What is communication?
any means of exchanging information or feelings between two or more people
*basic component of human relationship
*2 main purposes: to obtain info & to influence others
Why is communication important in nursing?
-essential for the establishment of a nurse-client relationship
-nurses:
*collect assessment data
*initiate interventions
*initiate change that promotes health
*evaluate outcomes
NURSES who communicate effectively are able to: "self-talk" - involves thinking before sending out the message
What is therapeutic communication?
*planned, deliberate, purposeful (elicit a response)
GOAL: to form a working relationship with clients to fulfill the purposes of the nursing process
Components of Communication
Sender (encodes message) --> Message (speaking, listening, gesturing, writing) -->Receiver (Decodes messages) --> Feedback --> Sender
What is the SENDER?
THE SOURCE!
*encoder
*a person or group who wishes to convey a message to another
*before encoding the sender must observe the receiver
What is the MESSAGE?
*what is actually being said or written
*includes body language
* the medium (mode) used to convey the message is the CHANNEL (make sure its appropriate for the message)
*modes or channels are affected by:
- physical & cultural development (developmental age v. chronological age)
- culture
- education
- life experiences
USE APPROPRIATE LANGUAGE (laman's terms)
3 main communication CHANNELS
1. visual (body language)
2. auditory
3. kinesthetic (touching)
What is the RECEIVER?
THE DECODER
*interprets the meaning of the message
*primary sensory skill used in verbal communication is listening
*active v. passive (actively listen to pt. BE ENGAGED!)
What is FEEDBACK?
*response or reaction
*the message that the receiver returns to the sender (verbal, non-verbal, both) ie. eye rolling
*provides opportunity for clarification (make sure its clear)
Verbal Communication
use of spoken or written word
*electronic communication (technology) - provides a record (refer back to it)
Non-verbal Communication
gestures and postures
facial expressions
touch
physical appearance (be clean)
Body Language
approx 60-80% of communication is transmitted by body cues
*body language can communicate more than spoken words
*unconsciously motivated & may be more accurate in expressing intended meaning
Communication & Culture
BE CULTURALLY AWARE
-transcultural non-verbal communication varies widely
-personal space
-smiling
-handshaking, touch
-eye contact
Criteria for Accurate Communication
*congruence in communication
-the verbal & non-verbal aspects of the message should match
-if the nurse's communication is congruent, the client is more likely to TRUST the nurse
FACIAL IMPRESSION IS IMPORTANT
*don't grimace when doing a dressing change and it smells
Criteria for Accurate Communication
1. pace - slow down when talking to patients
2. intonation (tone)
3. clarity & brevity
4. timing & relevance
Interpersonal Attitudes
Facilitate communication: caring/warmth, respect, ACCEPTANCE
Inhibit Communication: condescension, lack of interest, coldness
Attributes of an Effective Communicator
-knowledge of communication principles
-insight of own strengths and weaknesses
-sensitivity
-experience
Elements of Professional Communication
-professional appearance, demeanor & behavior
-courtesy (knock before entering, "hello" introduce yourself to patient
-privacy & confidentiality
-trustworthiness
-autonomy & responsibility
-assertiveness (don't be aggressive, its not the same)
Attentive Listening
-active process, requires energy and concentration
-listening to the total message (verbal & nonverbal)
-most important technique in effective communication
What does SOLER stand for?
S - sit facing the client
O - observe an open posture
L - lean toward the client
E - establish and maintain intermittent eye contact
R - relax
Social Relationships
-no specific purpose
-getting acquainted
-non-threatening
-unlimited
Professional Relationships
-therapeutic
-dynamic
-client directed (focus on wellbeing)
-goal directed
-time limited
What are the 4 phases of Therapeutic Relationships?
1. Pre-Interaction Phase
2. Introductory Phase
3. Working Phase
4. Termination Phase
Pre-Interaction Phase
-planning stage before the face-to-face meeting (review clients name, medical hx, labs, reports from previous shift)
-the nurse may have some anxiety prior to meeting the patient
Introduction Phase
-orientation phase or prehelping phase
-initial encounter of "getting to know each other"
-developing trust
-three stages of introductory phase
3 stages of Introductory Phase
1. opening the relationship (set the tone) BE PROFESSIONAL
2. clarifying the problem and expectations (let them know exactly what your plan is (client focused)
3. formulating the contract (setting goals; focus on priorities, timeline - tell them what you're gonna do to achieve goal)
Working Phase
Two main stages:
1. exploring & understanding thoughts and feelings
-empathetic listening and responding
-respect
-genuineness
-concreteness (trip & fall) - be firm about care (explain why) - make your point
-confrontation (point out discrepancies)
2. facilitating and taking action
Termination Phase
end of the nurse-client relationship
-may reminisce (summarize) "look how far you have come..."
*discharge planning starts on admission
-start termination discussion in advance (helps ease the patients transition)
Therapeutic Communication Techniques: SILENCE & PROVIDING GENERAL LEADS
USING SILENCE
-takes time and experience to become comfortable with silence (can be awkward)
*ie. dx cancer, death, surgery, etc...
PROVIDING GENERAL LEADS
-"perhaps you would like to talk about..
Therapeutic Communication Techniques: USE OPEN ENDED QUESTIONS & USING TOUCH
USE OPEN ENDED QUESTIONS
-"what brought you to the hospital?"
-"tell me about..."
-"how do you feel today?"
USING TOUCH
-remember cultural considerations
Therapeutic Communication Techniques: RESTATE OR PARAPHRASE & CLARIFYING
RESTATE OR PARAPHRASE
-client: "the doctor told me that I need surgery tomorrow but I am afraid that I may die during anesthesia"
nurse: "you are concerned about the anesthesia?"
client: "yes, my uncle died in the OR 3 years ago"
CLARIFYING
-rationale: to confirm accuracy of information
"i'm not sure I understand what you mean by 'sicker than usual' What is different today?
Therapeutic Communication Techniques: BE SPECIFIC & PROVIDING INFORMATION
BE SPECIFIC
-"on a scale of 0-10, tell me whar you pain level is"
PROVIDING INFORMATION
-tell the patient what they need or want to know
"this medication can make you feel that your heart is beating faster. it is normal and should subside within a few minutes.
Therapeutic Communication Techniques: ACKNOWLEDGING & PRESENTING REALITY
ACKNOWLEDGING
-giving recognition regarding a change in behavior
"i notice that you are squinting your eyes. are you having difficulty seeing?"
PRESENTING REALITY
"your magazine is here in the drawer. it has not been stolen
DOCUMENTATION
-form of communication
-clear, concise, & complete
-legible handwriting
-process recording
(verbatim - word for word recording, including verbal and nonverbal interactions)
SBAR
-framework for nurse/physician communication
SITUATION: information about the client's current situation
BACKGROUND: current clinical situation
ASSESSMENT: current problem
RECOMMENDATION: that addresses client's needs
BLOCKS TO THERAPEUTIC INTERACTIONS
-failure to listen
-improperly decoding the client's intended message
-placing the nurse's needs above the client
-being defensive
-challenging
BLOCKS TO THERAPEUTIC INTERACTIONS
-DEFENSIVE RESPONSES: "the nursing staff is very competent"
-REASSURING: "don't worry about that"
-ADVISING: "i think you should"
-BELITTLING THE CLIENTS FEELINGS: "pt: I don't have anything to live for, nurse: everyone gets down in the dumps" (DONT)
-STEREOTYPING
-ELDERSPEAK (baby talk to elderly)
-CHANGING THE SUBJECT
-ARGUING: "how can you say you haven't slept all night, when i came in the room, i heard you snoring
BLOCKS TO THERAPEUTIC INTERACTIONS
-poor data collection
-inappropriate nursing diagnosis
-lack of planning by the nurse
CHALLENGING COMMUNICATION SITUATIONS
-anger (dont like hospital food)
-grieving (loss of limb)
-ALOC (confused patients)
-demanding patients
-silence
-anxious
-language barrier (diff language or if intubated - help write instead of talk)
Health Interview
nursing interview v. social interview
PURPOSE: goal directed, client focused
GUIDELINES: utilize therapeutic communication techniques
The nurse-client relationship
people will forget what you say to them, however, they will never forget how you make them feel