Communication

ObjectivesDescribe the communication process,

identifying factors that influence communication

List ways in which people communicate nonverbally

Use a standardized communication technique (SBAR) to communicate with physicians and transfer patient information to other nurses

Describe how each type of ineffective communication hinders communication

Communication“Communication skills are the building blocks

of professional relationships between nurse and patient, nurse and nurse, and nurse and other health-team members.”

Def: the process of exchanging information and generating and transmitting meanings between two or more individuals.

Primary aspect of a nurse-patient interactionAbility to communicate is basic to human

functioning and well-being.

Communication Process

Based on a stimulus (a patient’s need for: medication, information, food or fluid)

Involves:1.Source (encoder) - Person who sends the

message2.Message - the physiologic product of the source

(speech, gesture, nursing note)3.Channel- the medium used to send the message4.Receiver (decoder) the person who receives and

interprets the message sent

Channels of Communication

1. Auditory: spoken words and cues2. Visual - sight, observations, and

perception3. Kinesthetic - touch

Communication Process

Forms of CommunicationVerbal: exchange of information using words;

including both the spoken and written word.Verbal communication depends on languageNursing depends on verbal language

extensively

Nonverbal: communication without the use of words; also know as “body language”

Can be an incongruence between verbal and nonverbal message

Generally, the non-verbal message is thought to be the one that is more valid or true

Forms of Non Verbal Communication1. Touch: can express comfort, love, affection,

security, anger, frustration, excitement, empathy2. Eye Contact: means different things in different

cultures; Eyes can carry expressions - anger, fear, happiness

3. Facial Expression: Some people have expressive faces, others hide their emotions

4. Posture: the way a person holds the body; can indicate depression, well-being, tension

5. Gait: Type of walk; can indicate energy level, debilitating conditions

6. Gestures: Many gestures are understood across cultures

Non Verbal Communication7. General Physical Appearance: Skin color,

body size, muscle tone8. Mode of Dress and grooming: High self

esteem individuals pay attention to details of dress and grooming; those with low self esteem pay less attention; Illness cause low energy levels for grooming; Economic status

9. Sounds: crying, moaning, gasping, sighing

10. Silence: can have multiple meanings

Levels of CommunicationIntrapersonal: “Self-Talk”

communication within an individual; can influence interactions with others

Interpersonal: between two or more people with a goal to exchange messages

Group: small group and organizational group communication

QuestionA nurse who reassures herself that she is prepared to speak in front of a group of her peers is using which of the following types of communication?A. IntrapersonalB. InterpersonalC. GroupD. Organizational

AnswerAnswer: A. IntrapersonalRationale:Intrapersonal communication is self-talk that happens within the individual.Interpersonal communication occurs between two or more people to exchange messages.Group communication includes small-group and organizational group communication.

Group Dynamics

Within a group, how individual group members relate to one another during the process of working toward group goals.

How effective or ineffective is the group in attaining its goals

Requires effective leadership, but depends largely on the behavior of the members of the group

Example: Study Group

Group Dynamics

Roles of Group MembersTask-oriented—focus on work to be done

Group building or maintenance—focus on well-being of people doing work

Self-serving—advance the needs of individual members at group’s expense

Factors Influencing Communication

Developmental levelGenderSociocultural differencesRoles and responsibilitiesSpace and territorialityPhysical, mental, and emotional stateValuesEnvironment

Developmental Level

Developmental Level

Environment

Personal Space

Personal Space

Hand off Communication: SBAR Technique Involves the accurate presentation of all

patient-related information to another caregiver.

Includes1.Nurse - to - Nurse report2.Nurse to physician report3.Report to and from other hospital

departmentsJCAHO - recommends a standardized

method of communication, including an opportunity to ask and respond to questions

SBARS = SituationB = BackgroundA = AssessmentR = Recommendations

Developed by the US Navy and then implemented by Kaiser Permanente in Colorado

SBARExample: Your patient has a temperature of 38.8.

He does not have an order for an antipyretic.

What would you say when you called the MD?

Nurse - Patient Interaction: The Helping Relationship

“ Of all the problems that can arise in nursing care, perhaps the most common is failure to establish rapport and a help-trust relationship with the other person” (Watson, 1985)

Nursing Relationship vs. Social Relationship

Does not occur spontaneouslyCharacterized by an unequal sharing of

informationBuilt on the patient’s needs

Characteristics of the Helping Relationship

Dynamic: Both parties are actively participating

Purposeful and time limitedPerson providing assistance is

professionally accountable for the outcomes

Goals of the Helping RelationshipGoals are determined cooperatively

between the nurse and the patientGoals for the patient change as the

patient’s condition changesThe patient’s goals are the focus of the

relationship

Phases of the Helping Relationship

Orientation phase: 1.includes data gathering2.sets the tone for the remainder of the

relationship3.Patient and nurse learn each other’s name4.Roles of both parties are clarified5.Goals are established6.Patient is oriented to facility, routines,

other staff members

Orientation Phase

Phases of the Helping RelationshipWorking Phase1.Longest phase; characterized by interaction2.Nursing interventions3.Patient teaching4.Assistance with ADL’s5.Nursing roles: teacher and counselor6.Satisfactory working relationship is crucial

Working Phase

Phases of the Helping RelationshipTermination Phase1.Occurs when the conclusion of the initial

agreement is acknowledged (change of shift, patient is discharged)

2.Evaluations of progress toward initial goals should be done

3.Set the stage for transfer of the helping relationship to another person or entity (home health, clinic)

Factors that Promote Effective Communication

Dispositional traits

Rapport builders

Factors Promoting Effective Communication Within the Helping RelationshipDispositional Traits

1.Warmth and Friendliness2.Openness and Respect3.Empathy4.Honestly, Authenticity and Trust5.Caring6.Competence

Rapport BuildersDef: a feeling of mutual trust experienced by

people in a satisfactory relationship; facilitates open communication

1.Specific Objectives2.Comfortable Environment3.Privacy4.Confidentiality5.Patient vs. task focus6.Using nursing observations7.Optimal pacing8.Respecting personal space

Communication SkillsConversational SkillsListening SkillsSilenceTouchHumorInterviewing Techniques

Touch

Developing Conversation SkillsControl the tone of your voice.Be knowledgeable about the topic of

conversation.Be flexible.Be clear and concise.Avoid words that might have different

interpretations.Be truthful.Keep an open mind.Take advantage of available opportunities.

Listening

Developing Listening SkillsSit when communicating with a patient.Be alert and relaxed and take your time.Keep the conversation as natural as

possible.Maintain eye contact if appropriate.Use appropriate facial expressions and body

gestures.Think before responding to the patient.Do not pretend to listen.Listen for themes in the patient’s comments.Use silence, therapeutic touch, and humor

appropriately.

Communication Skills

Interviewing Techniques

Open-ended questions or comments: Allows the patient an open field of responses “Tell me about that”

Closed questions or comments: Allows the patient a limited range of responses “Yes or No”

Validating questions or comments: Validates what the nurse believes she has heard “What I heard you saying was”

Interviewing TechniquesClarifying question or comment :Allows the nurse

to gain further understanding of the patient’s comment. “Could you explain what you mean”

Reflective questions or comments: Repeating what the person has said in order to encourage him to elaborate “You are worried about the surgery?”

Sequencing questions or comments: In order to determine cause and effect “When did this occur?

Directing questions or comments: To gain more information about something previously discussed, “You mentioned earlier that………”

Developing Conversation Skills

Control the tone of your voice.Be knowledgeable about the topic of

conversation.Be flexible.Be clear and concise.Avoid words that might have different

interpretations.Be truthful.Keep an open mind.Take advantage of available opportunities.

Developing Listening SkillsSit when communicating with a patient.Be alert and relaxed and take your time.Keep the conversation as natural as

possible.Maintain eye contact if appropriate.Use appropriate facial expressions and body

gestures.Think before responding to the patient.Do not pretend to listen.Listen for themes in the patient’s comments.Use silence, therapeutic touch, and humor

appropriately.

Basic Components of Assertiveness

Having empathyDescribing one’s feelings or the situationClarifying one’s expectationsAnticipating consequences

Blocks to CommunicationFailure to perceive the patient as a human

beingFailure to listenInappropriate comments and questionsUsing clichésUsing closed questionsUsing questions containing the words

“why” and “how”Using questions that probe for information

Angry Nurse

Blocks to Communication (cont.)Using leading questionsUsing comments that give adviceUsing judgmental commentsChanging the subjectGiving false assuranceUsing gossip and rumorsUsing aggressive interpersonal behavior

Stressed Nurse

Impaired Verbal CommunicationAphasia:

1. Expressive: inability to speak 2. Receptive - inability to understand

Hearing ProblemsVoice ProblemsDysarthria: inability to produce sounds,

slurred speech from strokes, parkinsonism etc

Other communications problems: brain impairment, disorientation