communication. objectives describe the communication process, identifying factors that influence...
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Communication
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ObjectivesDescribe the communication process,
identifying factors that influence communication
List ways in which people communicate nonverbally
Use a standardized communication technique (SBAR) to communicate with physicians and transfer patient information to other nurses
Describe how each type of ineffective communication hinders communication
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Communication“Communication skills are the building blocks
of professional relationships between nurse and patient, nurse and nurse, and nurse and other health-team members.”
Def: the process of exchanging information and generating and transmitting meanings between two or more individuals.
Primary aspect of a nurse-patient interactionAbility to communicate is basic to human
functioning and well-being.
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Communication Process
Based on a stimulus (a patient’s need for: medication, information, food or fluid)
Involves:1.Source (encoder) - Person who sends the
message2.Message - the physiologic product of the source
(speech, gesture, nursing note)3.Channel- the medium used to send the message4.Receiver (decoder) the person who receives and
interprets the message sent
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Channels of Communication
1. Auditory: spoken words and cues2. Visual - sight, observations, and
perception3. Kinesthetic - touch
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Communication Process
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Forms of CommunicationVerbal: exchange of information using words;
including both the spoken and written word.Verbal communication depends on languageNursing depends on verbal language
extensively
Nonverbal: communication without the use of words; also know as “body language”
Can be an incongruence between verbal and nonverbal message
Generally, the non-verbal message is thought to be the one that is more valid or true
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Forms of Non Verbal Communication1. Touch: can express comfort, love, affection,
security, anger, frustration, excitement, empathy2. Eye Contact: means different things in different
cultures; Eyes can carry expressions - anger, fear, happiness
3. Facial Expression: Some people have expressive faces, others hide their emotions
4. Posture: the way a person holds the body; can indicate depression, well-being, tension
5. Gait: Type of walk; can indicate energy level, debilitating conditions
6. Gestures: Many gestures are understood across cultures
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Non Verbal Communication7. General Physical Appearance: Skin color,
body size, muscle tone8. Mode of Dress and grooming: High self
esteem individuals pay attention to details of dress and grooming; those with low self esteem pay less attention; Illness cause low energy levels for grooming; Economic status
9. Sounds: crying, moaning, gasping, sighing
10. Silence: can have multiple meanings
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Levels of CommunicationIntrapersonal: “Self-Talk”
communication within an individual; can influence interactions with others
Interpersonal: between two or more people with a goal to exchange messages
Group: small group and organizational group communication
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QuestionA nurse who reassures herself that she is prepared to speak in front of a group of her peers is using which of the following types of communication?A. IntrapersonalB. InterpersonalC. GroupD. Organizational
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AnswerAnswer: A. IntrapersonalRationale:Intrapersonal communication is self-talk that happens within the individual.Interpersonal communication occurs between two or more people to exchange messages.Group communication includes small-group and organizational group communication.
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Group Dynamics
Within a group, how individual group members relate to one another during the process of working toward group goals.
How effective or ineffective is the group in attaining its goals
Requires effective leadership, but depends largely on the behavior of the members of the group
Example: Study Group
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Group Dynamics
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Roles of Group MembersTask-oriented—focus on work to be done
Group building or maintenance—focus on well-being of people doing work
Self-serving—advance the needs of individual members at group’s expense
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Factors Influencing Communication
Developmental levelGenderSociocultural differencesRoles and responsibilitiesSpace and territorialityPhysical, mental, and emotional stateValuesEnvironment
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Developmental Level
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Developmental Level
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Environment
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Personal Space
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Personal Space
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Hand off Communication: SBAR Technique Involves the accurate presentation of all
patient-related information to another caregiver.
Includes1.Nurse - to - Nurse report2.Nurse to physician report3.Report to and from other hospital
departmentsJCAHO - recommends a standardized
method of communication, including an opportunity to ask and respond to questions
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SBARS = SituationB = BackgroundA = AssessmentR = Recommendations
Developed by the US Navy and then implemented by Kaiser Permanente in Colorado
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SBARExample: Your patient has a temperature of 38.8.
He does not have an order for an antipyretic.
What would you say when you called the MD?
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Nurse - Patient Interaction: The Helping Relationship
“ Of all the problems that can arise in nursing care, perhaps the most common is failure to establish rapport and a help-trust relationship with the other person” (Watson, 1985)
Nursing Relationship vs. Social Relationship
Does not occur spontaneouslyCharacterized by an unequal sharing of
informationBuilt on the patient’s needs
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Characteristics of the Helping Relationship
Dynamic: Both parties are actively participating
Purposeful and time limitedPerson providing assistance is
professionally accountable for the outcomes
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Goals of the Helping RelationshipGoals are determined cooperatively
between the nurse and the patientGoals for the patient change as the
patient’s condition changesThe patient’s goals are the focus of the
relationship
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Phases of the Helping Relationship
Orientation phase: 1.includes data gathering2.sets the tone for the remainder of the
relationship3.Patient and nurse learn each other’s name4.Roles of both parties are clarified5.Goals are established6.Patient is oriented to facility, routines,
other staff members
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Orientation Phase
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Phases of the Helping RelationshipWorking Phase1.Longest phase; characterized by interaction2.Nursing interventions3.Patient teaching4.Assistance with ADL’s5.Nursing roles: teacher and counselor6.Satisfactory working relationship is crucial
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Working Phase
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Phases of the Helping RelationshipTermination Phase1.Occurs when the conclusion of the initial
agreement is acknowledged (change of shift, patient is discharged)
2.Evaluations of progress toward initial goals should be done
3.Set the stage for transfer of the helping relationship to another person or entity (home health, clinic)
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Factors that Promote Effective Communication
Dispositional traits
Rapport builders
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Factors Promoting Effective Communication Within the Helping RelationshipDispositional Traits
1.Warmth and Friendliness2.Openness and Respect3.Empathy4.Honestly, Authenticity and Trust5.Caring6.Competence
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Rapport BuildersDef: a feeling of mutual trust experienced by
people in a satisfactory relationship; facilitates open communication
1.Specific Objectives2.Comfortable Environment3.Privacy4.Confidentiality5.Patient vs. task focus6.Using nursing observations7.Optimal pacing8.Respecting personal space
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Communication SkillsConversational SkillsListening SkillsSilenceTouchHumorInterviewing Techniques
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Touch
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Developing Conversation SkillsControl the tone of your voice.Be knowledgeable about the topic of
conversation.Be flexible.Be clear and concise.Avoid words that might have different
interpretations.Be truthful.Keep an open mind.Take advantage of available opportunities.
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Listening
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Developing Listening SkillsSit when communicating with a patient.Be alert and relaxed and take your time.Keep the conversation as natural as
possible.Maintain eye contact if appropriate.Use appropriate facial expressions and body
gestures.Think before responding to the patient.Do not pretend to listen.Listen for themes in the patient’s comments.Use silence, therapeutic touch, and humor
appropriately.
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Communication Skills
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Interviewing Techniques
Open-ended questions or comments: Allows the patient an open field of responses “Tell me about that”
Closed questions or comments: Allows the patient a limited range of responses “Yes or No”
Validating questions or comments: Validates what the nurse believes she has heard “What I heard you saying was”
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Interviewing TechniquesClarifying question or comment :Allows the nurse
to gain further understanding of the patient’s comment. “Could you explain what you mean”
Reflective questions or comments: Repeating what the person has said in order to encourage him to elaborate “You are worried about the surgery?”
Sequencing questions or comments: In order to determine cause and effect “When did this occur?
Directing questions or comments: To gain more information about something previously discussed, “You mentioned earlier that………”
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Developing Conversation Skills
Control the tone of your voice.Be knowledgeable about the topic of
conversation.Be flexible.Be clear and concise.Avoid words that might have different
interpretations.Be truthful.Keep an open mind.Take advantage of available opportunities.
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Developing Listening SkillsSit when communicating with a patient.Be alert and relaxed and take your time.Keep the conversation as natural as
possible.Maintain eye contact if appropriate.Use appropriate facial expressions and body
gestures.Think before responding to the patient.Do not pretend to listen.Listen for themes in the patient’s comments.Use silence, therapeutic touch, and humor
appropriately.
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Basic Components of Assertiveness
Having empathyDescribing one’s feelings or the situationClarifying one’s expectationsAnticipating consequences
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Blocks to CommunicationFailure to perceive the patient as a human
beingFailure to listenInappropriate comments and questionsUsing clichésUsing closed questionsUsing questions containing the words
“why” and “how”Using questions that probe for information
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Angry Nurse
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Blocks to Communication (cont.)Using leading questionsUsing comments that give adviceUsing judgmental commentsChanging the subjectGiving false assuranceUsing gossip and rumorsUsing aggressive interpersonal behavior
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Stressed Nurse
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Impaired Verbal CommunicationAphasia:
1. Expressive: inability to speak 2. Receptive - inability to understand
Hearing ProblemsVoice ProblemsDysarthria: inability to produce sounds,
slurred speech from strokes, parkinsonism etc
Other communications problems: brain impairment, disorientation