Download Chapter_024 Communication Potter and Perry

Chapter 24
Communication
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2
Things to Ponder
 We have two ears and one mouth so that we can
listen twice as much as we speak. (Epictetus)
 Communication is depositing a part of yourself in
another person ( unknown)
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Communication and Nursing
Practice
 A lifelong learning process for nurses
 Therapeutic communication promotes personal
growth and attainment of patients’ health-related
goals
 Key to nurse-patient relationships
 Patient safety requires effective communication
 Improves patient outcomes and increases patient
satisfaction
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Communication
 Despite the complexity of technology and the multiple
demands on nurse’s time, It is the intimate moment of
connection that makes the difference in the quality of
care and meaning for the nurse and client .
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Communication and
Interpersonal Relationships
Communication establishes caring, healing
relationships.
The ability to relate to others is important for
interpersonal communication.
Communication, including posture,
expressions, gestures, words, and attitudes,
has the power to hurt or heal.
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Developing Communication
Skills
Critical thinking
Perseverance and creativity
Self-confidence
Humility
Integrity
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Developing Communication
Skills (Cont.)
 Thinking is influenced by perception
 Five senses
 Culture
 Education
 Perceptual bias
 Emotional intelligence
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Levels of Communication
 Intrapersonal
 Interpersonal
 Small group
 Public
 Electronic
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Quick Quiz!
1. Match the levels of communication.
1. Intrapersonal
A. One-to-one interaction
between two people
2. Interpersonal
B. Occurs within an individual
3. Transpersonal
C. Interaction with an audience
4. Small group
D. Interaction within a person’s
spiritual domain
5. Public
E. Interactions with a small
number of people
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Quick Quiz!
2. 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.
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Elements of the Communication
Process
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Circular Transactional Model
 Components
 Referent
 Sender and receiver
 Message
 Channels
 Feedback
 Interpersonal variables
 Environment
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Quick Quiz!
3. Match the basic elements of communication.
1. Referent
A. One who encodes and
one who decodes the
message
2. Sender and receiver
B. The setting for senderreceiver interactions
3. Message
C. Message the receiver
returns
4. Channels
D. Motivates one to
communicate with another
5. Feedback
E. Means of conveying and
receiving messages
F. Factors that influence
6. Interpersonal
communication
variables
G.All Content
of the message
7. EnvironmentCopyright © 2017, Elsevier Inc.
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Forms of Communication
 Verbal communication
 Vocabulary
 Denotative and connotative meaning
 Pacing
 Intonation
 Clarity and brevity
 Timing and relevance
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Forms of Communication
 Verbal
 Vocabulary: choice of words
 Denotative: primary meaning – understood meaning
 Connotative: idea or meaning of word influenced by persons
thoughts/ views
 Pacing: Speed of speech – not too fast/ slow
 Intonation: Tone – how we say something speaks louder than
what we say
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Verbal (cont.)
 Clarity and brevity: simple/ direct best approach –
“Where do you hurt?”
 Timing and relevance: message may be clear – but poor
timing can make it not be effective
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Forms of Communication
(Cont.)
 Nonverbal
 Personal appearance
 Posture and gait
 Facial expressions
 Eye contact
 Gestures
 Sounds
 Territoriality and personal space
 Metacommunication
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Nonverbal Communication
 Personal appearance: outward appearance –
picture to the world
 Posture and gait: form of self expression – confidence
or insecurity
 Facial expressions: MOST EXPRESSIVE PART OF BODY!!!
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Nonverbal (cont.)
 Eye contact: used to signal readiness to communicate
 Gestures: used to emphasize or clarify spoken words
 Sounds: Communicate feelings and thoughts – sighs/
moans/ groans
 Territory and Personal Space:
 Need to gain, maintain, protect defend one’s personal
right to space
 Personal space is invisible
 See zones p.314 Box 24-3
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Nurse-Patient Relationship
 Caring relationships are the foundation of clinical
nursing practice.
 Therapeutic relationships promote a psychological
climate that facilitates positive change and growth.
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Nurse-Patient Relationship
(Cont.)
1. Preinteraction phase: occurs before meeting the patient
2. Orientation phase: when the nurse and the patient meet and get
to know each other
3. Working phase: when the nurse and the patient work together to
solve problems and accomplish goals
4. Termination phase: occurs at the end of a relationship
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Motivational Interviewing
 A technique that holds promise for encouraging
patients to share their thoughts, beliefs, fears, and
concerns with the aim of changing their behavior.
 The interviewing is delivered in a nonjudgmental,
guided communication approach.
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Professional Nursing
Relationships (Cont.)
Nurse-family relationships
Nurse-health care team relationships
Nurse-community relationships
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Case Study
 Roberto Ruiz is a 44-year-old man of Puerto Rican
descent, suffering from HIV/AIDS. He was near death
and in hospice, but his condition has improved and he
is now home.
 Suzanne is a 54-year-old nurse dedicated to hospice
and committed to maximizing quality of life in end-oflife care.
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Quick Quiz!
4. Helping relationships serve as 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.
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Elements of Professional
Communication
Appearance,
demeanor, and
behavior
Courtesy
Use of names
Trustworthiness
Autonomy and
responsibility
Assertiveness
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Case Study (Cont.)
 As Suzanne works with Roberto, she develops a
helping relationship. Suzanne knows that posing
questions for the patient’s reflection helps her assess
his needs and support his self-care strategies.
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Nursing Process: Assessment
 Through the patient’s eyes
 Gather information, synthesize, apply critical thinking
 Physical and emotional factors
 Developmental factors
 Sociocultural factors
 Gender
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Case Study (Cont.)
 Suzanne learns that Roberto wants to travel to New
York to see his extended family.
 Even though Roberto is in poor health and the trip will
be difficult, Suzanne expresses her understanding of
the importance of the trip. She understands how
important extended family is in the Puerto Rican
culture.
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Nursing Diagnosis
 Nursing diagnosis for communication
 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
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Planning
 Goals and outcomes
 Specific and measurable
 Setting of priorities
 Teamwork and collaboration
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Case Study (Cont.)
 During her visit, Roberto tells Suzanne, “I really want to
go visit my uncles in New York, but I’m not sure I’m up
for the trip.”
 Suzanne is understanding: “It sounds like you miss your
family. Let’s talk about your options for maintaining
contact.”
 As they talk, Suzanne helps Roberto to identify two
methods of communicating with his family in New
York.
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Implementation
 Therapeutic communication techniques are specific
responses that encourage the expression of feelings
and ideas and convey acceptance and respect.
 Active listening means being attentive to what a patient
is saying both verbally and nonverbally.
 Use “SOLER”: Sit facing the patient; observe an open
posture, lean toward the patient, establish and maintain
intermittent eye contact; relax
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Implementation (Cont.)
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Therapeutic
communication
techniques (Cont.)
Sharing observations
Sharing empathy
Sharing hope
Sharing humor
Sharing feelings
Using touch
Using silence
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Implementation (Cont.)
 Therapeutic communication techniques (Cont.)
 Providing information
 Clarifying
 Focusing
 Paraphrasing
 Validation
 Asking relevant questions
 Summarizing
 Self-disclosure
 Confrontation
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Implementation (Cont.)
 Nontherpeutic communication techniques
 Asking personal questions
 Giving personal opinions
 Changing the subject
 Automatic responses
 False reassurance
 Sympathy
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Implementation (Cont.)
 Nontherpeutic communication techniques (Cont.)
 Asking for explanations
 Approval or disapproval
 Defensive responses
 Passive or aggressive responses
 Arguing
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Adapting Communication
Techniques
 Patients who cannot speak clearly
 Cognitive impairment
 Hearing impairment
 Visual impairment
 Unresponsive
 Patients who do not speak English (or your language)
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Quick Quiz!
5. 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 used
by the family member is:
A. focusing.
B. clarifying.
C. summarizing.
D. paraphrasing.
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Evaluation
 Through the patient’s eyes
 Patient outcomes
 Nurses and patients need to determine whether the plan
of care has been successful.
 Nursing interventions are evaluated to determine which
strategies or interventions were effective.
 If expected outcomes are not met, the plan of care
needs to be modified.
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Group Activity
 Define therapeutic communication and provide each
by role playing the following: clarifying, focusing,
summarizing, paraphrasing
 Define nontherapeutic communication and role play
each of the following: asking personal questions,
giving personal opinions, changing the subject,
defense response, and aruging
 Define active listening and demonstrate the acronym
SOLER
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