Communication and types of communication therapeutic communications and l nursing documentation

1. NAZIA NOREEN
NURSING INSTRUCTOR
COLLEGE OF NURSING,LADY READING HOSPITAL
PESHAWAR

2. Objectives
 Define Communication, elements of the communication
process, ways of communication
 Identify the characteristics of the effective verbal
communication
 Describe factors that's facilitates and interfere with the
effective communication
 Discuss techniques that facilitate and interfere with effective
communication
 Define ways to respond therapeutically
 Identify non therapeutically respond
 Discuss the legal aspects of documentations

3. Introduction
• The word ‘communication’ is derived from Latin word
‘communis’, which means common. It is a process of
exchange of facts, ideas, opinions and a means that
individuals or organizations share the meaning and
understanding with one another

4. Definition
• Communication is a process of sharing experience till it
becomes a common possession. It modifies the disposition
of both parties who partakes it- John Dewey.
• Communication is sharing of ideas and feelings in a mood of
mutuality
(Edgar Dale).
• Communication is a means of persuasion to influence other
so that desired effect is achieved-
(Aristotle)

5. Elements of the communication process
• Sender: anyone or anything that initiates the message
• Receiver: anyone or anything that receives the message
• Message: piece of information
• Medium: a means by which message is transmitted between
sender and receiver

6. Elements of the communication process
• Acknowledgement: confirmation of receipt of message by
receiver, sent back to sender
• Feedback: response to the message from receiver
• Noise: anything that interferes with the transmission of
message or acknowledgement. For instance, distance,
unfamiliar technology, lack of background information or
language

7. Elements of the communication process

8. Types of Communications

9. Purpose of Communication
• To allow the person to express thoughts , feelings, behavior
& life experiences in meaningful way.
• To understand the significance of the client’s problems & the
role of significant people in his/her life.
• To assist in the identification & resolution process of the
client’s problem areas.

10. Characteristics of Communication
• Caring
• Understanding
• Openness
• Warmth
• Directness
• Respect
• Empathy
• Simplicity
• Clarity
• Timing and relevance
• Adaptability

11. Communication model
(G. Parsons, “Basics of Communication” 1992 )

12. Types of Relationship
Social Collegial Therapeutic
Equal
disclosure of
information
Can happen
at any level
anywhere
Occurs among
colleagues in the
professional
work settings
and collaboration
Patient focus
communication
Is planned and
directed by
professional

13. THERAPEUTIC COMMUNICATION
• The therapeutic interaction between the nurse and the
client will be helpful to develop mutual understanding
between two individuals. Interaction is a learning experience
for both client and for the nurse and a corrective emotional
experience to the client to modify his behaviour

14. DEFINITIONS
• The nurse directs the communication towards the
patient to identify his current health problems, plan,
implements and evaluates the action taken
(Bimala kapoor, 2002 )
• Promotes mutual understanding, establishes a
constructive relationship between the nurse and the
client Kozier, 2004 It is a process ,in which the utilizes a
planned approach to learn about the client
( Potter A, 1997)

15. Communication Cycle
Effective
Communication
Nurses
Patients
Families
Optimal Outcome
in Quality Care

16. Effective Communication
• To achieve self realization ,self acceptance , self
respect ,personal identity, personal integration
• To formulate good interpersonal therapeutic
relationship
• Satisfy needs and to achieve realistic personal
goals
• Permits the client to express their thoughts
truly, openly.
• Improves client’s ego strengths

17. Effective Communication
• Encourages socialization and family interaction
process
• Treats communication problems
• Modifies maladaptive behaviour into adaptive
Motivates the client to utilize the new coping
strategies
• Helps the nurse to identify and intervene
appropriate nursing approaches
• Implement nursing process effectively

18. Effective Communication
• Message or information conveyed through the behavior or
body languages or by utilization of five senses. it
communicates interest ,respect, genuineness; checks
through feedback
• Vocal cues /paralinguistic cues , e.g. noise , tones, sounds,
and extras sounds
• Action cues /body movements ,e.g. posture, expression ,
gestures, mannerisms, and other action
• Object cues ,e.g. dressing , furnishings, possessions
• Space, e.g. nature and relationship between two cues or
people

19. Condition Affecting Communication
• Attitude
• Confidentiality
• Nurse's fear and feelings
• Culture and religion influences
• Gender
• Timing
• Knowledge
• Inappropriate response

20. Communication Strategies
• Active Listening Skills
• Silence
• Attending Behaviors
• Empathy
• Accepting
• Offering self
• Sharing observation
• Focusing
• Paraphrasing

21. Cont……
• Clarifying
• Using open ended question
• Focusing
• Being specific, tentative, and informative
• Using touch
• Using silence
• Providing general leads
• Summarizing

22. Barriers in Communication
• Behaviors or comments of the nurse.
• Not Listening.
• Reassuring clichés.
• Giving advice.
• Requesting an explanation (Asking Why?)
• Defending.
• Changing the subject.

23. Factors Influencing Communication
• Person Sociocultural background
• Language
• Age
• Education
• Ability of the communication
• Perceptions

24. Cont…..
• Personal space
• Territoriality
• Roles and relationship
• Time and setting
• Attitudes
• Emotions and self esteem

25. Documentation
• Nurses are legally and ethically bound to keep patient
information confidential
• Nurses must work to protect patient records from
unauthorized readers
• Documentation is required by the ANA/PNC standards for
practice and nurse practice acts in all states

26. Purpose of Records
• Purpose of Records Communication tool for healthcare team
• Legal document
• Financial billing
• Education
• Assessment
• Research
• Auditing and monitoring

27. Common Forms of Documentation
• Common Forms of Documentation
• Admission nursing assessment
• Client care plan
• Kardex or clinical worksheet
• Flowsheet
• Progress notes
• Nursing discharge or referral summaries

28. Guidelines for Legal Documentation
• Avoid words with unclear meanings
• Only include facts and observations not your interpretation
• Complete: assessment, interventions, client outcomes, client
response, progress toward goals, care that was omitted &
why, & who was notified, any communication with other
disciplines
• Current: done when care is provided, late entries must be
noted

29. Guidelines for Legal Documentation
• Guidelines for Legal Documentation
• Organized
• Appropriate: only include info relevant to current healthcare
status and care being delivered
• Agency policies: each entry contains date and time, legible,
permanent (black) ink, correct spelling, proper terminology,
contain signature

30. Pitfalls of Documentation
• Pitfalls of Documentation
• Writing illegibly: could lead to errors, misunderstanding
• Leaving blank lines: someone could insert info at a later date
• Altering someone else’s notes
• Back-dating records
• Correcting errors incorrectly: only draw single line through
error and write “error” above it with nurse’s initials
• Inserting info between lines: big no no

31. Pitfalls of Documentation
• Documenting for someone else: each nurse should only
document their own care and observations
• Expressing opinions
• Using immeasurable terms: each entry should reflect clarity
and brevity (use as few words as possible)
• Failing to document communication with other healthcare
members regarding client care: REMEMBER: “IF IT WAS NOT
DOCUMENTED, IT WAS NOT DONE”

32. Methods of Recording
• Narrative charting: normal assessment findings integrated
with the documentation about the problem
• Problem oriented medical record: 4 basic components;
database, problem list, plan of care, and progress notes
• Charting by exception: only the exception to the rule is
charted: Problem (P), Intervention (I) and Evaluation (E)

33. Methods of Recording
• Focus charting: clients needs that deviate from the normal;
data (D), action (A) and response (R)
• Critical pathways: Guidelines for client outcomes within
certain groups; Ex. Clients with Pneumonia or Post-
Mastectomy
• Computerized charting: becoming more popular, legible
records, easy to transfer client records

34. Reporting
• Transfer of info from one nurse to another at shift change, or
from nurse to another healthcare member
• Can be written, or verbal (in person or recorded)
• Change of shift report should include: Client name, age,
room # & physician. Diagnosis, general condition, diet,
activities permitted, scheduled diagnostic test, new orders,
teaching needs, safety needs, any procedures such as
dressing change, etc.
• Must be careful with tape recording report; follow proper
procedure to maintain confidentiality

35. LEGAL IMPLICATIONS IN NURSING
Legal Terms Negligence
• A general term that refers to conduct that does not show
due care
• Occurs when someone fails to do something that a
reasonably prudent person would do in a similar situation
Four essential characteristics
• Duty
• Breach of duty
• Harm
• Causation

36. Legal Terms
• Duty of a professional toward an individual
That duty is established when the nurse patient relationship is
started
• Breach of duty
• Nursing care fell below acceptable standards or the nurse
was negligent

37. Legal Terms
• Legal Terms Harm
• The patient has been injured in some way Causation
• The breach of duty caused the harm.
• Legal Terms Malpractice Specific type of negligence
• Applied to professionals who fail to follow a standard of care
prevalent for the profession and thereby harms another
person
• Ranges from being negligent when caring for a patient to
betraying a confidence

38. Legal Terms
Legal Terms Standard of Care
• Level of care a reasonably prudent nurse would have
maintained
• Standards of care change with each new medical advance
• Must keep up with the latest information in your field
• Must read journals, attend conferences
• Be familiar with the policy and procedure manuals and
clinical pathways in your facility

39. Legal Terms
Legal Term Liability
• And obligation or debt that can be enforced by law
• In cases of malpractice a person found guilty of a tort is
considered legally liable, or legally responsible for the
outcome

40. Causation
• Causation is the "causal relationship between the
defendant's conduct and end result". In other words,
causation provides a means of connecting conduct with a
resulting effect, typically an injury Causation only applies
where a result has been achieved and therefore is
immaterial with regard to inchoate offenses.

41. SUMMERY
• Communication, elements of the communication process,
ways of communication
• Characteristics of the effective verbal communication
• Factors that's facilitates and interfere with the effective
communication
• Techniques that facilitate and interfere with effective
communication
• ways to respond therapeutically
• Legal aspects of documentations

42. Difference between causation and
Liability
• A close analysis of the principles shows that factual
causation may require value judgment, and that scope of
liability often involves an assessment of the strength and
nature of the causal connection between breach and
harm

43. References
1.Basic Communication Model by SHIV SHENOY…
2.13-Jan-2016 — References • Canadian Nurses Protective
Society. Quality Documentation. https://ben.cnps.ca/ • College
of Nurses of Ontario, (2009). Practice ...
3.Principles for Nursing Documentation - American Nurses
...www.nursingworld.org › docs › ana › ethics › principle..