Chapter 24 Communication Copyright 2017 Elsevier Inc All

Chapter 24 Communication Copyright © 2017, Elsevier Inc. All Rights Reserved.

2 Things to Ponder � We have two ears and one mouth so that we can listen twice as much as we speak. (Epictetus) � Communication is depositing a part of yourself in another person ( unknown) Copyright © 2017, Elsevier Inc. All Rights Reserved.

3 Communication and Nursing Practice � A lifelong learning process for nurses � Therapeutic communication promotes personal growth and attainment of patients’ health-related goals � Key to nurse-patient relationships � Patient safety requires effective communication � Improves patient outcomes and increases patient satisfaction Copyright © 2017, Elsevier Inc. All Rights Reserved.

4 Communication � Despite the complexity of technology and the multiple demands on nurse’s time, It is the intimate moment of connection that makes the difference in the quality of care and meaning for the nurse and client. Copyright © 2017, Elsevier Inc. All Rights Reserved.

5 Communication and Interpersonal Relationships Communication establishes caring, healing relationships. The ability to relate to others is important for interpersonal communication. Communication, including posture, expressions, gestures, words, and attitudes, has the power to hurt or heal. Copyright © 2017, Elsevier Inc. All Rights Reserved.

6 Developing Communication Skills Critical thinking Perseverance and creativity Self-confidence Humility Integrity Copyright © 2017, Elsevier Inc. All Rights Reserved.

7 Developing Communication Skills (Cont. ) � Thinking is influenced by perception � Five senses � Culture � Education � Perceptual bias � Emotional intelligence Copyright © 2017, Elsevier Inc. All Rights Reserved.

8 Levels of Communication � Intrapersonal � Interpersonal � Small group � Public � Electronic Copyright © 2017, Elsevier Inc. All Rights Reserved.

Quick Quiz! 1. Match the 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 Copyright © 2017, Elsevier Inc. All Rights Reserved. 9

Quick Quiz! 2. You are invited to attend the weekly unit patient care conference. The staff discusses patient care issues. This type of communication is: A. public. B. intrapersonal. C. transpersonal. D. small group. Copyright © 2017, Elsevier Inc. All Rights Reserved. 10

Elements of the Communication Process Copyright © 2017, Elsevier Inc. All Rights Reserved. 11

12 Circular Transactional Model � Components � Referent � Sender and receiver � Message � Channels � Feedback � Interpersonal variables � Environment Copyright © 2017, Elsevier Inc. All Rights Reserved.

Quick Quiz! 3. Match the basic elements of communication. 1. Referent A. One who encodes and one who decodes the message 2. Sender and receiver B. The setting for senderreceiver 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 variables F. Factors that influence communication 7. Environment G. Content of the message Copyright © 2017, Elsevier Inc. All Rights Reserved. 13

14 Forms of Communication � Verbal communication � Vocabulary � Denotative and connotative meaning � Pacing � Intonation � Clarity and brevity � Timing and relevance Copyright © 2017, Elsevier Inc. All Rights Reserved.

15 Forms of Communication � Verbal � Vocabulary: choice of words � Denotative: primary meaning – understood meaning � Connotative: idea or meaning of word influenced by persons thoughts/ views � Pacing: Speed of speech – not too fast/ slow � Intonation: Tone – how we say something speaks louder than what we say Copyright © 2017, Elsevier Inc. All Rights Reserved.

16 Verbal (cont. ) � Clarity and brevity: simple/ direct best approach – “Where do you hurt? ” � Timing and relevance: message may be clear – but poor timing can make it not be effective Copyright © 2017, Elsevier Inc. All Rights Reserved.

17 Forms of Communication (Cont. ) � Nonverbal � Personal appearance � Posture and gait � Facial expressions � Eye contact � Gestures � Sounds � Territoriality and personal space � Metacommunication Copyright © 2017, Elsevier Inc. All Rights Reserved.

18 Nonverbal Communication � Personal appearance: outward appearance – picture to the world � Posture and gait: form of self expression – confidence or insecurity � Facial expressions: MOST EXPRESSIVE PART OF BODY!!! Copyright © 2017, Elsevier Inc. All Rights Reserved.

19 Nonverbal (cont. ) � Eye contact: used to signal readiness to communicate � Gestures: used to emphasize or clarify spoken words � Sounds: Communicate feelings and thoughts – sighs/ moans/ groans � Territory and Personal Space: � Need to gain, maintain, protect defend one’s personal right to space � Personal space is invisible � See zones p. 314 Box 24 -3 Copyright © 2017, Elsevier Inc. All Rights Reserved.

20 Nurse-Patient Relationship � Caring relationships are the foundation of clinical nursing practice. � Therapeutic relationships promote a psychological climate that facilitates positive change and growth. Copyright © 2017, Elsevier Inc. All Rights Reserved.

21 Nurse-Patient Relationship (Cont. ) 1. Preinteraction phase: occurs before meeting the patient 2. Orientation phase: when the nurse and the patient meet and get to know each other 3. Working phase: when the nurse and the patient work together to solve problems and accomplish goals 4. Termination phase: occurs at the end of a relationship Copyright © 2017, Elsevier Inc. All Rights Reserved.

22 Motivational Interviewing � A technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior. � The interviewing is delivered in a nonjudgmental, guided communication approach. Copyright © 2017, Elsevier Inc. All Rights Reserved.

23 Professional Nursing Relationships (Cont. ) Nurse-family relationships Nurse-health care team relationships Nurse-community relationships Copyright © 2017, Elsevier Inc. All Rights Reserved.

24 Case Study � Roberto Ruiz is a 44 -year-old man of Puerto Rican descent, suffering from HIV/AIDS. He was near death and in hospice, but his condition has improved and he is now home. � Suzanne is a 54 -year-old nurse dedicated to hospice and committed to maximizing quality of life in end-of-life care. Copyright © 2017, Elsevier Inc. All Rights Reserved.

25 Quick Quiz! 4. Helping relationships serve as the foundation of clinical nursing practice. Contracts for a therapeutic helping relationship are formed during the: A. orientation stage. B. working stage. C. termination stage. D. preinteraction stage. Copyright © 2017, Elsevier Inc. All Rights Reserved.

Elements of Professional Communication Appearance, demeanor, and behavior Courtesy Use of names Trustworthiness Autonomy and responsibility Assertiveness Copyright © 2017, Elsevier Inc. All Rights Reserved. 26

27 Case Study (Cont. ) � As Suzanne works with Roberto, she develops a helping relationship. Suzanne knows that posing questions for the patient’s reflection helps her assess his needs and support his self-care strategies. Copyright © 2017, Elsevier Inc. All Rights Reserved.

28 Nursing Process: Assessment � Through the patient’s eyes � Gather information, synthesize, apply critical thinking � Physical and emotional factors � Developmental factors � Sociocultural factors � Gender Copyright © 2017, Elsevier Inc. All Rights Reserved.

29 Case Study (Cont. ) � Suzanne learns that Roberto wants to travel to New York to see his extended family. � Even though Roberto is in poor health and the trip will be difficult, Suzanne expresses her understanding of the importance of the trip. She understands how important extended family is in the Puerto Rican culture. Copyright © 2017, Elsevier Inc. All Rights Reserved.

30 Nursing Diagnosis � Nursing diagnosis for communication � Many patients experience difficulty with communication: � Lacking skills in attending, listening, responding, or self-expression � Inability to articulate, inappropriate verbalization � Difficulty forming words � Difficulty with comprehension Copyright © 2017, Elsevier Inc. All Rights Reserved.

31 Planning � Goals and outcomes � Specific and measurable � Setting of priorities � Teamwork and collaboration Copyright © 2017, Elsevier Inc. All Rights Reserved.

32 Case Study (Cont. ) � During her visit, Roberto tells Suzanne, “I really want to go visit my uncles in New York, but I’m not sure I’m up for the trip. ” � Suzanne is understanding: “It sounds like you miss your family. Let’s talk about your options for maintaining contact. ” � As they talk, Suzanne helps Roberto to identify two methods of communicating with his family in New York. Copyright © 2017, Elsevier Inc. All Rights Reserved.

33 Implementation � Therapeutic communication techniques are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. � Active listening means being attentive to what a patient is saying both verbally and nonverbally. � Use “SOLER”: Sit facing the patient; observe an open posture, lean toward the patient, establish and maintain intermittent eye contact; relax Copyright © 2017, Elsevier Inc. All Rights Reserved.

Implementation (Cont. ) 34 �Therapeutic communication techniques (Cont. ) �Sharing observations �Sharing empathy �Sharing hope �Sharing humor �Sharing feelings �Using touch �Using silence Copyright © 2017, Elsevier Inc. All Rights Reserved.

35 Implementation (Cont. ) � Therapeutic communication techniques (Cont. ) � Providing information � Clarifying � Focusing � Paraphrasing � Validation � Asking relevant questions � Summarizing � Self-disclosure � Confrontation Copyright © 2017, Elsevier Inc. All Rights Reserved.

36 Implementation (Cont. ) � Nontherpeutic communication techniques � Asking personal questions � Giving personal opinions � Changing the subject � Automatic responses � False reassurance � Sympathy Copyright © 2017, Elsevier Inc. All Rights Reserved.

37 Implementation (Cont. ) � Nontherpeutic communication techniques (Cont. ) � Asking for explanations � Approval or disapproval � Defensive responses � Passive or aggressive responses � Arguing Copyright © 2017, Elsevier Inc. All Rights Reserved.

38 Adapting Communication Techniques � Patients who cannot speak clearly � Cognitive impairment � Hearing impairment � Visual impairment � Unresponsive � Patients who do not speak English (or your language) Copyright © 2017, Elsevier Inc. All Rights Reserved.

39 Quick Quiz! 5. While admitting a patient, during the initial interview, a family member tells you, “My mom really means that she does not understand her medical diagnosis. ” The communication form used by the family member is: A. focusing. B. clarifying. C. summarizing. D. paraphrasing. Copyright © 2017, Elsevier Inc. All Rights Reserved.

40 Evaluation � Through the patient’s eyes � Patient outcomes � Nurses and patients 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. Copyright © 2017, Elsevier Inc. All Rights Reserved.

41 Group Activity � Define therapeutic communication and provide each by role playing the following: clarifying, focusing, summarizing, paraphrasing � Define nontherapeutic communication and role play each of the following: asking personal questions, giving personal opinions, changing the subject, defense response, and aruging � Define active listening and demonstrate the acronym SOLER Copyright © 2017, Elsevier Inc. All Rights Reserved.