2. Communication and Nursing Practice A lifelong learning process for nurses An essential attribute of professional nursing practice Builds relationships with clients, families, and multidisciplinary team members

3. Communication and Interpersonal Relationships The means to establish helping and healing relationships. The ability to relate to others is important for interpersonal communication. Developing communication skills requires both an understanding of the communication process and of one’s own communication experience. Box 24-1 presents communication throughout the nursing process. Box 24-2 presents challenging communication situations.

4. Levels of Communication 1. Intrapersonal A. One-to-one interaction between two people 2. Interpersonal B. Occurs within an individual 3. Transpersonal C. Interaction with an audience 4. Small Group D. Interaction within a person’s spiritual domain 5. Public E. Interactions with a small number of people

5. Basic Elements of the Communication Process 1. Referent A. One who encodes and one who decodes the message 2. Sender and receiver B. The setting for sender- receiver interactions 3. Message C. Message the receiver returns 4. Channels D. Motivates one to communicate with another 5. Feedback E. Means of conveying and receiving messages 6. Interpersonal variable F. Factors that influence communication 7. Environment G. Content of the message

6. Forms of Communication Verbal Vocabulary Denotative and connotative meaning Pacing Intonation Clarity and brevity Timing and relevance

7. Nonverbal Communication Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds Territoriality and personal space

8. Other Forms of Communication Symbolic The verbal and nonverbal symbolism used by others to convey a meaning Metacommunication A broad term that refers to all factors that influence communication

9. Professional Nursing Relationships Nurse-client helping relationships Nurse-family relationships Nurse-health team relationships Nurse-community relationships

10. Elements of Professional Communication Appearance, demeanor, and behavior Courtesy Use of names Trustworthiness Autonomy and responsibility Assertiveness

11. Therapeutic Communication Techniques Attentive (active) listening – SOLER Sharing Observations, Empathy, Hope, Humor, Feelings Using Touch Using Silence Providing Information Clarifying

12. Therapeutic Communication Techniques Focusing Paraphrasing Asking Relevant Questions - Seeking validation Summarizing Self-Disclosure Confrontation Summarizing

13. Non-Therapeutic Communication Techniques Asking personal questions Giving personal opinions Changing the subject Automatic response False Re-assurance Sympathy Asking for Explanation Approval or Disapproval

14. Non-Therapeutic Communication Techniques Defensive Responses Passive or Aggressive Responses Arguing

15. Barriers to communication Agreeing or disagreeing Asking personal question Changing the subject Environment Giving advice Language and culture Passing judgment Physical limitation Stereotyping Testing

16. Adapting Communication Techniques for Client with Special Needs Aging population and communication disability. Cultural Difference Impaired communication because requires special thought and sensitivity. See Box – 24-10: Communicating With Clients Who Have Special needs See Sample Communication Analysis. Critical Thinking Exercises – page 359 NCLEX Style Questions – page 359.

17. Communication Within the Nursing Process Assessment Physical and emotional factors Developmental factors Sociocultural factors Gender

18. Communication and Nursing Process Diagnosis Many clients experience difficulty with communication Lacking skills in attending, listening, responding, or self- expression Inability to articulate, inappropriate verbalization Difficulty forming words Difficulty with comprehension

19. Communication and Nursing Process Planning: Goals and outcomes: Specific and measurable Setting of priorities Continuity of care: Collaboration with other health care providers

20. Communication and Nursing Process Implementation: Therapeutic communication techniques Nontherapeutic communication techniques Adapting communication techniques

21. Communication and Nursing Process Evaluation: Nurses and clients need to determine whether the plan of care has been successful. Nursing interventions are evaluated to determine which strategies or interventions were effective. If expected outcomes are not met, the plan of care needs to be modified.