Download Chapter 5

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 5
COMMUNICATION
Communication

The sending and receiving of a
message.
Aspects of Communication (i)
Sender - the one who conveys the
message to another person.
 Message - the thought, idea, or emotion
conveyed.
 Channel - how the message is sent.

Aspects of Communication (ii)
Receiver - physiological/ psychological
components.
 Feedback - the receiver’s response to
the sender.
 Influences - Culture, education,
emotions and other factors involved.

Methods of Communication

Verbal - Speaking, Listening, Writing,
Reading.

Nonverbal - Gestures, Facial
Expressions, Posture and Gait, Tone of
Voice, Touch, Eye Contact, Body
Position, Physical Appearance.
Influences on Communication
Age
 Education
 Emotions
 Culture

Language
 Attention
 Surroundings

Congruency of Messages
 Verbal and nonverbal communication
must be congruent, or in agreement.
Listening and Observing
 Listening and observing are two of the
most valuable skills a nurse can have.
 These two skills are used to gather the
subjective and objective data for the
nursing assessment.
Active Listening
 The process of hearing spoken words
and noting nonverbal behavior.
 Active listening takes energy and
concentration.
Therapeutic Communication
 Sometimes called effective
communication, it is purposeful and
goal-oriented, creating a beneficial
outcome for the client.
Goals of
Therapeutic Communication
To obtain or provide information
 To develop trust
 To show caring
 To explore feelings

Enhancing Communication







Self-Disclosure.
Caring.
Genuineness.
Warmth.
Active Listening.
Empathy (the capacity to understand another’s
feelings).
Acceptance and respect.
Communication Techniques








Clarifying/validating.
Asking open questions.
Using indirect statements.
Reflecting.
Paraphrasing.
Summarizing.
Focusing.
Silence.
Barriers Communication
Some barriers include:








Closed questions.
False reassurance.
Judgmental responses.
Defensive reflex.
Agreeing/Disagreeing or Approving/ Disapproving.
Giving advice.
Requesting an explanation.
Changing the subject.
Psychosocial Aspects of
Communication
Style.
 Gestures.
 Meaning of time.
 Meaning of space.
 Cultural values.
 Political correctness.

Style
Three types of style:
 Passive - apologetic, weak, makes little eye contact,
often fidgety.


Aggressive - haughty, angry, demanding, shows no
concern for anyone else’s feelings
Assertive - honest, direct, firm, makes eye contact,
confident, respectful of others.
Gestures
 Movements of the hands and arms.
 Nurses must be sensitive to cultural
variances with regard to gestures.
Meaning of Time
 In the U.S., great emphasis is placed on
time and schedules. Being on time is
very important.
 In other cultures, such emphasis is not
placed on time.
Meaning of Space
 Human beings all observe rules around
comfort zones—the distance observed
between two people. Such comfort
zones include:




Intimate: touch to 18 inches
Personal: 18 inches to 4 feet
Social: 4 feet to 12 feet
Public: 12 feet or more
Cultural Values

A nurse should be familiar with the
cultural values of the people in the
nurse’s region of employment.

A nurse needs to be aware of those
times when her values differ from the
values of the dominant culture.
Political Correctness

To be politically correct in
communication means to use language
sensitive to those who are different from
oneself.
Nurse-Client Communication

Almost every nurse-client interaction
should involve therapeutic
communication.

Nurse-client communication is
influenced by both the nurse and the
client.
Three Phases of
Nurse-Client Communication

Introduction: Fairly short; expectations clarified;
mutual goals set

Working: Major portion of the interaction; used to
accomplish goals outlined in introduction; feedback
from client essential.

Termination: Nurse asks if client has questions;
summarizing the topic is another way to indicate
closure.
Determinant Factors in
Communication
A nurse’s communication is affected by:






Past Experience
State of Health
Home Situation
Workload
Staff Relations
Self-Awareness
Determinant Factors in
Communication
A client’s communication is affected by:







Social Factors
Religion
Family Situation
Level of Consciousness
Stage of Illness
Visual, Hearing and Speech Ability
Language Proficiency
Communication within the
Health Care Team
 Providing care is a team effort.
 To ensure efficiency and effectiveness,
effective communication is necessary.
 This communication may be oral or
written.
The Nurse’s Ways of
Communication

Oral

Written

Self-Reflection
Oral Communication
Nurses communicate within many
different relationships, each with their
own rules.






Nurse-Nurse
Nurse-Nursing Assistant
Nurse-Student Nurse
Nurse-Physician
Nurse-Other Health Professionals
Group Communication (I.e. client-care conferences)
Written Communication
Nurses’ communications are often
written:




On charts
Requisitions for x-rays and other tests and services
Electronic communications, via computer
Telemedicine: the use of communications
technology to transmit health information from one
location to another.
Self-Reflection
Nurses often engage in internal
dialogue:

Positive self-talk: Saying positive thoughts aloud;
thinking, saying and hearing positive statements
about yourself

Negative self-talk: Self-destructive. Your self-image is
lowered by your own criticism.
Communicating With Yourself

Positive self-talk: Saying positive thoughts
aloud; thinking, saying and hearing
positive statements about yourself

Negative self-talk: Self-destructive. Your
self-image is lowered by your own
criticism.