of Nursing and Midwifery at the
University of Brighton and is a Registered and Accredited Cognitive Psychotherapist.
With a background in, originally, mental health nursing, and more latterly
psychotherapy, social science and psychology, he is now a course leader for the M.Sc.
in Cognitive Behavioural Psychotherapy. He has taught, researched, practised and
written about communication and interpersonal skills – and related areas such as
clinical supervision – in the caring profession since the mid-1970s.
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Introduction
Who is this book for?
This book is primarily intended for students of nursing, whether on a diploma or
degree pathway, starting their Common Foundation Programme or equivalent.
However, as communication and interpersonal skills (CIPS) develop throughout the
course as different contexts and situations are faced, the relevance of the topic will
still apply in years two and three. The focus is not to develop knowledge for any one
specific branch (Adult, Child, Mental Health or Learning Disabilities) but to support
development for progress into any branch and beyond. Therefore, there may well be
value for those who are studying on branch programmes and those on continuing
professional development modules. It may also be of interest to experienced nurses
who wish to develop their leadership roles. The Nursing and Midwifery Council’s
(NMC) Standards of Proficiency for Pre-registration Nursing Education are a
foundation for the book. However, the content is not narrowly defined by them.
Why communication and interpersonal skills for nursing?
Because we have learned since birth how to express ourselves within our family and
friendship groups, we all believe we are good at communicating. We have also been
honing our relationship skills, often through trial and error or role modelling, and we
think there is no need to consider very deeply about how we do it. It has become
second nature. There are times, though, when we experience situations where we
consider that an interaction did not go smoothly; perhaps we were misunderstood or
a friend reacted differently to how we expected. At times like these, we may think that
we could have said something differently that would have improved the reactions
and responses of ourselves and those around us. So, while we have developed
expertise, we can always learn and improve when it comes to human relationships,
mainly because there are so many factors that influence how we respond in various
situations.
If we shine the spotlight on healthcare situations, where there are many complexities
that are often similar to our everyday lives but enhanced by factors such as healthcare
policy, environment, hierarchies of responsibility, physical discomfort, anxiety, sadness
and fear, we have an even more complicated set of circumstances to deal with than
when we communicate or interact with family or friends. Healthcare interactions are
with patients, carers and peers in often demanding and stressful circumstances,
which inevitably lead to further demands on our abilities to communicate effectively.
Therefore, it is important that students take time to learn in more detail about
communicating in healthcare settings in order to interact as effectively as possible.
This means becoming more aware of oneself as well as others.
Unfortunately, there is ample literature to suggest that we do not communicate as
well as we might in healthcare settings. In this book we will be exploring the many
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