1. Communication

2. 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

3. 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.

5. 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

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

7. Communication Process

8. 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

9. 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

11. 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

15. 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

16. 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

17. 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.

18. 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

19. Group Dynamics

20. 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

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

22. Developmental Level

23. Developmental Level

24. Environment

25. Personal Space

26. Personal Space

28. 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

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

31. SBAR
Example:
Your patient has a temperature of He does not have an order for an antipyretic.
What would you say when you called the MD?

32. 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

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

35. 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

36. 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

37. Orientation Phase

38. 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

39. Working Phase

40. 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)

42. Factors that Promote Effective Communication
Dispositional traits
Rapport builders

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

44. 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

46. Communication Skills Conversational Skills Listening Skills Silence
Touch
Humor
Interviewing Techniques

47. Touch

48. 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.

49. Listening

50. 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.

51. Communication Skills

52. 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”

53. 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………”

54. 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.

55. 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.

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

57. 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

58. Angry Nurse

59. 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

60. Stressed Nurse

62. 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