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  2. 2. Efficient communication is ESSENTIAL to being successful in life.
  3. 3. Communication <ul><li>“ Any means of exchanging information or </li></ul><ul><li>feelings between two or more people. It is </li></ul><ul><li>a basic component of human relationships, </li></ul><ul><li>including nursing.” </li></ul>
  4. 4. The aim of communication is the transference and understanding of information between two or more people. Communication must always be between two or more people, one the sender and the other receiver. You participate in both roles and your role will change alternatively and frequently in conversation.
  5. 5. The Communication Process Source Encoding Channel Decoding Receiver Message Message Message Message Feedback
  6. 6. The Communication Process Encoding Channel Decoding Receiver Message Message Message Message Feedback Source “ I take sugar in my tea”
  7. 7. The Communication Process Encoding Channel Decoding Message Message Message Message Feedback Source “ One lump or two?”
  8. 8. Barriers to Communication <ul><ul><li>Unfamiliar language – including dialects and accents </li></ul></ul><ul><ul><li>Improper timing – Is the boss distracted today? </li></ul></ul><ul><ul><li>Noise and distractions in the environment </li></ul></ul><ul><ul><li>Attitude of both the source and the receiver </li></ul></ul><ul><ul><li>Differences between people – gender, age, culture, education, intelligence, etc. </li></ul></ul><ul><ul><li>Relationship between the sender and the receiver – status, boss-employee, parent-child, etc. </li></ul></ul>
  9. 9. Barriers to Communications <ul><ul><li>Filtering – manipulation of information so that it will seem more favorably to the receiver. </li></ul></ul><ul><ul><li>Selective Perception – receiver hears message based on his/her interests, needs, motivations, experience, background and other personal characteristics. </li></ul></ul><ul><ul><li>Defensiveness – response when receiver interprets message as threatening </li></ul></ul><ul><ul><li>Language – Words mean different things to different people </li></ul></ul>
  10. 10. Communication Enhancers <ul><li>Speaker </li></ul><ul><ul><li>Voice inflections </li></ul></ul><ul><ul><li>Gestures </li></ul></ul><ul><ul><li>Body language </li></ul></ul><ul><li>Listener </li></ul><ul><ul><li>Active listening </li></ul></ul><ul><ul><li>Eye contact </li></ul></ul>
  11. 11. Forms of Communication <ul><li>VERBAL COMMUNICATION </li></ul><ul><li>NONVERBAL COMMUNICATION </li></ul>
  12. 12. Modes of Communication <ul><li>Verbal Mode </li></ul><ul><li>Pace and Intonation </li></ul><ul><li>Simplicity </li></ul><ul><li>Clarity </li></ul><ul><li>Timing and Relevance </li></ul><ul><li>Adaptable </li></ul><ul><li>Credible </li></ul><ul><li>Humor </li></ul><ul><li>Nonverbal Mode </li></ul><ul><li>Personal Appearance </li></ul><ul><li>Posture/Gait </li></ul><ul><li>Facial Expression </li></ul><ul><li>Gestures </li></ul>
  13. 13. Verbal Communication <ul><li>Vocabulary </li></ul><ul><li>Denotative and connotative meaning </li></ul><ul><li>Pacing </li></ul><ul><li>Intonation </li></ul><ul><li>Clarity and brevity </li></ul><ul><li>Timing and relevance </li></ul>
  14. 14. Nonverbal Communication <ul><li>Personal appearance </li></ul><ul><li>Posture and gait </li></ul><ul><li>Facial expression </li></ul><ul><li>Eye contact </li></ul><ul><li>Gestures </li></ul><ul><li>Sounds </li></ul><ul><li>Territoriality and personal space </li></ul>
  15. 15. Zones of Personal Space <ul><li>Intimate zone: 0 to 18 inches </li></ul><ul><li>Personal zone: 18 inches to 4 feet </li></ul><ul><li>Social zone: 4 to 12 feet </li></ul><ul><li>Public zone: 12 feet and beyond </li></ul>
  16. 16. THERAPEUTIC COMMUNICATION <ul><li>Therapeutic communication is a goal –directed ,focused form of dialogue used as a tool in health care to promote a client 's well-being and positive response to treatment </li></ul>
  17. 17. Purpose of therapeutic communication is to help people cope more effectively as individuals and in relationships with others 1. Provide a safe place for the client to explore the meaning of the illness experience 2. For the nurse to function as a skilled companion and through communication help the client to achieve well-being
  18. 18. Therapeutic Communication <ul><li>Promotes understanding </li></ul><ul><li>Establishes a constructive relationship between the nurse and the client </li></ul><ul><li>Therapeutic helping relationship is client and goal directed </li></ul><ul><li>Respond to words and feelings </li></ul><ul><li>Strong emotions require more time </li></ul>
  19. 19. Therapeutic Communication <ul><li>Attentive Listening: </li></ul><ul><li>Uses all senses—note key themes </li></ul><ul><li>Most important technique in nursing </li></ul><ul><li>Basic to all other techniques </li></ul><ul><li>Requires energy and concentration </li></ul><ul><li>Receives total message—verbal and nonverbal </li></ul>
  20. 20. THERAPEUTIC COMMUNICATION TECHNIQUES <ul><li>Active listening (SOLER) </li></ul><ul><li>Sharing observations </li></ul><ul><li>Sharing empathy </li></ul><ul><li>Sharing hope </li></ul><ul><li>Sharing humour </li></ul><ul><li>Sharing feelings </li></ul>
  21. 21. THERAPEUTIC COMMUNICATION TECHNIQUES (continu..) <ul><li>Using touch </li></ul><ul><li>Using silence </li></ul><ul><li>Providing information </li></ul><ul><li>Clarifying </li></ul><ul><li>Focusing </li></ul><ul><li>Paraphrasing </li></ul>
  22. 22. Nontherapeutic Communication Techniques <ul><li>Asking personal questions </li></ul><ul><li>Giving personal opinions </li></ul><ul><li>Changing the subject </li></ul><ul><li>Automatic responses </li></ul><ul><li>False reassurance </li></ul><ul><li>Sympathy </li></ul>
  23. 23. Nontherapeutic Communication Techniques (cont’d) <ul><li>Asking for explanations </li></ul><ul><li>Approval or disapproval </li></ul><ul><li>Defensive responses </li></ul><ul><li>Passive or aggressive responses </li></ul><ul><li>Arguing </li></ul>
  24. 24. Professional Helping Relationships <ul><li>Nurse—client </li></ul><ul><li>Nurse—family </li></ul><ul><li>Nurse—health team </li></ul><ul><li>Nurse—community </li></ul>
  25. 25. ELEMENTS OF PROFESSIONAL COMMUNICATION <ul><li>Courtesy </li></ul><ul><li>Use of names </li></ul><ul><li>Privacy and confidentiality </li></ul><ul><li>Trustworthiness </li></ul><ul><li>Autonomy and responsibility </li></ul><ul><li>Assertiveness </li></ul>
  26. 26. Communication in the Nursing Process <ul><li>Assessment </li></ul><ul><li>Physical and emotional factors </li></ul><ul><li>Developmental factors </li></ul><ul><li>Socio-cultural factors </li></ul><ul><li>Gender </li></ul>
  27. 27. Nursing diagnosis examples <ul><li>Impaired verbal communication </li></ul><ul><li>Anxiety </li></ul><ul><li>Social isolation </li></ul><ul><li>Ineffective coping </li></ul><ul><li>Impaired social interaction </li></ul><ul><li>Powerlessness </li></ul>
  28. 28. <ul><li>Planning </li></ul><ul><li>Goals and outcomes </li></ul><ul><li>Priorities </li></ul><ul><li>Continuity of care </li></ul>Implementation Therapeutic communication techniques
  29. 29. <ul><li>Evaluation </li></ul><ul><li>Analysis of communication patterns </li></ul><ul><li>Process recordings </li></ul>
  31. 31. The Helping Relationship <ul><li>Nurse-Client Relationship referred to as interpersonal, therapeutic, and helping </li></ul><ul><li>Strives to achieve two major goals </li></ul><ul><li>Help clients manage their problems in living more effectively </li></ul><ul><li>Help clients become more effective at helping themselves </li></ul>
  32. 32. The Helping Relationship <ul><li>Caring </li></ul><ul><li>Comforting </li></ul><ul><li>Communicating </li></ul>
  33. 33. Caring <ul><li>Madeleine Leininger (1984): The essence of nursing and the dominant, distinctive, and unifying feature of nursing. </li></ul><ul><li>Jean Watson (1985): A set of universal human values;kindness, concern, love of self and others. </li></ul><ul><li>Miller (1995): “Intentional action that conveys physical and emotional security and genuine connectedness to another person…” </li></ul>
  34. 34. Comforting <ul><li>Morse (1996): A complex process that includes discrete, transitory actions, such as listening” </li></ul><ul><li>The comforting process is client-led </li></ul><ul><li>It occurs in response to those cues presented by a client. </li></ul><ul><li>Clients themselves are attempting personal comfort—the nurse supports these attempts. </li></ul>
  35. 35. Empathy <ul><li>Nurses develop attentive listening </li></ul><ul><li>Respond in ways that indicate understanding of how client feels </li></ul><ul><li>Egan (1998), Empathy “can be seen as an intellectual process that involves understanding correctly another person’s emotional state and point of view” </li></ul><ul><li>Communicate understanding to client. </li></ul>
  37. 37. Preinteraction Phase <ul><li>Similar to the planning stage before an interview </li></ul><ul><li>Nurses have information before the face to face </li></ul><ul><li>Nurse needs to recognize her own feelings </li></ul><ul><li>Focus on plan for information to be discussed </li></ul>
  38. 38. Nursing Skills for Preinteractive Phase <ul><li>Organize Data </li></ul><ul><li>Recognize Limitations </li></ul><ul><li>Seek Assistance </li></ul>
  39. 39. Introductory Phase <ul><li>Sets the tone for the rest of the relationship. </li></ul><ul><li>Closely observe each other and form judgments about each others behavior. </li></ul><ul><li>Opening relationship, clarifying the problem, building trust. </li></ul>
  40. 40. Nursing Skills for Introductory Phase <ul><li>Put client at ease. </li></ul><ul><li>Use relaxed , attentive attitude. </li></ul><ul><li>Not easy for clients to accept help in many situations. </li></ul><ul><li>Resistive Behaviors </li></ul><ul><li>Develop Trust </li></ul><ul><li>Respectful Culture </li></ul><ul><li>Concerned </li></ul><ul><li>Maintain Confidentiality </li></ul><ul><li>Mutual participant in plan of care </li></ul>
  41. 41. Working Phase <ul><li>The client and nurse begin to see each other as unique individuals. </li></ul><ul><li>Begin to explore thoughts and feelings </li></ul><ul><li>Begin to take action to meet goals </li></ul><ul><li>Nurse helps client form long and short term goals </li></ul><ul><li>Nurse reinforces successes and helps client to deal realistically with failure. </li></ul>
  42. 42. Nursing Skills for Working Phase <ul><li>Empathetic Listening </li></ul><ul><li>Respect </li></ul><ul><li>Genuineness </li></ul><ul><li>Concreteness </li></ul><ul><li>Confrontation </li></ul><ul><li>Decision making and Goal setting </li></ul>
  43. 43. Termination Phase <ul><li>Nurse and client accept feelings of ending the relationship </li></ul><ul><li>The client has developed independence and and has no feelings of anxiety or dependence </li></ul>
  44. 44. Nursing Skills for Termination Phase <ul><li>Summarize or review the hospitalization with a focus on accomplishments </li></ul><ul><li>Express feelings about termination </li></ul><ul><li>Allows time for client to adjust to independence </li></ul><ul><li>Follow up support may be needed </li></ul><ul><li>Follow up phone calls </li></ul><ul><li>Ease clients transition to independence </li></ul>
  45. 45. Final thoughts <ul><li>Communicating to be understood and being a good listener are crucial. </li></ul><ul><li>Another important aspect of communication is to think about what you are saying before you say it. </li></ul><ul><li>Today’s communications set the tone for tomorrow’s relationships. </li></ul>
  46. 46. “ Be a Bridge, Not a Wall ”