1. Nursing Management of Clients with Stressors that Affect Communication NUR101 Fall 2008 Lecture #2 K. Burger MSEd, MSN, RN, CNE

2. Elements of Communication Source (encoder) Message Channel Receiver (decoder) Feedback

3. Nurses Role Therapeutic communication Helping relationship between nurse and patient Utilizes interviewing techniques to gather information (assessing) PHASES of HELPING RELATIONSHIP Orientation Working Termination

4. Factors that Influence Communication Developmental Stage Gender Sociocultural Role/Occupation Space Physical Mental Emotional State

5. Effective Communication Friendliness, openness, respect Empathy, trust, caring, competence Purpose, privacy, confidentiality, comfortable environment, personal space

6. Verbal Communication Transmitting a message using the spoken or written word Nurses speaking to patients/ nurses/doctors or writing progress notes/ nursing care plans

7. Nonverbal Communication Transmission without using words Body language Touch Eye contact Facial expressions Posture Gait Physical appearance Dressing/grooming Sounds Silence

8. Techniques Facilitating Communication Conversational skills Tone of voice Knowledgeable Confidence Flexible Clear/Concise Avoid semantics Listening skills Alert/relaxed Indicate attentiveness Think before you speak Listen for themes Honesty/Authenticity

9. Facilitating Communication Silence Touch Eye contact Watch your body language Humor Assertive Utilize opportunities Use of supportive statements Displaying empathy

10. Blockers to Communication Not perceiving pt. as a human Not listening Changing the subject False reassurance Being judgmental Inappropriate comments Clichés Asking yes/no questions Giving advice Probing questions

11. Interviewing Techniques Used by nurses to obtain information about pt. Useful in the helping relationship FIRST STEP = attentive listening!!! ALSO NEED: privacy, comfortable environment Open ended questions “ What brings you to the clinic today?” Closed questions/comments – yes/no Validating questions/comments “Tell me whether my understanding of what you said is correct…..”

12. Interviewing Techniques Clarifying questions/comments Reflective ( re-stating) questions/comments Paraphrasing Direct questions Sequencing Re-focusing

13. AN EXAMPLE During your shift in the ICU you have been assigned to care for a man injured in a motor vehicle accident in which he has been charged with DWI. The driver of the other car was killed. The patient says to you: “I feel so terrible about what has happened”

14. SUPPORTIVE STATEMENT “I CAN IMAGINE HOW YOU FEEL” “THIS MUST BE VERY DIFFICULT FOR YOU”

15. CLARIFYING “ARE YOU FEELING BAD ABOUT HAVING BEEN DRINKING AND DRIVING?” “ARE YOU FEELING BAD ABOUT HAVING KILLED SOMEONE?” “ARE YOU FEELING TERRIBLE ABOUT YOUR INJURIES?” “ARE YOU FEELING TERRIBLE ABOUT THE FACT THAT YOU ARE GOING TO BE ARRESTED AND GO TO JAIL?”

16. CONVEYING EMPATHY USING CONGRUENT NON-VERBAL COMMUNICATION TECHNIQUES: TOUCH EYE CONTACT SILENCE ALONG WITH: SUPPORTIVE STATEMENTS

17. ??????? NURSE REPLIES: “YOU FEEL TERRIBLE?” REFLECTION (RESTATING)

18. ?????? NURSE REPLIES: “WELL, YOU SHOULDN’T HAVE BEEN DRINKING WHILE DRIVING” BEING JUDGMENTAL

19. ?????? NURSE REPLIES: “DON’T WORRY, I’M SURE EVERYTHING WILL BE ALRIGHT” FALSE REASSURANCE

20. Impaired Communication Hearing impaired Visually impaired Language barriers Physical barriers Cognitively impaired Unconscious