Leadership Academy

“Communication is a two-way street.”

Posted by: Dr Clare Price-Dowd - Posted on:

In her sixth blog of a series, Clare Price-Dowd, senior lead for evaluation and patient experience at the NHS Leadership Academy, talks about the importance of good communication in nursing.

The #hellomynameis campaign, created by Dr. Kate Granger MBE, was based on Kate’s frustration with the number of staff who failed to introduce themselves to her when she was receiving care for terminal cancer. The campaign – now supported by over 150 NHS trusts and organisations worldwide and reaching as far as New Zealand – has made a huge difference. Its premise is so simple: better communication results a better patient experience.

I’ve interviewed lots of people over the years in both clinical roles and non-clinical roles. When I ask people what their strengths are, they always seem to say ‘I’m a really good communicator’. But sometimes I wonder if we really understand what communication is about. It’s certainly a lot more than being in ‘transmit’ mode, something we’re all guilty of. Of course, part of communicating is imparting information to patients and colleagues about the things we do and the things we can help them with, but it’s also about listening. Do we really listen?


Ensuring that communication is two-way

Think about how we sometimes communicate in the NHS. How often do we unthinkingly use a secret language that only we understand? The jargon and acronyms which we use can exclude patients. How do you describe yourself for example; a nurse, nurse practitioner, specialist practitioner, highly specialist practitioner, nurse specialist? We can exclude people in the way that we describe things and the way that we communicate to them. This isn’t just clinical; we have acronyms for organisations, FT, CCG, CQC and big long words for conditions, which we shorten to acronyms so it’s easier for us. But for patients, it can be very hard to catch what the acronym was, let alone the big word behind it, and the information that sits behind the big word. When patients ask for an explanation, how many of us have thought we were being helpful when we said: “you don’t need to understand/worry about that – you just concentrate on getting better” (whatever that means). I used to hear it all the time, yet we should remain true to the ‘No decision about me, without me’ and that means open and honest, shared decision making based on excellent communication imparted a way that can be understood. Let’s not subconsciously use language and communication as a barrier to keep the expertise to ourselves.

Understanding the language that patients use is equally as important. This is something that was really brought home to me when I moved to South Yorkshire and worked as a health visitor. Visiting a family, I asked the Mum what she was feeding her child. She said: “Well she had some spice today”. I thought ‘this child is six months old!’ I had visions of hot spicy food, only to find out that spice in that part of the country is something that’s referred to as a treat. So, the child had been given a treat today – a small amount of sweet food – and spice was to this Mum the opposite of what spice actually is. Cultures also have different ways of describing illnesses and conditions. Again, while working as a health visitor, one of the things I didn’t understand and recognise until I was told is that in some languages, there’s actually no word for the word depression. But to use post-natal depression as one example, it’s said to affect up to 20% of new parents. So, when people (with depression) would be describing how they felt, they’d say ‘I feel unwell in my soul – I feel unhappy’ but there is actually no word that sums it up. If feeling depressed is an alien concept, how is someone supposed to explain it? That’s where good communication skills really show.


False communication

I’ve spoken before about not giving people false hope. False communication is just as bad. How often have we said ‘this won’t hurt’ when what we mean is ‘just hold still while I stick this big cannula in your hand? Isn’t it better to say: ‘Yes, this is going to hurt a little bit, but I’ll be as quick as I can’? In a previous blog I spoke about working as a staff nurse in a hospice. The sister – who I’ll never forget – had a beautiful phrase. When patients came in they’d often say: “you’ll be able to save me now won’t you nurse?” She would reply “We cannot make you better but believe me, we can make you feel better” – an example of honest communication at its best.


Non-verbal communication

As a nurse, communication isn’t just about words – it’s about your whole way of being. The ability to understand and interpret non-verbal communication is such an important skill; things like noticing when somebody’s in pain, or when someone’s body language indicates that they’re closed off and don’t want to talk. Not everybody is overt – they won’t tell you if they don’t feel like having a conversation yet will have one anyway. The danger of that is that it might not give us the full picture we need to co-design care. If communication is about more than just what we say, we need to think about our own body language as much as we do our patients’. What does your demeanour put across when you turn up at work, and what does that communicate to patients and their families?

Getting to know your patients and your colleagues is so important. That way, you can pick up on the things that are different about them today; their mannerisms and their actions. And when you see these differences, you can act appropriately. Part of the art of nursing is being able to understand, see and notice when things are changing for patients when they might not want – or are too frightened – to tell you. Having these skills might be the difference between noticing what’s normal for them, and what isn’t.

Communication is the one thing that transcends every bit of nursing practice – it’s an interaction on a very human level. It might be as simple as choosing to communicate with no words at all, by sitting and holding someone’s hand when they’re scared. After all, that communicates as much if not more as a million words and platitudes would.

We have a saying in the Academy: “What’s it like being on the receiving end of me?” And that is absolutely all about communication. How do you show up in the workplace, and what is your being – not just your words – communicating to everyone around you?

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