Communication Skills in Nursing Practice: Use of the Borton Method as a Reflective Structure

The assignment would discuss the use of the Borton method as a reflective structure for a critical incident review answering three questions: What? Describing the episode of the contact, So what? What’s going on? Analyze and ask whether misunderstandings have happened and what now? Re-assess expertise. What could I have done to improve this episode of communication? In relation to a polish patient diagnosed with depression, experiencing ‘ psychotic episodes ‘ and how this has affected and improved my skills as an effective communicator in maintaining therapeutic relationships (The Open University 2018b).

The goal of the daily therapy sessions was to explain how Peter interpreted the connection between his emotions, feelings and actions, while recognising the unique perspective of Peter as he is the expert on his own illness as he deals day and daily with the signs and symptoms of his illness. To establish an appropriate care plan Peter relied on me correctly asking the right questions and to be able to summarise, review and interpret the information in order to encourage an accurate diagnosis of his symptoms. Some of the advantages of therapy sessions include the secret to sustaining a therapeutic relationship is your listening ability. It will enable better communication with your patients and show respect. It also means that you are gathering accurate and relevant information to determine care and treatment plans that are suitable for treating and managing the defined disorders as Rogers and Farson (2015) cited in (The Open University 2018f) (The Open University 2018h)

Listening is the most significant competency in therapy sessions. When you listen carefully to what your patients are saying you are less likely to miss their message or misunderstand it. On reflection I should have concentrated more on the ‘LISTEN’ as an acronym, I maintained good eye contact although I could of asked more open questions, reiterating back to Peter was helpful however at times, communication with the language barrier was challenging, and the intervention of an interpreter often disrupted the dialogue flow. (Activity 2.7 The art of listening) To listen to Peter, I was able to understand the message he was trying to convey through his verbal and nonverbal communication. The challenging part of this was I had to put aside my own ideas and feelings by listening and not being judgmental (The Open University 2018g).

In nursing practice, communication is essential, and good communication skills are paramount in the development of a therapeutic nurse/patient relationship. As a nurse, you must be able to communicate with your professional colleagues and the people in your care, and their families reliably, clearly, and effectively. It includes verbal and nonverbal communication such as facial expression interpretation and body language (Unit 2 Developing therapeutic relationships). If you want to get accurate information from your patients about their health problems, health history, and treatment results, you must use effective communication strategies by conveying information as simply as possible to patients and others to educate and advise those in your care. A discussion has a multitude of different aspects; the patient can go off the spot to avoid discussing the issue or be over-talkative, offering more details than is required. When it’s easier to get the patient to concentrate, these issues are easily addressed in simple, same-language communication however communication with Peter was challenging due to the language barrier, and all therapy sessions had to be conducted with an interpreter therefore an additional shift in dynamics that their presence brings and how the patient communicates with you. (The Open University 2018i).

The role of interpreters

I used Communication accommodation theory (CAT) which focuses on ways in which individuals change their communicative actions by communicating with each other, by modifying speaking levels and eye contact, or by mirroring movements such as convergence the tactic I used to understand Peter’s viewpoint. This is an especially relevant key strategy in mental health nursing when you need to develop an understanding of what the patient is feeling. Convergence helps you align with their understandings, a simple act of sitting with someone, mirroring their body language, is an effective integration technique (Reference).

Whilst hypothesis of communication can help develop communication skills, our communication styles differ in different situations. I maintained an ‘on-point’ approach focusing on the needs of Peter by developing my interpersonal communication skills, knowledge of awareness, and assurance (The Open University 2018c). Upon reflection, I could have used more open questions to provide more space for the client to verbalise their understandings. I did find the session challenging because of verbal exchange difficulties which inhibited conversation therefore, I needed to be open in my technique, my tone, volume, velocity, and rhythm of my voice, and awareness as it was difficult to gauge the nonverbal pauses and silences (The Open university 2018f).

Methods of communication

Dunsford (2009) cited in (The Open University 2018f) proposed a structured communication model called Situation, Background, Assessment, Recommendation (SBAR) to facilitate clear and effective communication using different communication types to effectively reduce the chance of misinterpretation, like Peter who did not speak English, an interpreter was used as a communication tool to resolve communication barriers and to use the skills, representing expertise and attentive body language (The Open University 2018k).

An integral part of continual, evolving nursing practice is the need for reflection and evaluation in order to improve care due to constantly changing healthcare environment. Evaluation of practice requires the ability to reflect in a critical and focused way. Communication is managed in most areas of our lives and health professionals are bound in accordance with professional, statutory, and regulatory bodies such as NMC Code of Conduct (NMC). Reflection is a method of using experiential knowledge to enable professional and personal development while reinforcing continuous learning. The Code Professional Standards of Practice and Behaviour for Nurses and Midwives ( NMC 2018 ) states that to fulfil all registration requirements, nurses and midwives must ensure their knowledge and skills are up to date. This may be achieved by participating in continuing professional development (CPD) activities to maintain competencies and improve practice.

To summarise clear, concise communication is shown to have a direct impact on patient outcomes. By evaluating a critical incident analysis as a reflective approach such as the Borton’s model helps make sense of the assessment developing skills and provides high quality person-centred care. Effective communication is essential to both providing and developing interpersonal and therapeutic relationships. Communication is both verbal and nonverbal and important in creating empathetic relationships with boundaries under guidance of Professional bodies (The Open University 2018e). Theories of interpersonal communication can be applied to research to help improve communication in practice and develop communication skills. Communication theories help us to focus on achieving our aim of conveying empathy and support despite language barriers and is key to the provision of compassionate, high-quality person-centred care which ensures a positive experience for all patients and colleagues and is the way forward for future interactions especially developing cultural competency to meet individuals needs from different cultural backgrounds (The Open University 2018f).