2 ObjectivesDescribe the communication process, identifying factors that influence communicationList ways in which people communicate nonverballyUse a standardized communication technique (SBAR) to communicate with physicians and transfer patient information to other nursesDescribe how each type of ineffective communication hinders communication
3 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.
5 Communication Process Based on a stimulus (a patient’s need for: medication, information, food or fluid)Involves:Source (encoder) - Person who sends the messageMessage - the physiologic product of the source (speech, gesture, nursing note)Channel- the medium used to send the messageReceiver (decoder) the person who receives and interprets the message sent
6 Channels of Communication Auditory: spoken words and cuesVisual - sight, observations, and perceptionKinesthetic - touch
8 Forms of Communication Verbal: exchange of information using words; including both the spoken and written word.Verbal communication depends on languageNursing depends on verbal language extensivelyNonverbal: communication without the use of words; also know as “body language”Can be an incongruence between verbal and nonverbal messageGenerally, the non-verbal message is thought to be the one that is more valid or true
9 Forms of Non Verbal Communication Touch: can express comfort, love, affection, security, anger, frustration, excitement, empathyEye Contact: means different things in different cultures; Eyes can carry expressions - anger, fear, happinessFacial Expression: Some people have expressive faces, others hide their emotionsPosture: the way a person holds the body; can indicate depression, well-being, tensionGait: Type of walk; can indicate energy level, debilitating conditionsGestures: Many gestures are understood across cultures
11 Non Verbal Communication General Physical Appearance: Skin color, body size, muscle toneMode 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 statusSounds: crying, moaning, gasping, sighingSilence: can have multiple meanings
15 Levels of Communication Intrapersonal: “Self-Talk” communication within an individual; can influence interactions with othersInterpersonal: between two or more people with a goal to exchange messagesGroup: small group and organizational group communication
16 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
17 Answer Answer: A. Intrapersonal Rationale: 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.
18 Group DynamicsWithin 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 goalsRequires effective leadership, but depends largely on the behavior of the members of the groupExample: Study Group
20 Roles of Group Members Task-oriented—focus on work to be done Group building or maintenance—focus on well-being of people doing workSelf-serving—advance the needs of individual members at group’s expense
21 Factors Influencing Communication Developmental levelGenderSociocultural differencesRoles and responsibilitiesSpace and territorialityPhysical, mental, and emotional stateValuesEnvironment
28 Hand off Communication: SBAR Technique Involves the accurate presentation of all patient-related information to another caregiver.IncludesNurse - to - Nurse reportNurse to physician reportReport to and from other hospital departmentsJCAHO - recommends a standardized method of communication, including an opportunity to ask and respond to questions
29 SBAR S = Situation B = Background A = Assessment R = Recommendations Developed by the US Navy and then implemented by Kaiser Permanente in Colorado
31 SBARExample:Your patient has a temperature of He does not have an order for an antipyretic.What would you say when you called the MD?
32 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 RelationshipDoes not occur spontaneouslyCharacterized by an unequal sharing of informationBuilt on the patient’s needs
34 Characteristics of the Helping Relationship Dynamic: Both parties are actively participatingPurposeful and time limitedPerson providing assistance is professionally accountable for the outcomes
35 Goals of the Helping Relationship Goals 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
36 Phases of the Helping Relationship Orientation phase:includes data gatheringsets the tone for the remainder of the relationshipPatient and nurse learn each other’s nameRoles of both parties are clarifiedGoals are establishedPatient is oriented to facility, routines, other staff members
38 Phases of the Helping Relationship Working PhaseLongest phase; characterized by interactionNursing interventionsPatient teachingAssistance with ADL’sNursing roles: teacher and counselorSatisfactory working relationship is crucial
40 Phases of the Helping Relationship Termination PhaseOccurs when the conclusion of the initial agreement is acknowledged (change of shift, patient is discharged)Evaluations of progress toward initial goals should be doneSet the stage for transfer of the helping relationship to another person or entity (home health, clinic)
42 Factors that Promote Effective Communication Dispositional traitsRapport builders
43 Factors Promoting Effective Communication Within the Helping Relationship Dispositional TraitsWarmth and FriendlinessOpenness and RespectEmpathyHonestly, Authenticity and TrustCaringCompetence
44 Rapport BuildersDef: a feeling of mutual trust experienced by people in a satisfactory relationship; facilitates open communicationSpecific ObjectivesComfortable EnvironmentPrivacyConfidentialityPatient vs. task focusUsing nursing observationsOptimal pacingRespecting personal space
48 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.
50 Developing Listening Skills Sit 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.
52 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”
53 Interviewing Techniques Clarifying 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………”
54 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.
55 Developing Listening Skills Sit 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.
56 Basic Components of Assertiveness Having empathyDescribing one’s feelings or the situationClarifying one’s expectationsAnticipating consequences
57 Blocks to Communication Failure 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
59 Blocks to Communication (cont.) Using leading questionsUsing comments that give adviceUsing judgmental commentsChanging the subjectGiving false assuranceUsing gossip and rumorsUsing aggressive interpersonal behavior
62 Impaired Verbal Communication Aphasia:Expressive: inability to speakReceptive - inability to understandHearing ProblemsVoice ProblemsDysarthria: inability to produce sounds, slurred speech from strokes, parkinsonism etcOther communications problems: brain impairment, disorientation