Communication 1 Nursepatient Relationship Communication A vital tool

Communication 1

Nurse-patient Relationship �Communication – ◦ A vital tool in establishing & maintaining nurse-patient relationship (families, multidisciplinary team members) �Nurse-patient interactions ◦ Helps patient recall, describe, clarify ◦ Is a lifelong learning process ◦ Necessary to build therapeutic communications 2

Communication �Nurse-patient relationship - ◦ Should be guided by needs ◦ Should promote a sense of being heard & supported ◦ Should establish trust, safety, & acceptance ◦ Should provide feedback ◦ patient must feel that the nurse cares about & wants to help 3

Communication �Must be able to use self therapeutically– ◦ Use one’s personality consciously ◦ Know & understand self ◦ Realize that the extent in helping others is influenced by – �Self-awareness, self-understanding, & beliefs about life, death, etc. 4

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

• Figure 24 -1 Communication as active process between sender and receiver. 6

Elements of the Communication Process 1. Referent - A. Motivates one person to communicates with another. 2. Sender& Receiver B. One who encodes & one who decodes the message 3. Message C. Content of the communication 4. Channels D. Means of conveying & receiving message 5. Feedback E. message the receiver returns, (pt. may understand but has questions) 6. Interpersonal variables F. Factors within both sender and receiver that influences communication 7

Modes or Forms of Communication �Verbal – messages communicated through words & language, either spoken or written ◦ ◦ ◦ Vocabulary Denotative & Connotative Pace Intonation Clarity & brevity Timing & relevance 8

Non-Verbal Communication �Personal Appearance �Posture & Gait �Facial Expression �Eye Contact �Gestures �Sounds �Territoriality & Personal Space �Touch – ◦ Zones of touch 9

Communication �Zones of personal space – ◦ Intimate (0 to 18 inches) – �Ex. Holding Hands ◦ Personal (18 inches to 4 feet) – �Ex. Sitting at bedside ◦ Social (4 to 12 feet) – �Ex. Making rounds, sitting at head of table ◦ Public (12 feet & greater) – �Ex. Lecturing in class 10

Communication �Zones of touch – ◦ Social – permission not needed �Ex. Hands, arms ◦ Consent – permission needed �Ex. mouth, wrist, feet, ◦ Vulnerable – special care needed �Ex. Face, neck, front of body ◦ Intimate – great sensitivity needed �Ex. Genitalia 11

Communication � Symbolic communication – ◦ The verbal & non-verbal symbolism used by others to convey a meaning �Art, music � Metacommunication – ◦ A broad term that refers to all factors that influence communication �Incongruence in verbal & non-verbal communication �Often warrants further investigation 12

Professional Nursing Relationships • Nurse-patient – • Nurse-Family – • Nurse-Health Team - • Nurse-Community – 13

Four Phases of Helping Relationship ◦ Pre-interaction – occurs before meeting the patient ◦ Orientation – nurse & patient meet ◦ Working – nurse & patient work together to solve problems & accomplish goals ◦ Termination – occurs at the end of a relationship 14

Elements of Professional Communication �Appearance, demeanor & behavior �Courtesy Use of names • Trustworthiness • Autonomy & responsibility �Assertiveness • 15

Communication – Nursing Process �Assessment – ◦ Physical & emotional factors – �Altered health states, inability to communicate ◦ Development factors – �Developmental stage �Age ◦ Sociocultural factors – �Culture �language ◦ Gender – 16

Communication �Nursing Diagnosis – ◦ Many patients experience difficulty with communication �Lacking skills in attending, listening, responding, or selfexpression �Inability to articulate, inappropriate verbalization �Difficulty forming words �Difficulty with comprehension �Examples of NANDA Nursing DX: o Anxiety o Social Isolation o Ineffective Coping o Compromised Family Coping o Powerlessness o Impaired Social interaction 17

Communication �Planning – ◦ Goals & outcomes – �Specific & measurable ◦ Setting of priorities ◦ Continuity of care – �Collaboration with other health care providers 18

Communication �Implementation – ◦ Therapeutic communication technique – ◦ Non-therapeutic communication technique – ◦ Adapting communication techniques - 19

Therapeutic Techniques �Active listening – SOLER �Sharing observations, empathy, hope, humor, feelings – �Using touch – �Using silence �Providing information – �Clarifying �Focusing – �Paraphrasing – �Asking relevant questions _ �Summarizing – �Self-disclosure – �Confrontation 20

Non-therapeutic communication Techniques �Asking person questions �Giving personal opinions �Changing the subject �Automatic responses �False reassurance �Sympathy �Asking for explanations �Approval or disapproval �Defensive responses �Passive or aggressive responses �Arguing 21

Communication �Evaluation – ◦ Need to determine whether the plan of care has been successful ◦ Nursing interventions are evaluated to determine which strategies or interventions were effective ◦ Expected outcomes not met, the plan of care needs to be modified 22

Questions 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 23

Question 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 the family member used is: ◦ ◦ A. Focusing B. Clarifying C. Summarizing D. Paraphrasing 24

�Helping relationships is 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 25

� While taking an admission history from the mother of an 18 -month-old being admitted for surgery, the nurse notes that the mother is twisting her rings, running her hands through her hair, and moving about restlessly. � When the nurse asks the mother about any problems or concerns, she replies, “Everything is just fine. ” The mother’s behavior is an example of: � � Inappropriate communication � Inadequate language skills � The violation of personal space � Incongruent nonverbal communication 26

Question �The nurse asks a patient, “Did your husband hit you? ” This is an example of a {n}: �Closed question. �Open-ended question. �Leading question. �Neutral question. 27

Question � Which of the following responses would be most appropriate for the nurse to utilize when confronted with a patient that is very concerned or frightened? � “Let’s have a bath now and I’ll give you a nice massage. ” � “You seem upset. May I sit with you for a few minutes? ” � “Most people are afraid at a time like this so just try to relax. ” � “Have you asked your doctor when you may be discharged to go home? ” � 28

Question � The wife of a dying patient states she is overwhelmed by her husband’s illness and doesn’t think she can go on much longer. The nurse responds by saying, “It must be difficult having a loved one in such critical condition. Would you like to talk about it? ” This is an example of: � Focusing. � Clarifying. � Summarizing. � Providing general � leads. 29

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