Unlocking Unlocking CommunicationCommunication
You have the key:You have the key:
If the listener understands something different from what is meant, communication has not taken place- miscommunication has. Effective communication means what is understood matches what was intended.
Communication with nurses is Communication with nurses is valued by older adults because…valued by older adults because…
they appreciate nurses’…they appreciate nurses’…• knowledge• understanding approach• caring attitudes• kindness• sociability• intuition
Ford, P., & Heath, H. (Eds.). (1996).Ford, P., & Heath, H. (Eds.). (1996). Older people and nursing: Issues of living in a Older people and nursing: Issues of living in a care home. care home. London: Butterworth-Heinemann.London: Butterworth-Heinemann.
Communication can be blocked by…Communication can be blocked by… physical impairments learning abilities cultural & ethnic differences emotional stresses age sex lack of mutual trust attitudes language distractions, noise failure to listen language barriers
Effective Communication involves…Effective Communication involves…
active listening self-disclosure self-awareness awareness of others reciprocal disclosure meaningful relationship satisfaction that you have been heard
Active Listening TechniquesActive Listening Techniques
Open-ended Questions– can’t be answered with yes or no– begin with what, how, where, when– avoid why: makes one feel defensive
Example: •Where were you when you fell?•What happened?
Active Listening TechniquesActive Listening Techniques
Expanders– encourage one to continue talking– nod head, eye contact, “I see”, “That’s
interesting”, “Uh-huh”
Active Listening TechniquesActive Listening Techniques
Restatement
Example:• Let me see if I heard you correctly:
You fell in the kitchen, near the dog’s water which had spilled?
Active Listening TechniquesActive Listening Techniques
Reflection
Example:“You seem angry about that.”“That sort of thing frustrates you.”
Active Listening TechniquesActive Listening Techniques
Silence
Communication andCommunication andHearing ImpairmentHearing Impairment
Face client and establish eye contact Speak slowly and clearly Eliminate background noise Check and maintain hearing aids Supplement oral with written Clear obstruction from ear canal Check understanding with rephrasing
Communication andCommunication andVision ImpairmentVision Impairment
Ensure adequate lighting, free of glare Have assistive devices available and in
use Written communication: black print on
white or yellow paper, font size at least 14
Speak as you approach, touch hand or forearm
Sit at eye level
Communication and Culture: Communication and Culture: TimeTime
A central difference between cultures is the perception and use of time.
In Western cultures, time may be seen as• Quantitative (“time is money”)
• Linear
In some Eastern cultures, time is seen as• Fluid, without boundaries
• Circular (“we will get there eventually”)
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:Communication and Culture:Personal SpacePersonal Space
Personal space refers to the amount of space between individuals. It varies, depending on our culture and our relationships.
For example:• In France, Latin America, and Africa,
– closeness is preferred and distance is viewed as aloofness, dislike, or unwillingness to talk.
• In the US, – distance between individuals is usually greater in a social
context. As the relationship develops, people move closer together.
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:Communication and Culture:Eye ContactEye Contact
Old proverb: Old proverb:
“The eyes are the windows of the soul.”
In the US, • lack of eye contact is interpreted as the individual trying to hide
something or avoiding the issue.
In some other cultures, • prolonged eye contact is rude and an invasion of privacy. It may be
seen as aggressive and hostile.Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:Communication and Culture:SilenceSilence
Silence in a conversation can have several interpretations, depending on the cultural group:• A space that needs to be filled• Agreement between those talking• Opportunity for everyone to speak• A sign of respect and understanding
• Time to reflect
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Communication and Culture:Communication and Culture:The Nurse’s RoleThe Nurse’s Role
It is always important to recognize It is always important to recognize each person’s individuality, each person’s individuality, regardless of his or her culture.regardless of his or her culture.
Understanding cultural Understanding cultural differences…differences…• facilitates the establishment of rapport facilitates the establishment of rapport
with clients, families and communities.with clients, families and communities.• assists in problem-solving clinical assists in problem-solving clinical
issues with positive outcomes for all issues with positive outcomes for all involved.involved.
Luckmann, J. (1999). Transcultural communication in nursing. Albany: Delmar.
Other Communication Other Communication ApproachesApproaches
Reminiscence and life review Reality orientation Validation Relaxation Expressive writing Music Humor Touch
– massage– Reiki
Communication TipsCommunication Tips Establish a relationshipEstablish a relationship Focus on abilitiesFocus on abilities Assess and reassessAssess and reassess Keep client informedKeep client informed Eliminate distractionsEliminate distractions Be aware of roadblocksBe aware of roadblocks Use eye contact, listening skills and gesturesUse eye contact, listening skills and gestures Observe non-verbal cuesObserve non-verbal cues Use adaptive devicesUse adaptive devices Let person know when you Let person know when you don’tdon’t understand understand
Client Teaching:Client Teaching:Get and Keep AttentionGet and Keep Attention
Make your point right from the startMake your point right from the start
Vary your tone of voiceVary your tone of voice
Use assorted teaching methods Use assorted teaching methods
Make the abstract concreteMake the abstract concrete
Client Teaching:Client Teaching:Stick to the BasicsStick to the Basics
Less is moreLess is more
Be specific about what you want the Be specific about what you want the client to knowclient to know
Use simple everyday languageUse simple everyday language
Allow older adults more time for Allow older adults more time for information processinginformation processing
Copyright 1995 by C. R. Van SonCopyright 1995 by C. R. Van Son
Example: Example: The 6 “P’s” of Insulin InjectionsThe 6 “P’s” of Insulin Injections
PPrepare repare (gather supplies, draw-up insulin)(gather supplies, draw-up insulin)
PPinchinch (pinch skin on stomach, thigh. Rotate) (pinch skin on stomach, thigh. Rotate)
PPoke oke (quickly poke skin, dart)(quickly poke skin, dart)
PPush-in ush-in (push plunger in)(push plunger in)
PPull-out ull-out (pull out syringe, do not rub skin)(pull out syringe, do not rub skin)
PPut-awayut-away (put syringe in safety container) (put syringe in safety container)
Client Teaching:Client Teaching:Make the Most of Your TimeMake the Most of Your Time
Incorporate teaching Incorporate teaching into client care into client care activitiesactivities
Involve family Involve family members and members and caregiverscaregivers
Supplement your Supplement your teaching with written teaching with written materials if materials if appropriateappropriate
Client Teaching:Client Teaching:Reinforcement is the KeyReinforcement is the Key
Be a role modelBe a role model Reward, reward, Reward, reward,
rewardreward Review material Review material
over several periods over several periods of timeof time
Client Teaching:Client Teaching:Test UnderstandingTest Understanding
Ask client to restate and return-Ask client to restate and return-demonstrate what you taught him or demonstrate what you taught him or her.her.
Have client (family member) keep a Have client (family member) keep a diary or record of behaviors.diary or record of behaviors.
Review the written materials with the Review the written materials with the client, if appropriate.client, if appropriate.
Overcome Barriers to LearningOvercome Barriers to Learning
Physical barriersPhysical barriers
Emotional barriersEmotional barriers
Language and cultureLanguage and culture
LiteracyLiteracy
Simplify WritingSimplify Writing
Write short sentencesWrite short sentences Use easy to understand wordsUse easy to understand words Define clinical termsDefine clinical terms Use action wordsUse action words Number the stepsNumber the steps Use pictures and diagramsUse pictures and diagrams Have large typeHave large type Make lots of white spaceMake lots of white space
Teaching TipsTeaching Tips
Keep it simpleKeep it simple Ask how client likes to learnAsk how client likes to learn Take time to get to know clientTake time to get to know client Ask client if he or she has questionsAsk client if he or she has questions Don’t wait until the last minuteDon’t wait until the last minute Follow upFollow up
Communication: A Team EffortCommunication: A Team Effort Utilize other members of Utilize other members of
interdisciplinary team and make interdisciplinary team and make appropriate referralsappropriate referrals
Facilitate interagency exchange of Facilitate interagency exchange of information and supportinformation and support
Acknowledge information from Acknowledge information from family members and caregiversfamily members and caregivers
Unlocking Communication was prepared Unlocking Communication was prepared by Catherine Van Son, Ph.D., R.N. for the by Catherine Van Son, Ph.D., R.N. for the Older Adult Focus Project, OHSU School Older Adult Focus Project, OHSU School of Nursingof Nursing