Knowing Patients as People Key to Good Communication, Nurses Say
Nurses emphasize the importance of developing relationships with Parkinson’s patients in their care and getting to know these people as individuals for effective communication in healthcare settings, a study from Australia reports.
People with Parkinson’s often experience trouble communicating — the disease commonly causes difficulty with speech, and its cognitive and emotional changes can further complicate interactions with others.
Difficulties in communicating can cause substantial frustration and poorer outcomes in a healthcare setting, both for the person receiving care and the clinicians giving care. In this setting, Parkinson’s nurses often play a key role in communicating with patients, and many nurses have honed skillsets to help navigate situations where communication is difficult.
Scientists in Australia conducted semi-structured interviews with nine Parkinson’s nurses to learn more about the strategies they use.
“Understanding more about these skills could assist other health professionals in knowing what they can do in their own healthcare settings to improve healthcare communication and improve the quality of healthcare for those with Parkinson’s,” the researchers wrote.
Many of the nurses stressed the importance of treating each patient as an individual, and devoting time and energy to developing an ongoing relationship with the person and giving them emotional support.
“Communication is much enhanced when you’ve got that relationship with a person,” one nurse said.
“If nothing else, I’m someone at the end of the telephone, maybe to just troubleshoot things with or provide that emotional support,” said another.
The nurses also stressed the importance of working with each individual to find ways of communication that are most effective for them, and letting the patient decide what is and is not important.
“I’ll give you one example of a patient who has got a terrible stutter. He’s in a nursing home. He’s been known to speech pathologists for years … He knows all the strategies. He knows how to not stutter. But he chooses not to not stutter,” said one nurse.
When difficulties arise, a number of approaches were noted. For example, the nurses said that replying on simple language, like yes-or-no questions, or pictures can help some with cognitive challenges.
“If you are trying to explain something complex, you need to break it down to simple parts, so that the complexity of it makes sense,” said one nurse.
“Sometimes they prefer a whiteboard and a marker, or just a little notebook to help them express themselves,” a nurse noted.
The nurses emphasized the importance of checking in with patients to ensure their understanding, especially when it comes to complicated medical information.
“I’m quite open about saying, ‘Did I make myself clear, you know, are you understanding me?'” one nurse said.
Nurses also stressed the importance of giving Parkinson’s patients tools they can use to help overcome their own obstacles, and supporting them in implementing those tools.
“I would do the strategies with them. You know, ‘Stop. Take a deep breath.’ Get them to think big, think loud,” said one nurse.
Another spoke of reminding a patient, “was there anything the speech therapist was saying to you about what might help you?”
The nurses generally agreed that, when working with Parkinson’s patients in a healthcare setting, it is good to have a solid understanding of the disease, and to consider how the disease manifests in a person, as this can help to inform communication strategies. For example, one nurse said that drawing or writing may be useful for people with difficulty speaking, but might prove challenging for people with a tremor. Picture-based communication also can be challenging for those with cognitive impairments.
“Parkinson’s will not let you force anything; it’s got a mind of its own. I think you’ve just got to adapt around it,” one nurse said.
In general, strategies tend to evolve over time, and grow refined as nurses and patients develop a deeper working relationship, the nurses said. They noted that, particularly in latter disease stages, family members and other caregivers may be helpful in facilitating communication — while noting that caregivers could end up drowning out the patient’s voice.
“Participants described caregivers as helpful and sometimes necessary in facilitating the healthcare interaction, particularly as Parkinson’s signs of progress and communication and cognition become more affected … Parkinson’s nurses also acknowledged that caregivers sometimes speak over or for the people with Parkinson’s,” the researchers wrote.