Communication

Objectives Describe 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

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 interaction Ability to communicate is basic to human functioning and well-being.

Communication Process Based on a stimulus (a patient’s need for: medication, information, food or fluid) Involves: Source (encoder) - Person who sends the message Message - the physiologic product of the source (speech, gesture, nursing note) Channel- the medium used to send the message Receiver (decoder) the person who receives and interprets the message sent

Channels of Communication Auditory: spoken words and cues Visual - sight, observations, and perception Kinesthetic - touch

Communication Process

Forms of Communication Verbal: exchange of information using words; including both the spoken and written word. Verbal communication depends on language Nursing 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

Forms of Non Verbal Communication Touch: can express comfort, love, affection, security, anger, frustration, excitement, empathy Eye Contact: means different things in different cultures; Eyes can carry expressions - anger, fear, happiness Facial Expression: Some people have expressive faces, others hide their emotions Posture: the way a person holds the body; can indicate depression, well-being, tension Gait: Type of walk; can indicate energy level, debilitating conditions Gestures: Many gestures are understood across cultures

Non Verbal Communication General Physical Appearance: Skin color, body size, muscle tone 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 Sounds: crying, moaning, gasping, sighing Silence: can have multiple meanings

Levels of Communication Intrapersonal: “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

Question A 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. Intrapersonal B. Interpersonal C. Group D. Organizational

Answer Answer: A. Intrapersonal Rationale: 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.

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

Group Dynamics

Roles of Group Members Task-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

Factors Influencing Communication Developmental level Gender Sociocultural differences Roles and responsibilities Space and territoriality Physical, mental, and emotional state Values Environment

Developmental Level

Developmental Level

Environment

Personal Space

Personal Space

Hand off Communication: SBAR Technique Involves the accurate presentation of all patient-related information to another caregiver. Includes Nurse - to - Nurse report Nurse to physician report Report to and from other hospital departments JCAHO - recommends a standardized method of communication, including an opportunity to ask and respond to questions

SBAR S = Situation B = Background A = Assessment R = Recommendations Developed by the US Navy and then implemented by Kaiser Permanente in Colorado

SBAR Example: 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?

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 spontaneously Characterized by an unequal sharing of information Built on the patient’s needs

Characteristics of the Helping Relationship Dynamic: Both parties are actively participating Purposeful and time limited Person providing assistance is professionally accountable for the outcomes

Goals of the Helping Relationship Goals are determined cooperatively between the nurse and the patient Goals for the patient change as the patient’s condition changes The patient’s goals are the focus of the relationship

Phases of the Helping Relationship Orientation phase: includes data gathering sets the tone for the remainder of the relationship Patient and nurse learn each other’s name Roles of both parties are clarified Goals are established Patient is oriented to facility, routines, other staff members

Orientation Phase

Phases of the Helping Relationship Working Phase Longest phase; characterized by interaction Nursing interventions Patient teaching Assistance with ADL’s Nursing roles: teacher and counselor Satisfactory working relationship is crucial

Working Phase

Phases of the Helping Relationship Termination Phase Occurs when the conclusion of the initial agreement is acknowledged (change of shift, patient is discharged) Evaluations of progress toward initial goals should be done Set the stage for transfer of the helping relationship to another person or entity (home health, clinic)

Factors that Promote Effective Communication Dispositional traits Rapport builders

Factors Promoting Effective Communication Within the Helping Relationship Dispositional Traits Warmth and Friendliness Openness and Respect Empathy Honestly, Authenticity and Trust Caring Competence

Rapport Builders Def: a feeling of mutual trust experienced by people in a satisfactory relationship; facilitates open communication Specific Objectives Comfortable Environment Privacy Confidentiality Patient vs. task focus Using nursing observations Optimal pacing Respecting personal space

Communication Skills Conversational Skills Listening Skills Silence Touch Humor Interviewing Techniques

Touch

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.

Listening

Developing Listening Skills Sit 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.

Communication Skills

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”

Interviewing Techniques Clarifying 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………”

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.

Developing Listening Skills Sit 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.

Basic Components of Assertiveness Having empathy Describing one’s feelings or the situation Clarifying one’s expectations Anticipating consequences

Blocks to Communication Failure to perceive the patient as a human being Failure to listen Inappropriate comments and questions Using clichés Using closed questions Using questions containing the words “why” and “how” Using questions that probe for information

Angry Nurse

Blocks to Communication (cont.) Using leading questions Using comments that give advice Using judgmental comments Changing the subject Giving false assurance Using gossip and rumors Using aggressive interpersonal behavior

Stressed Nurse

Impaired Verbal Communication Aphasia: Expressive: inability to speak Receptive - inability to understand Hearing Problems Voice Problems Dysarthria: inability to produce sounds, slurred speech from strokes, parkinsonism etc Other communications problems: brain impairment, disorientation