- (2012) Volume 6, Issue 1
Fotoula P. Babatsikou1 and Georgia K. Gerogianni2*
1Assistant Professor of Nursing, Laboratory of Community Heath Nursing, Department of Nursing A΄, Technological Educational Institute (T.E.I.) of Athens, Greece
2Lecturer of Nursing, Laboratory of Community Heath Nursing, Department of Nursing A΄, Technological Educational Institute (TEI) of Athens, Greece
Background: A role-play situation is designed to reflect the interaction between a care provider and a patient in order to implement the expected therapeutic outcome. The most important themes derived from a role-play situation are understanding, self-disclosure and trust, respect, truth telling and honesty, power and interpersonal conflicts, empowerment and support, reflective thoughts. Method and Material: Literature review based on studies and reviews derived from international (Medline, PubMed, Cinahl, Scopus) and Greek (Iatrotek) data bases concerning nurse-patient relationship in the context of therapeutic communication, using the following key words: Role play, interaction, communication skills, patient, therapeutic outcome Results: The issue of understanding is present in each role-play situation. Self-disclosure is an important issue in a role-play situation, since it allows patients to trust nurses. Additionally, during a role play situation the nurse needs to respect the patient, while honesty is closely associated with trust and affects the credibility of the care provider. Also, care providers need to be tolerant during their interaction with their patients in order to avoid any interpersonal conflicts. Conclusions: The use of a role play situation between a nurse and a patient is very important, because it can contribute to the implementation of the expected therapeutic outcome. However, a theoretical basis is essential for an effective interaction between patients and nurses.
Keywords
Role play, interaction, communication skills, patient, therapeutic outcome.
Introduction
Communication is an essential component in people’s life, since it gives them the opportunity to exchange opinions, thoughts and ideas. Communication is transactional, since people can affect or become affected through their interactions [1]. Effective communication is of great importance in the clinical area, as it can contribute to the implementation of the expected therapeutic outcome. The last years nursing inquiry has been mostly focused on the nurse-patient relationship in the context of therapeutic communication [2].
A role-play situation is designed to reflect the interaction between a care provider and a patient in order to implement the expected therapeutic outcome. It is very important that health professionals should have the ability to apply effective communication skills during their interaction with their patients [3].
The most important issues derived from the analysis of a role-play situation are as follows:
• Understanding
• Self-disclosure and trust
• Respect
• Truth telling and honesty
• Power and interpersonal conflicts
• Empowerment and support
• Reflective thoughts [3].
Understanding
The issue of understanding is present in each role-play situation. Nurses have to use the appropriate listening skills in order to understand patients’ problems. Understanding is of vast importance in the context of therapeutic communication, since it enables nurses to explore patients' problems and effectively support them [3]. For this purpose, nurses have to use active listening in order to let patients know that they hear and understand them and collect useful information about their condition.
Although a considerable number of health professionals use listening skills when communicating with patients, few of them use these effectively [4]. When care providers use active listening during interaction with their patients, they encourage them to express their fears and worries, while they have the ability to control the conversation and collect accurate information about their condition [5].
Self-disclosure and trust
Self-disclosure is an important issue in a role-play situation, since it allows patients to trust nurses. Self-disclosure is essential in the context of therapeutic communication, since it helps health professionals to gain patients' trust [6]. People who self-disclose are open, honest, authentic, warm, friendly, free, together, strong, trusting, and maturing personally and interpersonally [7]. Care providers need to disclose their emotions to patients in order to build a therapeutic relationship with them. Self-disclosure helps patients to reduce their anxiety and their psychological concerns [8].
Apart from self-disclosure, nurses need to create a friendly relationship with their patients and gain their trust during a role-play situation. For this purpose, they need to encourage patients to speak freely, promising that they will not break their confidentiality. Once a person is trusted, his or her ability to influence others is greatly enhanced [9].
Trust plays an important role in human relationships. So, nurses need to keep their promise and maintain a good relationship with their patients. Otherwise, breaking a promise is hurtful for them, as they regard nurses as the most appropriate persons to help them. A considerable number of patients cannot fully trust their nurses, even if they feel the necessity to express their pain. Consequently, nurses need to develop effective communication skills with their patients in order to gain their trust during a role play situation [3].
Respect
During a role play situation, nurses need to respect their patients, since respect helps them to form a good opinion of nurses and open their heart. The notion of respect has a close relationship with trust, honesty, and understanding, and is of great importance in the context of therapeutic communication [3]. It is important that nurses should perceive emotions and attitudes of their patients in order to create an effective communication with them [6].
Truth telling and honesty
The issue of truth telling and honesty is present in a role-play situation. Honesty is closely associated with trust and affects the credibility of the care provider, as it makes patient trust his nurse [3].
Honesty can contribute to therapeutic communication, as it helps patients to be informed about their condition and deal better with their problem [10]. Additionally, information can reduce anxiety and improve patients’ recovery process. In a role play situation the patient needs to be aware of what to expect from the care provider, in order to be willing to co-operate with him [11]. So, it is important that nurses and other health professionals should be honest during their interaction with their patients.
Power and interpersonal conflicts
Interpersonal conflicts occur frequently in a health environment and health professionals need to manage them effectively. For this purpose, care providers need to be tolerant and keep their temper during their interaction with their patients, and try not to show irritation [8].
People who use power have the ability to control behaviors, gain compliance and change beliefs, and thus, it is essential in human relationships [12]. On the other hand, the use of power is a cause of conflict [13]. Consequently, care providers need to play a conciliatory role in their interaction with aggressive patients during a role play situation.
Reflective thoughts
Reflecting is a kind of interpretation of what other people say. Reflective thoughts help nurses to provide assistance to their patients by understanding and confronting feelings and emotions which are expressed indirectly. Additionally, reflective thoughts help nurses to interpret what patients say and find strategies to interact with them effectively during a role play situation [14].
Empowerment and support
The issue of empowerment and support is the initial purpose of each nurse in the context of therapeutic communication. Patients need to participate in their own treatment [11], while health providers need to protect patients' rights and make them feel confident to make their own decisions [15]. Similarly, there is a need to facilitate the patient in arriving at free choices in determining his progression through health or disease [16].
Moreover, in a role-play situation, the nurse has to empower patient to deal better with his problem and provide him with accurate information about his condition. The provision of accurate information and encouragement help care providers to create a therapeutic environment with their patients during a role play situation [17].
Theoretical frameworks for the analysis of a role-play situation
A variety of communication frameworks and processes can be used to guide the analysis of the interaction in a role-play situation. The Intersystem model serves as useful guide for nurses, since it is focused on the assessment of biological, psychological and spiritual subsystems of people, as well as the environment affecting them, and supports nurse-patient collaboration in the provision of effective care [18]. Communication frameworks have many different formats but they all contain the following elements:
1. The sender
2. The receiver
3. The message
For the analysis of the interpersonal interactions of a role-play situation, nurses can use the three-stage model of the counseling process. This model helps the patient to explore, understand and act, while the helping relationship aims to establish warmth and rapport, to clarify problems, to set goals, to identify ways of action and evaluate their effectiveness [8]. Moreover, nurses can follow the psychoanalytical approach to counseling, where the counselor intends to establish a clear picture of the patient's early development and life experiences, while he/she tries to uncover previous repressed conflicts in his life [20].
Additionally, nurses can use the cognitive approach to communication which focuses on people's opinion, considering them to be active participants in their learning [20,21]. In a role-play situation the nurse has to give patient the opportunity to express his opinion about his problem and participate in decision making. The counselling relationship includes eight stages, which are as follows:
1. Meeting the patient.
2. Discussion of the surface issues.
3. Revelation of deeper issues.
4. Ownership of feelings and possibly emotional release.
5. Generation of insight-the patient’s life is viewed by them in a different light.
6. Problem-solving and future planning.
7. Action by the patient.
8. Disengagement from the counselling relationship by the patient [20].
Furthermore, for the analysis of the interaction between a nurse and a patient, the nurse can utilize the communication strategy for conformity or diversity [22]. This type of communication plan usually views communication and information as means of control and conformity in terms of knowledge, attitudes, values, and behaviours. Additionally, strategies of supportive communication can guide the conversation between the nurse and the patient and result in a supportive solution [23]. For applying the principles of supportive communication, the interviewer needs:
1. To focus communication on specific behaviours
2. To be congruent
3. To be descriptive towards other people
4. To be conjunctive
5. To adopt supportive and active listening
6. To accept responsibility for his/her own prejudice [23].
When nurses apply the above principles during a role play situation, they can create the appropriate environment for the provision of effective counselling and support to their patients.
Conclusion
Nurses need to have the ability to communicate effectively with patients in order to achieve the desirable therapeutic outcome. For this purpose, the use of a role play situation between a nurse and a patient can contribute to the implementation of the expected therapeutic outcomes. However, a theoretical basis is essential for an effective interaction between patients and nurses.
Apart from good care providers, nurses should be good counsellors in their interaction with their patients. They also need to be honest and friendly in order to create a therapeutic relationship with patients. Finally, it is very important that nurses should be able to deal effectively with different types of patients and maintain the therapeutic environment during a role play situation.
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