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Giving patients the opportunity to communicate their needs well

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I distinctly remember revising the six Cs for my university nursing interviews.

I would recite them over and over again the night before. At the time, I thought I had a pretty good idea of what nurses do and how the six Cs encompassed that. However, now in my third year, I have a completely different perspective on what the six Cs truly mean and what they represent.

I am definitely more of an introvert, so one of the biggest ‘challenges’ I faced going into nursing was combatting nerves when communicating with lots of different people.

I have been surrounded all my life by chatterboxes – namely by older brother, my mum and my grandmother. It wasn’t that I didn’t want to talk to anyone, it was just I didn’t want to say the wrong thing, offend or overstep the mark. Nursing, therefore, was the exact definition of throwing myself in the deep end and I learnt fast.

By the end of first year, I felt competent and quite proud that I could hold a conversation with anyone. That was until my first placement, in my second year, where I was placed on a head and neck ward.

Before this placement, I had never really had experience of looking after patients with tracheostomies. I didn’t realise it at the time, but I was about to learn a completely new set of communication skills. 

”In other settings, it can be easy to take for granted that our patients can speak without difficulty”

When people have tracheostomies they can speak – normally using a speaking value - although this can be very difficult, particularly when they are first inserted. They cannot talk well because the air that would normally pass over the vocal cords, now passes over the tube instead.

Having a tracheostomy can be very hard to deal with. It doesn’t matter whether the surgery was elective, semi-elective or done in an emergency; a patient with a tracheostomy or laryngectomy in situ can feel a loss of independence, and the tube can cause big body image issues.

However, it is important to note that tracheostomies do in fact preserve life, and that only a few patients are discharged with a tracheostomy in situ. So for most patients this is a short-term predicament. 

Nursing for these individuals was tough at times. In other settings, it can be easy to take for granted that our patients can speak without difficulty. The simple fact that they can tell you their worries or if they are in pain in less than 10 seconds often goes unnoted. In comparison, patients with tracheostomies struggle and become largely frustrated due to a decrease in their ability to speak clearly.

On the ward, we communicated largely through whiteboards and lip-reading, as well as using vocal speech when patients were able to do so. Over the eight weeks I was on placement, I almost became a proficient lip-reader, a skill which has undoubtedly helped me as I have progressed through my nursing training.

One of the biggest struggles I faced was convincing patients with tracheostomies, that there was no rush and that they could take their time telling me whatever they needed to. It was difficult to watch numerous patients repeatedly give up due to their frustration of not being able to talk coherently. 

This made me even more determined to make them feel better about having a tracheostomy. I hoped that by showing how unbothered I was that I was taking some time to understand what they were saying and that they too would begin to feel the same and put less pressure on themselves.

Even if it was just in those 15 minutes I spent with them, I hoped that the burden of having a tracheostomy seemed less.

While patience was a skill I knew I already had, it evolved and expanded beyond my expectations while on this placement.

I remember trying to help soothe and calm a patient who struggled immensely with his tracheostomy. During the night he became very panicked and anxious but was struggling with communicating just why he was in such a panic.

”This episode really showed me how important it was that we take our time”

However, having been on placement for six weeks already, I knew how to deal with the situation and immediately worked together with my mentor to soothe him and talked him through the worries he had managed to write on his whiteboard.

This episode really showed me how important it was that we take our time and give all patients the opportunity to communicate their needs well. 

As a result of this placement I now make sure I take my time with every single one of the patients I look after. It’s not as though before this I rushed or declared I was too busy to listen to patients’ concerns, but it is a placement like this that makes you pin back your nursing approach and go back to the basics.

Maya Angelou said it best when she stated ”I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel”.

The six Cs of nursing were developed to show the professional commitment nurses make to deliver excellent care. Although they seem such simple things to remember, they make such a difference to our patients and the care we deliver.

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