unlocking communication. you have the key: if the listener understands something different from what...

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?


Expanders– encourage one to continue talking– nod head, eye contact, “I see”, “That’s

interesting”, “Uh-huh”


Restatement

Example:• Let me see if I heard you correctly:

You fell in the kitchen, near the dog’s water which had spilled?


Reflection

Example:“You seem angry about that.”“That sort of thing frustrates you.”


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.


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


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.


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

unlocking communication. you have the key: if the listener understands something different from what...

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