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Chapter 024
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  • •Every nuance of posture, every small expression and gesture, every word chosen, every attitude held—all have the potential to hurt or heal.•Respect the potential power of communication, and do not carelessly misuse communication to hurt, manipulate, or coerce others.[Ask the class: What are some ways that nurses with expertise in communication express caring? Then discuss.]•Nurses with expertise in communication express caring by:Becoming sensitive to self and othersPromoting and accepting the expression of positive and negative feelingsDeveloping helping-trust relationshipsInstilling faith and hopePromoting interpersonal teaching and learningProviding a supportive environmentAssisting with gratification of human needsAllowing for spiritual expression
  • •Nurses who develop critical thinking skills make the best communicators. They draw on theoretical knowledge about communication and integrate this knowledge with knowledge previously learned through personal experience. Critical thinking skills can be used to interpret messages received from others, analyze their content, make inferences about their meaning, evaluate their effects, explain rationale for communication techniques used, and self-examine personal communication skills.•Perseverance and creativity are also helpful because they motivate a nurse to identify innovative solutions. •Patients respond more readily to a self-confident attitude.[How could self-confidence help you in making suggestions about nursing interventions to your colleagues?]•Colleagues sometimes question suggested nursing interventions; having confidence in yourself will help you speak up and offer new ideas.•An attitude of fairness goes a long way in the ability to listen to both sides in any discussion; integrity allows nurses to recognize when their opinions conflict with those of their patients, review positions, and decide how to communicate to reach mutually beneficial decisions. •You won’t know everything. Having an attitude of humility is necessary to recognize and communicate the need for more information before making a decision.
  • Communication is most effective when the receiver and the sender accurately perceive the meaning of one another’s messages.It is challenging to understand human communication within interpersonal relationships.•Each person bases understanding of a situation through the filter of her senses (sight, hearing, taste, touch, and smell) and her life experiences (culture, education, past events).•Perceptual biases are human tendencies that interfere with accurately perceiving and interpreting messages from others.•People often assume that others think, feel, act, react, and behave as they would in similar circumstances. They tend to distort or ignore information that goes against their expectations, preconceptions, or stereotypes.•You can overcome perceptual bias by thinking critically, which will help you control these tendencies and communicate effectively.
  • •This simple linear model represents a very complex process with its essential components.•The sender’s and the receiver’s physical and developmental status, perceptions, values, emotions, knowledge, sociocultural background, roles, and environment all influence message transmission.[Image is Figure 24-1 from text p. 312 Communication as an active process between sender and receiver.]
  • •The nurse-patient relationship has four phases.[See Box 24-4on text p. 315Phases of the Helping Relationship for further discussion.]
  • [Ask the class: What are some important communication areas for Suzanne and Roberto? Possible answers include “What are your needs at this time?” “What are your concerns at this time and for the future?”][Discuss.]
  • •A helping relationship between you and your patient does not just happen. You create it with care and skill, and build it on the patient’s trust in you as a nurse.•You help patients to clarify needs and goals, solve problems, and cope with situational or maturational crises. •Creating this therapeutic environment depends on your ability to communicate, provide comfort, and help the patient meet his or her needs.
  • [What is Suzanne demonstrating?]•Her understanding of the importance of the extended family in the Puerto Rican culture helps her appreciate the importance of the trip to New York. Expressing an understanding of the importance of the trip, even though he is in poor health and it will be a difficult trip, demonstrates cultural sensitivity.•In the example above, Suzanne did not question why he felt it important to see more distant relatives.
  • [Suzanne identifies two outcomes from her conversation with Roberto. What are the outcomes that Suzanne identifies?]•Outcomes for Roberto include the following:Patient identifies two methods to maintain communication with family in New York.Patient verbalizes his concerns regarding his declining health.
  • •Communication techniques need to be used to prevent barriers when rendering care to patients. •Effective communication techniques are facilitative and tend to encourage the other person to openly express ideas, feelings, or concerns.•Active listening mnemonic means: S—This posture (sitting) conveys the message that you are there to listen and are interested in what the patient is saying. O—Observe an open posture (i.e., keep arms and legs uncrossed). This posture suggests that the you are “open” to what the patient says. A “closed” position conveys a defensive attitude, possibly provoking a similar response in the patient. L—Lean toward the patient. This posture conveys that you are involved and interested in the interaction. E—Establish and maintain intermittent eye contact. This behavior conveys your involvement in and willingness to listen to what the patient is saying. Absence of eye contact or shifting the eyes gives the message that you are not interested in what the patient is saying. R—Relax. It is important to communicate a sense of being relaxed and comfortable with the patient. Restlessness communicates to the patient lack of interest and a feeling of discomfort.[Ask the class for other therapeutic techniques in addition to active listening. Discuss the following: active listening, sharing observations, sharing empathy, sharing hope, sharing humor, sharing feelings, using touch, using silence, providing information, clarifying, focusing, paraphrasing, asking relevant questions, summarizing, self-disclosure, and confrontation.]
  • Older adults with sensory, motor, or cognitive impairments require adaptation of communication techniques to compensate for their loss of function and special needs.[Ask the students to consider how they would adapt communication techniques for patients with each of the situations listed. Discuss.] Patients with impaired verbal communication require special consideration and alterations in communication techniques to facilitate sending, receiving, and interpreting messages.

Transcript

  • 1. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Chapter 24Communication
  • 2. 2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Communication and Nursing Practice A lifelong learning process for nurses An essential attribute of professional nursingpractice Builds relationships with patients, families,and multidisciplinary team members
  • 3. 3Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Communication and InterpersonalRelationshipsCommunication is the means to establishhelping-trust relationships.The ability to relate to others is importantfor interpersonal communication.Developing communication skills requiresan understanding both of thecommunication process and ofone’s own communication experience.
  • 4. 4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Communication and InterpersonalRelationships (cont’d) Therapeutic communication occurs within ahealing relationship between a nurse and apatient. The nurse’s communication can result in bothharm and good. Skilled communication empowers others andenables people to know themselves and tomake their own choices.
  • 5. 5Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Developing Communication SkillsCritical thinkingPerseverance and creativitySelf-confidenceFairness and integrityHumility
  • 6. 6Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Developing Communication Skills(cont’d) Thinking is influenced by perception Five senses Culture Education Perceptual bias
  • 7. 7Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Quick Quiz!1. Match the levels of communication.1. Intrapersonal A. One-to-one interactionbetween two people2. Interpersonal B. Occurs within an individual3. Transpersonal C. Interaction with an audience4. Small group D. Interaction within a person’sspiritual domain5. Public E. Interactions with a smallnumber of peopleCopyright line.
  • 8. 8Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Levels of Communication1. Intrapersonal B. Occurs within an individual2. Interpersonal A. One-to-one interactionbetween two people3. Transpersonal D. Interaction within a person’sspiritual domain4. Small group E. Interactions with a smallnumber of people5. Public C. Interaction with an audience
  • 9. 9Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.2. You are invited to attend the weekly unitpatient care conference. The staff discussespatient care issues. This type of communicationisA. Public.B. Intrapersonal.C. Transpersonal.D. Small group.Quick Quiz!
  • 10. 10Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Basic Elements of theCommunication Process
  • 11. 11Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Quick Quiz!3. Match the basic elements of communication.1. Referent A. One who encodes and onewho decodes the message2. Sender and receiver B. The setting for sender-receiver interactions3. Message C. Message the receiverreturns4. Channels D. Motivates one tocommunicate with another5. Feedback E. Means of conveying andreceiving messages6. Interpersonal variables F. Factors that influencecommunication7. Environment G. Content of the message
  • 12. 12Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Basic Elements of theCommunication Process1. Referent D. Motivates one to communicatewith another2. Sender and receiver A. One who encodes and one whodecodes the message3. Message G. Content of the message4. Channels E. Means of conveying andreceiving messages5. Feedback C. Message the receiver returns6. InterpersonalvariablesF. Factors that influencecommunication7. Environment B. The setting for sender-receiverinteractions
  • 13. 13Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Forms of Communication Verbal aspects of communication:Vocabulary Intonation PacingDenotativeandconnotativemeaningClarity andbrevityTiming andrelevance
  • 14. 14Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Forms of Communication (cont’d) Nonverbal Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds Territoriality and personal space
  • 15. 15Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Forms of Communication (cont’d) Symbolic The verbal and nonverbal symbolism used byothers to convey meaning Metacommunication A broad term that refers to all factors that influencecommunication
  • 16. 16Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nurse-Patient Relationship1. Preinteraction phase: occurs before meetingthe patient2. Orientation phase: when the nurse and thepatient meet and get to know each other3. Working phase: when the nurse and thepatient work together to solve problems andaccomplish goals4. Termination phase: occurs at the end of arelationship
  • 17. 17Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Professional Nursing RelationshipsNurse-patient helping relationshipsNurse-family relationshipsNurse-health team relationshipsNurse-community relationships
  • 18. 18Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Case Study Roberto Ruiz is a 44-year-old man of Puerto Ricandescent, suffering fromHIV/AIDS. He was neardeath and in hospice, buthis condition has improvedand he is now home. Suzanne is a 54-year-oldnurse dedicated to hospiceand committed tomaximizing quality of life inend-of-life care.
  • 19. 19Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Quick Quiz!4. Helping relationships serve as the foundationof clinical nursing practice. Contracts for atherapeutic helping relationship are formedduring theA. Orientation stage.B. Working stage.C. Termination stage.D. Preinteraction stage.
  • 20. 20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Elements of ProfessionalCommunicationAppearance,demeanor, andbehaviorCourtesyUse of names TrustworthinessAutonomy andresponsibilityAssertiveness
  • 21. 21Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Case Study (cont’d) As Suzanne works with Roberto, shedevelops a helping relationship. Suzanneknows that posing questions for the patient’sreflection helps her assess his needs andsupport his self-care strategies.
  • 22. 22Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nursing Process: Assessment Through the patient’s eyes Gather information, synthesize, apply criticalthinking Physical and emotional factors Developmental factors Sociocultural factors Gender
  • 23. 23Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Case Study (cont’d) Suzanne learns that Roberto wants to travelto New York to see his extended family. Even though Roberto is in poor health andthe trip will be difficult, Suzanne expressesher understanding of the importance of thetrip. She understands how importantextended family is in the Puerto Rican culture.
  • 24. 24Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nursing Process: Diagnosis Nursing diagnosis for communication Many patients experience difficulty withcommunication:• Lacking skills in attending, listening, responding, or self-expression• Inability to articulate, inappropriate verbalization• Difficulty forming words• Difficulty with comprehension
  • 25. 25Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nursing Process: Planning Goals and outcomes Specific and measurable Setting of priorities Teamwork and collaboration
  • 26. 26Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Case Study (cont’d) During her visit, Roberto tells Suzanne, “Ireally 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 youmiss your family. Let’s talk about your optionsfor maintaining contact.” As they talk, Suzanne helps Roberto toidentify two methods of communicating withhis family in New York.
  • 27. 27Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nursing Process: Implementation Therapeutic communication techniquesare specific responses that encourage theexpression of feelings and ideas and conveyacceptance and respect. Active listening means being attentive towhat a patient is saying both verbally andnonverbally. Use “SOLER”: Sit facing the patient; observe anopen posture, lean toward the patient, establishand maintain intermittent eye contact; relax
  • 28. 28Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nursing Process: Implementation(cont’d) Therapeuticcommunicationtechniques Nontherapeuticcommunicationtechniques Adaptingcommunicationtechniques
  • 29. 29Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Adapting CommunicationTechniques Patients who cannot speak clearly Cognitive impairment Hearing impairment Visual impairment Unresponsive Patients who do not speak English (or yourlanguage)
  • 30. 30Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Quick Quiz!5. While admitting a patient, during the initialinterview, a family member tells you, “My momreally means that she does not understand hermedical diagnosis.” The communication formused by the family member isA. Focusing.B. Clarifying.C. Summarizing.D. Paraphrasing.
  • 31. 31Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.Nursing Process: Evaluation Through the patient’s eyes Patient outcomes Nurses and patients need to determine whetherthe plan of care has been successful. Nursing interventions are evaluated to determinewhich strategies or interventions were effective. If expected outcomes are not met, the plan of careneeds to be modified.