Craven Ch 5 - Communication in the Nurse-Patient Relationship

Written Communication

A means to document and convey information to others. The writer selects and organizes words in a way that is legible and comprehensible to the reader.

Verbal Communication

Involves the spoken word. It is an exchange using the elements of language. The specific use of words and jargon in nursing is particularly powerful because it defines the perceptions and realities of people's experiences. Words of education, persuasion,

Nonverbal Communication

A person communicates by gestures, facial expressions, posture, space, appearance, body movement, tough, voice tone and volume, and rate of speech. Silence is a form of nonverbal communication.

Metacommunication

Communication about the communication or lack thereof. This form of communication means different things at different levels. It can be verbal or nonverbal and is information that is constantly available during the proces of communication, giving context

Congruent Relationship ****

The way relationships among the different types of communication fit together are congruent.

Incongruent Relationship ****

The way relationships among the different types of communication do not fit together are incongruent.

Sender

All communication has a sender (a person or group with a purpose for the communication.

Encoding

The process of getting the purpose translated into the code. Encoding results in a message.

Communication Channel

The medium or carrier of the message.

Decode

The receiver is the target of the communication and must be able to understand or decode the message.

Feedback

Once messages are decoded and received, feedback occurs. Feedback means that the sender and the receiver use one another's reactions to produce further messages.

Six Key Elements that contributed to reduction in difficult encounters:

1) Knowing the patient
2) Knowing families
3) Collaborative relationships with other staff while at work
4 & 5) Availability of supplies and equipment
6) Care space changes (changes in the patient's care environment, often focused on medical needs having

Importance of Language and Experience

Bandler and Grinder (1975) suggest in their early and now classic work on neurolinguistic programming that a person's view of the world is developed through several kinds of filters. One such filter consists of the neurologic receptor systems: sight, hear

Phases

The nurse-patient relationship can be thought o f in terms of three phases: orientation, working, and termination. During all phases, the nurse solicits feedback from the patient so that the nurse can adjust subsequent encounters to maximize care.

Orientation Phase ****

The orientation phase consists of introductions and an agreement between nurse and patient about their mutual roles and responsibilities. (Development of trust in relationship)

Working Phase ****

During the working phase, the nurse and patient explore and develop solutions that are enacted and evaluated in subsequent interactions. The nurse functions as a coach and advocate while attending to the patient's physical and emotional healthcare needs.

Termination Phase ****

The closure of the relationship. The nurse and patient review health changes and how the patient has dealt with emotional responses. Discharge planning is a key component in the termination process. Termination can take various forms. For example, the nur

Contract Setting

Patients are given information necessary for making decisions, and patients choose among options, including acceptance, refusal , or termination of treatment. Aspects of care, goals of treatment, and necessary adaptations are discussed with the patient. T

Advocacy

Taking the patient's side, is the basis for communication with patients. Advocacy supports the patient's right to the information necessary to make his or her own decisions about treatment options and nursing care. Being an advocate for the patient means

Circle of Confidentiality ****

Depending on legal restrictions, certain patient information must be shared with other professionals involved in a patient's care. This can be thought of as a circle of confidentiality, and it included all the people in a nursing unit who have responsibil

Empathy

Encompasses the ability to look at things from another's perspective, to walk in his or her shoes, and to be able to share the essence of that understanding through verbal and nonverbal communication. Importance of maintaining objectivity. In order to mai

Positive Regard

Refers to warmth, caring, interest, and respect for the person's, seeing the person unconditionally or nonjudgmentally. Positive regard also means that the professional avoids unnecessary labeling of patients (a diabetic, an amputee, an alcoholic).

Comfortable sense of self

Before a nurse can communicate therapeutically, a comfortable sense of self, such as being aware of one's own personality, values, cultural background, and style of communication, is necessary. A person's sense of self comprises a collection of characteri

Professional Self-Care Safety Nets

Self awareness and clinical supervision (a regular protected time for facilitated in-depth reflection of clinical practice guided by an expert or peer).

Assessment ****

During the initial phase of the relationship, the nurse assesses the patient' communication, using the theoretical base. Assessing the environment in which communication takes place is also important. The external environment must be conducive to communic

Implementation ****

Once communication has been assessed, the nurse must use communication as a therapeutic intervention. The nurse can encourage a patient to express concerns by sitting down; often, patients are reluctant to express themselves to someone who is always in a

Open Ended Questions ****

A question that elicits more than a "yes" or "no" answer. (Ex: How are things going for you at this point? What have your experiences been like?

Opening Marks ****

Other ways to help patient get started include opening remarks based on observations and assessment about the patient. These questions and statements must be neutral and tentative, not probing or interrogating. (Ex: You've been having a pretty rough time.

Active Listening ****

Listening actively involved the ability to focus on the patient and the content of the patient's message, conveying back to the patient an accurate picture of what he or she is expressing. Active listening also involves constant decoding of the content an

Restatement ****

Refers mainly to the content portion of the communication. After listening carefully to the patient, repeat the content of the message back to the patient in order to verify understanding with the patient. When the content is restated, the patient has the

Reflection ****

Means identifying the main emotional themes contained in a communication and directing them back to the patient. The purpose is to verify and check the feelings that are being heard. Listen for the underlying feelings that a patient is conveying: then, re

Exploring ****

A way of communicating therapeutically without giving direct advice. Instead, the nurse helps patients express their concerns and solve their own problems by investigating the situation, how the patient feels about it, and what some alternatives might be.

Focusing ****

Involves asking goal-directed questions to help the patient stay on the topic and talk more about it. The questions, still open-ended, are directed toward the patient's key concerns.

Encouraging Elaboration ****

A technique used to help the patient describe more fully the concerns or problems being discussed.

Seeking Clarification ****

Means helping the patient put into words unclear thoughts or ideas. It can also be used to clarify events by putting them in a time sequence.

Giving Information ****

Involves sharing information about the patient's health and well-being in a timely manner and based on what is currently known about the patient's condition. Can mean sharing what is known about a patient's illness, treatment, and recovery. It can also me

Looking at Alternatives ****

Means exploring options for the patient's consideration. When more options are identified, the patient's perceived choices are increased.

Using Silence ****

A pause in communication that allows the nurse and patient to reflect on what has taken place.

Summarizing ****

Highlighting the important points of a conversation by condensing what has been said. This helps both the nurse and patient review the main themes of the conversation and give a sense of closure. It also enables the nurse and patient to think about what e

Developing Communication Skills

Time and experience are needed to become skilled at using therapeutic communication. One way to develop this skill is to study one's interactions, either by recording a therapeutic conversation (after obtaining the patient's permission) or by re-creating

Nontherapeutic Responses

Nontherapeutic responses interfere with or block therapeutic communication. Nontherapeutic responses may prevent nurses from functioning as professionals and therapeutic agents in the care of patients. Presenting quick solutions and unwarranted cheerfulne

Rescue Feelings **** (black asterisks)

Occur when a nurse feels essential to the patient's welfare. The nurse thinks that he or she has exceptional abilities to help the patient, and the nurse's expectations for the patient will be high.

False Reassurance ****

Giving reassurance that is not based on the real situation. It is a way of minimizing the patient's situation. Giving false reassurance violates the patient's trust. Instead, supply any needed information and give reassurances based on actuality. Real rea

Giving Advice ****

Another common nontherapeutic response. Doing so focuses exclusively on the nurse's experiences and opinions.

Changing the Subject **** (black asterisks)

A nontherapeutic response that usually indicates anxiety on the nurse's part. It is a way of resisting hearing about a patient's distress, sadness, and difficulties.

Being Moralistic **** (black asterisks)

Seeing a situation as good or bad or right or wrong. It is a judgmental approach. The nurse must become aware of how he or she uses the word should. Talking to patients in terms of "shoulds" infers a preconceived idea about the "right" thing to do. Anothe

Non-Professional Involvement **** (black asterisks)

Occurs at a time when the nurse goes outside the boundaries of the therapeutic relationship and establishes a social, economic, or personal relationship with the patient. Sexual boundary violation is another example of nonprofessional involvement.

Special Situations

Adults and older adults, cross-cultural communication, the client in intensive care unit.