Communication Skills for Midwifery Practice - Essay Example

The Importance of Communication Skills to Midwifery Practice Introduction Communication and inter-relationships, specially among professionals and the clients have become an increasing focus of attention in both the present and future of health and social care. People working in health and other care services are often encouraged to improve communication processes, to develop more participatory relationships with service users, and to work more closely in partnership with other professionals, and it is one of their competency standards. This also applies to the midwifery, and research has supported the need for better development of communications skills for midwives. Research emphasises the need to see interpersonal communication through interrelationships which develop taking into account the issues of power and diversity, and good communication likewise flourish through and revolve around the emotional dimensions of care work. Chant et al. (2001) indicated that in general in the care practices, effective communication skills on the part of the practitioner leads to greater satisfaction out of care. basically, patient satisfaction leads to compliance, which in turn minimises complaint rates, emotional and psychological distress (Chant et al. 2001). An effective communication to any patient on the part of the care giver induces many favourable changes in the client that may be conducive to positive health. Rogers et al. (1999) indicated that communicated patients are "better educated and empowered to participate in their own health decisions and as a result will make shared decisions" (p.175). These principles are also applicable in midwifery practice, where the definition of communication is same as elsewhere in the care professions. Communication means exchange of information, ideas, or feelings, which can be complex in the sense that this is a broad term indicating both verbal and nonverbal communications. These become more complex in the healthcare settings due to the very nature of the interactions being complex, charged with emotions, and related to very personal feelings and situations. All these may affect the process of communication, and knowledge, training, and practice on communication skills is thus necessary to effect a clinically effective interpersonal communication, specially between the provider and the recipient. It has been estimated that communication skills and relationships are important parameters of healthcare services, and the practice of midwifery is not an exception to that. By the term relationships, it is meant interrelationships between the care professionals and their clients and between the care professionals themselves. The new plans for healthcare reforms include strategies for improvement of communications skills to improve the interaction processes with the service users and to break the barriers between disparate groups of care professionals (Department of Health 1999) involved in the care of the same patient. Appropriate communication is an important tool to address the psychological and holistic issues involved in many diseases and conditions, and without a good communication skill, the health promotion cannot be achieved. While research has shown that one of the determinants of the quality of services provided is effective communication, it is gradually being understood that a comprehensive and holistic care provision is possible through interprofessional teams, where better communication skills can foster improvement of interpersonal communication, which has been deemed to be fundamental in this process. Indeed, without being armed with a reasonably sound communication skill, partnership in care not feasible, even for the midwives. In reality, it has been observed that failure of communication on the part of practitioners or providers including midwives is quite common. In this area, they often fail to meet the expectation of the patients and their needs. Quite frequently, complaints arise from ineffective and clumsy communication between interprofessional teams or between patients and care givers. Bristol Royal Infirmary Inquiry indicates that failure to communicate in the healthcare areas affect healthcare outcomes. It has been indicated that effectiveness in healthcare professional communication skills is extremely important. DOH has issued guidance on communications skills training at the point of professional registration for all healthcare professions. Butler et al. (2008) in their study involving the competencies of midwives identified three essential midwifery competencies, which are being a safe practitioner, having the right attitude to practice, and being an effective communicator. In fact, if the midwives desire to project themselves as a part of the profession which is supposed to be caring and kind, they need to acquire communication skills which are absolutely essential to relate to and to work in partnerships with women leading to the options of informed choices to their clients. According to communication theories, effective communication skills would include active listening and communicating in order to provide appropriate information and flexibility among different options. It has been suggested that effective midwifery would have the personal attributes towards effective communications, and this skill must be included in the skills training curriculum (Butler et al. 2008). According to the theories of communication, an effective communication occurs through a loop, where a clear message tailored to the audience is received and understood leading to a reaction or a change, and thus will lead to feedback. The initial formulation of the message should be influenced by feedback from previous communications and research into the audience, and any follow up to the message itself must be equally influenced by how recipients have responded in the first instance (Butler, 2001). Effective communication is the method to serve both utilitarian and emotional needs of both the parties communicating so an agreed goal is achieved. The midwife as a communicator thus must study her clients and formulate a clear message based on the highest priority elements relevant to the client. This also indicates the need for appropriate language and a suitable presentation. The communicator has also the responsibility to check whether the client has received and understood the message, and she must be patient enough to deal with questions, objections, or uncertainties of the message. A communication has always an intent; either it desires to inflict a change, induce an action, or assure out of uncertainties. In some cases communication thus must have an element of negotiation in order to ensure intended understanding. In case of diminished understanding, the communicator must be skilled enough to reformulate the message. Some change in action is imminent, or even in some cases, no changes will be evident. In such cases, the communicator must review the outcome and agreement, and if necessary will repeat the message. The most important step perhaps is to receive a feedback from the client about what needs to be changed further about the communication (Butler, 2005). It is clear that communication has practical purposes to serve professional ends. However, in relation to midwifery practice all communications actually indicate relationships and intimacy that urges for approval and attachment. Self-awareness on the part of the professional who is mature and secured makes these urges for approval, which may enrich and energise a relationship. From that point of view, excellent communications skill is an important attribute of midwife performance. Midwives attitudes to the patients and direction of care must be personalised where during the care the midwife must understand the social, emotional, and psychological needs of the patient. All these factors actually influence the performance of the midwives. When the midwife executes care in the hospital environment, there is a considerable amount of anxiety created by the hospital admission. The care provided by the midwife may alleviate this anxiety. Good communication skills become important in reducing the anxiety-creating incidents during care, such as, labour pain, episiotomy, childs health, and many other issues. Evidence suggests that appropriate communication during care can be an effective anxiolytic. This can be accomplished through information about the condition, proposed treatment, and environment (Rice, 2000). This means through communication of information, the midwife can provide both institutionalised and personalised care that may serve to fulfill the social, emotional, and psychological needs. It is evident without communication skills on the part of the midwife this is impossible. Taking a care process as simple as bowel care, the care is initiated by the midwife, where the patients physical and psychological needs are taken care of. However, along with that practical skill, perception about the condition, knowledge, the midwife must demonstrate communication skill, since that assures the patient about environment. Research has supported the hypothesis that communication of information always produces less anxiety and pain. Pain has been considered to be a combination of physical and psychological factor, which combined together produces the experience of pain. All care situations related to pain produce premonitory anxiety, and as anxiety increases the pain awareness also increases. These invariably leads to situations where the patient suffers uncertainty about the future situation related to childbirth. Communication from the attending midwife may ameliorate the uncertainty through provision of information, and this has been noted to reduce anxiety. Research studies also indicate that alleviation of excessive anxiety in pregnant mothers who are perturating is always desirable and produces good outcomes. By information it is meant the information which an experienced and trained midwife is expected to possess and to pass at appropriate times in an appropriate manner (Robinson & Cottrell, 2005). The midwife must possess as essential competencies safe practice, right attitude, and ability to effectively communicate. It has been suggested that a midwife who is a safe practitioner. A safe practitioner is a midwife, who has reasonable self-sufficiency, can take her own decisions, uses most up-to-date knowledge in practice, and demonstrate self and professional awareness. These can produce a right attitude which is demonstrated through motivation, commitment, and a caring and kind behaviour towards clients. All these can be achieved through satisfaction through effective practice, where effective communication is an important part. Effective communication builds solid partnership with women and provides truly informative care (Wylie & Wagen-Heintz, (2004). Essential communication skills necessary for the midwives include active listening skills, providing appropriate information, and flexibility to cope up with the care and patient needs. As directed and indicated by NMC (2004a), in professional practice, the midwives must have emphasis on connecting and relating to their patients who are patients with need of maternal and child health care. The midwife care centres round the interests of the woman and the baby. It has been shown that their interests are best served through care were the midwives communicate the care that they are going to deliver. Communication with the mothers is not the only aspect of the communication. Where interprofessional care is necessary, communication may be used as tool to collaborate with the other professionals involved in their care. Effective communication, team working, and a co-operative attitude with the patient and the family have been noted to be personal attributes of a midwife, and they are known to influence the outcome of care in midwifery practice. On the contrary, lack of effective communication such as in cases of fetal or perinatal loss may have devastating effects on the mother compromising the outcome and satisfaction on the part of a midwife. In fact the best possible health care outcomes are possible when patients are equally involved in the decision making about their own care. This ownership and empowerment can be promoted by the midwife who is aware about her own standing. Therefore a self-aware midwife can foster an environment of joint decision-making and the consensus on care decisions is possible through a skillful and effective communication (Enkin, 2006). DOH (2003) links effective and skillful communication to the midwives personal qualities and attributes. This means a self-aware, knowledgeable, confident midwife can only communicate best, when her attitudes are congruent with the competency standards. These are the effective practitioners who demonstrate not only kindness and intelligence in practice, they are also rated high by the clients due to the energy, enthusiasm, joy, and excitement they demonstrate in care delivery. These in turn would lead to development of reciprocal relationship between the midwife and her client (Department of Health 2003). Prior studies indicated that difficulty in communication in the case of midwives arise from lack of self-awareness. Those who have communication difficulties have problems with information sharing in the labour ward. Studies involving midwifery teachers indicate that self-aware and self-sufficient teachers were more confident in communicating. All of them had good clinical skills, and they used their communication skills as a tool for socialising. If relation building and getting cooperation is the goal of communication, intelligent and present day midwifery must base of communication. Self-awareness also alleviates performance anxiety and anxiety for communicating well to the clients (Silverman et al., 1998). Thus it is evident that midwife-patient relationship is an important parameter of quality of care. It is now acknowledged that communication skills in practice allow the self-aware midwives foster building up of social interactions with the clients. This also allows development of attitude of the midwives to their clients. The socialisation is an important means through which the midwives can develop a person perspective towards the patients. This can also foster moving away from evaluating patients stereotypically towards a care that is person centred and build on kindness. This would also generate the very reciprocal reactions in the clients, and the midwives can respond to the clients individual needs. While it seems very appropriate and there appears to be no barrier to this mechanism of utilisation of communication skills, in clinical practice this is not easy for many midwives. While developing a personal relationship to foster communication and facilitate care, there seems to be a conflict between management of string feelings of professional responsibilities in the backdrop of personal enclosure. This is only possible again through self-awareness, which has been described by Walsh (2007) to be increased knowledge base, level of confidence, and ability to manage feelings and emotions do the patient encounters become personal for the patient, professional for the midwives and therapeutic for both. However, despite these factors, other parameters of self-awareness are desire to learn and intense interest to provide good nursing care may also foster the desired closeness (Walsh 2007). Conclusion At least for the clients being cared for by the midwives, the central component of their relationship with the caregivers is not care, rather interpersonal dynamics. For the midwives care is an element of the relationship, and this can be accomplished through communication. While talking about communication skills, the most important component of midwives communication should be paying heed to their clients. Paying heed means properly understanding the needs and desires of the patients and their families in regard to the care. As has been demonstrated in this discourse, this can be achieved through communication skills of the midwives, which is a direct derivative of attitudes towards clients and their competence in practice, and most importantly through self awareness. Through communication, the midwives can gain clearer insight into the patients needs but it is also medium to gain self awareness where they can perceive their personal strengths and limitations. Moreover this can confer enough close encounters with the patients and their families to be able to understand their conditions from their viewpoints leading to a favourable attitude towards the patient, which can be the key to clinical effectiveness. This is evidently a route to enhance the quality of patient care through build up of partnership with the patients. In short, the midwives can build up a relationship through their communication skills and positive consequences of this relationship can be best used to provide best clinical outcome from care. Reference Butler, M., (2001). Definitions of midwifery competence: implications for professional learning. Unpublished PhD Thesis. School of Education: University of Nottingham Butler, M., (2005). What are the essential competencies required of a midwife at the point of registration? Midwifery: Pathways to Healthy Nations, ICM 27th Triennial Congress, Conference Proceedings CD-ROM. Brisbane, Australia. Butler, MM., Fraser, DM., and Murphy, RJ., (2008). What are the essential competencies required of a midwife at the point of registration? Midwifery; 24(3): 260-9. Chant, S., Jenkinson, T., and Russel, G. (2001). Communications Skill Training in Healthcare: A review of Literature. Journal of Clinical Nursing. 16:1, 31-38 Department of Health (1999) Making A Difference: Strengthening the Nursing, Midwifery, and Health Visiting controbution to Healthcare. London: Department of Health Department of Health. (2003). Guiding principles relating to the commissioning and provision of communication skills training in pre-registration and undergraduate education for healthcare professionals. Leeds: DoH. Enkin, M. (Ed.), (2006). Beyond evidence: the complexity of maternity care. Guest Editorial, Birth 33 (4), 265–269. NMC, (2004a). Midwives rules and standards. Nursing and Midwifery Council, London. Rogers, A., Hassell, K., and Nicholas G. (1999). Demanding Patients? Analysing the Use of Primary care. Buckingham: Open University Press. Silverman, J., Kurtz, S., & Draper, J. (1998). Skills for communication with patients. Oxford: Radcliffe Medical Press. Rice, A. H. (2000). Interdisciplinary collaboration in health care: Education, practice and research. National Academies of Practice Forum: Issues in Interdisciplinary Care, 2, 59–73. Robinson, M., & Cottrell, D. (2005). Health professionals in multi-disciplinary and multi-agency teams: Changing professional practice. Journal of Interprofessional Care, 19, 547–560. Walsh, D., (2007). Improving Maternity Services. Small is Beautiful-Lessons from a Birth Centre. Radcliffe Publishing, Oxford. Read More