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Chapter 21
Communicator
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
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Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Five Parts of the Communication
Process (Berlo)
• The stimulus or referent
• The sender or source of message (encoder)
• The message itself
• The medium or channel of communication
• The receiver
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Components in the Process of
Communication
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Four Levels of Communication
• Intrapersonal
• Interpersonal
• Small-group
• Organizational
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Question
A nurse who reassures herself that she is prepared to
speak in front of a group of her peers is using which of
the following types of communication?
A. Intrapersonal
B. Interpersonal
C. Group
D. Organizational
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Answer
Answer: A. Intrapersonal
Rationale:
Intrapersonal communication is self-talk that happens
within the individual.
Interpersonal communication occurs between two or
more people to exchange messages.
Group communication includes small-group and
organizational group communication.
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Roles of Group Members
• Task-oriented—focus on work to be done
• Group building or maintenance—focus on well-being of
people doing work
• Self-serving—advance the needs of individual members
at group’s expense
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Question
An individual who dominates a group meeting to promote
his own personal agenda is performing which of the
following group-member roles?
A. Task-oriented
B. Group building
C. Maintenance
D. Self-serving
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Question
Answer: D. Self-serving
Rationale:
Self-serving roles advance the needs of individual
members at the group’s expense.
Task-oriented roles focus on the work to be done (e.g.,
information giver/seeker, coordinator, delegator)
Group-building and maintenance roles focus on the wellbeing of the people doing the work (e.g., listener, trust
builder, supporter).
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Factors Influencing Communication
• Developmental level
• Gender
• Sociocultural differences
• Roles and responsibilities
• Space and territoriality
• Physical, mental, and emotional state
• Environment
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Forms of Communication
• Verbal (language)
• Nonverbal (body language)
– Facial expressions, touch, eye contact
– Posture, gait
– Gestures
– General physical appearance
– Mode of dress and grooming
– Sounds, silence
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Question
Tell whether the following statement is true or false.
Touch is a personal behavior that means the same thing
to all persons.
A. True
B. False
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Answer
Answer: B. False
Touch is a personal behavior that means different things
to different people.
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The Helping Relationship
• Does not occur spontaneously
• Characterized by an unequal sharing of information
• Built on the patient’s needs
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Characteristics of the
Helping Relationship
• Dynamic
• Purposeful and time limited
• Person providing assistance is professionally accountable
for the outcomes
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Phases of the Helping Relationship
• Orientation phase
• Working phase
• Termination phase
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Question
Which of the following activities generally occurs during
the orientation phase of the helping relationship?
A. An agreement or contract about the relationship is
established.
B. The nurse provides any assistance needed to achieve
patient goals.
C. The nurse provides patient counseling and teaching.
D. The patient and nurse examine the goals of the
helping relationship for indications of attainment.
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Answer
Answer: A. An agreement or contract about the
relationship is established
Rationale
In the orientation phase a contract is made defining the
goals of the relationship, frequency, location, length of
contacts, and duration of the relationship.
The nurse provides assistance needed to achieve patient
goals, counseling and teaching in the working phase.
The patient and nurse examine the goals of the helping
relationship for indications of attainment in the
terminations phase.
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Goals of the Orientation Phase
• Establish tone and guidelines for the relationship.
• Identify each other by name.
• Clarify roles of both people.
• Establish an agreement about the relationship.
• Provide the patient with orientation to the healthcare
system.
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Goals of the Working Phase
• Work together to meet the patient’s needs.
• Provide whatever assistance is needed to achieve each
goal.
• Provide teaching and counseling.
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Goals of the Termination Phase
• Examine goals of helping relationship for attainment.
• Make suggestions for future efforts if necessary.
• Encourage patient to express his or her emotions about
the termination.
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Factors that Promote Effective
Communication
• Dispositional traits
• Rapport builders
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Dispositional Traits
• Warmth and friendliness
• Openness and respect
• Empathy
• Honesty, authenticity, trust
• Caring
• Competence
• Genuineness
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Rapport Builders
• Specific objectives
• Comfortable environment
• Privacy
• Confidentiality
• Patient vs. task focus
• Utilization of nursing observations
• Optimal pacing
• Providing personal space
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Question
Tell whether the following statement is true or false.
A nurse should respect a patient’s personal space by
remaining outside an arm’s length of the patient and
refraining from touching the patient unnecessarily.
A. True
B. False
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Answer
Answer: B. False
A nurse should respect a patient’s personal space by
assessing this space through careful observations of
nonverbal communication.
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Methods of SBAR Communication
• Posters
• Stickers on phones
• Peer observation
• Inclusion of SBAR in orientation and safety training
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Developing Conversation Skills
• Control the tone of your voice.
• Be knowledgeable about the topic of conversation.
• Be flexible.
• Be clear and concise.
• Avoid words that might have different interpretations.
• Be truthful.
• Keep an open mind.
• Take advantage of available opportunities.
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Developing Listening Skills
• Sit when communicating with a patient.
• Be alert and relaxed and take your time.
• Keep the conversation as natural as possible.
• Maintain eye contact if appropriate.
• Use appropriate facial expressions and body gestures.
• Think before responding to the patient.
• Do not pretend to listen.
• Listen for themes in the patient’s comments.
• Use silence, therapeutic touch, and humor appropriately.
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Using Therapeutic Touch to Convey a
Message
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Interviewing Techniques
• Open-ended questions or comments
• Closed questions or comments
• Validating questions or comments
• Clarifying questions or comments
• Reflective questions or comments
• Sequencing questions or comments
• Directing questions or comments
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Basic Components of Assertiveness
• Having empathy
• Describing one’s feelings or the situation
• Clarifying one’s expectations
• Anticipating consequences
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Blocks to Communication
• Failure to perceive the patient as a human being
• Failure to listen
• Inappropriate comments and questions
• Using clichés
• Using closed questions
• Using questions containing the words “why” and “how”
• Using questions that probe for information
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Blocks to Communication (cont.)
• Using leading questions
• Using comments that give advice
• Using judgmental comments
• Changing the subject
• Giving false assurance
• Using gossip and rumors
• Using aggressive interpersonal behavior
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Question
Tell whether the following statement is true or false.
An open-ended question or comment serves to validate
what the nurse believes is heard or observed.
A. True
B. False
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Answer
Answer: B. False
A validating question or comment serves to validate what
the nurse believes is heard or observed.
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