Effective Communication in Nursing Progress Notes: A Case Study

This report analyzes a nursing progress note focusing on a 73-year-old Aboriginal male in transition care. It explores the significance of effective verbal and non-verbal communication and health literacy in healthcare. The report highlights the importance of comprehensive and accurate nursing progress notes for informed clinical decision-making and patient care. It examines how the nurse's communication, both verbal and non-verbal, impacted the patient's experience, particularly in an aged care facility. The analysis emphasizes the need for nurses to demonstrate empathy, provide mental support, and ensure the patient feels secure in their new environment. The report also identifies the need for detailed documentation of the patient's health issues and transition care requirements. The conclusion reinforces the thesis that detailed nursing progress notes are crucial for providing effective patient care, especially during transitions, and underscores the importance of patient education and communication.

LITERACY AND COMMUNICATON FOR HEALTHCARE
Name of the Student
Name of the University
Author note

Introduction
• The nursing medical note is the medical note or the medical healthcare record which is
kept by the nurse which provides an effective reflection of the assessments of the
nursing, the changes in the conditions of the patients, the provided care and all other
relevant information for supporting the clinical team.
• The thesis statement is that ineffective nursing progress note can hamper in providing
effective care to the patient.
• The complete and accurate nursing care are important to make perfect decisions for
taking care of patients.
• The given case study is about a 73 years old aboriginal male who was about to get a
transition care but because of the lack of communication he has not received such care.
• The nurse could have used the verbal and non-verbal communication in a much effective
way in order to provide the patient effective care.

Importance of literacy and communication in the
healthcare
• The health literacy and effective communication in between the nurses and in
between the patients and the doctors is one of the key aspects in the
improvement of the health and also in the improvement of the quality of the
care which is provided to the patients.
• Literacy refers to the ability of any person to read or to write and the
communication is the way the nurses speak with the patients (Attai et al., 2015).
• It really becomes difficult for a patient to talk with the doctors or the nurses if
the person does not have the minimum of the health literacy, so it is important
for everyone to have the minimum of the medical literacy.
• Effective communication provides the care providers and the care takers to
receive the highest quality of healthcare .

Using of non-verbal communication in the
progress of nursing
• The ability to use the non-verbal communication is one of the effective tools
which help the healthcare professionals to communicate properly with the
patients (Small et al, 2015).
• The providers must be conscious enough that the patients are able to
understand in details all the body languages of the nurses (Choi, Song & Oh,
2015).
• In the given case study, the body language of the patient has described that
he was really very upset about the fact of being transferred from his own
country.
• His slumped body posture showed that he told that he told the truth that he
had not eaten anything since the last three days

• The nurse was able to note down in the progress note about the body
language and activities of the patient but she has nor mentioned
anything about her own non-verbal actions, the care she showed to
the patient.
• The nurse could have shown such care to the patients so that he
would have felt secured in the new place. He had already reported
that he has been feeling very upset in the new age care facility and
also he was not getting proper care in the new place.
• It was the duty of nurse to show the aged person such attitudes that
he feels he is in his own place (Abdolrahimi et al., 2017)

Using of verbal communication in the progress of
nursing
• The verbal communication is the most efficient way of communicating
with the patient as it involves direct communication between the
nurses and the patient (Kiani, Balouchi & Shahsavani, 2016).
• In the given case study, the nurses had been able to note in details
about each and every details of the statements of the patient but
nothing has been mentioned about the way the nurse communicated
with the patient.
• So it can be said the verbal communication that the nurse followed
was actually not appropriate in taking care of an aged person in an
aged care facility.

• The nurse should have shown much love, care and confidence so that the mental
conditions of the patient get improved (Batch & Windsor, 2015).
• The nurse should have communicated with the patient politely and should have
used such languages which can increase the confidence level of the patient.

The transition care required for the patient to
progress
• In the present case study, the patient has got shifted from the old
aged care facility to a new aged care facility in Toowooomba, so it is
quite obvious for the patient to find some difficulties in adjusting in a
new aged care and that also in a different city.
• In the new aged care center, the patient is supposed to get a new
treatment according to the new care plan.
• Firstly, the aged person needs mental support so that the confidence
level of the person gets increased.

• The person also need to feel a homely environment as he is living without his
family members and also he changed the old aged care facility because that city
has suffered from severe flood (Sprangers, Dijkstra & Romijn-Luijten, 2015).
• According to the statements of the patient as noted down by the nurse, it can be
concluded that the patient is going through extreme mental trauma for which he
can be counseled by psychiatric apart from providing only the mental support.
• The health conditions are also required to checked, especially the person need to
reduce his weight and also he need to check the oxygen saturations and the
respiratory rate of the parson.
• The progress note do not contain detail information about the health issues that
the person is suffering from.

Conclusion
• The thesis statement is thus proved that if the nursing progress note
do not contain detail information about the health and the mental
issues then it is not possible to provide the patient with effective care
and especially when the patient changes the aged care facility.
• The communication as well as the patient education is also important
in order to make the patient feel the need to understand in details
about the issues from which he is suffering.

References
• Attai, D. J., Cowher, M. S., Al-Hamadani, M., Schoger, J. M., Staley, A. C., & Landercasper, J.
(2015). Twitter social media is an effective tool for breast cancer patient education and support:
patient-reported outcomes by survey. Journal of medical Internet research, 17(7), e188.
• Choi, Y., Song, E., & Oh, E. (2015). Effects of teaching communication skills using a video clip on
a smart phone on communication competence and emotional intelligence in nursing
students. Archives of psychiatric nursing, 29(2), 90-95.
• Small, J., Chan, S. M., Drance, E., Globerman, J., Hulko, W., O’Connor, D., ... & Ho, L. (2015).
Verbal and nonverbal indicators of quality of communication between care staff and residents
in ethnoculturally and linguistically diverse long-term care settings. Journal of cross-cultural
gerontology, 30(3), 285-304.
• Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic
communication in nursing students: A Walker & Avant concept analysis. Electronic
physician, 9(8), 4968.