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The teaching of communication as a subject within nursing curricula is now well established. In the seventies the teaching of psychology produced in students, what researchers then described as a state of "psychological mindedness", meaning that whilst students acquired some theoretical knowledge about human behaviour, the practice of communication with patients and clients was little affected. In the late seventies and early eighties in the UK and USA discrete units of study were established to teach the more practical aspects of communication within health care settings. Such units of study have been an integral part of nursing curricula in Australia since nursing education moved into the university sector.A number of dilemmas however have been posed by factors such as large classes, group sizes, the need for expert facilitation and feedback and the constraints (and possibilities) imposed and afforded by institutional expectations regarding teaching methodologies and cost effectiveness. The authors have been teaching communication in nursing for seven and six years respectively to both pre and post registration nursing students by both the attended and distance mode of study. One of the major challenges in teaching and learning in this area is provision for recognition and analysis of examples of both good and bad practice. Aware of this and of the other factors summarised above and also cognisant of the relative dearth of good audio visual material it was decided to seek funding to produce a learning package.
This paper describes the production of a video and workbook to teach caring communication and the lessons that have been learned by the authors. In production the video utilised both professional actors and professional nurses. Thirty three scenarios in five major groupings are depicted. The demonstration will include use of some of the material and discussion of the applications.
Early in the development phase it was agreed that the content focus would relate to the communication skills of listening and questioning within the context of interviewing, defined broadly as a conversation with a purpose. In the experience of the writers and as supported by numerous authors for example Faulkner (1992), and Kagan et al(1995) these are pivotal communication skills for health professionals. With this focus in mind the original three authors collaborated on the writing of scripts around credible health care scenarios. We were aware of the need to provide a framework for learning which would go beyond the symbolic and iconic and move towards the enactive mode of representation, Bruner (1967).With the scripting task unfinished by the end of the first semester the participants agreed to put in their own time to complete the project. The second half of the year saw the completion of the scripts and the compilation of story boards ready for filming. The story boards were later abandoned as unnecessary when there was a change of producer in the middle of the project!
The decision to hire professional actors for most of the characters was taken on the advice of the producer. Professional nurses were also invited to apply for parts. Following audition, two professional nurses were selected for major parts and seven actors were hired to portray one or more characters. Selection was made following viewing of audition tapes. Concern about the credibility of the subtle nuances of communication expressed by actors portraying communication behaviours of health professionals was discussed but not considered to be a major problem.
Following rehearsals and set creation for all the scenes, to be shot entirely in the studio, filming was commenced and completed in July 1994. Although the script writers were able to be present for part of the filming, it would in retrospect have been more functional for the content experts to have had direct input throughout all the filming, to facilitate immediate feedback on actor interpretations of subtle communication behaviours. Editing and compilation of the final tape with subtitles and commentary completed this part of the process.
In designing the print materials, flexibility of use was a paramount consideration. Potential for use by both individuals and groups with or without a facilitator and potential for analysis at different levels of theoretical sophistication, depending on student entry behaviour were all factors which influenced the final design. The outcome is a workbook which directs students to relevant readings for theoretical input, invites observation, analysis, and reflection. We are cognisant of the work of Boud et al(1985) and feel that we have provided the conditions where reflection can be a major activity within the learning experience. No answers, solutions or "correct" interpretations are given. This reflects the position of the authors and others, which is that all communication is contextual, De Vito (1995). Although at the poles on a continuum, functional and dysfunctional communication can be identified, students and practitioners need to be able to understand, analyse, explain and justify their choices within a given context.
The content of the print materials which matches that of the video is divided into five scenario sections. Each scenario features a number of sequential or related vignettes as follows:
Scenario One - Listening
Vignettes: Too busy to listen; Hearing but not listening; Taking time to listen; contracting to listen; Empathic reflective listening.
Scenario Two - Conflict
Vignettes: Disinterest in the feelings of others; A collaboration of ideas; Confrontation; Resolution through reflection.
Scenario Three - Sensitivity
Vignettes: Establishing rapport; Time to comfort; Not reading the message; Facing feelings; Empathy
Scenario Four - The Interview
Vignettes: The nurse's agenda; A client focused introduction; An empathic approach; Clarifying concerns; Drawing information together; Summarising.
Scenario Five - Roadblocks
Vignettes: Parroting; Sympathy; Advising; Threatening; Empty reassurance; Diagnosing; Diverting; Using a cliche; Ordering; Criticising; Moralising; False understanding; Excessive and inappropriate questioning. The roadblocks have been based on Gordon's dirty dozen communication spoilers, Gordon (1970) cited in Bolton (1994).
It was originally intended that we include screen grabs of video scenes to be printed in the work book with the text. Although much work was done towards this end, the final version of the print materials does not include pictures, largely for cost and technical reasons.
Boud, D. Keogh, K. and Walker, D. (1985). Reflection: Turning experience into learning. London: Kogan Page.
Bruner, J. (1967). Toward a theory of instruction. Cambridge Massachusetts: Harvard University Press.
De Vito, J. (1995). The interpersonal communication book (7th ed.) Sydney: Harper Collins.
Faulkner, A. (1992). Effective interaction with patients. Melbourne: Churchill Livingstone.
Gordon, T. (1970). Parent effectiveness training: The no lose program for raising responsible children. New York: Peter H Wyden.
Kagan, C. and Evans, J. (1995). Professional interpersonal skills for nurses. Melbourne: Chapman & Hall.
McGregor, A. (1993). A way forward: A review of the project - open learning for rural, remote and disadvantaged students through multi media packages. Perth: Edith Cowan University.
| Authors: Tony Hussey and Yvonne Hauck Faculty of Health and Human Sciences Edith Cowan University, Perth, Western Australia Email: a.hussey@cowan.edu.au, y.hauck@ cowan.edu.au Please cite as: Hussey, A. and Hauck, Y. (1996). Teaching "Caring Communication" to nursing students. Different Approaches: Theory and Practice in Higher Education. Proceedings HERDSA Conference 1996. Perth, Western Australia, 8-12 July. http://www.herdsa.org.au/confs/1996/hussey.html |