Book Review
Patient and Person: Developing Interpersonal Skills in Nursing, 2nd Edition
J Stein-Parbury
ISBN: 0-443-06291-9; 2000; 332 pages; Churchill Livingstone;
Margaret McAllister
School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore QLD
Students and educators can choose from a range of good texts to learn technical nursing skills, anatomy and physiology and even sociological and psychological concepts. But when it comes to communication skills, Patient and Person is really the only one.
This second edition is enriched with substantial sections on caring and on practice-relevant research. Like the first edition, the book explores principles for interpersonal skill development and practice, provides practical illustration of its implementation as well as interesting, engaging learning activities at the end of each of the eleven chapters. The book is divided into three sections: an introduction, an exploration of key interpersonal skills, and application of these skills in the context of nursing practice. Chapter 1 doesn't begin with the usual, 'What is communication?' Rather, Jane Stein-Parbury explores why interpersonal skills are crucial to nursing and what happens to patients (and persons) when these skills are lacking. Several lengthy stories are told at the beginning which will resonate as timeless and true to many nurses. The author then highlights the key lessons embedded within them: that patients remain people despite the sometimes dehumanising, alienating effect of the experience of health service; that nurses ought to be concerned, to show concern, to feel it and be moved to care; that nurses need to respond to demands with skill rather than routine or common sense; that nurses need to look beyond the surface and find the complex whole which is the personal experience of health, illness and adaptation; and that nurses ought not be seduced by the task for it is never, and can never be, the whole of nursing.
Research on caring is summarised and critiqued in Chapter 2 and Stein-Parbury exposes some problematic and frequently overlooked notions about care. For patients, the meaning of care is often akin to providing comfort, but nurses may construct care as something different. For nurses, care may also be about being patient, suspending judgement, being involved, looking at the complex whole. Such an insight reveals difference rather than oversimplifies a fundamental part of the nature and difficulty in nursing work. Further, it reveals that compassion without competence is pointless and that the process of care is difficult to defend if outcomes are not achieved. Stein-Parbury also critiques the literature on caring to reveal that most research tends to focus on nurses' perceptions of care, rather than actual nursing actions and practices.
The most impressive and engaging attribute to this book is the way it elaborates on, theorises, and values those aspects of nursing which have been taken for granted and undervalued, even by nurses themselves. For example, in a section on involvement and over-involvement, Stein-Parbury reminds us that interactions with patients often begin at a superficial level. Indeed, sometimes superficiality is what patients might need. Rather than attempt to force the relationship to a deeper, more intimate level, nurses ought to value the primary relationship, even if it is shallow, because such a connection builds trust, and can become a safe place for patients to retreat to when therapeutic work becomes tiring. Thus, nurses have a valuable role in maintaining connection and that conversation, not just counselling, has a place within health care. The skill for nurses is in knowing how to keep a balance and avoid under- or over-involvement.
The skills discussed move nursing practices beyond taken-for-granted routine. For example, 'to give reassurance' is a common, important, yet usually unarticulated practice. Stein-Parbury dedicates six interesting pages to it detailing its complexity, providing practical alternative approaches. Just one insight I gained about how to provide reassurance was to give concrete feedback to a patient about their progress. By saying, 'I can tell you are getting a little stronger, because yesterday you could walk to the edge of the bed, but today you made it to the shower' is far more meaningful than providing glib and non-specific platitudes. The section on empathy and sympathy is also beyond routine. Stein-Parbury takes a novel approach by critiquing the literature and enticing the reader to rethink the differences between the two terms and to reclaim the value of both.
For teachers who may be a little put off by the size of the book, I would like to make the following recommendation: use Chapters 1 to 6 in a beginning nursing course like 'Introduction to Nursing' or 'Communication'. Then use Chapters 7 to 11 for a more advanced-skills based course like 'Nursing Practices' or 'Mental Health Nursing'. I would suggest students spend two weeks reading and then discussing one chapter before moving on to the next. The activities following each chapter make interesting tutorial activities and could easily last one hour.
If one wants to say something really impressive about a book, then one might hail it as a 'foundational text'! But I think Patient and Person is more than foundational - it is progressive, interesting, skill building, and a key theoretical reference on usually unproblematic practices of nursing.
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