Communication is an exchange of information by different methods which include verbal and non-verbal (Oxford, 2016). In health and social care, communication is a way to build a therapeutic relationship with the client. This requires the use of effective communication and engagement skills with clients or their carer (Morrisey et al2011). By using these skills appropriately during an assessment, you can create a connection with the individual which will enable them to feel relaxed and engage more in the conversation. If clients get more involved during the assessment, they will provide more information about their thoughts and feelings which will help a practitioner formulate the client’s presenting problems and strengths. After identifying the problems, the next step is finding solutions which requires informing the client about different possible solutions (Norman and Ryrie, 2014). All of these are done through communication which means that in most aspect of a client’s care and treatment, communication plays a vital role.
Throughout the conversation, I displayed active listening to encourage the client to engage in the conversation. I used non-verbal techniques such as nodding and accompanied this with “mmm” or “Yes”. This indicated that I was listening to the client and prompted him to continue talking. He was able to express himself in great detail which helped me picture his situation and understood what he felt. By gathering more information, it allowed the client and I to identify what’s going on and what’s going wrong (Watkins, 2008, p. 56).
Open questions are a way to explore more about the client and make them open up about themselves (Royal Marsden Hospital, 2015). I found that open questions gave more insights therefore I asked “What did you feel about this?”. This approach was encouraging and did not make the client feel uncomfortable in comparison to asking question such as “How was it?”. One of Roger’s (1992) condition suggested that it is important to have empathic understanding of the client’s awareness of his own experience. When the client talked about how talking to people made him feel anxious, I put myself in his shoes and replied “You want the conversation to end.” I used paraphrasing by putting into my own words what he must have felt during those circumstances.
From time to time, I used silence to allow the client to sort out his thoughts and to provide him time to reflect on what he had said. The silence also ensured that I didn’t interrupt him inappropriately in case he hadn’t finished talking yet. However, during the conversation, some silence that I’ve used were too long which must have made the client uncomfortable. This was one of the challenges for me during the session as I had difficulty coming up with a response which made the silence longer. I experienced anxiety, as I felt that I made the patient feel more distressed. Stickley and Stacey suggests that by pausing for five seconds before making an intervention, does not make the silence to be too long to cause distress to client (Callaghan et al, 2009). I will take this practice into consideration when there are cues indicating that an intervention is followed.
Summarising helps to check the pace and progress of an interview and this is a useful skill to demonstrate to the client that I have grasped the main issues clearly (Bach and Grant, 2011). To be able to recollect my thoughts to formulate a response, I have used summarising. I summarised the client’s problem, (he does not like talking to costumers), his thoughts and feelings (he feels anxious) and what he wanted to achieve (take medication for anxiety). Summarising the main points allowed me to organise my thoughts as well as the client’s thoughts. I continued this by asking if he wanted to add more information in order to clarify with him that what I summarised were correct.
After paraphrasing, it was my chance to introduce talking therapy to him. I did this by asking him different questions on why he refuses to do talking therapy. However, it was clear that he didn’t know how talking therapy can help him. At this stage, I was in panic as I didn’t know how to reply, not because I didn’t know the benefits of talking therapy but because I didn’t know how relay it to him. I thought that I can only ask him questions and I cannot give him advice. I struggled in this area, which caused the silence to be longer as I was thinking about how to put my response into a question that will lead him to answer his own questions.
If I did this assessment again, I would use Heron’s six category intervention analysis model of communication (Morrissey et al, 2011). I would use a mixture of the six categories and apply them appropriately in the conversation. For example, I can use a prescriptive intervention to suggest or propose to the client how talking therapy can help him and how this method have worked to other people before. By giving him more information to understand how talking therapy will help him will surely allow him to give talking therapy an option for treatment.
According to Hemsley et al, the environmental conditions in which nurses work, with competing professional demands and time pressures can reduce the capacity to form therapeutic relationship with individuals. Barriers to communication can be overcome or reduced by making changes to environmental factors. One barrier for me was the time limit of the assessment. Before the assessment, I thought that 20 minutes would be enough time but the time limit pressured me to ask more questions. As I could not get the answer I wanted from the client, this made me feel nervous whilst thinking about the time which resulted me to ask repetitive questions. I was aware that this approach made the client feel distress.
I think that if I was more aware of my time and manage this accurately, and focus on the main purpose of the conversation which is informing the client about talking therapy, then I could have used my time wisely.