Communication Process
Tool for health-promotion interventions
Basis for professional nurse-client relationship
Information exchange between
... [Show More] individuals
Client-centered communication important
Nurses who critically think make the best communicators
Verbal Communication
Includes spoken and written communication
Think about:
Conversation pace-Speak slowly and clearly
Tone of voice
Timing
Vocabulary used-When speaking to clients, use common language (don't use complex medical terminology)
Clarity of message-Effective communication is simple and direct; Clarify information when needed
Nonverbal Communication
Personal appearance-First impressions are largely based upon appearance
Posture
Facial expressions
Eye contact-be aware of client's cultural background
Gestures
Sounds-sighs, groans, etc.
Personal space
Metacommunication
Involves reading in between the lines
Going beyond the surface content of the message to understand meaning
Refers to all factors that influence communication
Phases of the nurse-patient relationship-Preinteraction Phase
First Phase
-Before meeting the client
-Review client chart and history
-Anticipate potential issues or concerns
Phases of the nurse-patient relationship-Orientation phase
Second Phase
-When the patient & nurse meet and get to know each other
-Sets the tone for the relationship
-Let the patient know when the relationship will end
-Use AIDET
-Always be courteous: knock on the door, say hello and goodbye, say "please" and "thank you"
-Always introduce yourself
-Calling a client by their last name is respectful; ok to call them by their first name if they ask you to
***Avoid calling client names like "honey", "sweetie" or "sweetheart"
Phases of the nurse-patient relationship-Working Phase
Third Phase
-Set goals with client and take action to meet goals
-Use therapeutic communication techniques
-Encourage the client to express their feelings about their health
-A friendly, warm communication style establishes trust but you have to move beyond social conversation to discuss issues concerning the client's health
-Ok to be assertive, not aggressive
Phases of the nurse-patient relationship-Termination Phase
Fourth Phase
-Evaluate goal achievement with the client
-Reminisce about the relationship with the client
-Achieve a smooth transition for the client to other care givers
AIDET
A=Acknowledge
I=Introduce
D=Duration
E=Explanation
T=Thank you
Steps to Functional Communication
1. Firmly stating case
-Need congruent content and metacommunication
2. Clarifying the message
-Use "I" statements
-Ask open ended questions
-Validating/clarifying allows the nurse to recognize and acknowledge a patient's thoughts, feelings, and needs
Steps to Functional Communication
3. Seeking feedback
-Provides validation and confirmation of the message communicated
4. Being receptive to received feedback
-Facilitates functional communication
Factors in Effective Communication
Listening—actively focusing on message
-Nonverbal cues—influenced by culture/situation
-Eye contact, head nodding, leaning forward, making facial appropriate facial expressions, uncross arms and legs, and using brief verbal statements ("tell me more about...") are nonverbal cues that you are actively listing to the individual speaking
Flexibility—balance between control and permissiveness
-Rules of appropriate communication
Example: the RN should not answer questions about intimate details of their life in order to set a limit; however, it does not mean the nurse should refuse to answer every question about themselves.
Silence—can be therapeutic
-Conveying support
-Silence allows the individual to reflect on what is being discussed; it lets them know the RN is willing to wait until they are ready to say more or the can be their to provide comfort and support; in general, let the patient break the silence
Factors in Effective Communication
Humor
-Positive: Relieves tension, creates a climate of sharing
-Negative: Blocks communication, inflicts emotional pain
Touch
-Can express concern
-May be inappropriate and threatening
-be aware of personal/cultural preferences of the client; ask permission
Space between communicators
-Varies according to type, setting, culture
-Proxemics—four zones of space (intimate space, personal space, social-consultative space, and public space)
-Understanding space enhances communication congruency
Proxemics—Four zones of space
1. Intimate space: up to 18 inches (45.5 centimeters); used for high interpersonal sensory stimulation
2. Personal space: 18 inches to 4 feet (45.5 centimeters to 1.2 meters); appropriate for close relationships in which touching may be involved and good visualization is desired
3. Social-consultative space: 9 to 12 feet (2.7 to 3.6 meters); less intimate and personal, requiring louder verbal communication
4. Public space: 12 feet (3.6 meters) and over; appropriately used for formal gatherings, such as giving speeches
The Helping or Therapeutic Relationship: Characteristics
Purposeful communication
-Communication focused on a particular goal
Rapport
-Harmony and affinity between people
-Facilitated by being genuine, open, and concerned
Trust
-Reliance on another based on sense of safety, honesty, reliability
-Facilitated by clear relationship definitions; being consistent
-Strategies to promote trust: do what you have promised to do, examine behaviors that interfere with trust, define relationship and expectations
The Helping or Therapeutic Relationship: Characteristics
Empathy
-Understand other's feelings without losing identity
-Personal understanding while maintaining boundaries
Goal direction
-Meet need or promote growth of recipient
-Goals measurable, focus on change, short- or long-term
-Developed jointly by nurse/client when possible
Ethics
-Behavior effects others, actions involve choices that may be judged by standards of right/wrong
-Nurse: Respect individual rights, support person's/family's integrity
You never know what internal battles people are struggling with; be aware of your words/actions as you interact with others; each patient room you walk into will be different
Therapeutic Techniques
Focusing on client
-Person, not nurse, focus of interaction
Helping client to clarify content/meaning
-Prompt further description/data
-Goal: To help client describe problem and solve together
Reflection
-Selective paraphrasing or literal repetition
-Goal: Emphasize, summarize, elicit information
Therapeutic Techniques
Share observations: commenting on how the client looks, sounds, or acts helps a patient communicate without the need for extensive questioning
Try not to ask a lot of "why" questions; these types of questions tend to increase anxiety because they demand reasons, conclusions, analysis or causes
Ok for the nurse to express emotion; makes the RN seem more human and brings people closer together
-As long as you are in control of your feelings and express them in a way that does not burden the patient
Barriers to Effective Communication
Anxiety, attitudes, noise, activity, distance, language barriers, beliefs, touch, eye contact, appearance, emotions, body language, gestures, interruptions, distractions, illness, medication side effects
Barriers to effective communication can originate with the nurse, the individual, or both
Barriers to Effective Communication
Anxiety
-Alters perception, distorts reality
Attitudes
-Bias/stereotypes
-Communicates negativity; distorts perceptions
Barriers to Effective Communication
Gaps between the nurse and individual
-Gender, age, ethnicity, language
-Causes difference in perception; blocks understanding
-seek clarification from translators; explore ways in which perceptions may differ and how meanings can be clarified
-If client does not speak English use a professional interpreter
-Do not use family or visitors as interpreters
Resistance
-Behavior to reduce anxiety
-Avoidance, anger, tardiness, changing the subject
Barriers to Effective Communication
Transference
-The nurse reminds the client of someone
Countertransference
-The client reminds the nurse of someone
Sensory factors
-Use other senses; obtain specialized assistance
Barriers to Effective Communication
Failure to address concerns/needs
-Identify and correct source of failure such as inadequate assessment
Setting
-Control/alter disturbing environmental factors
Consider client's developmental level
Nontherapeutic techniques
Do not force your personal opinions on the client
Do not change the subject
Do not give false reassurance or false hope
Avoid becoming defensive
Avoid passive aggressive responses or behaviors
Do not argue with the client
Think before you speak
Defensive statement: "no one here would intentionally lie to you"
-Implies the client does not have the right to an opinion
Older adults & Hearing loss
Make sure they have their hearing aids in
Get patient's attention before speaking
Speak clearly, but do not shout or exaggerate lip movements
Speak at a slower pace
Use a quiet, will lit environment with minimal distractions
Speak on the side of their "good ear"
Allow time for the patient to respond and ask questions
Keep communication short and to the point
Communicating with visually impaired clients
Check for use of glasses or contact lenses
Identify yourself when you walk into the room and when you leave the room
Speak in a normal tone of voice
Do not rely on gestures or nonverbal communication
Use indirect lighting and avoid glare
Use at least 14 point font
Communicating with clients who have special needs-Clients Who Are Unresponsive
Call patient by name during interactions
Communicate verbally and by touch
Speak to them as though they can hear you
Explain all procedures and sensations
Provide orientation to person, place, time
Avoid speaking to others about patient in their presence
Communicating with clients who have special needs-Clients Who Have Difficulty Speaking
Listen attentively
Do not interrupt them and be patient
Ask simple "yes" or "no" questions
Use visual cues or communication boards
Encourage client to converse
Collaborate with speech therapist
Let them know if you have understood them or not
Nurse-Health care Team Relationship
Affects client safety and the work environment
Risks for miscommunication occurs most frequently during:
-Shift change report
-Client transfer from one unit to another
Standardized reporting reduce risk of errors
ISBAR
Used when calling health care providers about a client
I=Introduction; Identify yourself (your name, role, and location) and give a reason for calling; "I am calling because...
S=Situation-Give the patient's age and gender; What is the patient's status now?
-Stable (but not in danger of deterioration)
-Unstable
B=Background-Give the relevant details such as presenting problems and clinical history
A=Assessment-Put it all together (their current condition, risks, and needs). What is your assessment?
R=Recommendation-Be clear about what you are requesting; e.g. transfer/review/treatment?
When should it happen?
Lateral violence
Leads to workplace dissatisfaction, poor teamwork, poor retention of qualified nurses, and nurses leaving the profession
Lateral violence
Workplace bullying
Includes:
-Withholding information
-Making snide remarks
-Raising eyebrows
-Making faces
Lateral violence
The RN experiencing lateral violence should:
-Address the behavior in a calm manner when it occurs
-Describe how the behavior is affecting your functioning
-Ask for the abuse to stop
-Notify the manager to get support
-Make a plan for taking action in the future
-Document all incidences in detail
Introducing yourself
It is important to introduce yourself and your status to the patient. A person should be addressed by using his or her last name because this is a way of showing respect in most cultures. Lucy should also wait to be introduced to Mrs. Jonas because she does not know that she is his wife.
Sharing Observations
The patient does not have to be extensively questioned, and this helps a quiet or withdrawn patient to be able to respond. This is different from making assumptions based on observations.
Understanding the use of therapeutic techniques
Example:
By sitting down and making eye contact, Lucy is using an active listening skill that indicates acceptance and respect for the patient. By asking him to clarify his statement, she is seeking more information and not just a closed-ended response. Touch is a way to show caring and connection with the patient. [Show Less]