I am a registered nurse from Westmoreland County Community College in Youngwood, Pennsylvania and currently taking up a Bachelor of Science in Nursing at Waynesburg College. At present, I am a nurse case manager at the Mercy Home Health in Pittsburgh, Pennsylvania where I extend nursing care of clients at home and attend to their educational requirements in collaboration with a multi-disciplinary team and physicians. I also coordinate with the staff on patient care and document reimbursement requirements. I likewise function as a disease case manager at the McKesson Health Solutions in Broomfield Colorado. In discharging this function, I education health plan members on the disease process and management, document and input findings into their health plans, make referrals and coordinate individual needs with treatment providers and the health plan.
From 1989 to 2004, I was a worker compensation case manager at the AIG/HDI in Pittsburgh, Pennsylvania; a disease case manager for American Healthways; a physical and behavioral healthcare coordinator at the APS Healthcare in North Huntingdon; case manager at the Forbes Regional in Monroeville; a managed care analyst at Gateway Health Plan also in Pittsburgh; a case manager at the UPMC-Magee Woman's Hospital. At Southwest Women's Council in Uniontown, at the Three Rivers Health Plan in Monroeville, at the HIS of Greater Pittsburgh in Greensburg; a utilization review coordinator at the Medi Home Health in Monroeville; nurse manager at In Home Health also in Greensbur; a patient care coordinator at Family Home Health; field staff nurse at Key Care Home Health Services, staff nurse at Saint Mary's Hospital in Richmond, Virginia and at the Frick Hospital in Mount Pleasant, Pennsylvania. I was given the Case Manager of the Week award at the AIG/HDI.
David Kolb and fellow theorists in the early 1980s suggested that all learning lies in the way a person processes experience or the critical reflection of experience (Kelly 1997). They saw learning as beginning from experience, continuing with reflection and leading to action, in turn translating into another experience for reflection. Kolb first refined the concept into two separate learning activities, i.e., perceiving and processing, and then added a third stage, abstract conceptualization. If the critical reflection stage asks questions about the experience in terms of previous and similar or related experiences, the abstract conceptualization stage attempts to find answers to the questions. In this stage, generalizations, conclusions and hypotheses are drawn about the experience. It provides a kind of interpretation for the action stage, where the hypotheses are tried out. Learning utilizes logic and ideas instead of feelings, in understanding problems or situations. It relies on systematic planning and forms theories and ideas to solve problems.
Kolb thought that a preferred learning style enables a person to understand his areas of weakness, increases his proficiency, and helps him realize his strengths in certain situations, such as deciding on a career (Kelly 1997). This is of greater value on educators than on learners, as it re-emphasizes experience as a critical part of learning. Kolb noted that even in current times, most education is still essentialist, which puts little weight or focus on learner experience. Most teachers tend to pay greater attention on introducing information than on students' need to reflect on the information. The Theory can be integrated into one's teaching style, wherein the teacher can give students a few minutes to reflect on what has been introduced, taught or explained, especially if it is difficult. The Theory stresses that the internal processes of learning are just as important as the external (Kelly).
Ray L. Birdwhistell focused on non-verbal communication and derived most of his studies on kinesics (Kirby 2003). He studied and analyzed the way people interacted among themselves through watching films. His observation was that people appeared to transfer information by speaking, through their eye movements, facial expressions and their chest. He noticed that these forms of non-verbal communication occur without their noticing it. He was most fascinated with his studies and, as a consequence, he co-produced the film TRD 009, an 80-minute 16 mm black-and-white sound film, with Jacques van Valck. It was about an English pub scene in a middle class London hotel and provided them with a tool in observing the behavior of listeners and their relationship with speakers (Kirby).
Claude Shannon believed that the basic elements of any general communications system should include a transmitting device, which transforms the information into a form suitable to a particular means through which it is sent (New York University 2005). He also noted that information has less to do with its inherent message or meaning and more to a degree of order or non-randomness, which is measurable and treated mathematically like mass, energy or other physical quantities. A generalized communication system is characterized by a rate at which information is produced at the source, the capacity of the means to handle or transfer information, and the average amount of information in a message of some type. Shannon added that most of the techniques used with information theory are derived from the mathematical science of probability (New York University).
OK Berlo writes about the Leary Model and therapeutic communication (Plattsburg 2005). It grows out of the concept that communication is a reciprocal process wherein the sender and the receiver of a message simultaneously participate. People who send and receive messages day by day are influenced by past experiences, values, beliefs, knowledge, culture, education, the content of the message, and how they feel about themselves and others. These factors can and often disrupt the sender's intention of the message when it reaches the recipient. It thus becomes important to evaluate and validate the message. People self-talk. This is intrapersonal communication, or the way one communicates with himself. A staff nurse, for example, who has just had a bad time with her nurse manager will be angry in her self-talk and make unpleasant or angry self-comments about the nurse manager. Her self-talk will also influence or shape her further communication with the staff. Getting trapped or too involved in routine tasks and procedures and socialization or environmental issues can interfere with nurse-client communication.
This calls attention to the importance of forming therapeutic relationships and fostering therapeutic communication (Plattsburg 2005). Nurses must improve communication skills constantly. Their workloads may reach a high when challenges ensue especially in acute care settings. Nurses who are experienced and skilled in communication techniques can establish such relationships. Berlo emphasizes that messages are sent and received simultaneously and they thus constitute a transaction, wherein the sender continuously reacts to the response of the receiver and the other way around. The exchange is also the relationship between them and how they influence each other. A nurse who is sensitive to a client's cues shapes the appropriate technique for meeting the latter's needs. As already mentioned, it is multi-dimensional, in that both sender and receiver put in their separate values, beliefs, culture, knowledge and past experiences into the exchange and such factors can alter or interfere with the authentic message being transmitted. People reveal themselves through these interactions and thus enable or disable the formation of a relationship. Through this relationship, communication is shaped and enhanced and proper results are achieved.
Another element of communication is content (Plattsburgh 2005). Content includes words and information and the relationship or the lack of it shapes or colors the message sent or received. Within a caring relationship, the information is interpreted by the recipient as helpful, while an antagonistic relationship will construe the same message as an attempt to control his or her behavior. Communication transaction, therefore, derives from both the relationship and the content of the message and calls for attention to both. Berlo sees relationship as the more powerful determinant of effective or therapeutic communication. A nurse-client relationship is viewed as an interpersonal, therapeutic or helping relationship, which develops out of an emotional bonding of mutual trust, respect and acceptance focused on the client's well-being. Such a relationship is dynamic, with time constraint, and goal-oriented and with unequal sharing. It is not like a spontaneous and mutual social relationship. Berlo suggests his classic source-message-channel receiver model or SMCR communication model, which has a source, a message, a channel and a receiver. The message depends on communication skills, attitudes, knowledge, social system and culture inputs. The message is passed on through sensory channels while the recipient interprets through communication skills, attitudes, knowledge, social systems and culture.
In my nursing career, I have had the opportunity of putting all the given theories into practice. I apply both critical reflection and abstract conceptualization of my experiences with clients in confronting questions raised by critical reflection of their situations and in attempting to derive answers to these questions. I reflect on what experience teaches me and compares it with previous ones as well as those of others in the practice.
I find Birdwhistell's non-verbal communication theory useful in observing my clients' responses to me and to others in the field. I recognize that many responses are non-verbal…