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communication and nurse patient relationship by Tamanya Samui.pdf

communication, process, barriers, overcome of barriers, factors, types, IPR.

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COMMUNICATION
PATIENT
Communication is a dynamic, reciprocal process of sending
and receiving messages.Communication is more than the act
of talking and listening. From the first cry of a newborn to the
whisper of a person who is dying, the primary purpose of a
communication is to share a information and obtain a
response. People use communication to meet their physical,
psychological, emotional and spiritual needs.
Communication is ‘any act by which one person gives to or
receives from person information about that person’s needs,
desires, perception, knowledge, or affective state’.
Communication may be intentional or unintentional, may
involve conventional or unconventional signals, may take
linguistic or non-linguistic forms and may occur through
spoken or other modes.
Intrapersonal Communication
Interpersonal Communication
Group Communication
Public Communication
Electronic Communication
Intrapersonal communication is a powerful form of
communication that can use as a professional nurse. This level
of communication is also called self-talk. People’s thoughts
and inner communication strongly influence perceptions,
feelings, behaviour, and self-esteem. Always be aware of the
nature and content of your own thinking. Positive self-talk
provide a mental rehearsal for difficult task or situations so
individuals deal with them more effectively and with
increased confidence. Nurses use intrapersonal
communication to develop self-awarness and a positive self-
esteem that enhances appropriate self-expression. Negative
self-talk can help the nurse to diminish cognitive distortions
that lead to a decrease in self-esteem and impact the nurses
ability to work with patients.
➢ It is communication between two or more people.
➢ Face to face conversation between two people is the
most frequent form of interpersonal relationship.
➢ Nurse use interpersonal communication to gather
information during assessment, to teach about health
issues to explain care and to provide comfort and
support.
It is the interaction that occurs when a small number of people
meet. This type of communication is usually goal directed and
requires an understanding of group dynamics. When nurses
work on committees with nurses or other disciplines and
participate in patient care conferences, they use a small-group
communication process. Communication in these situations
should be organized, concise and complete. All participating
disciplines are encouraged to contribute and provide feedback.
Good communication skills help each participant better meet a
patient’s needs and promote a safe care environment.
Public communication is interaction with an audience.
Nurses often speak with groups of consumers about health
related topics, present scholarly work to colleagues, or lead
classroom discussions with peers or students. Public
communication requires special adaptations in eye contact,
gestures, voice inflection, and use of media materials to
communicate message effectively. Effective public
communication increases audience knowledge about health

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communication and nurse patient relationship by Tamanya Samui.pdf

  • 2. Communication is a dynamic, reciprocal process of sending and receiving messages.Communication is more than the act of talking and listening. From the first cry of a newborn to the whisper of a person who is dying, the primary purpose of a communication is to share a information and obtain a response. People use communication to meet their physical, psychological, emotional and spiritual needs.
  • 3. Communication is ‘any act by which one person gives to or receives from person information about that person’s needs, desires, perception, knowledge, or affective state’. Communication may be intentional or unintentional, may involve conventional or unconventional signals, may take linguistic or non-linguistic forms and may occur through spoken or other modes.
  • 4. Intrapersonal Communication Interpersonal Communication Group Communication Public Communication Electronic Communication
  • 5. Intrapersonal communication is a powerful form of communication that can use as a professional nurse. This level of communication is also called self-talk. People’s thoughts and inner communication strongly influence perceptions, feelings, behaviour, and self-esteem. Always be aware of the nature and content of your own thinking. Positive self-talk provide a mental rehearsal for difficult task or situations so individuals deal with them more effectively and with increased confidence. Nurses use intrapersonal communication to develop self-awarness and a positive self- esteem that enhances appropriate self-expression. Negative self-talk can help the nurse to diminish cognitive distortions that lead to a decrease in self-esteem and impact the nurses ability to work with patients. ➢ It is communication between two or more people. ➢ Face to face conversation between two people is the most frequent form of interpersonal relationship. ➢ Nurse use interpersonal communication to gather information during assessment, to teach about health
  • 6. issues to explain care and to provide comfort and support. It is the interaction that occurs when a small number of people meet. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees with nurses or other disciplines and participate in patient care conferences, they use a small-group communication process. Communication in these situations should be organized, concise and complete. All participating disciplines are encouraged to contribute and provide feedback. Good communication skills help each participant better meet a patient’s needs and promote a safe care environment. Public communication is interaction with an audience. Nurses often speak with groups of consumers about health related topics, present scholarly work to colleagues, or lead classroom discussions with peers or students. Public communication requires special adaptations in eye contact, gestures, voice inflection, and use of media materials to communicate message effectively. Effective public communication increases audience knowledge about health
  • 7. related topics, health issues, and other issues important to the nursing profession. Electronic communication is the use of technology to create ongoing relationship with patients and their health care team. Secure messaging provides an opportunity for frequent and timely communication with a patient’s physician or nurse via a patient portal. An electronic portal enables patients to stay engaged and informed and build a therapeutic relationship with the health care team.
  • 8. ➢ The communication requires a sender, a message, a receiver and a response or feedback. ➢ Communication is two-way process involving the sending and receiving of a message. Because the internet of communication is to elicit a response the process of ongoing, the receiver of the message then becomes the sender of a response, and the original sender then becomes the receiver. • Message • Source(sender) • Channel • Receiver • Feedback(response)
  • 9. VERBAL COMMUNICATION (a type of communication where we use spoken and written words to get our message and information across to the other person) NONVERBAL COMMUNICATION(is the transfer of information through body language, facial expression, gestures, created space and more) ❖ Sender- A sender is a person who encodes and sends the message to the expected receiver through an appropriate channel A sender is the source of the message that is generated to be delivered to the receiver after appropriate stimulus from the referent. ❖ Message- The message is the content of communication and may contain verbal, nonverbal or symbolic language. Perception and personal factors of the sender and receiver may sometimes distort this element and the intended outcome of communication may not be achieved.
  • 10. ❖ Channel- A channel is a medium through which a message is sent or received between two or more people. Several channels can be used to send or receive the message, i.e seeing, hearing, touching, smelling and tasting. While selecting channels of communication, several factors must be considered: availability of channels, purpose, suitability, types of receivers, communication skill of sender, cost, etc. CLASSIFICATION OF CHANNELS OF COMMUNICATIONS- • VISUAL- Facial expression, body language, posture, gestures, pictures and written words, electronic mails, mass media etc. • AUDITORY- Spoken words, sounds, telephone or mobile communications etc. • TACTILE- Touch sensation, therapeutic touch etc. • COMBINED- Audiovisual media, consoling a person with touch and spoken words. ❖ Receiver- A receiver is an individual or group individuals intended to receive, decode and interpret the message sent by the sender/source of message. A receiver also known as decoder. He is expected to have the ability and skills to receive, decode and interpret the message. ❖Feedback- It is a return message sent by the receiver to the sender. It is most essential element of the communication process as it shows that the receiver has understood the primary message sent by the sender and the communication process is non consider complete.
  • 11. A successful communication must be a two-way process where the sender sends the message and receives feedback from the receiver. TYPES OF COMMUNICATION BASED ON THE COMMUNICATION CHANNEL USED ARE:- 1. Verbal:- Verbal communication refers to the form of communication in which message is transmitted verbally, communication is done by word of mouth and a piece of writing. Verbal communication is further divided into:- Oral:- In oral communication, spoken words are used. It includes face to face conversation, speech, telephonic conversation, video, radio, television, voice over internet. In oral communication, communication is influenced by pitch, volume, speed and clarity of speaking. Written- In written communication, written signs or symbols are used to communicate. A written message may be printed or hand written message may be printed or hand written. In written communication message can be transmitted via email, letter, report, memo etc. 2. Non-Verbal:- Non-verbal communication is the sending or receiving of wordless message. We can
  • 12. say that communication other than oral and written, such as gesture, body language, posture, tone of voice or facial expression, is called non- verbal communication. Non-verbal communication has the following elements:- Speaker:- Appearance, clothing, hairstyle, neatness, use of cosmetics Surrounding:- Room size, lighting, decorations, furnishings Body language:- Facial expression, gestures, postures. Sounds:- Voice tone, volume, speech rate. TYPES OF COMMUNICATION BASED ON PURPOSE AND STYLE Communication types based on style and purpose are:- • Formal Communication • Informal Communication Formal Communication- In formal communication, certain rules, conventions and principles are followed while communicate: Formal communication occurs in formal and official style. Usually professional settings, corporate meetings, conferences undergo in formal pattern. Informal communication- Informal communication is done using channels that are in contrast with formal communication channels. It’s just a casual talk.
  • 13. Informal communication channel, unlike formal communication, doesn’t follow authority lines. In an organization, it helps in finding out staff grievances as people express more when talking informally. Informal communication helps in building relationships. OTHER TYPES COMMUNICATION One-way Communication- Communication in which information is only transmitted from one point to another or to many points simultaneously. There is no reception of information at the transmitting point and no transmission of information from a receiving point. One-way communication is used to transmit current information and accurate time and frequency signals, as well as for radio and television broadcasting. Two-way Communication- Two-way communication as processing can best be characterized as a style of auditing. The process has everything to do with getting the patient to it is about an area and keep him talking on the subject. To do that, the auditor does not use set commands, but listens with interest and uses light questions and half acknowledgements.
  • 14. FACTORS INFLUENCING 1. Cultural Diversity- The chance of misunderstanding or misinterpretation of message is higher in organizations with people from different cultural background. This is due to inability to relate and truly understand someone with different background. This leads to assumptions and speculation which feed bigger problems in organizations if left unresolved. Being aware of this is the first step to take measures to address this issue. 2. Emotional Difference- Emotions and how people feel when communicating affect the meaning of communication. Again, being aware or conscious that people often bring in personal issues into the workplace no matter how hard they try to compartmentalize them. 3. Misunderstanding or Misinterpretation of the message- Communication can falter when people assign different meanings to the same word. This issue is very common in the communication process but if left unchecked can lead to bigger problems for organizations. Message must be prepared properly, be specific, and have a feedback system.
  • 15. 4. Educational Difference- Different education level between the sender and receiver also influence the meaning of communication. If they have similar educational qualifications, communication will be effective. 5. Past Experiences- Previous communication with the sender and receiver strongly determines the effectiveness of further communication between them. If either of the parties has a negative experience, further communication between them is likely ineffective. 6. Functional relationship between sender and receiver- It is quite common that when a sender and receiver belong to different functional departments or areas, the receiver may not clearly understand the sender’s message. ▪ Create an open communication environment ▪ Implement an inclusive communication strategy ▪ Communication must be two-way and focused on results ▪ Use multiple channels to communicate effectively ▪ Make sure that the massage is delivered. ▪ Feedback and be accountable with communication process.
  • 16. 1. Physiological barriers- Poor retention due to memory problems, lac of attention, discomfort due to illness, poor sensory perception, hearing problems, poor listening skills, information overload, gender physiological differences. 2. Environmental barriers- Loud background noise, poor lighting, uncomfortable settings, unhygienic surroundings and bad odour, very hot or cold room, distance. 3. Psychological barriers- Misinterpretation and misunderstanding, distrust and unhappy emotions, emotional disturbance such as anger, jealousy, and suspicion, psychotic or neurotic illness, worry and emotional disturbance, fear, anxiety and confused thinking. 4. Social barriers- Diffidence in social norms, values, and behaviour, social strata(when we divided the people based on the socioeconomic condition like income, race, ethnicity, gender occupation etc.) 5. Semantic barriers- Language barriers, faulty language translation, past experience of an individual, failure to listen. 6. Cultural barriers- Religious, cultural differences, cultural traditions, values and behaviour. 7. Organizational barriers- Organizational policy, rules, and regulations, technical failure, time
  • 17. pressure, complexity of organizational structure due to hierarchy, size of the organization. 8. Communication process related barriers- Unclear and conflicting message, inappropriate channels, lack of poor feedback. OVERCOME OF COMMUNICATION 1. Physiological barriers- • Sender and recipient must keep in mind each other’s retention and memory abilities. • Sender and recipient must have each other’s complete attention. • Before initiating communication, the sender and the recipient must ensure each other’s comfort. • Limitations of hearing ability must be kept in mind. • Information overload must be avoided. • Gender differences must be kept in mind. 2. Environmental barriers- • Background noise must be kept at the lowest possible level. • Good lighting must be ensured to facilitate nonverbal communication.
  • 18. • Comfortable seating arrangement must be for effective communication. 3. Psychological barriers- • Communication must be carried out in happy and trustworthy manner. • Sender and recipient must avoid negative feelings such as anger, jealousy and suspicion. • Sender and recipient must be free from fear, anxiety and confused thinking. 4. Social barriers- • Social beliefs of the sender and recipient must be kept in mind while communicating. 5. Cultural barriers- • Cultural traditions, values, and behaviour must be kept in mind during communication. 6. Semantic barriers ( barriers results in faulty translation)- • Technical jargons must be avoided during communication. • The language must be simple and clear and individual differences of social-cultural back ground must be kept in mind 7. Organizational barriers-
  • 19. • There must be clear organizational policy of promotion on better communication. 8. Communication process related barriers- • There must be use of appropriate channels of communication. • Must be effective feedback to promote better communication. Therapeutic communication is a techniques that prioritize the physical, mental, and emotional well-being of patients. Nurses provide patients with support and information while maintaining a level of professional distance and objectively. With therapeutic communication, nurses often use open-ended statements and questions, repeat information, or use silence to prompt patients to work through problems on their own. Techniques of Therapeutic Communication- Using Silence- At times, it’s useful to not speak at all. Deliberate silence can give both nurses and patients an opportunity to think through and process what comes next in conversation. It may give patients the time and space they need to broach a new topic. Nurses should always let patients break the silence. Accepting- Sometimes it’s necessary to acknowledge what patients say and affirm that they’ve been heard.
  • 20. Acceptance isn’t necessarily the same thing as agreement, it can be enough to simply make eye contact and say “Yes, I understand.” Patients who feel their nurses are listening to them and taking them seriously are more likely to be receptive to care. Giving Recognition- Recognition acknowledge a patient’s behaviour and highlights it without giving an overt compliment. A compliment can sometimes like “I noticed you took all of your medications” draws attention to the action and encourages it without requiring a compliment. Giving Broad Openings- Therapeutic communication is often most effective when patients direct flow of conversation and decide what to talk about. To that end, giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow patients an opportunity to discuss what’s on their mind. Offering Self- Hospital stays can be lonely, stressful times when nurses offer their time, it shows they value patients and that someone is willing to give them time and attention. Offering to stay for lunch, watch a TV show, or simply sit with patients for a while can help boost their mood. Active Listening- By using nonverbal and verbal cues such as nodding and saying “I see,” nurses can.
  • 21. Active listening involves showing interest in what patient have to say, acknowledging that you are listening and understanding, and engaging with them throughout the conversation. Nurses can offer general leads such as “What happened next?” to guide the conversation or propel it forward. Seeking Clarification- Similar to active listening, asking patients for clarification when they say something confusing or ambiguous is important. Saying something like “I am not sure I understand. Can you explain it to me?” helps nurses ensure they understand what’s actually being said and can helps patients process their ideas more thoroughly. Summarizing- It is frequently useful for nurses to summarize what patients have said after the fact. This demonstrates to patients that the nurse was listening and allows the nurse to document conversations. Ending a summary with phrase like “Does that sound correct?” gives patients permission to make corrections if they are necessary. Reflecting- Patients often ask nurses for advice about what they should do about particular problems or in specific situations. Nurses ask patients what they think they should do, which encourages patients to be accountable for their own action and helps them come up with solutions themselves. Focusing- Sometimes during a conversation, patients mention something particularly important. When this
  • 22. happens, nurses can focus on their statement, prompting patients to discuss it further. Confronting- Nurses should only apply this technique after they have established trust. It can be vital to the care of patients to disagree with them, present them with reality, or challenge their assumptions. Confrontation, when used correctly, can help patients break destructive routines or understand the state of their situation. Voicing Doubt- Voicing doubt can be a gentler way to call attention to the incorrect or delusional ideas and perception of patients. By expressing doubt, nurses can force patients to examine their assumption. Offering Hope and Humors- Because hospitals can be stressful places for patients, sharing hope that they can persevere through their current situation and lightening the mood with humors can help nurses establish rapport quickly. This technique can keep patients in a more positive state of mind. Non-Therapeutic communication involves words, phrases, actions, and tones that make patients feel
  • 23. uncomfortable, increase their stress, and worsen their mental and even physical wellbeing. Overloading- • Talking rapidly, changing subjects to often and ask for more information that can be absorbed at one time. Value Judgements- • Givings one’s own opinion, evaluating, normalizing, or implying one’s values by using words such as “nice”, “bad”, “right” “wrong”. Underloading- • Remaining silent and unresponsive, not picking up cues and failing to give feedback. Invalidation- • Ignoring or denying another’s presence, thought’s or feelings. • Ex. Client: How are you? Nurse responds: I can’t talk now. I am too busy. Focusing on self- • Responding in a way that focuses attention to the nurse instead of the client.
  • 24. Changing the subject- • Introducing new topic. Giving advice- • Telling the client what to do, giving opinions or making decision for the client cannot handle his or her own life decisions and that the nurse is accepting responsibility. Internal validation- • Making an assumption about the meaning of someone else’s behaviour that is not validated by the other person (jumping into conclusion) Disagreeing- • Another nontherapeutic communication techniques is disagreeing, or opposing whatever idea the patient has expressed. By saying something like, ‘That’s wrong, you are not just saying to the client that their idea is wrong. Probing- • Non-therapeutic communication also includes probing or continuous questioning of the client about something.
  • 25. Professional communication is defined as oral, written, digital, or visual forms of information delivery in a workplace. Professional communication also involves various forms of speaking, writing, and responding within and beyond the workplace environment. It is used in letters, business proposals and press releases. ❖ Learn the importance of communication well in a professional settings. ❖Discuss different types of communication for a professional. ❖Review proper verbal and non-verbal communication skills. ❖Discuss the importance of communicating in difficult situations. ❖Discuss business e-mail communication ❖Identify several professional writing techniques and avoid common mistakes when writing.
  • 26. Definition- The nurse patient relationship is an interaction between a nurse and patient aimed at enhancing the well being of the client, who may be an individual, a family, a group or a community. Phases of Nurse Patient Relationship- 1. Pre-interaction phase 2. Engagement phase 3. Active intervention phase 4. Termination phase 1. Pre-interaction phase- During this phase- • Nurses assess the environment in which the nurse meet with patient. • Explain the professional goals and set priorities. • Both parties enter to the relationship with expectations. • Patient and nurse become oriented to overall needs and expectations from the relationship. 2. Engagement- • Begin to develop the relationship. • Nurse create a supportive environment. • Establish a therapeutic contact with patients. • Trust and empathy are basic qualities here. • Developed strong bond and feel less anxiety.
  • 27. • Nurse plays the key role with expertise on illness. • Nurse act as a coordinator. • Nurse observe and assess patients. • Patients come to know their health issues and feel fear, discomfort, or insecure feelings and expect help. • Nurses realize patients through their body languages and help them. • Therapeutic relationship is well established. 3. Active Intervention Phase- • The sense of mutuality is developed between nurse and patient. • Discuss conflicting situation deeply. • Nurse and patient work with commitment. • Nurse sort out problem and solve them. • Collaboration and equal participation is seen. • Aware of the differences of rights, roles, and responsibilities. • Nurse acknowledge the patients’ feelings, show the genuine interest, and honesty. • Nurse convince the patient of equal rights to make decision. • Patients become independent decision maker. 4. Termination Phase- • Start at the times of explaning plans and goals. • Patient should be informed of this phase at the beginning.
  • 28. • Otherwise patients develops strong feelings of separation at this phase. • Nurse work on education, health advices preparing discharge plan.
  • 29. Many nursing situations, especially those in community and home care setting, require the nurse to form helping relationships with the patient’s entire family. The same principles that guide one-to-one helping relationships also also apply when the patient is family unit, communication within familes requires additional understanding of the complexities of family dynamics, needs and relationship. COMMUNICATION WITH 1. Identify and map your vulnerable groups- Before crisis happens, you need to know who your vulnerable groups are, where they are located, and what their specific challenges and preferences are. You can use various sources of data, such as surveys, reports or community networks to identify and map your vulnerable groups. You can also consult with representatives of these groups, such as leaders, advocates, or service providers, to understand their prospective and expectations.
  • 30. 2. Tailor your messages and channels- Once you have identified your vulnerable groups, you need to tailor your message and channels to suit their and preferences. You need to use clear, simple, and consistent language that avoids jargon, acronyms or technical terms. You need to use multiple formats and media, such as text, audio, video or graphics, to convey your messages. You need to use trusted and credible sources, such as local leaders, influencers, or experts, to deliver your messages. 3.Monitor and adjust your communication- Communication is not one-way process. You need to monitor and adjust your communication based on the feedback and response of the vulnerable groups. You need to use various methods and tools such as surveys, polls, focus groups, or analytics, to measures the effectiveness and impact of your communication. You need to use feedback and data to improve your message and channels, as well as to address any gaps, misinformation, concerns that may arise. 4.Collaborate and coordinate with partners- Communication is not a solo effort. You need to collaborate and coordinate with partners who can help you reach and serve your vulnerable groups. You need to identify and engage with partners who have relevant expertise, resources or networks, such as NGOs, media outlet or community organizations. You need to establish and maintain regular communication and coordination mechanisms, such as
  • 31. meetings, updates, or protocols, to ensure alignment and consistency of your messages and actions. 5. Respect and empower your vulnerable groups- Communication is not a top-down approach. You need to respect and empower your vulnerable groups as active and vulnerable participants in your communication and emergency management. COMMUNICATION WITH HEALTH • Health team members communicate with each other to give coordinated and effective care. • Health team members share information about:- o What was done for the person. o What needs to be done for the person. o The person’s response to treatment. 5 Best ways to improve communication in healthcare- 1. Assess your current method of communication. 2. Streamline communication channels. 3. Encourage mobile collaborative for effective communication between healthcare professionals. 4. Give healthcare employees a voice. 5. Prioritize face-to-face communication.
  • 32. NOTES:- The 7 Cs of Communication:- 1. Clear- When writing or speaking to someone, be clear about your goal or message. 2. Concise- When you are concise in your communication, you stick to the point and keep it brief. 3. Concrete- Be clear, not fuzzy. Provide detail, but not too much detail. 4. Correct- Make sure your message is accurate and grammatically correct. 5. Coherent- Make sure your message flows well and laid out logically. 6. Complete- Ensure the recipient has everything they need to understand. 7. Courteous- Your message should be polite, friendly, professional and open.