2. COMMUNICATION Module D

3. Communication  Definition  Consists of five elements –Encoder, or sender –Message –Sensory channel –Decoder –The feedback, or return This indicates the degree of understanding of the message

4. Communication (cont.)  Levels of Communication –Intrapersonal –Interpersonal –Public

5. Forms Of Communication  Verbal –Vocabulary –Denotative meaning –Connotative meaning –Pacing –Intonation –Clarity & Brevity –Timing & Relevance

6. Forms of Communication (cont.)  Non-verbal –*adds cues & meaning to verbal communication –Personal appearance –Posture & gait –Facial expression –Eye contact –Gestures –Territoriality & Space

7. Forms of Communication  Therapeutic- Communication that is beneficial in developing a nurse-client helping relationship (Ex. Active listening- SOLER, empathy, humor, touch)  Non-Therapeutic- Communication that is not beneficial or helpful to people involved Ex. Personal questions, personal opinions, changing the subject.

8. Zones of Personal Space  Intimate (0-18 in)  Personal (18-4ft)  Social (4- 12 ft)  Public (12 ft or greater)

9. Zones of Touch  Social ( permission not needed)  Consent (permission needed)  Vulnerable (special care needed)  Intimate (great sensitivity needed)

10. The Nurse-Client Helping Relationship  The Nurse-Client Helping Relationship  Helping relationships are created through the nurse’s: –Application of scientific knowledge –Understanding of human behavior and communication –Commitment to caring  *Therapeutic communication doesn’t happen. You have to work at it.

11. Building and Maintaining Nurse- Client Helping Relationships  Pre-interaction Phase  Orientation Phase  Working Phase  Termination Phase

12. Pre-interaction Phase  Before meeting client  Review data available ( diagnosis, medical history  Assign appropriate room  Anticipate concerns or needs

13. Orientation Phase  Introduce yourself  Set a positive tone with a warm empathetic manner  Assess client health status  Prioritize needs and goals of your client  Clarify client’s and your roles  Let the client know when to expect the relationship to end

14. Working Phase  Encourage and help the client express feelings  Encourage and help client set goals  Take action to meet the goals set the client

15. Termination Phase  Remind client that termination is near  Evaluate goal achievement  Help to achieve a smooth transition to other caregivers

16. Techniques for improved therapeutic communication  Professionalism  Courtesy  Confidentiality  Availabilty  Trust  Empathy  Sympathy  Acceptance  Respect  Silence  Hope  Encouragement  Socializing  Gender/Cultural sensitivity

17. Barriers to Effective Communication  Inattentive listening  Medical vocabulary  Giving personal opinions  Being defensiveness  Showing disapproval  Cultural differences  Be aware of language barriers  Sensory impairments

18.  WHAT CAN WE DO TO OVERCOME THESE BARRIERS?

19. Documentation- What is it and why do we do it??????  Documentation is defined as anything written or printed within a client record.  A record is a permanent legal written document.  NOT CHARTED NOT DONE!!!!!!!!!  Documentation provides written record of the care given to the patient.

20. Documentation:  Financial record of care.  Used for clinical research  Used for professional development

21. What do we chart?  Assessment  Vital signs  Any change in pt condition  If verbal order taken  Procedure done  PRN medication  Intake & output

22. What is in “The Chart”?  Admission sheet- demographic data, in case of emergency, etc..  Physician’s order sheet- record of MD orders( meds, Tx,etc.)  Nurses admission assessment- Nsg summary of Hx & Physical  Graphic/ Flowsheet- VS, Daily wts, I/O  Med Hx & Exam- Initial exam and hx taken by MD  RN notes- record of RN assessments, treatments, etc. What we did!!!

23. “The Chart” cont  Med Record- MAR Tells Who, What, When, and Where!!  Client education record- Documentation of teaching done, response, if reinforcement needed, how it was done.  Physician’s progress notes- Updated record of how the pt is doing,response to tx, and any changes.  Healthcare discipline records- all areas of healthcare have a place to chart their specifics (resp, PT)_

24. More…  Discharge summary-  Summary of the pt’s condition upon D/C, meds, prognosis, F/U care, teaching needs, etc.

25. Types and Categories of Information  Flowsheets  Graphics Sheets  Computerized charting  Charting by exception  SOAP  Narrative  Careplans  POMR  PIE  Focus charting  Critical pathways  DRGS-for reimbursement  Kardex

26. Reporting and Documenting  REPORTING – Change of Shift Report  Types  Purpose  Information to include  Information to omit

27. REPORTING – Transfer Report  Name, age, primary physician, medical dx  Summary of medical progress up to time of transfer.  Current health status (physical & psycho- social)  Current nsg. Dx or problems & care plans  Any critical assessments or interventions  Need for any special equipment

28. Telephone Orders and Reports  Complete info given to MD  Verbal or telephone order- given to RN by MD and written by RN that takes order. Note as TO or VO. Repeat order back to MD After receiving it. MD must sign w/in 24hrs or by hosp policy  TO should be used only when necessary not for convenience. WHY?

29. Professional Communication  Courtesy  Use of names  Privacy  Confidentiality  Trustworthiness  Autonomy  Responsibility  Assertiveness