Chapter 3: Literacies across the disciplines
English 102, February 2021
In my synthesis essay, I will outline and show the importance and challenges of communicating in nursing with patients, patients’ parents, and other healthcare workers such as doctors and other nurses. Whether that be a patient who is a child, a new and fresh incoming nurse first day on the job, or sobbing parents because they just found out some horrible news. All of those situations have proper ways to go about communicating so that the other side can fully understand or feel better about the situation. Also, this essay will entail some of the struggles nursing students have learning how to communicate with different people while in school. In the health care professions, communication is the number one aspect to success in both the worker and the patient. In my essay I will use 4 different scholarly articles about communication with patient, other doctors, and anyone else nurses may come in contact with on the way. The first article used is “Use of stimulated patients to develop communication skills in nursing education: An integrative review”, the next article is “Communication skills in nursing: A phenomenologically-based communication training approach”, the third is “Relationships Between Nursing Staff and Patients’ Experiences, and the mediating effects of missed communication”, and the las one being Gee’s “What is Literacy”.
Primary and secondary discourses are discussed in Gee’s academic article “What is Literacy?”. A primary discourse is the one that you get for free because it comes first nature to you (18). You usually learn this stuff in your house from mom, dad, sister, or brother and the environment you are brough up in (22). Essentially, you can learn all of these things from your house, and it is the base of your identity like first learning how to walk, speak, read or even how to wash your laundry. A secondary discourse is anything outside of the primary discourse, so you learn from outside sources like school, work, sports, etc (21-22). It is taught or seen outside of your home like learning a second language, learning how to swim in swimming lessons, church groups, and many more.
With that being said, communication is vital for everyone and is a part of your primary discourse but learning new ways to communicate in a hospital setting can be described as secondary discourse. Another example of how discourses relate to communication in Nursing is with different knowledge and age levels of words and speech. You wouldn’t use highly skilled health care words when talking to a patient or their family because most likely they won’t know what you’re talking about. Those medical terms are learned in your secondary discourse not your primary. Another example is a child, you aren’t going to talk to a child the same way you talk to an adult patient. You’re most likely only going to be able to speak and use words from a child’s primary discourse. They will have a better understanding because it is stuff they were taught in their own home, so it will be first nature to the kids, and they will have a better time understanding what you are saying to them.
The first article is from the journal of nursing scholarship titled “Relationships Between Nurse Staffing and Patients Experiences, and the Mediating Effects of Missed Communication” by Sung-Hyun Cho, this article is talking about patient and medical staff experience with each other. They had a study that surveyed patients asking about the overall care they were receiving and the communication they got while in the hospital (349). In this study conducted, “approximately one third of the patients experienced at least one adverse event” (Cho et al. 350). Meaning, one third of the patients had a bad connection/communication with the nurse (350), making them feel uneasy and not forming a bond with the nursing staff. Also, on the other hand the good part was that they find in this study that, “45.9% of the patient’s communication with nurses was listed as an “always” rating” (Cho et al. 350). So, a little less than half of the patients get outstanding care and communication while in the hospital (350). Yes, it should be one hundred percent of the time with one hundred percent effort from the nurses. But it can get very tiring at the end of shifts, so that is where the patients are receiving little to no communication. This article and study also show about how staff with lower schooling or lower status in the hospital have a hard time connecting and communicating well with the patients, so it is looked at as missed communication (350). And those nurses were getting a lower rating in the studies. When in reality they just don’t have a lot of knowledge or confidence in themselves to speak to the patient in a way that makes sense to both the staff member and the patient. It is all a blame game, “lower nurse perceived missed communication from the patient, but lower patient perceived missed communication from the nurses” (Cho et al. 347). So, therefore it is important for nurses to be on their A game all the time because they are always being watched and critiqued by everyone they are working with and working for.
The second article I am using is from Nurse Education in Practice titled “Communication skills in nursing: A phenomenologically based communication training approach” by Jennifer Bullington et al., This article talks about the “struggles of trying to learn effective ways to speak and communicate with patients, like giving bad news, discussing spiritual concerns, and communications about others culture” (Bullington et al. 136). In relation to the first article, these articles both look at researched approaches for better and more effective communication habits for nurses already in the field and students in school learning. This article also talks about how nurses have a hard time trying to communicate with their patients sometimes because they can’t separate the dialogues properly (136). So, they go over some studies and different methodology that they are trying to experiment with for learning to be more effective. This study is, “a communication training program based on phenomenology which provides a theoretical and practical training in person centered communication” (Bullington et al. 137). Essentially a better way to help the patients and other team members to all be on the same page and to feel empathetic. Put yourself in your patients’ shoes while they’re going through sickness and how you would want to be talked to or communicate with. This approach helps students use their knowledge and help patients with exactly what they need and not just a generic question (137). This approach started in Sweden in 1981 and has been a part of their curriculum in nursing education ever since (137). This approach helps reflect upon what your patient is telling you so you can give an answer pertaining to them and specific to them because a lot of times nurses and doctors give a generalized answer because they get the same questions asked repeatedly (138). It is also taught in this strategy of communication for students not to try to run from discomfort in situations. Often you are put in a sticky situation while being a nurse but that is why you must know when to say something, how to say something, and who to say it to and that’s what this phenomenological approach is all about.
The last article is titled “Use of stimulated patients to develop communication skills in nursing education: An integrative review” by Sharon Maclean et al., this article talks about the primary goals as a nurse to, “create and foster an environment of compassion, understanding, and empathy” (MacLean et al. 90) and your role as a student to learn the proper ways to approach those types of communication. This article and the second article relate the most due to the connection of trying to teach skilled approaches to nursing students who are learning and the best skill complexity to each and every one of them. But also, being able to understand that they are being taught and carry it through with them to the next steps, the higher levels of education and the workplace. This article also shows the importance of including your patients in decision making and planning because in reality it is their life (90). Dealing with “patients and families during difficult conversations can be challenging particularly about explaining complex treatment, mental issues, or discussions about the end of life” (MacLean et al. 91). These types of conversations are never easy for anyone, not even the nurses and doctors that may make it seem like they are okay. In most cases this gives an uneasy feeling or a feeling of anxiety in nurses and in students as well when in clinicals. Therefore, it is important to learn the specific qualities of effective communication. There were studies that took place “using SP’s (Stimulated patients) and showed the realization and utilization of SP has increased over the last decade and has had an increase in performance” (MacLean et al. 96). There are and have been tons of studies but this one showed a lot of improvement in nursing students compared to the ones that didn’t get the SP learning (96). The integrative use was very helpful in the way that “it showed students and made students feel the real stress, pain, anxiety, and agony of the “bad news” communication having to be delivered” (Maclean et al. 97). But it also allowed them to feel the relief of easy-going conversations between specific patients.
In conclusion, communication for nurses, doctors, or anyone in the medical field is important. It helps you connect to the patients so they can feel a sense of compassion while trying to get better and feel a burst of happiness again. It also helps you gain insight on how the patient and family feel as well as learning new day to day skills. It can show you how you may have to speak to people in different settings and the ways you can speak to people in a correct or incorrect manor. Communication in nursing can also teach you about thinking before you speak, and communication can be helpful in your learning process as well as your patients.
Bullington, J., Söderlund, M., Sparén, E. B., Kneck, Å., Omérov, P., & Cronqvist, A. (2019, August 28). “Communication skills in nursing: A phenomenologically based communication training approach”. https://www.sciencedirect.com/science/article/abs/pii/S1471595318303901.
Cho, S. H., Mark, B. A., Knafl, G., Chang, H. E., & Yoon, H. J. (2017, April 7). “Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care”.
MacLean, S., Kelly, M., Geddes, F., & Della, P. (2016, September 28). “Use of simulated patients to develop communication skills in nursing education: An integrative review”. https://www.sciencedirect.com/science/article/abs/pii/S026069171630212X.
Gee, James Paul. “What is Literacy?” In Negotiating Academic Literacies: Teaching and Learning Across Languages and Cultures. Ed. Vivian Zamel and Ruth Spack. Mahwah, NJ: Lawrence Erlbaum, 1998. 51-59