The Role of Peri-Operative Practitioners in Holistic Care

(Ralston 1998, p8 -11). Non verbal communication, described as the “How” of communication, relates to how we speak both unconsciously and consciously (Ralston 1998, p8 -11) and includes natural distances; proxemics, kinesics, body language facial expressions, posture, eye contact and touch (Hayes 1994, p516 -518).

Written communication can take various forms such as; policy documents, patient care plans, prescription charts, letters, memos, emails and other Information Technology (Plowes 1999, p217). Communication is the art of imparting a message, idea or information between two or more people (Stanton 2003, p10) and is a two way process of transferring information from a source (sender) to a destination (receiver) without the information becoming scrambled on its way so that the exact meaning is understood (Bradley & Edinberg 1990, p. 8). Therefore, communication is the reciprocal process of sharing information that involves a message being communicated and, with the exception of written communication, the message may be on a verbal or non-verbal level, however it is usual for the message to be communicated simultaneously on both levels (Hayes 1994, p551 - 553). A failure to ensure effective communication may adversely affect clinical practice due to increased staff frustration and subsequently causes undue anxiety and apprehension to the patient.

Pincock (2004, p 10) maintains that poor communication by health service staff is a significant cause of complaints brought against the NHS and clearly shows the importance of achieving effective communication at all times. It is suggested that being in hospital for any surgical procedure always causes concern and anxiety to patients (Oliver 1999, p. 460 - 462 & James 2000, p 472).This in turn produces an imbalance in the body’s natural homeostasis

that results in an increased cardiac workload and immune system suppression (Gross 1996, p266 - 277), all of which are detrimental to postoperative recovery.

Using effective communication skills ensures that patient anxieties are minimised and increases the ability of practitioners to meet the individual needs of patients, in turn, enhancing a patients preparation for and recovery from surgical procedures (Mitchell 2002, p 43).In regard to verbal communication, a clear explanation of procedures should be given to the patient in terms that they can understand taking into account age, ethnicity and level of understanding. Westwood (2001, p220) suggests that professionals can often be poor listeners as they are too busy to listen properly and jump ahead to reach their own conclusions and appear impatient and high handed as they already have a fixed idea of what they intend to do.Effective verbal communication is intrinsically linked with the ability to understand what another person is saying and in order to achieve this it is essential to utilise active listening skills (Westwood 2001, p218-22).

Active listening incorporates a range of both verbal and non-verbal behaviours such as adopting an open posture, nodding, using interested facial expressions as well as using verbal phrases to encourage the patient to communicate with the practitioner further.In the peri operative setting such skills are essential in achieving an accurate assessment of the information needs of the patient and their suitability for anaesthesia (Markanday 1997, p20). The use of effective verbal communication and active listening skills are crucial when considering the issue of informed consent as informed consent is a legal requirement before any invasive procedure.However, consent can only be considered informed once a

patient has been provided with sufficient information with which to make an informed decision (Bates 2001, p1283 – 1284). The use of active listening techniques such as open posture and questions enhance a practitioner’s ability to accurately assess the information needs of a patient, by creating and encouraging an atmosphere in which the patient feels free to express their needs (Markanday 1997, p20).

In this way, active listening skills are essential in the process of obtaining informed consent.Barriers which exist to inhibit effective communication in this situation include time constraints, personal preoccupation with what the practitioner wishes to say and self-consciousness, in that a person may be overly preoccupied with ones self, language and conversation which serves to deflect focus from the patient who is talking (Sidell 2000, p350 - 358). A further barrier to effective verbal communication within the peri operative setting may be found within styles of speech.Speech that is heavily accented, containing technical and medical jargon or which is spoken too quickly may present communication barriers for both staff and patients but when caring for patients with hearing, learning, or language difficulties, such as when English is not a person’s first language, an increased awareness to this aspect of communication is necessary and requires careful consideration (Hogg & Vaughan 1995, p 730). Whereas verbal communication is perceived audibly, non-verbal communication is visual (Kenworthy, Snowley & Gilling 2002, p254 - 267) and an ever present component of our communications with others.

Virtually all human communication is via non verbal cues such as facial expression, gesture, posture and tactile communication (Caris-Verhallen 1999, p810), all of which broadcast messages to others providing the emotional climate for

the interpretation of these messages before the actual words are spoken. Therefore, a clear understanding of non verbal communication is essential if the message given is to be congruent, in that, a persons body language does not contradict their spoken words (Miller 1995, p103 – 105).The theatre environment poses many communication challenges to staff as many barriers, which exist to inhibit effective communication, are unique to this setting. For example, when members of the perioperative team are present during surgery.

At this time it should be remembered that surgical masks muffle speech and therefore, reliance upon non-verbal cues such as facial expression is increased and significant consideration should be given to ensure that the meaning of the messages are clearly understood.Medical staff present often rely on non verbal cues, such as body and facial gestures, to indicate to theatre staff the various instruments and equipment needed and the time that they are required, for example, a quick scissor action with the hand to indicate that scissors are needed immediately (Taylor & Campbell 1999, p220). With regard to communication between staff and patient, practitioners need to pay careful attention to non verbal cues, as things such as the eye contact, body gestures and the facial expressions of a scrub team can all indicate, to the patient, the mood within the theatre and that of the staff giving care.In such an instance the visual message is often more accurate than the verbal message and may aid or inhibit the relationship of trust between the practitioner and patient. Communication is fundamental in achieving good nursing care (Faulkner 1998, p1) and with the modern healthcare environment evolving, lead by

government initiatives (DOH 2000, p1 – 9 (appendix a) and DOH 2001, p 1 - 201) requiring healthcare professionals focus predominantly on cost and quality issues, the use of effective communication skills will become essential in order to provide care that is both individualised and patient focused.

In order that such patient centred care is provided within the perioperative setting, practitioners will need to utilise effective communication skills and build upon existing communication skills and knowledge by increasing awareness of the many unique barriers to communication that exist within the theatre environment (Rogan and Timmins 2004, p40). In increasing awareness of such barriers, perioperative practitioners are well placed to address and minimise them this, in turn will increase the practitioners’ ability to provide effective communication.In this way practitioners are able to really listen to patients and address their unique needs and consequently increase the ability of the whole perioperative team to provide patients with safe, good quality care, tailored to the needs of the individual. Providing such care will ultimately enhance a patient’s preparation for and recovery from surgical procedures (Mitchell 2002, p41 – 43). Bates, T.

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