The Nursing Associate at a Glance. Ian Peate

being resilient is important, as caring for people can be physically, mentally, emotionally and spiritually demanding. This can bring with it pressure, and your well‐being can suffer.

9 Effective communication

      At the point of registration, the Nursing Associate will be able to: communicate effectively using a range of skills and strategies with colleagues and people at all stages of life and with a range of mental, physical, cognitive and behavioural health challenges.

Box 9.1 Communicating with a person who has a cognitive impairment.

      When next on a practice placement, take time to consider how someone with a cognitive impairment might find it difficult to understand a care procedure. This could be due to a learning difficulty, dementia, impairment due to a head injury or stroke or a perceptual disturbance due to a psychotic illness.

      Identify a particular procedure that you believe may be confusing to the patient, and think of how you can use a variety of different and appropriate communication aids to help the person better understand their care

Box 9.2 Communicating with children and young people and their families.

      Observe and take notes (with permission) during a care interaction episode with a child, young person and their family. In particular make notes on how the care interaction episode was terminated: how was it brought to a close?

      Consider, for example, how the health or social care professional made verbal and non‐verbal signs that the interaction was ending. What was the response of the child, young person and their family? Was an opportunity given for the child, young person and their family to ask questions? Was there any follow‐up?

      Would you make any changes as to how the interaction was closed, and if so, why? Did you identify any factors that impacted the communication positively?

      Communicating with people with chronic and long‐term condition

      Reflect on one of your practice placements, where a health or social work practitioner had to deliver bad news to a person (and their family) with a chronic and long‐term condition. There are several accepted ways to break bad news. Using the mnemonic SPIKES can help. In the grid, did you identify any components of the mnemonic?

Table 9.1 Communication exercise SPIKES (Source: adapted Webb, 2011).

	Your notes
Setting up (Setting the stage for optimal communication)
Perception (The patient’s perception of the news to be shared determines how the news is conveyed).
Invitation (Permission to have information shared, granted by the patient or family)
Knowledge (When delivering the news ‘Fire a Warning Shot’; let the patient and family know that the incoming news is not good)
Emotions with Empathy (Emotional response may range from silence to dramatic crying and sobbing; be empathic)
Strategy or Summary (establish that the patient and family have a clear plan for the future)

      Top Tip

      It may sound obvious to say that ‘It's how you say it that's important’, but this is so true.

Effective communication

      At the core of everything that is done, everything we do in our work and also outside of work, communication is central. It is key to how we learn, how we perform at work and how we enjoy our non‐work interests. Effective communication is especially important when the Nursing Associate and other health and social care professionals offer healthcare and support, where those we offer care and support to (including families) might feel vulnerable, alone, isolated and scared. It is also important because the Nursing Associate works as an integral part of the health and social care team where effective communication is key to helping deliver safe, coordinated and effective care.

Engaging with patients and their families

      Every contact counts. All health and social care organisations are responsible for health, well‐being, care and safety and each one of us has the opportunity to impact people’s mental and physical health and well‐being.

At all levels, good, honed communication skills are needed if interventions are to be effective. These interventions begin with the signals that the Nursing Associate gives out when they approach a person; this is even before your interaction has begun. People subconsciously pick up signals from you, and this has the ability to influence whether or not they feel they want to interact with you or not, whether or not they trust you. See Boxes 9.1 and 9.2.

Effective communication

Good communication can help people feel at ease. It is not unusual for people who need health and social care services to express anxieties about their health. They may have anxieties about the variety of tests and investigations they are to undergo, the outcomes of the tests and what the future might hold for them. People react in different ways to stressors or the anxieties that they are facing, and this may sometimes lead them to behave in ways they would not normally behave. For example, they may speak out of character; they might come across as being rude or even aggressive. When the Nursing Associate has effective communication skills and uses them, this can reduce their anxiety, and it can also help to build their confidence.

Connecting with patients

Nursing Associate–patient communication is underpinned by robust interpersonal relationships. When relationships are meaningful, the Nursing Associate can engage the patient in their care. Simple but well‐thought‐out communication strategies are essential. Table 9.1 provides a range of exercises that may help you become more self‐aware and hone the ways in which you care for and approach people.

      Making positive connections with patients and others requires the Nursing Associate to listen with attention and to frequently demonstrate to the patient that they have unconditional positive regard for that person.

Unconditional positive regard

      By using verbal and non‐verbal communication skills, the Nursing Associate can offer the three central requisites of all therapeutic relationships to patients: empathy, genuineness and unconditional positive regard. Having and displaying unconditional positive regards means that you respect the other person as a human being.

      Unconditional positive regard involves taking a non‐judgemental attitude towards the person, accepting and respecting them for who and what they are. This is not always easy. Unconditional positive regard can be