1. Communicating Effectively
Monica Williams, MSN, RN

2. Class Objectives:
Discuss the elements of the communication process and their relevance to providing safe and effective nursing care. CO1, CO7, CO9
Describe various influences and barriers to effective communication. CO7
Define the major types of communication and identify examples of each. CO7
Recognize congruency vs. incongruence between verbal and nonverbal communication. CO7
Identify the nursing role, nursing actions, and expected outcomes in each phase of the nurse-client relationship. CO1, CO7

3. Class Objectives (cont’d):
Distinguish between a professional and social relationship. CO1, CO7, CO9
Discuss essential components necessary for therapeutic communication with clients and families. CO7
Identify special situations and/or clients from culturally diverse or vulnerable populations which may require alterations in communication. CO7
Describe characteristics of assertive communication and how it applies to conflict resolution. CO7, CO9
Differentiate therapeutic and non-therapeutic communication techniques, their anticipated effects on clients, and examples of each. CO1, CO7

4. Lab/Simulation/Clinical Objectives:
Assess the communication abilities and needs of clients and families.
Demonstrate the use of professional and effective verbal/nonverbal communication when providing care to clients and interacting with families, peers, faculty, and health care personnel.
Provide examples of both therapeutic and non- therapeutic nurse responses to given client situations. (Communication Exercise #1)
Participate in and analyze a simulated nurse-client communication exchange (by role playing both the nurse and client) as assigned. (Communication Exercise #2)

5. Elements of Communication
*LEARNED PROCESS*

6. Effective Communication… ESSENTIAL to Ensure Client Safety!!!

7. There are many influences that can become barriers to effective communication. Select all that apply.
Values, Attitudes, Beliefs
Culture, Language, Ethnicity, Religion
Social status, Economic background
Gender, Age, Developmental level
Environment, Past experiences
Knowledge of subject matter
Skill/ability to relate to others

8. Biggest Barrier to Effective Communication???
***Failure to LISTEN***
Active Listening
Communicates interest/understanding
Role models more effective communication
Sit squarely facing client
Open posture
Lean toward client
Eye contact
Relax

9. Types of Communication
Written
Means to document/convey information to others
Verbal
Spoken (or “signed”) word
Nonverbal- “body language”
Better indicator of true feelings (less control over)
Metacommunication
Communication about the communication-
Interpretation/analysis

10. Nonverbal Communication Examples
Gestures
Facial expressions
Eye contact
Posture/appearance
Position/movement
Space/distance
Touch
Vocal cues (tone, volume, rate of speech, pause, etc.)
***DETERMINE IF VERBAL/NON-VERBAL COMMUNICATION CONGRUENT OR INCONGRUENT***

11. Most therapeutic interactions between nurse and client occur within which distance?
Public- 12 to 15 feet
Social- 4 to 12 feet
Personal- 1 ½ to 4 feet
Intimate- touching to 1 ½ feet

12. Which nurse-client exchange demonstrates that client communication is incongruent?
A client is crying softly and whispers, “I can’t believe this is happening to me.”
A client is sitting slumped over in her chair and reports “My stomach is cramping pretty bad.”
A client is standing with his fists clenched and yells, “I am not angry.”
A client smiles at the nurse and says, “I’m so glad you are my nurse today.”

13. Nurse-Client Relationship Phase 1
Orientation (Introductory)
Nursing Role
Initiate/facilitate therapeutic relationship
MAIN GOAL
Establish trust/rapport & “informal contract” (Craven, Box 5-2, p. 80)
Nursing Actions
Introduce self/intention; explore feelings
Detail expectations/responsibilities of nurse & client
Discuss confidentiality/boundaries
Gather information; identify strengths/weaknesses
Formulate nursing diagnoses
Set mutually agreeable goals
Develop realistic plan of action
***BEGIN DISCHARGE PLANNING***

14. Nurse-Client Relationship Phase 2
Working
Nursing Role
Coach/facilitator/advocate
MAIN GOAL
Promote client change
Nursing Actions
Mutually explore/develop solutions
Implement plan (interventions)
Attend to/support physical & emotional needs
Want client to gain insight r/t feelings, level of coping, etc.
Evaluate progress/outcomes
Alter plan as needed

15. Nurse-Client Relationship Phase 3
Termination (Resolution)
Nursing Role
Facilitate closure
MAIN GOAL
Evaluate goal attainment; ensure therapeutic closure
Nursing Actions
***DISCHARGE PLANNING- goals met?
Summarize achievements/review health changes
Discuss how will integrate new coping/changes
Clarify aftercare plans/support
Explore feelings r/t termination

16. The nurse is teaching a client with diabetes the importance of checking his blood sugar before taking his prescribed insulin dose each morning. The nurse-client relationship is in which phase?
Pre-interaction
Orientation
Working
Termination

17. Nurse-Client Relationship Professional vs. Social
***Should ALWAYS BE PROFESSIONAL***
-Focus on CLIENT
-Nurse self-discloses ONLY what’s appropriate for client’s
benefit
-Nurse abides by “advocacy” and “circle of confidentiality”
guidelines (Craven, pp )
-Relationship terminated when goals met/service no
longer needed
***Continued contact beyond professional responsibilities is usually not advisable and may violate professional and ethical codes of conduct. (Craven, p. 79)

18. Therapeutic Communication Essential Components
Empathy
-consider another’s perspective (“walk in their shoes”)
Positive regard
-caring/non-judgmental attitude
-unconditional respect
Comfortable sense of self
-self awareness (nurse considers own feelings, values,
beliefs, role, etc. BEFORE ORIENTATION; PRE-interaction)
-protect self from emotional trauma, stress, burnout, etc.
-need self care “safety nets” (Craven, p. 83)
***See guidelines for facilitating communication
(Craven, Box 5-4, p. 86)

19. A nurse has been working on a hospice unit for several months and has witnessed several client deaths. Which actions will likely help to protect the nurse's emotional health? Select all that apply.
Request a transfer to another unit
Keep a written journal of personal feelings
Take a mild sedative to ensure adequate sleep
Reflect on experiences with a group of peers
Limit interactions with dying clients/families
Explore personal feelings r/t each client situation

20. Communicating in Special Situations (Craven, pp. 90-92)
Children/adolescents
Adults/older adults
Diverse populations (cross-cultural)
Critically ill clients
***Also…may need alterations in communication with clients with mental illness, cognitive disturbances, anger, etc.

21. Assertive Communication
ASSERTIVE BEHAVIOR IS NOT:
Passive (submissive- violates own rights)
Aggressive (hostile- violates others’ rights)
Passive-aggressive (hostile in a passive way-
violates others’ rights in a “sneaky” fashion)
ASSERTIVE BEHAVIOR IS:
-Standing up for one’s own rights while respecting
the rights of others
-being accountable for one’s actions
-addressing conflict responsibly

22. Assertive Conflict Resolution
***Use “I” statements- NOT “You”
“I feel______ when______, and I wish (need, or would like)______(desired change).”
Example:
Non-productive:
“You make me so mad when you leave your stuff all around the house!”
Productive:
“I feel very unappreciated when you leave things lying around the house, and I wish you would take a few moments to pick up your belongings.”

23. The charge nurse overhears a co-worker complaining about her leadership style to another nurse. Which is the BEST response by the charge nurse?
“You should be talking to me if you have an issue with how I manage things.”
“I cannot believe that you would talk about me like that behind my back.”
“I am disappointed that you are talking about me and wish you would discuss your concerns with me.”
“You should feel ashamed for talking about me, and I wish you would stop doing that.”

24. Therapeutic vs. Non-therapeutic Communication Techniques
Review Technique Handouts (posted on Canvas)
Review Techniques in textbook (Craven, pp )
ASSIGNMENT (Completed BEFORE CLASS):
Communication Worksheet (posted on Canvas)
Write/bring (1) example of a therapeutic nurse-client interaction and (1) example of a non-therapeutic nurse-client interaction
***Will review these and other examples/ questions IN CLASS!***