Communication Skills for Midwifery Practice

Part A
By Richard Byrt Former Lecturer/Practitioner, Nursin !e Montfort "ni#ersity,
Leicester and Arnold Lode Medium Secure "nit, Nottinhamshire $ealthcare N$S
%rust&
Ada'ted for midwifery (y )ac*ui +illiams, Senior Lecturer in Midwifery
,&,& -ntroductory Notes
Welcome to the lectures and exercises on communication skills.
A list of recommended reading/references is at the end of this handout.
The examples of clients based on the lecturers practical nursing experience are fictitious
and not intended to describe clients in local services or elsewhere.
The terms woman and midwives have replaced the original terms of clients, patients,
residents and other users of health services.
,&.& Aim of Lectures/%o'ics for Consideration
The aim of the lectures is to enhance our reflection on, and understandin of
communication and thera'eutic 'rofessional / client relationshi's in midwifery.
Topics include
The meaning of communication. 0er(al and non #er(al communication in midwifery
+hy effecti#e communication is essential for good midwifery care.
Acti#e listenin to women.
1m'athy the importance of womens perspectives.
The concept of 'resence in relation to non verbal communication and empathy.
The influence of cultural and other factors on communication.
Nursin and Midwifery Council 2NMC3 re*uirements for effective communication,
respect and dignity.
+omen with s'ecific communication needs.
Communication in health 'romotion&
,&4& Methods to 1na(le Reflection and "nderstandin of Communication
1
!uring the lectures on communication, a variety of methods will be used to enable reflection
on communication and to gain information about specific communication skills in nursing.
Some of these methods may (e new to you, (ut it is suested that you i#e them a
try, as they may enhance your reflection on communication in midwifery& We will
consider
The use of women5s accounts of their care in 'rose .
16ercises involving two or three midwifery students.
Research studies and other literature on communication in midwifery , especially on
clients experiences of communication with midwives.
.&,& +hat is Communication7
"#arroll and $ark %&''() define inter'ersonal communication 2communication (etween
'eo'le3 as
*The process by which information, meanings and feelings are shared by people
through the exchange of verbal and non + verbal messages,.
%" #arroll and $ark, &''(, p-'.).
%The word *meanings, in "#arroll and $ark %&''(), probably refers to things that people
understand or experience).
.&.& 0er(al and Non 8 0er(al Communication
0er(al communication refers to using speech and writing to share thoughts, feelings
and ideas with other people.
Non 8 #er(al communication includes all other ways that people share their thoughts.
feelings and ideas e.g.
/acial expressions.
Touch.
0estures such as nods of the head.
1ilence.
The way people sit or stand.
The space they maintain between them.
%Arnold and 2oggs &''(, 1ully and !allas &'-')
Aspects of verbal and non + verbal communication are considered in more detail later in this
handout.
4& +hy 1ffecti#e Communication is an -m'ortant Part of Professional Care
3ffective communication is a #ital 'art of midwifery and other 'rofessional care for the
following reasons
2
3ffective communication enables holistic care caring for the whole person and her/his
many needs, instead of concentrating on only one aspect of care, for example, physical
health needs %American 4olistic 5urses Association &'--, 4unter et al &''6, 7c8enna
and 1levin &''6).
0ood communication skills help the health professional to a''reciate and understand
the woman5s feelins and 'ers'ecti#es e.g., her perception of health needs. This
understanding constitutes part of em'athy %Arnold and 2oggs &''(, 2utler et al &''6).
3mpathy includes an a''reciation of the woman5s 'ers'ecti#es related to as'ects of
di#ersity e.g., her culture, spirituality, ethnic group, age, gender, sexual orientation and
gender identity %Andrews and 2oyle &''6). %S'irituality refers to the individuals
important religious and other beliefs9 and their sense of hope, purpose and what gives
their life meaning %7c1herry &''.). 9ender identity refers to the persons sense of
herself/himself as a woman/girl or as a man/boy %$oorman &'':).
1ome women have s'ecific communication needs. ;t is not possible to provide
assessment, care and treatment unless the midwife adapts her/his communication to the
clients needs related to their specific communication skills and problems %Arnold and
2oggs &''().
Research findins from different health care settins suest that:
o Clients are more satisfied, and less an6ious if there is effective communication and a
therapeutic professional + client relationship %2yrt et al &''6, 4unter et al &''6).
An example from nursing suggests that there is evidence that some nurses a#oid
communicatin with certain clients e.g., people who are dying %Taylor &''.)9 or who
are seen as *difficult, e.g., because they dont *fit in, with ward regimes or staff
expectations %!uxbury &''', 1tockwell &''<).
o 7any com'laints from clients and their carers at home are about poor communication
from health professionals %=angland et al &'':, The $atients Association &'': This is a
voluntary organi>ation concerned with the health and welfare of patients and clients).
Clients who do not s'eak or understand 1nlish sometimes ha#e less access to
health ser#ices and rele#ant information %$eckover and #hidlaw &''(, Tribe and
?aval &''@).
o 0ood communication skills, particularly relieving anxiety and giving clear information,
result in 'ositi#e outcomes in 'hysical and 'sycholoical health followin surery
2o'erations3 and other 'rocedures %7orrison and 2ennett &'':, Taylor &''.). 7any
studies have found statistically significant positive outcomes %that is, these outcomes are
unlikely to have occurred by chance 0errish and Aacey &''.).
o 3ffective communication, including clear information, can im'ro#e the health of 'eo'le
with lon 8 lastin illnesses e.g., diabetes and asthma %7orrison and 2ennett &'':)
and with illnesses which may recur %occur again), such as schi>ophrenia %0amble and
2rennan &''.).
o #ommunicating in ways which are meaningful and understandable to clients may,
amongst other factors, ena(le indi#iduals to make informed choices related to their
own health or that of their children 2includin un(orn children3& This has been found
in research on breastfeeding %Wood &'':), cessation of smoking and changes in diet
%7orrison and 2ennett &'':).
3
;&1ffecti#e Communication in ,<<< and %oday
*As long ago as -666, 3va Auckes, B7atron of the ?oyal Aondon 4ospitalC, referred to the
importance of goodDcommunication with clients
*It is especially when your patients are weak and helpless and irritable, that you need
to be gentle and considerate towards them; they are so completely in your power,
and they may so easily be made to suffer more than they need do, by your having a
sharp way of speaking, a rough touch, or a grumbling manner of attending to them.
%Auckes, -666, p-<, Euoted in /ord et al &'-', p6F)
7ore recently, 2oggs %&''() writes
=Since effective communication has been shown to produce better health outcomes,
greater client satisfaction, and increased client understanding, nurses ( include
midwives here) should be interested in improving their communication styles.
%2oggs &''(, p-6.)
The next part of this handout will consider the importance of effective communication in more
detail.
>& Communication in $olistic Care
The term =holistic care? refers to recogni>ing that clients have a wide #ariety of 'hysical,
'sycholoical, s'iritual, cultural, 'sychose6ual, safety and other needs@ assessin
these needs@ and 'ro#idin care which meets them %American 4olistic 5urses
Association &'--). According to many theories and models of nursing and midwifery,
effecti#e communication ena(les holistic care of clients and the meeting of a wide range
of needs %#utcliffe et al &'':, Aavender and =acob &''6, 7c8enna and 1levin &''6).
4olistic care can be contrasted, for example, with care which is concerned with a narrow
range of clients needs e.g., only carrying out a practical procedure such as dressing a
wound, without considering the clients feelings or need for information. 3xamples of this are
given in 3xercise , p6 of this handout.
Most theories and models of nursin and midwifery em'hasise the im'ortance of the
client5s e6'eriences and 'ers'ecti#es %Arnold and 2oggs &''(, 7c8enna and 1levin
&''6), as do many innovations in nursing practice. The latter include developments in
Child/centred/family 8 centred nursin %1mith et al &''&).
Patient/centred care in adult nursing %8oubel and 2ungay &'':).
4umanistic or client/centred a''roaches in mental health nursing and learning disability
nursing %1anderson &''(), based on the theories of #arl ?ogers %2arker &'':, /reeth
&''().
A& Sensiti#ity to +omen5s Needs and Pers'ecti#es
4
0ood communication skills, including active listening and the development of empathy,
enhance 'rofessionals5 a(ility to (e sensiti#e to, and meet, clients5 s'ecific needs@ and
understand their 'ers'ecti#es, including those related to culture, s'irituality, ethnic
rou', ae, ender, se6ual orientation and ender identity %defined earlier in this
handout).
16am'les include the followin:
7onica 8han needs a Euiet time to pray each day whilst she is on the antenatal ward as
an inpatient due to $lacenta $raevia. %he midwi#es demonstrate em'athy (y
a''reciatin Ms Bhan5s need not to (e distur(ed durin these times. Where this is
not possible, e.g., because of an urgent procedure, a midwife e6'lains this to 7onica
7onicas need to pray are also documented in her handheld notes and included in a
care 'lan on her spiritual needs, which are assessed soon after 7onica is admitted.
Ameera 8aur is && weeks gestation and is admitted following a vaginal bleed. 7rs 8aur,
who lives in the $unGab region of ;ndia, is visiting family in Aeicester. 1he speaks and
understands several languages, but not 3nglish. A 'rofessional inter'reter is
arraned as soon as 'ossi(le. ;n the meantime, besides attending to 7rs 8aurs
physical care needs, the midwives enable 7rs 8aur to feel welcome and relie#e her
an6iety throuh #er(al communication 2inter'reted (y her sister3 and non 8 #er(al
communication. The latter includes appropriate eye contact, and the use of touch,
which 7rs 8aur finds comforting. /or example, she derives considerable comfort from
holding the hand of a student midwife. The midwives comfortin tone of #oice is also
important.
When 7s 4yacinth #hurchill is admitted with premature labour she tells the midwife
looking after her that she wants her lesbian partner to be given information. The midwife
and the rest of the ward team ensure that Ms Churchill5s 'artner is i#en rele#ant
information, in line with Ms Churchill5s re*uest. They also a#oid assumin, in their
assessments, that all women and men are heterose6ual that is, attracted to someone
of the opposite sex %/ish &''., ?oyal #ollege and Hnison &''<).
=anet =ones, aged @-, is asked 2as all clients should (e3 his 'referred name and title.
1he prefers to be called *=ane,, as only her mother calls her =anet. The #ommunity
7idwife who will be visiting her at home ensures that her 'referred name is used& The
'erson5s 'referred name needs to (e ascertained and recorded at the (ookin
a''ointment , and all staff need to address the woman in the way she 'refers&
C&,& 0er(al Communication
0er(al communication includes the following
What is said %speech content).
Clarity of speech whether what is said is clear or not. A midwife could, for example,
explain a procedure in a way that was clear to the woman. ;n doing so, the professional
would need to adapt her/his explanation to take account of the individuals communication
strengths, needs and problems. ;n relation to clear communication, the professional
would need to take account of the following
+hether the client understands and s'eaks 1nlish or other lanuaes&
The clients le#el of coniti#e de#elo'ment %related, e.g., to thought,
understanding, memory, perception, vocabulary, intelligence 0ross &'-').
#ognitive development varies considerably amongst children of the same
5
age9 and nurses adapt their communication in relation to this %Arnold &''(b).
;n addition, cognitive development in a child or adult can be influenced by
brain damage or changes to brain functioning. %he structure and/or
functionin of the (rain affects understandin and res'ondin to
communication in many individuals with learning disabilities %/erris + Taylor
&''()9 and some people with mental health problems or brain inGury for
example, from strokes or road traffic accidents %0amble and 2rennan &''.,
?ichardson &''().
The indi#idual5s understandin of her/his health problem, and how
she perceives this. This might be related to the persons culture
%shared values, beliefs and ideas by members of a specific social
group Thompson &''@) and e6'erience& %Women with diabetes or
epilepsy for example are experts in knowing about, and managing,
long + term or recurrent health problems of themselves or their
children or other family members. ;t is seen as good practice for
professionals to respect the expertise of clients and their carers at
home9 and to work collaboratively with them %2yrt and !ooher &''@).
The clients le#el of an6iety may affect the individuals ability to
concentrate on, or retain information given by the midwife. Some
mental health 'ro(lems and learnin disa(ilities may also affect
this %2arker &'':).
C&.& Dther As'ects of 0er(al Communication
These include
The tone of voice the way in which somethin is said& /or example, a midwife could
have a tone of voice that was abrupt or harsh. Alternatively, her voice could indicate
concern and interest.
The voices 'itch how high or low it is.
The use or absence of Earon %e.g., terms the woman doesnt understand 2oggs &''(,
"#arroll and $arks, &''().
C&4& Communication !ifficulties
*The interpretation of the meaning of words may vary according to the individuals background
and experience. ;t is danerous to assume that words ha#e the same meanin for all
'ersons who hear themF 2Bos .GGC '& ,<C3
/or example,
A midwife speaking to a woman who does not have 3nglish as her first language.
Talking to a woman about antenatal screening.
C&;& Cultural 0ariations in S'oken Communication
"f crucial importance is midwives appreciation of #ariations in cultural e6'ression %2oggs
&''(). +hat may a''ear to (e rude or aressi#e in the midwife5s culture miht (e
friendly (eha#iour in another. ;n a study of black mental health clients views, one
individual said
6
*%he 'erce'tion that oes alon with (ein (lack is that they5re #iolent and they
are aressi#e, and the misconception that necessarily, because we might
gesticulate Euite a lot or we might talk loudly, we might laugh loudly, yeah, the
perception thats linked with that is of a violent and aggressive nature,.
%#handler + "atts and 5elstrop &''6, p@., Euoted in /ord et al &'-', p--6)
2oggs %&''(, p-66) comments
*The tone of #oice used to e6'ress aner and other emotions #aries accordin
to culture and family& /or example, it is sometimes difficult for BaCDnurse to tell
when someone from another culture is angry because their vocali>ation of strong
emotion may be more controlled.
*2y contrast, loud, rapid vocali>ation may seem angrier than intended, when in reality,
they Gust convey culturally learned emotional intensity.
*%hrouh re'eated interaction with clients, the nurse Hand midwifeI learns to
understand the messae the client is tryin to communicate,.
%2oggs &''(, p-66)
<&,& Non 8 0er(al Communication and %hera'eutic Relationshi' Skills
5on + verbal communication and related skills include the following

Acti#e listenin to the clients verbal and non verbal communication.
*5on verbal body cues, or *(ody lanuae, %2oggs &''(a, p-:'), including
*Facial e6'ression, %2oggs &''(a, p-:').
1ye contact&
9estures e.g., to convey understanding for example, appropriate nods of the head.
+ays of sittin or standin %including 'osture).
Amount of s'ace e.g., between the professional and the client.
The therapeutic use of touch e.g., to comfort a child or adult client.
1m'athy attempting to understand the feelings and experiences of the client9 conveying
this understanding9 and taking related practical action.
Presence *being with, the client e.g., conveying compassion nonIverbally to an
individual whose relative has Gust died.
Non + Eudmentalism: accepting the client and what she/he says, without making moral
Gudgments and whilst conveying respect for her/him.
Res'ect includes #aluin the 'erson and her/his indi#iduality, uni*ueness and
di#ersity related to culture, s'irituality, ethnic rou', ae, ender, se6ual
orientation and ender identity .
3nsuring an individuals 'ri#acy and dinity is crucial to respecting the individual
7
%2arker &'':, 2aughan and 1mith &'':, 0ates &''(, 4unter et al &''6)
<&.& 1nsurin !inity
*%o treat someone with dinity is to treat them as (ein of worth, in a way that is
res'ectful of them as #alued indi#idualsF
*!ignity may be promoted or diminished byDthe attitudes and behaviour of the nursing team
and others9 and by the way in which care activities are carried out,.
%?oyal #ollege of 5ursing &''6)
<&4& Res'ect for Clients and the Nursin and Midwifery Council
%he Nursin and Midwifery 2NMC3 2.GG<3 Code: Standards of Conduct, Performance
and 1thics for Nurses and Midwi#es states that nurses and midwives must =make the care
of 'eo'le your first concern, treatin them as indi#iduals and res'ectin their dinityF
=Jou must not discriminate in any way aainst those in your care?&
<&;& 16ercise ,& Communication as Part of Care
#hoose one of the examples below, and discuss with one or more colleagues sitting near you
-n what ways could the midwife communicate more effecti#ely with the woman7
-n what ways would this (e likely to (enefit the woman7
;n preparing 7s Ann Amber for an elective lower caesarean section , a midwife
concentrates on her 'hysical needs, (ut fails to reconiKe that Ms Am(er is #ery
an6ious about her operation, and worried about whether her husband has been told that
she is being prepared. 7s Amber is worried about bothering the midwife, but her facial
expression reveals considerable anxiety.
A midwife inores Mada5s concerns whether she is 'roducin enouh (reast milk
for her (a(y, assumin that these concerns are =a new mother (ein o#er
an6ious?& 7agda has given up breast feeding when she visits later in the week.
7r 0us 0reen, a young man of -6, is rude and hostile towards the midwife , who decides
that she will not (other communicatin with him if he is oin to (eha#e in this
way. 4owever, 7r 0reens behaviour is partly caused by his fears for his partner who is
bleeding per vaginum. ;ts easier for him to be rude and hostile than to cry or say hes
anxious, partly because hes worried about losing face, and wants to appear tough when
his best mate %his partners brother) comes in to visit.
9. Acti#e Listenin and 1m'athy: %wo Bey Skills in Midwifery and for other $ealth
Care Professionals
;n the examples weve Gust considered, the use of two key skills would have helped the
clients
Acti#e listenin careful attention to the clients non + verbal and verbal communication.
1m'athy attempting to understand the clients feelings and experiences, communicating
this understanding to her/him9 and taking practical action to help the client.
%Arnold and 2oggs &''(, 2aughan and 1mith &'':)
8
,G&,& Acti#e Listenin
Arnold and 2oggs %&''(, pF@-) define active listening as
*A dynamic, interpersonal process whereby a person, %such as a midwife)
*$ears a messae?& %The message may be verbal and non verbal, as when 7r 0us
0reen describe says he doesnt have any concerns or Eueries because hes worried that
the midwife will ask him Euestions about having sexual intercourse with his partner earlier
in the day. 4owever, the midwife might pick up 7r 0reens non verbal messages and put
him at ease before asking more direct Euestions to gain the information.
=!ecodes its meanin?: that is, the midwife interprets the non verbal message %*7r
0reen is in pain because hes grimacing and clutching his abdomen),9 or the possible
meaning behind a verbal message %*7r 0reen is being rude to me because hes acting
tough so as not to lose face, when hes really anxious about whether or not he has
caused the bleeding).
=Con#eys an understandin a(out the meanin Hof the #er(al or non #er(al
messaeI to the sender?& The midwife could convey understanding by saying *7any
woman experience bleeding per vaginum but we need to find out the cause and ensure
she and the baby are okay. "r *;f youd like to, youre very welcome to tell me if
anythings bothering you,. The midwife could also show an interest in anything that 7r
0reen said about his relationship with his partner.
%Juotes, above, are from Arnold and 2oggs &''(, pF@-).
,G&. Features of Acti#e Listenin
;n active listening, the professional e6'resses interest and concern in what the client is
sayin through
Close attention to what is (ein said, without interru'tion&
Close attention to the client5s non 8 #er(al communication, such as angry or sad
facial e6'ressions %as in the above example with 7agda).
The use of 'rom'ts, such as =would you like to tell me more7? can also indicate
interest and a readiness to listen.
The professionals tone of #oice /

And a''ro'riate eye contact is also important.
%Arnold and 2oggs, &''(, 1ully and !allas &'-')
The compiler of this handout once facilitated percussion bands for men and women with
learning disabilities. %he music 'ro#ided a means of communication, as an alternati#e to
s'eech, for some of these individuals. -t was necessary to acti#ely listen: to o(ser#e
clients5 non / #er(al communication to assess whether or not they enEoyed the music,
and (enefitted from usin it to communicate and e6'ress feelins&
/or example, one individual conveyed distress by rushing out of the music room, and was
provided with Euiet space and an alternative activity. Another individual showed his
enGoyment of the music by smiling broadly, especially when his hands were moved in rhythm
to the music. This provided him with an additional means of communication and enGoyment
9
%0ates &''(). 2%his e6am'le also has a''lica(ility to the use of music with other
'eo'le: e&&, youner or older 'eo'le with dementia3&
,G&4& Acti#e Listenin and Ba(ies: "nderstandin the Meanin of Ba(ies5
Communications
4organ et al %&''&) studied non + verbal communication in recently born babies
*D/urther studyDidentified A;!1 Bthe Aiverpool ;nfant !istress 1caleC as providing a
continuum along which all neonatal (eha#iour could (e measured, ranin from no
distress/rela6ed, at one end, to e6treme distress/'ain at the other. /or example, the
category for facial expression is defined from
' +*3yelids closed and relaxed I no lines, lips slightly apart. 5o movement of nostrils or face,
indicating normal, comfortable behaviour9 to F + *$ractically all the time without relief, a
constantly furrowed brow. Kery flared nostrils, unnaturally open mouth with tightly held lips.
3yes tightly shut. A grey pallor to face, indicating very distressed behaviourD,
%4organ et al, &''&, p:6).

,G&;& 16ercise .& Acti#e Listenin
Please di#ide into 'airs& Student A talks to Student B a(out her/his ho((ies and
interests for . minutes& !urin this time, Student B is to look as uninterested and
(ored as 'ossi(le: e&&, yawn, look at your watch, read this handout, whilst a''earin
com'letely uninterested&
After . minutes, swa' roles so that Student B talks a(out her/his ho((ies and interests
and Student A is as uninterested and (ored as 'ossi(le&
&
After this e6ercise, 'lease discuss the followin *uestion:
+hat did it feel like to (e com'letely inored7
$ow easy was it to inore your fellow Student7
$as the e6ercise hel'ed you at all to reflect on what it is like for clients to (e
inored or not listened to7
ACBND+L1!91M1N%
%his e6ercise was de#ised (y -an Rudd, Senior Lecturer in Nursin, School of Nursin
and Midwifery, !e Montfort "ni#ersity& %hanks to -an Rudd for areein to the use of
this e6ercise, and its inclusion in this handout&
,,& Conruence Between 0er(al and Non80er(al Communication
An important part of active listening involves conruence. "ne aspect of congruence
concerns the match (etween the indi#idual5s #er(al and non #er(al communication& A
midwife would be congruent if her/his facial expression and the way she was sitting mirrored
her verbal communication.
10
An example of inconruence would be for the professional to state that she/he was
interested, (ut then look out of the window or lance at a watch to see if it was time to go
off duty %Arnold and 2oggs &''().
#ongruence is also relevant to nurses noticin whether or not there is a match (etween
clients5 non #er(al and #er(al communications& /or example, a woman might say that he
is not in pain because she doesnt want to trouble the midwives. *Theyre always rushed off
their feet, poor things, ; dont like to trouble them,.
,.&,& 1m'athy
1m'athy comprises
An attempt to accurately understand and a''reciate the feelins, #iews,
'ers'ecti#es and e6'eriences of the client.
Clearly con#eyin this understandin to the client so that she/he feels understood
and acce'ted %/reeth &''(, 1tuart, &'':).
*;n addition, 8unyk and "lson %&''-) argued that empathy must also include taking
practical action in relation to the clients expressed concerns, %/ord et al &'-', p6(),
including *nursin 2read midwifery3 inter#entions that meet the 'hysical needs of the
client and alle#iate emotional sufferinF, %8unyk and "lsen, p@&&).
,.&.& Checkin that the Client5s 16'eriences and Feelins $a#e Been Correctly
"nderstood
Another aspect of empathy is for the midwife to check that she/he has correctly
understood the woman5s non 8 #er(al and/or #er(al communication& /or example, a
woman might seem anxious Gust before a procedure such as taking blood. ;t would be easy to
assume that the venepuncture is the cause of the anxiety, when this might not be the case.
An empathetic midwife would check this *Are you worried about having your blood takenL,
#larifying this would enable the client to say *yes,, or give information that they are worried
about what will happen if the results are abnormal. ;n using empathy, the professional
*Doffers the HclientI an o''ortunity to #alidate the accuracy of the
H'rofessional5sI 'erce'tions and to e6'erience (ein understood. The BclientsC
Dawareness of the BprofessionalsC communication allows him/her to say, *Mes, that is
how ; see things, and, *Mes, that is what ; would like to happen,.
%?eynolds &''F, p:F)
,.&4& An 16am'le of 1m'athy
*;n relation to a BwomanC called %*8ay,) who is expressing a complaint in a verbally aggressive
manner, a BmidwifesC empathy would include an attempt to appreciate *8ays, perspective
through acti#e listeninD%Arnold &''@, p&@F).
*$art of the BmidwifesC empathetic response would be to seek clarification if she/he was
not sure what Bay meant, or ask for more 'recise details e.g., related to the nature of the
complaint.
*The *taking practical action, aspect of empathy could be offerin an a'oloy, i#in
information a(out the Hwoman5sI com'laints 'rocedure and res'ondin (y remedyin
a situation about which the client is concerned.,
11
%/ord et al &'-', p6(, citing 3vans and 2yrt, &''&).
,.&;& 1m'athy and Self 8 Awareness

*;n some situations and with some women, it may be appropriate to see empathy as a
de#elo'in 'rocess, which im'ro#es as the HmidwifeI ets to know the HwomanI (etter?
%/ord et al &'-', p6()& 3mpathy involves self 8 awareness, including the midwifes
appreciation of gaps in her/his understanding of the woman, and an acceptance that this may
take time to develop. 1elf + awareness has been defined as =the means (y which a 'erson
ains knowlede and understandin? %Arnold and 2oggs &''(, pF@.).
Recommended Readin and References
Bey %e6ts on Communication
Arnold, 1& and Bos, B& "& 2.GGC3& 2>th 1d&3& -nter'ersonal Relationshi's& Personal
Communication Skills for Nurses& St& Louis, Missouri& Saunders 1lse#ier&
Barker, P& 2ed&3& 2.GGL3& 2.
nd
1d&3& Psychiatric and Mental $ealth Nursin: %he Craft of
Carin& Arnold: London&
Bauhan, )& and Smith, A& 2.GGL3& Carin in Nursin Practice& $arlow& Pearson
1ducation, Ltd&
2urnard, $. %&''F). %<
th
3d.). #ounselling 1kills for 4ealth $rofessionals. #heltenham.
5elson Thornes, Atd.
Ferris 8 %aylor, R& 2.GGC3& Communication& -n: 9ates, B& 21d&3& 2.GGC3& 2>
th
1d&3&
Learnin !isa(ilities& %owards -nclusion& 1din(urh& Churchill Li#instone 1lse#ier&
?iley, =.2. %&''6). %.
th
3d.). #ommunication in 5ursing. 1t. Aouis, 7issouri. 3lsevier
7osby.
Sully, P& and !allas, )& 2.G,G3& 2.
nd
1d&3& 1ssential Communication Skills for Nursin
and Midwifery& London& Mos(y&
Nursin and Midwifery Council 2NMC3 Pu(lications
5ursing and 7idwifery #ouncil. %&''&). %?evised 3d.) $ractitioner + #lient ?elationships
and the $revention of Abuse. Aondon. 5ursing and 7idwifery #ouncil.
Nursin and Midwifery Council& 2.GG<3& %he Code& Standards of Conduct,
Performance and 1thics for Nurses and Midwi#es& London& Nursin and Midwifery
Council&
Nursin and Midwifery Council& 2"ndated3& 9uidance for the Care of Dlder Peo'le&
London& Nursin and Midwifery Council&
Communication in S'ecific Areas of Nursin
Andrews, 7.7. and 2oyle, =.1. %3ds.). %&''6). Transcultural #oncepts in 5ursing #are
%#hapter -). $hiladelphia. Aippincott, Williams and Wilkins.
Arnold, 1& 2.GGCa3& !e#elo'in %hera'eutic Communication Skills in the Nurse/Client
Relationshi'& Cha'ter ,G in: Arnold, 1& and Bos, B& "& 2.GGC3& 21ds&3& 2>th 1d&3&
-nter'ersonal Relationshi's& Personal Communication Skills for Nurses& St& Louis,
Missouri& Saunders 1lse#ier&

12
Arnold, 1& 2.GGC(3& Communicatin with Children& -n: Arnold, 1&, Bos, B&"& 21ds&3&
2.GGC3& 2;
th
1d&3& -nter'ersonal Relationshi's& St& Louis, Missouri& Saunders 1lse#ier&
Arnold, 1& 2.GGCc3& -ntercultural Communication& Cha'ter ,, in: Arnold, 1&, Bos, B&"&
21ds&3& 2;
th
1d&3& -nter'ersonal Relationshi's& St& Louis, Missouri& Saunders 1lse#ier&
Arnold, 1& and Ryan, )&+& 2.GGC3& Communicatin with Dlder Adults& -n: Arnold, 1& and
Bos, B& 21ds&3& 2.GGC3 2>
th
1d&3& -nter'ersonal Relationshi's& Professional
Communication Skills for Nurses& St& Louis, Missouri& Saunders 1lse#ier&
Bos, B&"& 2.GGC3& Communication Styles& -n: Arnold, 1& and Bos, B& "& 2.GGC3&
2>th 1d&3& -nter'ersonal Relationshi's& Personal Communication Skills for Nurses& St&
Louis, Missouri& Saunders 1lse#ier&
2rown, A. and !raper, $. %&''@). Accommodative 1peech and Terms of 3ndearment
3lements of a Aanguage 7ode "ften 3xperienced by "lder Adults. =ournal of Advanced
5ursing. <-, %-), -F + &-.
2ryan, 8. and 7axim, =. %3ds.). %&''.). #ommunication !isability in the !ementias.
Aondon. Whurr $ublishers.
2uckley, 2. %&''@). #hildrens #ommunication 1kills /rom 2irth to /ive Mears. Aondon.
?outledge.
2yrne, 3.=. %-::(). Acute and 1ubIAcute #onfusional 1tates %!elirium) in Aater Aife.
#hapter -' in 5orman. ;.=. and ?edfern, 1.=. %3ds.) %-::(). 7ental 4ealth #are for 3lderly
$eople. 5ew Mork. #hurchill Aivingstone.
2yrt, ?. and !ooher, =. %&''@). *1ervice Hsers and #arers and their !esire for
3mpowerment and $articipation,. #hapter - in !ooher, =. and 2yrt, ?. %3ds.) &''@.
3mpowerment and the ?ecipients of 4ealth #are. !inton, 1alisbury. Juay 2ooks, 7ark
Allen $ublishing.
2yrt, ?., 4art, A. and =ames + 1ow, A. &''6. *$atient 3mpowerment and $articipation
2arriers and the Way /orward,. #hapter ( in 5ational /orensic 5urses ?esearch and
!evelopment 0roup 8ettles, A.7. Woods, $., and 2yrt, ?. %3ds.). &''6. /orensic 7ental
4ealth 5ursing#ompetencies, ?oles, ?esponsibilities,. Aondon. Juay 2ooks, 7A
4ealthcare, Atd.
#handler + "atts, =. and 5elstrop, A. %&''6). Aistening to the Koices of African + #aribbean
7ental 4ealth 1erice Hsers to !evelop 0uideline ?ecommendations on 7anaging Kiolent
2ehaviour,. !iversity in 4ealth and 1ocial #are. F, @- + <-.
#utcliffe, =. et al. %&'':). 5ursing 7odels Htility and Application to #linical $ractice.
Aondon. Juay 2ooks, 7A $ublishing, Atd.
!uxbury, =. %&'''). !ifficult $atients. "xford. 2utterworth 4einemann.
3ngebretson, =. %&''<). #aring $resence A #ase 1tudy. ;n ?obb, 7., 2arrett, 1.,
8omaromy, #. and ?ogers, A. %3ds.). %&''<). #ommunication, ?elationships and #are. A
?eader. ?outledge, /rancis and Taylor 0roup/The "pen Hniversity.
3vans, 1. and 2yrt, ?. %&''&). The ?ight to #omplainL #hapter -F in !ooher, =. and 2yrt,
?. %3ds.). %&''&). 3mpowerment and $articipation $ower, ;nfluence and #ontrol in
#ontemporary 4ealth #are. !inton, 1alisbury. Juay 2ooks/7ark Allen $ublishing.
/ish, =. %&''.). 4eterosexism in 4ealth and 1ocial #are. 2asingstoke. $algrave 7acmillan.
/ord, 8., 2yrt, ?. and !ooher, =. %&'-'). $reventing and ?educing Aggression and Kiolence
in 4ealth and 1ocial #are. A 4olistic Approach. 8eswick. 7N8 $ublishing.
13
/reeth, ?. %&''(). 4umanising $sychiatry and 7ental 4ealth #are. The #hallenge of the
$erson + #entred Approach. "xford. ?adcliffe $ublishing.
0amble, #. and 2rennan, 0. %3ds.). %&''.). Working with 1erious 7ental ;llness. A 7anual
for #linical $ractice. 3dinburgh. 3lsevier.
0ates, 2. %3d.). %&''(). %F
th
3d.). Aearning !isabilities. Towards ;nclusion. 3dinburgh.
#hurchill Aivingstone 3lsevier.
$oran, M&F&, 9lenn, S& and Choonara, -& 2.GG.3& Further !e#elo'ment of the Li#er'ool
-nfant !istress Scale& )ournal of Child $ealth Care& A, 2.3, LA/,GA&
=angland, 3. et al. %&'':). $atients and ?elatives #omplaints About 3ncounters and
#ommunication in 4ealth #are 3vidence for Juality ;mprovement. $atient 3ducation and
#ounselling. (F, -:: + &'<.
=eanette, T. et al. %3ds.). %&''6). $erson + #entred $ractice for $rofessionals. 7aidenhead.
"pen Hniversity $ress.
=onas + 1impson, #. et al. %&''.). The 3xperience of 2eing Aistened To. A Qualitative
Study of Older Adults in Long Term Care Settings. Journal of Gerontological Nursing.
36 !"# $6 % &3.
'ou(el G. and )ungay *. !+,,-#. T.e C.allenge of /erson % Centred Care0 An
1nternational /ers2ective. )asingsto3e. /algrave 4acmillan.
'unyc3 5. and Olson J.'. !+,,"#. Clarification of Conce2tualisations of 6m2at.y.
Journal of Advanced Nursing. 3& !3# 3"783+&.
Luc3es 6. !"999#. !3
rd
6d.#. Lectures on General Nursing. 5elivered to t.e London
*os2ital Training Sc.ool for Nurses. London. 'egan /aul Trenc. and Co Ltd.
4c'enna *./. and Slevin O. !+,,9#. Nursing 4odels T.eories and /ractice.
C.ic.ester. )lac3:ell.
7c1herry, W. &''.. %&nd 3d.) 7aking 1ense of 1pirituality in 5ursing and 4ealth #are
$ractice. Aondon. =essica 8ingsley.
7orrison, K. and 2ennett, $. %&'':). %&
nd
3d.). An ;ntroduction to 4ealth $sychology. 4arlow.
$earson $rentice 4all.
"#arroll, 7. and $ark, A. %&''(). 3ssential 7ental 4ealth 5ursing 1kills. 3dinburgh/
7osby 3lsevier.
$atients Association, The. %&'':). $atientsD 5ot 5umbers, $eopleD5ot 1tatistics.
Aondon. The $atients Association.
$eckover, 1. and #hidlaw, ?.0. %&''(). Too /rightened to #areL Accounts by !istrict
5urses Working with #lients Who 7isuse 1unstances. 4ealth and 1ocial #are in the
#ommunity. -F, %@), &@6 + &<F.
$atterson, =. and Oderad, A. %-:(.). 4umanistic 5ursing. 5ew Mork. =ohn Wiley and 1ons.
#ited in 3ngebretson, =. %&''<). #aring $resence A #ase 1tudy. ;n ?obb, 7., 2arrett, 1.,
8omaromy, #. and ?ogers, A. %3ds.). %&''<). #ommunication, ?elationships and #are. A
?eader. ?outledge, /rancis and Taylor 0roup/The "pen Hniversity.
14
$oorman, 1.0. %&'':). 1exual ?esponses and 1exual !isorders. ;n 1tuart, 0.W. %3d). %(
th

3d.). . $rinciples and $ractice of $sychiatric 5ursing.. 1t. Aouis, 7issouri. 7osby 3lsevier.
?eynolds, W. %&''F). The #oncept of 3mpathy. ;n #utcliffe, =.?. and 7c8enna, 4.$.
%3ds.). %&''F). The 3ssential #oncepts of 5ursing. 3dinburgh. 3lsevier #hurchill
Aivingstone.
?oyal #ollege of 5ursing. %&''6). !ignity. At the 4eart of 3verything We !o. Aeaflet.
"ctober, &''6. Aondon. ?oyal #ollege of 5ursing.
1anderson, 4. %&''(). $erson + #entred $lanning. ;n 0ates, 2. %3d.). %&''(). %F
th
3d.).
Aearning !isabilities. Towards ;nclusion. 3dinburgh. #hurchill Aivingstone 3lsevier.
1mith. A. and #oleman, K. %&'-'). %&
nd
3d.). #hild and /amily + #entred 4ealthcare
#oncept, Theory and $ractice. 2asingstoke. $algrave 7acmillan.
1tockwell, /. %&''&). The Hnpopular $atient. ;n ?afferty, A.7. and Traynor, 7. %3ds.).
%&''&). 3xemplary ?esearch for 5ursing and 7idwifery. Aondon. ?outledge.
Stuart, 9& +& 2.GGL3& %hera'eutic Nurse 8 Patient Relationshi'& -n: Stuart, 9&+& 21d&3&
.GGL& 2L
th
1d&3& Princi'les and Practice of Psychiatric Nursin& St& Louis, Missouri&
Mos(y/1lse#ier&
Taylor, 1. %&''.). %Fth 3d.). 4ealth $sychology. 2oston. 7c0raw + 4ill 4igher 3ducation.
Thompson, 5. %&''@). %&
nd
3d). $romoting 3Euality #hallenging !iscrimination and
"ppression. 2asingstoke. $algrave, 7acmillan..
Tribe, ?. and ?aval, 4. %3ds.). %&''@). Working with ;nterpreters in 7ental 4ealth. 4ove.
2runner + ?outledge, Taylor and /rancis 0roup.
"nison and Royal Collee of Nursin& 2.GG;3& Not )ust a Friend: Best Practice
9uidance on $ealth Care for Les(ian, 9ay and Bise6ual Ser#ice "sers and %heir
Families& "N-SDN: London&
Dther References in this $andout
American 4olistic 5urses Association. %&'--). Website. www.ahna.org
0errish, 8. and Aacey, A. %&''.). %F
th
3d.). The ?esearch $rocess in 5ursing. "xford.
2lackwell $ublishing.
0ross, ?. %&'-'). %.
th
3d). $sychology. The 1cience of 7ind and 2ehaviour. Aondon.
4odder Arnold, 4achette H8.
15
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