The Competency In Communication

Published Date: 02 Nov 2017

The following profile has been developed in alignment with the Nursing and Midwifery (NMC 2010) competency framework, which sets the standards that nursing students must acquire prior to being placed on the nursing register. Upon deconstructing the job specification (Appendix one), the three profile skill areas I will concentrate on are communication, partnership and assessment/intervention planning.

The job specification requires the applicant to develop and maintain communication via proactive engagement with patients, family and professionals, effective record keeping and the accurate conveyance of client information. This highlights the need for collaborative working and quality communication skills.

Partnership skills, collaborative working and leadership qualities are required by the need to provide supervision for nursing assistants and students, working towards effective multidisciplinary relationships and the co-ordination of the nursing team during a shift.

Management of change, collaboration and quality are required in the job description via assessment and intervention skills to measure patient progress, symptom management, relapse prevention planning and the ability to develop effective risk management and care plans with the patient.

The profile graph (Table one) demonstrates my strengths and weaknesses when measured against the NMC standards for pre-registration nursing education (NMC 2010). Effective communication, assessment skills and good patient and interprofessional working are the backbone of good quality care and are an aspect that I have been consistently demonstrated, to a high standard, within my pre-registration studies.

Table one: Profile Graph

1

Communication

2

Working in partnerships

3

Assessment and intervention planning

4

Delivery and evaluation of intervention

5

Ethical and culturally-competent practice

6

Health and safety

7

Promotion of health and well-being

8

Management and development of self

9

Management and development of others

10

Service development and improvement

11

Knowledge for professional practice

12

Research and evidence-based practice



Standard of proficiency for practice.

Throughout my placements, I have made use of reflection as a means of assessing my strengths and the development of my skills. My chosen model of reflection is the Gibbs (1998) model. Self-reflection is acknowledged within the Quality Assurance Agency for Higher Education (QAA 2001) benchmark statement on mental health (MH) nursing. This identifies nursing as "essentially a human activity which has at its core the relationship between the nurse and his/her client(s) and carers" (QAA 2001:8), where self-reflection, self-awareness and person-centred care helps to facilitate the needs of the client (QAA 2001).

Competency in communication.

In respect of my professional skills in communication, I have made good progress since beginning my nursing degree and feel that I have reached the required level of competency as stated by the NMC (2010).

The NMC (2010) identifies the criteria for meeting the communication competency as the ability to:

engage, support and facilitate therapeutic interventions.

ensure person-centred care and enhance quality.

gain, interpret and record…[the nurse’s]…understanding of people’s needs.

show sensitivity of the impact of abuse and trauma on people’s wellbeing and mental health.

enable psychosocial education, problem-solving and other interventions.

maintain accurate, clear and complete records, including the use of electronic formats, using appropriate plain language.

Whilst working with a community patient and their family, I was involved in discussions concerning increasing medication as the patient felt that the dose was insufficient. This involved negotiation with the patient, family and the doctor in coming up with a solution that was acceptable to all involved. I feel that this shows that I place good communication skills at the heart of my nursing care and through my communication skills; I have demonstrated good collaborative working between patient, family and professionals colleagues.

The Department of Health’s (DH) Knowledge and Skills Framework (KSF) (DH 2004) and Essence of Care Benchmarks (DH 2010) consider communication, using a wide range of resources and skills, as a quality component of nursing which underpins all the other dimensions and benchmarks (DH 2010, DH 2004). Communication involves the identification and recognition of what others are communicating as well as imparting information and is a vital leadership skill in "encouraging the effective participation of all involved" (DH 2004:54).

Mentor feedback (charge nurse, forensic placement) stated that I have ‘the ability to manage and lead a team and considers all the information, given by the team, in the decision-making process’. This was stated due to my proficiency in the running of clinical team meetings (CTM) and taking the role of the nurse-in-charge of numerous shifts. My collaboration with other staff ensured that everybody was clear about what was being discussed (Hutchings et al 2003) and what actions had been decided upon. Therefore demonstrating open communication as an important factor in leadership (Wheeler & Grice 2000), which involves keeping colleagues informed of changes.

Clear, accurate records that are both clear and legible are also a vital communication tool (NMC 2008). I have acquired the requisite quality standards for record keeping as defined by both the KSF and the NMC standards. My mentor (community psychiatric nurse, older adults placement) stated that my ‘record keeping and care planning was very skilled in terms of recording patient records and assessments’.

Communication as a core skill is also supported within the code of conduct (NMC 2008), which expresses that nurses must communicate information to patients "in a way they can understand" (NMC 2008:3) and in a manner that allows patients to make informed choices and share decision making (NMC 2010). I have demonstrated achievement in this many times, where comments from my mentors include ‘his communication skills have proved second to none, which he has used successfully in dealing with challenging behaviour’ (charge nurse, forensic placement) and ‘shows great engagement skills in a positive manner when de-escalating a distressed patient’ (mentor, adult acute placement). I feel that the above quotes show my demonstration of effective and safe care that provides as positive an experience for the patient as possible (DH 2013) as defined by the National Quality Board (NQB 2013).

Competency in working in partnership.

I have demonstrated excellent partnership skills throughout my previous career in MH and as a MH student. I feel that I have reached the level of competency required by the NMC (2010).

The NMC (2010) identifies the criteria for meeting the MH nurse partnership and collaborative working competency as the ability to:

work in partnership with other health professionals and agencies, patients, carers and families.

work with people in a way that values, respects and explores the meaning of their individual lived experiences.

practise in a way that addresses the potential power imbalances between professionals and people experiencing mental health problems.

maximise service user involvement and therapeutic engagement.

Partnership working is a widely recognised within MH nursing as an agreement of co-operation to achieve a common goal (Goodwin 2007), where commitment to working with colleagues, patients, families and external agencies is considered key in providing quality care (QAA 2001). This is further supported by the NMC code of conduct which states that "You must work with colleagues to monitor the quality of your work and maintain the safety of those in your care" (NMC 2008:5).

Partnership working is also considered as a vital capability within the essential shared capabilities framework (National Institute for Mental Health England/Sainsbury Centre for Mental Health 2004) via the development and maintenance of constructive working relationships with patients, family and colleagues.

As part of my clinical placements I have been fully involved in numerous multiprofessional meetings including, clinical team meetings, managers meetings and best interest meetings; all of which involves interprofessional partnership working. Willing participation and a high level of motivation are central to effective partnership working (Barrett & Keeping 2005) where collaborative working within teams utilises the skills and experience of all disciplines involved (Jessup 2007) and empowers the patient to be a part of the decision making-process (Pryjmachuk 2011).

Feedback from mentors and tutors includes comments such as my ability ‘to build trusting therapeutic relationships very quickly, while at the same time gaining the intuitive trust of the patient group’ (Staff Nurse, Forensic Placement) and ‘shows a clear understanding of the relationship between collaborative work, the recovery process and person-centred care where the wishes, views and hopes of the patient are incorporated into your work’ (Tutor, Oxford Brookes University).

I also show good leadership qualities in my role as an accredited City & Guilds Prevention and Management of Violence and Aggression (PMVA) instructor for Oxford Health NHS Trust. Goodwin (2006) describes leadership as having an influential relationship on others, needing leaders and followers and it intends real change which must reflect a mutual purpose. However, leadership does not always belong to one person (Wheeler & Grice 2000). As a PMVA instructor I work as part of a three-person team where shared leadership is practiced. Shared leadership is defined as a leadership approach where every team member carries responsibility for team processes and outcomes (McCallin 2003).

This role involves the delivery of training using leadership skills, direction setting and collaborative working (DH 2011:3). The use of PowerPoint© presentations and workshop training have helped me provide high quality education on issues such as personal safety, safe-restraint and de-escalation techniques. Upon being assessed for re-accreditation, my assessor highlighted my ‘ability to lead and manage a class using appropriate skills in managing and directing a class of students’ (PMVA manager, Oxford Health).

The Productive Mental Health Ward Programme (NHS Institute for Innovation and Improvement (NHSIII) is an initiative to develop ways to increase the amount of direct care time by way of improvements in effectiveness, safety and reliability of ward processes (NHSIII 2008).

To analyse the forces which assist and obstruct the implementation of change (Sale 2005) to the productive ward process, we can applying a three-stage Force-Field analysis (Table two), (Lewin 1951 cited in Grice & Wheeler 2000). Firstly, we can see that we first need to audit the effectiveness of current practice. Demonstrating that the current system is inefficient helps to facilitate the will change, thus ‘unfreeze’ the current situation. Once the will to change is achieved an effective collaborative plan of change can be discussed and agreed with all employees, thus effecting the ‘change’. Once change is effected we can then lock it in place by ‘refreezing’ and re-auditing to demonstrate better working practice.

Table Two. Force-field Analysis of the Productive Ward Process.

Ineffectiveness of current practice

Older practice "we have always done it this way"

Staff willingness to change

Change enforced by top down management. Non -collaborative approach

Demonstration of better working practice

Productive Ward embodies both collaborative working and requires transformational leadership to overcome resistance to change (Sale 2005). As part of my placement on a psychiatric intensive care unit (PICU) I was involved in the productive mental health ward process by participating in modules looking at the introduction of better handover recording and easier access to patient information modules. This shows a good contribution to improving quality and demonstrates the KSF core dimension 5 that relates to "maintaining high quality in all areas of work and practice, including the important aspect of effective teamworking" (DH 2004: 74). Upon qualifying as a MH nurse I intend to take up a leadership role within the remaining modules, upon my chosen ward, to aid in the facilitation of change. Thus providing high quality care that is safe, effective and provides as positive an experience as possible (DH 2008:5, NQB 2013), by freeing time to facilitate the quality standards under section 234 of the Health and Social Care Act (GB 2012).

Competency in assessment and intervention planning.

In respect of the competency for assessment and intervention planning, I have made excellent progress throughout my course and will maintain the required level of competency within my next placement.

The NMC (2010) competency on assessment and intervention requires the ability to demonstrate:

the application of knowledge and skills in individual and group interventions.

the ability to carry out systematic needs assessments, develop case formulations and negotiate goals.

proficiency in the development and implementation of care plans and evaluate their outcomes.

Recognition of the biopsychosocial factors that can contribute to crisis and relapse.

Clinical assessment and intervention skills are considered fundamental when working with patients with mental health needs (Barker 2009) and "permeates all aspects of nursing care" (Ryrie & Norman 2009:211). The KSF framework recognises the importance of quality assessment and treatment planning (DH 2004) by asking that staff be competent in the planning and development of care in order to promote health (DH 2004).

The ten essential shared capabilities (DH 2004) explain that it is essential for nurses to be able to engage patients in a collaborative assessment process that has, at its focus, the strengths and needs of the patient. This is further supported by government policy calling for "An assessment that provides an objective analysis of the current and future health and wellbeing" (Great Britain (GB) 2011:87). During my time working in an adults community placement I had the opportunity to partake and lead many assessments, ranging from core assessments, initial assessments, care planning, CTM’s and Care Programme Approach (CPA) meetings.

Wheeler & Grice (2000) discuss quality of care by explaining that it is only achieved and sustained by the dedication of the professional involved. They introduce a theoretical framework by describing a quality service as one that satisfies three criteria:

it must do what the patient wants.

it must be reliable.

it must represent good value.

In the case of assessment and intervention, the issue of meeting patient’s wishes is central; however the responsibility of the nurse to impose their knowledge remains an important factor. The combination of patient wishes and nurse knowledge allows for collaborative intervention decisions that are acceptable to both parties (Wheeler & Grice 2000). Reliability of the nursing interaction is an important factor in gaining the trust of the patient, without which we would not be able to build good collaborative working relationships. Good value care can be seen as one that "meets the client/clinician agreed needs, first time every time" (Wheeler & Grice 2000: 117). Feedback from placement mentor in this area have been positive, comments such as ‘Good ability to identify need, respond appropriately and handover changes in patient presentation’ (Staff Nurse, Eating Disorders Unit) and ‘involves the patients in every step of their assessment and care, even when it was not a treatment choice’ (Charge Nurse, Forensic Placement) demonstrate my achievement of good quality care as well as facilitating changes in patient care standards.

The CPA (DH 1990) has been described as the key structure used to assess and review the needs of mentally ill patients (O’Carroll and Park 2007) and is one of the core processes that underpin the National Service Framework (DH 1999) that was introduced to drive up quality within the NHS via clinical governance. The DH developed positive practice guidelines which outlines a "whole system approach" (DH 2008:27) via integrated pathways to improve quality at key points in care, facilitate collaborative working practice and ensuring quality of information (DH 2007). I have been involved in numerous CPA meetings throughout my time as a MH student. Portfolio feedback (Staff Nurse, Forensic Placement) has identified that I am ‘versed in risk assessment and able to demonstrate this with confidence’ and ‘the ability to complete core assessments and implement plans of care effectively’ (CPN, Older Adults Placement).

During my time as a student I have been nominated and short-listed for the National Student of the Year Awards (Nursing Times 2013). As part of this nomination I received positive supporting statements on my assessment and implementation skills such as demonstrating the ability to ‘play a full part in our teams’ clinical work, presenting information about patients in our weekly clinical team meetings and taking part in discussions about their care’ (CPN, Community Placement) and ‘implementing and planning care to a high standard relevant to the setting’ (Charge Nurse, Forensic Placement).

Personal Development Plan.

In terms of personal development, I have used a gap analysis to compare my current and required level of competency in order to identify areas of proficiency that require development. Despite being less proficient in health and safety, my gap analysis shows that I need to concentrate on the delivery and evaluation of intervention category as it has more emphasis within the post I am applying for. The job description requires the timely review of the risk management plan in order to help in the identification of opportunities of positive risk taking in collaboration with the patient and to work with patients in crisis management and relapse prevention; both of which would require effective skills in the delivery and evaluation of interventions (NMC 2010).

Using SWOT analysis to explore my personal opportunities in change management to further my career opportunities (Table three), I have built up my SMART goal and personal development plan.

Table three; SWOT analysis exploring personal change management.

STRENGTHS

Good assessment skills

Good communication skills

Collaboration at the core of my nursing

Good theoretical understanding of assessment.

WEAKNESSES

Underdeveloped skills in evaluation and delivery of care due to not having enough time in placement area.

OPPORTUNITIES

New placement with opportunity and time to follow process through (16 weeks).

Newly admitted patients in order to complete assessment, intervention planning, intervention delivery and evaluation process through

THREATS

Placement staff unwilling to facilitate student involvement.

Patient unwillingness to collaborate.

SMART Goal.

In light of my personal SWOT analysis my SMART goal is:

By the end of my next placement, (7th July 2013), I will have received positive confirmation on the improvement of my evaluation skills to bring it in line with the NMC (2010) competency framework for inclusion on the NMC register.

Action Plan.

Have an initial discussion with my mentor on the opportunities available to achieve this goal.

Assess a patient’s need and devise an intervention care plan.

Deliver and evaluate the plan of care in line with quality standards.

Present effectiveness of intervention and suggested changes at patients CTM.

Gain feedback on effectiveness of my care delivery and evaluation skills.

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