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Chapter 3Communication Skills 1. Apply your knowledge of communication skills to enhance relationships with others. 2. Conduct periodic self-assessments in communication skills. 3. Use techniques that enhance communication with patients. 4. Communicate empathy in the health care environment. 5. Avoid blocks to effective communication. 6. Use knowledge and resources to effectively communicate with people with special needs. OBJECTIVES Communication takes place when one mind so acts upon its environment that another mind is influenced, and in that other mind an experience occurs, which is like the experience in the first mind, and is caused in part by that experience. Communication is an exchange of information. The more complex the information or concept, the more difficult the task Definition of Communication How effective is your Communication Style? Take the self assessment Quiz On page 61 Communication Skills Assessment Assessment of communication skills can tell you what you may need to do to be a better communicator. Ways to improve communication skills: ◦ ◦ ◦ ◦ Learn about how people communicate Practice sending clear messages Practice listening to messages from others Learn about how to communicate with people who have special needs ◦ Ask friends and teachers for constructive criticism The Communication Process Verbal (speaking or writing-the actual words) Vocal (sound and tone of your voice) Nonverbal (signs, signals, symbols) Components of Communication Verbal communication can be ◦ One-way (ex. News broadcast) ◦ Two-way (ex. Simple conversation-2 people) ◦ Multidirectional-more than 2 persons (ex. Conversation about pt. care) Components of Communication Verbal Language expressed in speaking and writing Seven parts: ◦ Source or sender ◦ Encoder (converts message-eardrum, electric wires) ◦ Message (what is being communicated) ◦ Channel (face to face, or over wires or cable) Components of Communication ◦ Decoder (brain, television, radio, etc., converts codes into the message) ◦ Receiver (the person who is the recipient of the message) ◦ Feedback (the recipient responds in some way to the message) Components of Communication Components of Communication Vocal Communication The sound and tone of your voice Habits can reduce your effectiveness as a speaker Clear speaking is a learned skill ◦ Study the way you speak ◦ Face the person you are addressing ◦ Use words you are comfortable with ◦ Words, tone, rhythm, inflection, and posture work together Nonverbal Communication Includes signs (picture or drawing), signals (shout for help), and symbols (wedding ring) Includes body language ◦ Facial expressions ◦ Posture ◦ Body position ◦ Other actions that do not use words Components of Communication Sending the Message (speaking and writing) Information communicated from or to you Think through electronic messages to avoid misunderstandings and misinterpretations Use the method most appropriate to the situation Speaking Use correct vocabulary, grammar, medical terminology, and abbreviations The Process of Communicating Sending a Message •Speak clearly •Use good judgment •Express confidence •Listen without interrupting •Use accurate descriptions •Follow guidelines to improve quality of message The Process of Communicating Writing A significant way of communicating information in health care Charting as a direct influence on patient care −Give facts, not opinions −Use approved abbreviations The Process of Communicating Receiving the Message (reading and listening) Reading ◦ An important vehicle for conveying information and ideas ◦ Essentials of effective reading How fast you read? How well you understand what you read? The Process of Communicating Observe how you read Changing poor reading habits will make learning easier Building a good vocabulary is an excellent way to improve comprehensive ◦ Common language ◦ Medical terms The Process of Communicating Listening Receiver’s role is to listen. Hearing and listening are two distinct activities. −Hearing is biophysical −Listening is an active process Effective listening skills are necessary and a major part of your expertise as a nurse. A good listener gains the confidence of the speaker. The Process of Communicating Egocentricity (focus on the self) conflicts with needs for nurses to be exceptional listeners Three steps to good listening: 1. Focus attention on the speaker and what is being said 2. Interpret what is said to understand 3. Restate what you thought you heard Being a good listener means being receptive and open, but not playing the role of advisor The Process of Communicating •Listen without interrupting •Ask questions to show interest related to what is being said •Be courteous, interested, and nonjudgmental •Ineffective communication skills can lead to errors in patient care. The Process of Communicating Pay close attention to what patients say, and how they say it ◦ Avoid frivolous conversations ◦ Respect patients and address them as they prefer ◦ Be honest to develop trust ◦ Ask questions requiring more than “yes” or “no” ◦ Restate what you thought you heard Communicating with Patients ◦ Use clarifying phrases ◦ Have a purpose to your communication ◦ Keep confidentiality ◦ Write down important facts and instructions ◦ Show by nonverbal communication that you have time and want to listen Communicating with Patients Communicating Empathy Nursing requires providing emotional support, encouragement, and understanding. Learn to provide compassionate care without emotionally exhausting yourself. Conservation of physical and emotional energy helps avoid exhaustion and loss of interest. Empathy is intellectually but not emotionally identifying with feelings, thoughts, or attitudes of another person. Communicating with Patients Sympathy goes beyond empathy because it involves an emotional response. Being empathic helps to keep distance so you can think and act in your patient’s best interest. Being empathic helps to conserve emotional energy. Communicating with Patients Communicating with Patients Blocks to Effective Communication Avoid using techniques that prevent knowing what and how the patient feels and thinks ◦ Nonverbal barriers (posture, disinterest) ◦ Changing the subject (when uncomfortable) ◦ Stereotyped responses (“Everybody feels..”) ◦ Personal bias (expressing own feelings) ◦ Asking “yes” or “no” questions ◦ Belittling feelings or expressing disapproval Communicating with Team Members Physicians Have all information needed to describe a situation Give facts, not personal opinion unless asked Use tact to clarify written or verbal communication Supervisors Supervisor and legal liability for your actions All rules for good communication apply to this relationship Nursing Team Members Good communication skills reduce misunderstandings and conflicts. Good communication is necessary in planning and implementing nursing care. Maintain a professional attitude Show respect for the opinion of others If you offend someone, apologize GA #1 Communicating with Team Members There have always been problems with nurse–physician communication and relationships throughout the history of the profession. Search the Web for articles about the effect of poor communications between nurses and physicians on patient care and some of the reasons why those poor communications occur. Group Assignment #1 . Students can enter “nurse–physician conflict” to find such Web sites as the following: http://deepblue.lib.umich.edu/bitstream/2027.42/34675/1/7_ft p.pdf http://findarticles.com/p/articles/mi_qa4102/is_200602/ai_n1 7170215/ Students can enter “nurse–physician collaboration to find such Web sites as the following: http://www.nursingworld.org/mods/mod775/article.pdf http://www.rmf.harvard.edu/files/documents/Forum_V26N2erickson.pdf Group Assignment #1 Communicating in Special Situations Communicating with Culturally Diverse People Avoid confusing or offending another person A chance to learn about other cultures and people Cultural Competence ◦ ◦ ◦ ◦ Understand your own cultural values and biases Respect the culture of others Have an interest in learning about others Have the ability to avoid judging others’ behavior Communicating in Special Situations Communicating with Non-English Speaking People Use printed information in other languages Broadcast informational television in different languages Use interpreters ◦ Know interpreter’s educational level ◦ Watch for nonverbal cues Communicating in Special Situations When communicating without an interpreter ◦ ◦ ◦ ◦ ◦ ◦ Don’t shout Greet the person by name Give your name while pointing at yourself Pantomime actions or procedures Use preprinted list of phrases Determine understanding of words, other languages ◦ Use simple words and phrases Communicating in Special Situations Communicating with Hearing-Impaired People Speak slowly and face the person Don’t move your head or position yourself too far away Repeat to clarify Use bright lighting Eliminate background noise Make use of technology to assist in communication Communicating in Special Situations Communicating with Vision-Impaired People Speak in a normal tone of voice Announce yourself when entering a room State your name and the person’s name Continue talking as you work Say what you are to do before you do it Tell patients before you touch them Communicating in Special Situations Tell patient what foods are on the tray and where they are located Put needed items within reach and tell where they are Keep room free of clutter Don’t move furniture without telling Use vocal tones to convey feelings associated with the conversation Communicating in Special Situations Communicating with Speech-Impaired People Be patient when communicating If the person can write: ◦ ◦ ◦ ◦ Provide paper and pencil or computer Look at the patient as she writes the message Don’t allow interruptions Don’t be distracted Communicating in Special Situations Encourage pantomiming thoughts Don’t shout Take time to determine what the patient needs Use picture cards to communicate basic needs Ask other members of the team for tips and techniques Is the following statement true or false? Sending a message requires using signs, signals, and symbols. Question False Rationale: Signs, signals, and symbols are part of nonverbal communication and are not always required when sending a message. Answer Which of the following is true about listening? A. Listening is biophysical B. You must interrupt to understand C. Restate what you thought you heard D. Change the subject to a more pleasant one Question C. Restate what you thought you heard Rationale: Restate what you hear to better understand what has been said. Listening is an active process involving the mind. You should listen without interrupting. Do not change the subject. Answer Is the following statement true or false? Empathy is understanding intellectually the feelings, thoughts, or attitudes of another person. Question True Rationale: By understanding intellectually and not emotionally, you will avoid emotional exhaustion and loss of interest. DT#1 Answer You have been assigned to care for Mr. Penhaus, a 72-year-old retired German immigrant who lives alone. Mr. Penhaus is a newly diagnosed diabetic preparing for discharge, and you are to teach him how to draw up and administer his insulin. ◦ What communication barriers will you want to assess before beginning your teaching? ◦ How will you prepare yourself to teach Mr. Penhaus? DT#2 Discussion Topic #1 1. You are the charge nurse on your shift this evening. Lisa, a staff nurse discusses a patient whom she is working with is refusing to take liquids. Her mucous membranes are dry and she shows poor skin turgor. You check her 24 hour input and output records and find she is not in good fluid balance. You call her doctor and tell him, “Mrs. Jones is dehydrated. I think you should order intravenous fluids for her.” Is this a good example of nurse to physician communication? Why or why not? Using this scenario, what information would you give to the physician? DT #3 Discussion Topic #2 1. You are giving a bed bath to your patient and a fellow student Joyce is providing care to your patient’s roommate, Beverly. You hear Beverly say that she is concerned about the surgery she is to have the next day. Joyce asks her what she is worried about, and Beverly tells her that she is afraid she might not make it through the operation. Beverly laughs and tells her that this is not a good way to be thinking before having an operation, and that the surgeon is very skillful. She tells her not to worry, and that everything will be just fine. Describe the communication used by Joyce in responding to Beverly’s concern? How would you have responded to Beverly? Discussion Topic #3
