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Chapter 20 Video Lecture: Communicator Nurses need to use both nonverbal and verbal communication Communication is an essential attribute to the profession of nursing Levels of communication: o Intrapersonal - occurs within an individual o Interpersonal - one-to-one interaction between two people with a goal in mind o Transpersonal - interaction within a person's spiritual domain o Small group - interactions with a small number of people o Public - interaction with an audience Basic elements of the communication process: o Referent - motivates one to communicate with another (i.e., the patient could be having pain and the nurse needs to communicate with them to find out more about the pain) o Sender and receiver - one who encodes and one who decodes the message o Message - content of the message (can be verbal or nonverbal language) o Channels - means of conveying and receiving messages (through hands-on, visual, etc.; the more channels you use, the better and easier it can be to grasp the message) o Feedback - message the receiver returns o Interpersonal variable - factors that influence communication (i.e., educational background, pain and anxiety can influence the process, maybe the medication that the patient has taken can influence their perception) o Environment - the setting for sender-receiver interactions Verbal communication: consists of spoken or written words to convey different meanings
o Vocabulary - can be talking with children and vocabulary is limited, or those who know English as a second language o Denotative and connotative meaning - meaning of the word; association of that word o Pacing - use an appropriate pace … think of speaking with someone elderly and how you need to speak at a slower pace o Intonation - tone of the voice can change the meaning of the message o Clarity and brevity - use simple, brief and direct statements; the more wordy, the more confusing the statement can be for the patient or listener o Timing and relevance - you don't want to teach the patient about something when they are distracted (think of when they are in pain) remember that a patient will generally pay more attention to what you do than what you say Nonverbal communication: includes all 5 senses such as sight, taste, smell, touch and hearing o Personal appearance - the impression you get by the way one looks (55% of communication is transmitted by body cues and 7% of communication is transmitted by the words) o Posture and gait - while discussing, leaning forward shows interest o Facial expressions - be aware o Eye contact - shows willingness to listen but some cultures find it intrusive o Gestures - can be negative like pointing -> accusations o Sounds - have to be careful with sounds like sighs, moaning, groaning, etc. o Territoriality and personal space - people maintain their personal space
o Gender - don't make assumptions because it is obvious that females may talk and reveal more as opposed to males Diagnosis (second step) - the nurses communicate findings to other nursing professionals through the use of the written and spoken word; the permanent part of the patient's record o Physiological o Mechanical o Anatomical o Psychological o Cultural o Developmental Planning (third step) - requires communication among the patient, nurse, and other team members as mutually agreed-upon outcomes are developed and interventions are determined o May need to seek services for interpretation or a speech therapist if client/patient has trouble communicating Implementation (fourth step) o Therapeutic techniques - includes active listening (i.e., sitting at the same level, leaning forward, making eye contact, sharing observations, empathy, feelings, hope; touch, paraphrasing, ask relevant questions, clarify, provide info., ask for comprehension, use focusing, summarize the conversation, use confrontation, or even staying silent, etc.) o Nontherapeutic techniques - asking personal questions, giving personal opinions, using sympathy, defensive responses, argumentive talking, changing the subject, automatic response, false reassurance, asking for explanations, passive/aggressive responses NEED to always use open-ended questions
o Adapting techniques - used with patients with special needs Evaluation (fifth step) - to verify whether patient objectives or goals have been achieved Roles and Responsibilities: intimate zone (giving IV), personal zone, social zone, and public zone Goals between the patient and nurse have to meet the SMART acronym. (specific, measureable, attainable, realistic, and timely manner)
most trustworthy in the field so if this fails, the whole relationship between a nurse and the patient fails. b. Demonstrating caring In regards to therapeutic communication, a nurse should take advantage of available opportunities. For instance, the nurse can facilitate conversation when giving a bed bath to the patient, asking about their personal lives. This would make even the most routine task meaningful, and it is comforting for the patient to know that someone understands and cares. On the other hand, simply stating clichés to the patient during tasks like these could lead the patient to feeling as if the nurse doesn’t really care for their well-being, which is a part of non- therapeutic communication. c. Encouraging open communication A nurse controlling the tone of their voice can help convey to the patient that they are interested and have the patience to have a conversation with them. Along with this, keeping an open mind is good, making the patient feel that they also can contribute to their own health care and express any concerns they may have. On the other hand, a nurse can use a tone or even let out a sigh while a patient is talking, leading the patient to feel as if they are wrong to speak out for their clinical manifestations. This would be a form of non-therapeutic communication. d. Enhancing understanding In regards to therapeutic communication, a nurse should be clear and concise, and make statements as simple as possible. This is seen with children most of the time because they do not have much knowledge on what an infection is or what is happening to their bodies when they are sick. This can also occur between the parent of a child and the nurse; the nurse needs to be detailed and be as clear as possible, so not using big medical terms would be best. In non-
therapeutic communication, the nurse would simply just use big medical terms or leave out details that could possibly help the patient to understanding what they are trying to convey. e. Reducing stress In this case, a nurse can practice therapeutic communication by being alert and relaxed with their patient. Taking the time to have a conversation with the patient can help the patient feel at ease during the talk with their nurse. If a patient were waiting in the emergency room and a nurse walked into the examination room looking frantic and dropping instruments from how rushed they feel they need to be, the patient could feel even more stressed, which would be a form of non-therapeutic communication. f. Reinforcing patient focus In regards to therapeutic communication, a nurse should always be flexible. If a patient wishes to discuss something else, it is best for the nurse to follow the patient's lead whenever possible. For instance, a nurse may wish to speak to the patient about medications, but the patient may wish to focus on their diet habits. The nurse would focus on the patient's diet rather than trying to make the patient think their concerns are not as important. The nurse should also sit, if possible, when communicating with the patient to convey the message that the patient is a priority and there is enough time for everything. In non-therapeutic communication, the nurse would simply dismiss whatever the patient is trying to say about their illness or manifestations, leading the patient to feel as if their thoughts or values are not important. This would be a non-therapeutic type of communication because the nurse is failing to listen to the patient.
3. Impact Health Formulate appropriate nursing diagnoses for patients with communication difficulties.
relationship built between the patient and their nurse is built on the patient's needs, so the nurse will consider the needs of the patient first and dedicate their time to helping the patient understand what is going on in each step of the nursing process (i.e., assessment, diagnosis, planning, etc.). The nurse needs to communicate a clear sense or confidence and expertise in their practice. Patients are more likely to trust and value their nurses who appear competent, confident and focused on putting their patient's needs ahead of anything else, besides safety of course.
6. Describe qualities, behaviors and communication techniques that affect professional communication. Qualities and behaviors such as the following can affect professional communication techniques: rudeness, sloppiness, inattention to the patient, sexually inappropriate behavior, and other breaches of professionalism. Rudeness can lead the patient to feeling like they are not respected in the health care environment and they may request a new health care provider. Sloppiness leads the patient to feel as if the nurse isn't competent in their field; the nurse can be rushed or not complete a physical assessment of a patient correctly. Inattention to the patient is literally lack of attention to the patient, so this would lead the patient to feel as if they are not receiving sufficient care from the nurse, thus leading them to feel that the nurse is not doing their job properly since nurses have the most interaction with the patients in health care settings. Lastly, sexually inappropriate behavior can lead the patient to feel uncomfortable with a health care worker who should be focusing on comforting the patient and respecting them. 7. What is SBAR? SBAR is another communication tool, specifically a hands-off communication tool. It involves the process of gathering accurate presentation and acceptance of patient-related information from
one healthcare professional or team to another healthcare professional. Its purpose was to demonstrate effective communication by helping to eliminate breakdowns in communication and potential adverse events. The acronym stands for S ituation, B ackground, A ssessment, and R ecommendations. This report/tool allows healthcare professionals to effectively communicate to other healthcare professionals through shift reports, conversations with physicians, and transfers of patients. The S (situation) and B (background) sections provide objective data, so this focuses on things like vital signs, signs, symptoms, and general appearance of the patient, along with some background information. The A (assessment) and R (recommendations) provide subjective data, so this is where conclusions and findings are communicated, along with any further steps that should be taken by the healthcare providers.
8. What are the phases of therapeutic communication? The three phases of therapeutic communication are the following: the orientation phase, the working phase and the termination phase. In the orientation phase, the tone and guidelines for the relationship are established, so this involves an introduction from both the patient and the nurse to help ease the situation and bring comfort to both people. The working phase is usually the longest part of the process, and interaction is the essence, so communication is very key. The last phase, termination, is the point in which the nurse examines the outcomes/goals of a treatment with a patient and the progress in general is acknowledged. The last phase usually happens when the patient is being discharged, if the nurse is leaving for some time, or if there is a shift change between a morning and evening shift. You have to introduce the patient to the incoming nurse aside from just sending the report to that nurse. 9. How does the orientation phase differ from the working phase?
