The Amazing Art of Complex Communication In Nursing

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I’m Cynarra, you could say that I have been practicing being a nurse since I was born. I grew up with a sister with complex disabilities due to spina bifida (myelomeningocele). She communicated by nonverbal communication mostly including finger-pointing, selecting with her eyes and other body language cues. I developed skills of observation and communicating in different ways other than the usual ‘speaking’. What I didn’t realise until later in life is how important these complex communication skills would be as a nurse.

Here is another great article on communication: Untangling nursing communication – “My patient can’t talk to me… Help!”

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Communication Basics

During training we learn about communication, nonverbal and verbal communication so let’s do a refresh.

Verbal communication are sounds made by our mouth, usually words to convey a message. Looking at our pitch of voice, tone of voice and the pace we speak at and the words we choose to use. This can help to determine the meaning of the message beyond just the words. For example, if someone is angry then they may raise their voice and develop a tone we recognise as angry.

Nonverbal is body language or things we do other than speaking. This looks at gestures, body language, facial expressions, eye contact, touch, and even personal space. We base our communication generally 80% on nonverbal communication without realising that we are. When someone is angry, they may lean forward, have an angry facial expression and make eye contact to show their emotion is matching the verbal communication.

Communication is basically receiving a message from another person then reacting/responding with a new message. It is important to consider our own communication both verbal and nonverbal as this can impact other people’s reactions/messages back to us.

Different communication skills

During training, we learn about verbal and non verbal communication and in nursing this can also involve interviewing clients using open and closed questions. Although during my training communication with a person with a disability was not thoroughly discussed or taught. When discussing with other colleagues from different universities and tafes they also expressed similar thoughts.

The differences found in complex communication or augmentative and alternative communication can include but not limited to; nonverbal, sign language, lip reading, alternative body language (eye movement or finger pointing), devices (like tobii), picture boards and many more. Being able to communicate with our patients is a fundamental part of being able to ensure we are providing person-centred and quality care.

Times this has been important

As a student nurse I remember walking in to meet a patient, a teenage boy with cerebral palsy who was nonverbal. I entered the room, touched his hand, and introduced myself. I explained my plan for the morning shift with him, he was smiling but not replying but I kept talking to him looking for any further reactions.

Then I noticed his mum crying, suddenly I was worried that I had done something wrong and asked the mum if she was ok? She explained that in the five days they had been admitted, I was the first nurse to speak to the patient and not his mum. To try to engage, ask him questions, touch his hand, and talk to him as I would anyone else. I honestly didn’t think I had done anything ‘special’ just treated him as I would treat any other patient.

The Feels

I have discovered that disability awareness and different communication strategies is not taught thoroughly enough during our education. When speaking with colleagues and students I have found that majority are unsure where to start, feel awkward or not prepared.

An example of this is whilst being a recovery nurse we were informed by the preop nurse that a patient on the list had a disability and was non verbal. The nurse who would be their recovery nurse voiced that they hoped it would go smoothly. I then asked the nurse if they were going to meet the patient prior? They asked why would that be helpful?

I explained that the opportunity of meeting the patient prior would mean then becoming a friendly face in recovery amongst an unfamiliar environment. Attempting to observe signs of pain can be difficult when the patient is unable to speak. Whereas asking the patient, their family or support workers prior could provide insight on what to look (signs of pain) for and how to help (eg positioning or how to calm/relieve pain etc). Having the opportunity to ask questions and gather information can change the recovery experience for the patient and the nurse.

As nurses we aren’t expected to be experts at everything, but sometimes starting a conversation on a topic is a great way to begin learning and sharing amongst our team/peers.

Tips

Trying to communicate is better than pretending you understand
There is no harm in observing family interacting to learn what the patient likes
Speak to the person & ask questions even if they can’t reply
Don’t undervalue the power of touch
Look for reactions from the patient
Ask for confirmation if you think you have misunderstood
Don’t be afraid to make to mistakes
Speech & OT can be contacted for further information & resources

Where to get further information or PD