Transcript Unit 2

Communication Chapter 13
Communication Process
Communication can be a complex process
that can easily
breakdown
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Communication
Personal communication is an integral part of
your personal and professional world
Communication
 One-way communication
 Sender controls the message
 No opportunity for feedback
 Two-way communication
 Each person contributes equally
 Involves feedback or discussion
Communication
Example: Sara walks into the patients room without
knocking on the door. “ I am going to take your blood
pressure . Give me your arm.” The patient gave her a
quizzical look, but complied and put his arm out.
This was the patient’s first impression and interaction
with his nurse.
Communication
What kind of communication did Sara engage in?
Was it one way communication or two way?
What else should Sara have done when interacting with
her patient the first time?
Communication
 Announce (Knock on the door) Address the patient
 Introduce self and her role
 Explain what your going to do
 Thank the patient
 This is an example of two way communication.
Factors that Affect Communication
 Personal characteristics of sender and receiver
 Age, gender, , life experiences, attitude, personal
opinion etc.
 Cultural characteristics
 Language, use and meaning of touch, gestures, etc.
 Situational influences
 Physical and emotional state, background noise,
interruptions, etc.
 Context
 Appropriateness/inappropriateness of the message
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Types of Communication
 Verbal
 Nonverbal
 Affective (Refers to Mood or emotion)
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Types of Communication
Verbal communication: spoken message
The spoken word is powerful
Think before your speak
Speak clearly
Speak professionally
No slang (May have different meanings for different
age groups)
 No medical jargon Examples: OOB, NPO
 Colloquial expressions may be appropriate example
urinate, potty, bathroom, pass water. .



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Speak only about what you know.
If a patient asks you a question and you don’t
know the answer what would be the
appropriate response?
Communication
I don’t know but I will be able to get you someone who
may be able to help you.
Communication
• Maintain professional boundaries but communicate with the
patient .
• Patients trust the nursing staff more when they are
communicated to effectively
• Quality care is measured by positive patient outcomes which
includes how the nurses and health team communicate with a
patient.
See example next page of a sample communication board
that is common in many facilities today.
WASHINGTON, D.C. -- In 2014,
Americans say nurses
Types of Communication
 Nonverbal communication: body language
 Expressions, posture, movements, gestures, physical
appearance may say something different than the verbal
 Clues to the truth of the spoken message
 Indicators of patient discomfort
 Physical appearance is a part of nonverbal
communication grimacing, wincing, crying
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Types of Communication
 Affective communication: feeling tone
 Tone of communication
 Emission of energy
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Communication
 Give me an example of a time that you stepped
into a room or approached a person and before
anyone spoke a word, you experienced a feeling of
excitement, happiness, sadness, anger?
Communication Strategies
Active Listening
 Most important part of any therapeutic
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
communication
Key factors include
Purpose a reason for the communication to obtain
information from the patient
Disciplined attention pick up on things check
accuracy of information
Focus ( Listen to what the patient says and clarify.)
A common mistake is to listen to the words, but not
really hear the words
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Communication Strategies
Active Listening Behaviors
Restating- Repeating in a slightly different way
what the patient said
Example:
Patient: “ My chest hurts.” I can’t sleep at night.
Nurse: You’ve been unable to sleep at night because
of chest pain?
Gives the nurse more clarity and information
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Therapeutic Communication
Clarifying – Is asking a closed ended question in
response to a patient’s statement to be sure you
understand
Example:
Patient: “ My chest hurts.”
Nurse: “Exactly where does your chest hurt?”
Therapeutic Communication
Minimal Encouraging – Involves using sounds words
or short phrases to encourage the patient to continue
Example:
Patient: “ It happened so fast …”
Nurse: “Yes go on, and then what…. hum uh really
Therapeutic Communication
Paraphrasing- Refers t0 expressing in your own words
the information you are receiving from the patient.
Example:
Patient: “I don’t think I am being told the truth about
my condition.”
Nurse: “You think you may have other problems that
have not been discussed with you?
Therapeutic Communication
 Reflecting – Is putting into words the information
you are receiving from the patient at an affective
communication level.
Example:
Patient: “I am sick of seeing Doctors and not getting
answers.”
Nurse:
“You are upset with not getting information
about your health problems?”
Communication
Remaining Silent Involves using pauses effectively.
 The normal tendency is to fill silence with chatter
your speculation.
 This may shut a conversation down.
 Avoid interruptions and busy work and give the
patient your attention.
Therapeutic Communication
Summarizing- Means briefly stating the main data you
have gathered
Nurse: Is what I heard you say correct?
Therapeutic Communication
Validation- Provides the patient with an opportunity to
correct information, if necessary at the time of
summary.
Example:
Patient: That is correct or no you got this part wrong.
This allows the patient to correct what was said.
Communication Strategies
Types of Questions
 Open-ended questions
 Permit variety of responses
 Often begin with what, where, when, how, or why

“What happened to your leg?”
 Closed-ended questions
 Require a specific answer

“When did you first notice the pain?”
 Focused questions
 Provide more definitive information

“On a scale of 1 to 10, with 10 as the worst possible pain, how would you
rate your pain right now?”
Therapeutic Communication
Patient: My knee hurts even while
I’m sitting in my chair.
Nurse: So you are telling me you
have pain in your left knee even at
rest?
 Restating
Therapeutic Communication
Nurse: “In this hour you and I
discussed…when the pain started,
and that it was sharp in the right
side .”
 Summarizing
Therapeutic Communication
Patient: “It’s a waste of time to talk
to anyone.”
Nurse: “You don’t think anyone
understands?”
 Paraphrasing
Therapeutic Communication
Nurse: “Tell me whether my
understanding is the same as
yours.”
Validation
Therapeutic Communication
Nurse: “Go on…I see.”
 Minimal encouraging
Therapeutic Communication
Patient: “Should I have the surgery?”
Nurse: “Do you think you should?”
 Reflection
Communication Strategies
Nurse/Patient Communication
Evaluation
 Communication is far more complex than just
talking
 Evaluate the characteristics that are working for
you and those you need to work on
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Blocks to Communication
 False reassurance guarantees positive outcome
 Probing pushes for information beyond medical
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necessity
Chiding or scolding for behavior such as smoking
Belittling, mimicking, or making fun of the patient,
downplaying symptoms
Giving advice
Providing pat answers negates individuality of the
situation
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Male/Female Differences
 Most males and females follow certain patterns
with regard to:
 Conversation
 Head movements
 Smiling
 Posture
 Differences in patient communication have
important nursing implications
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Cultural Differences
 Understanding cultural differences will help nurses
respond respectfully and therapeutically
 Differences apply generally to groups as a whole
 Individual patient differences should still be identified
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Role
Changes
for
the
Patient
 Dependent position
 Set tone by providing respect and information;
do not use first name unless specifically
requested by patient
 Avoid medical jargon
 Ask if patient has questions
 Be sensitive to personal or environmental
factors that may cause anxiety
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Communication Characteristics
Important in All Communications
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Respect
Trust
Honesty
Empathy
Sensitivity
Humor
Knowledge
Patience
Commitment
Self-esteem
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Communication Characteristics
 Self-esteem
 Earned, not learned
 Gives you permission to recognize that you have
something very special to offer in nursing
communication
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Life Span Communication
Each age group has different
communication needs
 Infants
 Cries have different meanings
 Influenced by the sound of the voice
 Respond to calm, low tones
 Preschool
 Cannot verbally express frustration, leading to tantrums
 Communicate by pointing
 Can help if coached
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Life Span Communication
 School-age
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Can be part of many discussions
Can use drawings or pictures to explain an illness
 Teenage
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Extend same courtesy as to adults
Encourage expression of feelings
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Life Span Communication
 Adult
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Collect data at all three communication levels
Limit questions to medical areas
 Elderly


Check which side is best for hearing
Read directions aloud
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Electronic Communication
 Fax machines
 Computer patient charting
 E-mail
 Keep sentences and paragraphs short; check spelling,
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punctuation
Skip a line to separate topics
Send message to the right person
Write “subject” line carefully
Be specific
Be cautious with humor
Avoid all CAPS
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Electronic Communication
Cell Phones and Text Messaging
 Shut off cell and text messaging phones during
class and clinical
 Avoid behaving in ways disruptive to the instructor
and other students
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Conflict Resolution
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Accept conflict as a natural part of life
Shift your own attitude and behavior
Take time to think critically before reacting
Treat conflict as an opportunity to voice your own
opinion and listen to the other side of the story
Choose your approach
Listen and learn
Discover what is important
Respect each other
Find common ground, generally the patient’s highest
good
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Question 1
Which of the following factors does not affect
communication?
1.
2.
3.
4.
Personal characteristics
Cultural characteristics
Situational influences
Economic influences
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Slide 48
Question 2
Billy’s patient states, “It really hurts when you change
my dressing.” Billy responds by asking, “Exactly where
does it hurt when I change your dressing?” This is an
example of which active listening response?
1.
2.
3.
4.
Restating
Clarification
Reflection
Paraphrasing
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Slide 49
Question 3
When Billy is with his patient he knows that the most
important part of therapeutic communication is active
listening. In order for Billy to actively listen to his
patient he must include all of the following except:
1.
2.
3.
4.
purpose.
disciplined attention.
focus.
memorization.
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Slide 50
Question 4
Billy’s patient is going to surgery tomorrow. Billy tells his
patient, “Don’t worry, everything will be all right.” This is
what type of communication block?
1.
2.
3.
4.
Probing
False reassuring
Giving advice
Chiding
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Slide 51
Assertiveness in Nursing
What do you think of when you hear
the term assertive behavior?”
Assertiveness: Expected in Nursing
 Assertiveness is a style of interaction that promotes
honest, open communication and behavior.
 Helps nurse advocate for the patient
 Considers others’ feelings and needs
 Benefits nurse, patient, and staff
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Communication
Imagine for the next few minutes that the nurse Patient
roles are reversed and that you are the patient.
What are your expectations of the nurse assigned to you?
Communication Styles
 Translate into behavior patterns
 Nonassertive (passive)
 Aggressive
 Assertive
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Nonassertive (Passive) Behavior
 Automatic response not based on choice
 Emotional response based on fear
 Dishonest, self-defeating not speaking up for self or
others.
 Overall message: “I do not count. You count.”
 Consequence: nurse unable to recognize and meet
patient needs
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Aggressive Behavior
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Automatic response not based on choice
Emotional behavior based in anger
Violates the rights of others
Attacks person instead of behavior
Overall message: “You do not count. I count.”
Consequence: distances aggressor from staff and
patients
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Assertive Behavior
 Assertiveness: current name for honesty
 Pro-active, not emotional response
 Positive, confident, open stand
 Overall message: “I count. You count.”
 Consequence: Nurse feels in control of emotions and
responses, and can be more effective patient advocate.
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Assertive Behavior
 Nonassertive (passive) and aggressive behaviors are
based on emotional hooks.
 These styles are ultimately damaging to all parties.
 Be alert to unresolved feelings that can lead to a cycle
of:
worry > fear > anger > rage
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Assertive Behavior
 Own your own feelings.
 Don’t blame others.
 Be direct.
 Use “I” statements to make your feelings known.
 Make sure verbal and non-verbal messages are
consistent.
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Work-Related Aggressiveness
 Workplace assaults take place more often against
health care workers, especially nurses, than people
in any other occupation.
 Contributing factors

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
Personal Factors
Workplace Practices
Environmental Factors
Risk Diagnosis
 Nurses can and should
 protect themselves.
 advocate for a safer workplace.
Sexual Harassment
 Unwanted Sexual Advances
 Verbal or Physical Conduct of a Sexual Nature
 A condition of employment or advancement
 A hostile environment, where the advances intimidate,
offend, or interfere with the nurses’ ability to do their
work
 Not about sex or passion; about abuse of power
Problem-Solving Process
 Unresolved issues can result in a continuous cycle:
 worry > fear > anger > rage
 Problem-solving and communication skills can help
break the cycle
 Nurse should recognize signs of each stage
Sexual Harassment:
What the Nurse Can Do
 Respond assertively.
 Make sure verbal, nonverbal, and affective messages

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are consistent.
Document what happened.
Report to management.
Consider counseling.
Consider seeking legal redress.
Question 1
Amanda is working on a busy floor. Her charge nurse
asks her to take on more patients. She is already too
busy. She tells her charge nurse, “Well, uh, I guess I
could.” Amanda is displaying what type of behavior?
1.
2.
3.
4.
Nonassertive
Aggressive
Assertive
None of the above
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Slide 66
Question 2
Dr. Tingle orders a new medication for Amanda’s
patient. She knows her patient is allergic to the
medication. She asks Dr. Tingle if she can speak to him
in the hallway. After discussing the situation, Dr. Tingle
returns to the room and changes the medication. Which
behavior did Amanda display?
1.
2.
3.
4.
Nonassertive
Aggressive
Assertive
None of the above
Problem Solving Process
 A series of steps used to solve problems long before the
nursing process was developed
 The self tries to find relief of unresolved feelings
through behavior
 Codependency
 Self-medicating with alcohol and/or other drugs (or
food)
 Projecting the anger toward patients (burnout)
Problem Solving Process
 Step 1: Define the problem
 Step 2: Decide on a goal
 Step 3: Choose alternatives
 Step 4: Try out the alternatives
 Step 5: Evaluate the effectiveness of your approach
 Step 6: Repeat the process if the solution is not
effective