1. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Professional Nursing Practice Concepts and Perspectives Seventh Edition Chapter 14 Communicating Effectively

2. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved 14.1 Describe communication. 14.2 Describe the five components of the communication process. 14.3 Analyze factors influencing the communication process. 14.4 Discuss the types of communication and their characteristics. 14.5 Differentiate between therapeutic and nontherapeutic communication. 14.6 Identify barriers to effective communication. 14.7 Differentiate between nursing documentation and other forms of written communication. 14.8 Discuss technology as a form of communication. Learning Objectives

3. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Hallmark Features A focus on foundational knowledge related to professional nursing –Includes nursing history, nursing theory, ethics, and legal aspects, etc. An overview of professional nursing roles, issues, and changes in the profession –Discusses nurses as healthcare providers, learners and teachers, and leaders

4. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Challenges and Opportunities Clear and appropriate communication is essential for providing effective nursing care Many languages are spoken Population is multicultural Opportunities for nurses to bridge communication gaps in delivering health care

5. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.1 Describe communication.

6. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Definitions of Communication Communication –Giving or exchanging of information or feelings through oral, written, or nonverbal means –The act of communicating enables exchange of information Rapport –Building of mutual understanding and trust as component of effective communication

7. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Definitions of Communication Health communication –Study and use of communication strategies to inform and influence individual and community health decisions –Includes  Health promotion  Disease/injury prevention  Healthcare policy  Business of health care

8. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Definitions of Communication Health communication –Goal to engage and support various sectors in society to adopt and maintain practices that will improve health outcomes Interpersonal communication is communication between two or more people Intrapersonal communication is communication within oneself; reflection Effective communication helps to prevent errors

9. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.2 Describe the five components of the communication process.

10. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Communication Process Communication process involves –Sender  Person or group that wishes to transmit message to another  Also called source encoder  Encoding involves selection of specific signs or symbols to transmit message: choice of words, speech inflection, body language

11. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Communication Process Communication process involves –Message  Thoughts, ideas, information, or feelings to be transmitted  May be oral or written  May be directed toward individuals or groups  May be face-to-face or through another channel

12. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Communication Process Communication process involves –Channel  Method selected to convey the message  Includes whether message is spoken or written, choice of words or language, choice of body language  Can be visual, auditory, or through touch  Some of most effective communication interactions involve use of more than one sensory channel

13. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Communication Process Communication process involves –Receiver  Also called the decoder  The one who receives the message, interprets or decodes it, and makes decision about how to respond  Messages are decoded in relation to experiences, knowledge, and personal characteristics  Communication is effective when receiver interprets message congruently with intent of sender  Communication is ineffective when message is not understood or is interpreted inaccurately

14. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved The Communication Process Communication process involves –Response  Also called feedback  Enables the sender to know whether message was received and interpreted correctly  Communication is ineffective when there is a failure to obtain a response  Can be verbal or nonverbal Communication is cyclical: Once response is given, process starts over again until communication is ended

15. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.3 Analyze factors influencing the communication process.

16. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Developmental stage –As individuals grow and develop, language and communication skills develop through various stages –Important for nurse to understand developmental processes related to speech, language, and communication skills –Intellectual processes develop across the life span as people acquire knowledge and experience

17. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Gender –Kneisl and Trigoboff state that  Men tend to require more space and are more likely to use gestures  Women use their voices to communicate a wider range of emotions and smile more often –Communication, gender, culture, and religion are interconnected

18. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Roles and relationships –Roles may influence choice of message content, communication vehicle, tone of voice, body language –Length of relationship may affect communication

19. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Sociocultural characteristics –Culture, religion, education, and economic level can influence communication –People’s level of education may affect extent of their vocabulary or ability to read –Lack of access to computers may limit communication for some

20. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Values and perceptions –Values people hold about themselves, others, and the world in which they live influence communication –Important for nurse to validate perceptions and their meanings with clients, families, and colleagues

21. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Space and territoriality –Proxemics  Study of spatial separation or distance maintained by people in personal and social interactions –Space  Distance at which interaction takes place –Territoriality  Space and contents of the space that the individual considers belonging to him or her

22. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Environment –Nature of the environment can affect communication –Communication occurs best in environment that supports exchange of information, feelings, and ideas –Lack of privacy, arrangement of the space, distractions, and discomforts can all affect communication

23. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Factors Influencing the Communication Process Congruence –When communication is congruent, nonverbal behaviors match the verbal message Interpersonal attitudes –Positive attitudes of respect, acceptance, trust, and caring facilitate communication –Negative attitudes of mistrust, rejection, and condescension inhibit communication –Attitudes are conveyed by facial expression, tone of voice, choice of words, and body language

24. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.4 Discuss the types of communication and their characteristics.

25. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Types of Communication Verbal –May be spoken or written and involves words –Mainly conscious –Depends on language mastery –Oral communication is spoken exchange of information, ideas, or feelings using words

26. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Types of Communication Verbal –When choosing words for oral communication, nurses must consider  Pace and intonation  Simplicity  Clarity and brevity  Timing and relevance  Adaptability  Credibility  Humor

27. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Types of Communication Verbal –Paralanguage or paralinguistic sounds are sounds that accompany verbal language and add to message, including  Tone  Pitch  Volume of voice  Speed or tempo of speech  Hesitation before or during speech  Emotions expressed

28. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Types of Communication Nonverbal –Uses other forms such as eye contact, facial expressions, body movements, gestures, touch, and physical appearance –Includes use of pictures, signs, and symbols to communicate

29. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.5 Differentiate between therapeutic and nontherapeutic communication.

30. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Therapeutic Communication Interaction between nurse or other healthcare provider and the client and/or family with purpose of establishing a trusting relationship and assisting client –To overcome stress/anxiety –Gain personal insight –Control symptoms of physical or psychological disease –Promote healing

31. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Therapeutic Communication Always a specific purpose or direction to communication Therapeutic communication is planned Specific techniques that express attitude of trust and caring –Presence, or attitude of being wholly there for the client –Active, attentive, or mindful listening is one of the most important techniques; requires undivided attention with personal biases and judgments put aside

32. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Therapeutic Communication Specific techniques that express attitude of trust and caring –Silence is part of attentive listening, allows clients to reflect or think about what has been said, can enable expression of feelings and emotions

33. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Written Communication Nurses are required to be proficient in written communication Most common form is notes in medical record Nurses also write –Discharge instructions –Memos to colleagues and other health professionals –Client educational materials

34. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Written Communication Characteristics of effective written communication, in addition to characteristics of effective oral communication –Appropriate language and terminology –Correct grammar, spelling, and punctuation –Logical organization –Appropriate use and citation of resources

35. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.6 Identify barriers to effective communication.

36. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Barriers to Communication Nurses need to be cognizant of barriers and avoid them –Failure to listen –Improperly decoding client’s intended message –Placing nurse’s needs above client’s needs –Stereotyping –Agreeing and disagreeing –Being defensive –Challenging

37. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Barriers to Communication Nurses need to be cognizant of barriers and avoid them –Probing –Testing –Rejecting –Changing topics and subjects –Unwarranted reassurance –Passing judgment –Giving common advice

38. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.7 Differentiate between nursing documentation and other forms of written communication.

39. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Documentation Documentation of clients’ care is essential for effective communication of clients’ status between healthcare providers

40. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Documentation Uses of information provided in clients’ records –Planning client care –Auditing for quality assurance –Research –Education –Reimbursement –Legal documentation –Healthcare analysis

41. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Documentation Methods of documentation –Traditional source-oriented narrative record –Problem-oriented medical record (POMR) –Problems, interventions, evaluation (PIE) model –Focus charting –Charting by exception (CBE) –Computerized documentation –Case management

42. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Nursing Documentation One must be cautious about use of abbreviations in documentation; abbreviations can result in medical errors –Development of “do-not-use” abbreviations list

43. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Learning Objective 14.8 Discuss technology as a form of communication.

44. Copyright © 2016, 2012, 2009 Pearson Education, Inc. All Rights Reserved Communicating Through Technology Nurses use technology to enhance communication –Email or text messaging to communicate with clients and families, other nurses, other departments in their employment setting, outside resources –Computers to access health information through websites and electronic literature databases –Electronic health record (EHR) systems Nurses need to use proper etiquette and professionalism when communicating through technology