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Communication skills

The document outlines essential communication skills for nursing, focusing on effective listening, professional writing, and questioning techniques. It emphasizes the importance of understanding the audience and purpose, as well as the role of non-verbal communication in establishing rapport and providing patient care. Additionally, it addresses common barriers to effective communication and offers practical strategies to enhance interactions with patients and colleagues.

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By Ronald Speener
Areas Written Listening & Speaking Rev 1/2018 Nursing Readiness-Communication 2
Table of Content What is Communication Professional Writing Skills Effective Listening Effective Questioning Scenarios Resources Rev 1/2018 Nursing Readiness-Communication 3
Objectives • Understand the two requirements of effective communication • Describe the communication paradigm • Explain the elements of professional written communication • Discuss the needs for good listening skills for nurses • List key listening skills • Develop good questioning strategies • Demonstrate good listening and questioning strategies Rev 1/2018 Nursing Readiness-Communication 4
What is communication? Rev 1/2018 Nursing Readiness-Communication 5
Communication • Communication is the conveying of information. •How is communication done? Rev 1/2018 Nursing Readiness-Communication 6
Exercise What is in the bag? 1 Gestures only Rev 1/2018 Nursing Readiness-Communication 7
Communication Paradigm Talking Listening Writing Reading Rev 1/2018 Nursing Readiness-Communication 8
Exercise What is in the bag? 2 Limited vocabulary a)Big b)Small c)Black d)White e)One f) Two g)Many h)Round i) Square j) Not Rev 1/2018 Nursing Readiness-Communication 9
Four Areas of Communication As a College Student As a Professional As a Citizen As a friend/family Rev 1/2018 Nursing Readiness-Communication 10
Considerations When Communicating Purpose Audience Meaning Structure Formality Grammar Vocabulary Rev 1/2018 Nursing Readiness-Communication 11
Purpose and Audience Purpose •What is the goal of the communication? •The purpose will influence all other considerations Audience • Who is going to the message? • What is his or her language skills? • What is his or her vocabulary level? • What is his or her general knowledge? Rev 1/2018 Nursing Readiness-Communication 12
Meaning and Structure Meaning • Looks at what is being said • Determines why it needs to be said • Asks if what is being said is what is meant • Drives the structure, formality, vocabulary and grammar Structure • How the information is put together • The layout of the communication • E-mail • Documentation • Research paper • Conversation • Meeting • Teaching Rev 1/2018 Nursing Readiness-Communication 13
Formality • Formality is how casual the writing is • This is determined by the purpose and the audience • It is a matter of degree not yes or no. Formal Informal Buttock Rump Behind Caboose Ass Rev 1/2018 Nursing Readiness-Communication 14
Vocabulary •It is through words that ideas are expressed •The more words one has the better able to express one’s ideas •Not everyone has the same vocabulary Grammar • The basic rules of language • Used to understand vocabulary • All languages have grammar, including computer languages • A brigant was bending toward the wind. • Man the dog big the bit. Rev 1/2018 Nursing Readiness-Communication 15
Exercise Acceptable or Unacceptable 1. Samantha is a well groomed African American woman. 2. Charles stinks from poor personal hygiene because he is fat and cannot reach all body areas. 3. Zanem, an effeminate male, cried when given the flu shot. 4. Quill because she is heavily tattooed requires extra caution with blood draws. Rev 1/2018 Nursing Readiness-Communication 16
Professional Writing Skills Rev 1/2018 Nursing Readiness-Communication 17
Exercise Bad Medical Writing—Why? “The greater pain caused by larger-sized tubes was the result of increased pain during the insertion of the tube and pain while the tube was in situ, with no pain difference during tube removal ” •Is this clear writing. •When is the pain? •“Greater pain was experienced with a larger tube during insertion, while in situ and during removal.” Rev 1/2018 Nursing Readiness-Communication 18
Why Writing Matters • Better Patient Care • Clear Communication • Expanded Career Opportunities Rev 1/2018 Nursing Readiness-Communication 19
Audience To Doctors To Co-Workers • Supervisors • Peers • Subordinates Patients To Family Rev 1/2018 Nursing Readiness-Communication 20
Professional Writing Expectations Types • Emails • Reports • Physician orders • Charting/Documentation • Shift Summaries • Care plans • Case studies Quality • Full sentences • Solid grammar • Clear organization • Formal style • Be Precise • Be Objective • Remember the reader • Accurate information • Accurate use of medical terms • Accurate spelling Rev 1/2018 Nursing Readiness-Communication 21
Emails Rev 1/2018 Nursing Readiness-Communication 23
Definition Email is the electronic transmission of messages through a computer network Not everything is appropriate for emails HIPPA requirements Rev 1/2018 Nursing Readiness-Communication 24
Basics of Good Communication • Know your audience • Write to that audience • Emphasize clarity over cleverness • Emphasis content over expansiveness • Use standard fonts • Keep bolds, underlines, and italics to a minimum • If using a priority system, be honest. • Avoid backgrounds or stationary that detract from the message Rev 1/2018 Nursing Readiness-Communication 25
Signature Block • Sender’s information • Include • Name • Job title • email address • Company, Department • Separate from text by two or three lines Rev 1/2018 Nursing Readiness-Communication 26
Before Sending • Check spelling • Check grammar • Check for clarity • Check Addressee's name • Don’t send emails when angry • Remember telephones still exist – Is email the best way to respond? • HIPPA and emails • If patient initiates the email • If patient prior consents to email • If information emailed is included in the consent • Patient should be advised about the risks in emails Rev 1/2018 Nursing Readiness-Communication 27
Email and Security • Emails and email attachments are a primary entry method for computer viruses • Viruses can spread extremely fast • Computer crime is the growth sector of organized crime • Be skeptical • Open an email from an unknown sender with caution • Never open email attachments from an unknown sender • Never give out passwords, social security numbers, bank account numbers, etc. Rev 1/2018 Nursing Readiness-Communication 28
Email Security Terms • Virus – A type of software that run without your knowledge, replicates itself and spreads to other computers • Trojan Horse– A type of virus that is intended to do harm to the computer. It is usually hidden inside something attractive, such as a cartoon • Worm – a type of virus that spreads by Email • Zombie—Unauthorized use of a computer by others for their personal reasons • Bot—A web site that automatically transfers the user to another undesired website • Spam—Mass mailings to know email users • Phish—Requests for personal information from what appears to be a trusted organization; e.g. personal bank • Ransomware-is a type of malicious software that threatens to publish the victim's data or perpetually block access to it unless a ransom is paid Rev 1/2018 Nursing Readiness-Communication 29
Security Measures • Have a good anti-virus program • Use a firewall • Have good spyware and adware filters  Update regularly • Have a good spam filter • Update programs frequently and quickly • Do not open emails with multiple forwards • Be cautious in downloading free or shareware programs • Be cautious in opening emails from unknown senders • Be wary of attachments Rev 1/2018 Nursing Readiness-Communication 30
Exercise Bad Medical Email—Why? From: Mabel Lean, RN To: Cmesoon@Hotmail.com RE: Lab results Dear Ms. Didledump, Since your son is covered under your insurance. I am notifying you about the lab results for him after he went to the college health center. He tested positive for gonorrhea and is being treated. I suggest you have a discussion with your son about his sexual behavior. Thanks Nurse Lean Rev 1/2018 Nursing Readiness-Communication 31 HIPPA violation
Exercise Bad Medical Email—Why? From: doctorawesome@aol.com To: orthorules@hotmail.com Hey THIS IS JOE FROM THE ER. GOT A PT FOR U!! HAHA I KNO U ORTHO DOCS LOVE A BROKE BONE, AND THIS ONE HAS 2 LOL! TIB/FIB FRACS. 60 yo named Ned Carson, fall dwn stairs Later Joe DR. JOE ACULA ER PHYSICIAN “A flower cannot blossom without sunshine, and man cannot live without love.” —Max Muller Rev 1/2018 Nursing Readiness-Communication 32 • Too informal for the workplace • All caps • Acronyms
Listening Skills Rev 1/2018 Nursing Readiness-Communication 33
Listening helps clients • Feel cared about and accepted • Feel significant and respected • Feel heard and understood • Feel connected with other people • Feel less isolated and alone • Establish a sense of trust with helper(s) • Make sense of their current situations and/or past experiences ask for help • Give feedback about their care express emotions and release tensions • Participate in their care planning Rev 1/2018 Nursing Readiness-Communication 34
Listening involves • Providing time for the person to tell his/her story offering a quiet and private space, • free from distractions to listen to the person listening • with the purpose of understanding the person’s message giving full attention • by focusing on what the person is saying tuning out external distractions, such as background noises tuning out internal distractions, such as thoughts about what to say next. Rev 1/2018 Nursing Readiness-Communication 35
Listening to non-verbal communication • Eye contact such as staring, avoiding eye contact • Facial expressions such as frowning, smiling, clenching or ‘biting’ lips, raising eyebrows • Voice, such as tone, volume, accent, inflection, pauses • Body movement, such as posture, gestures, fidgeting • Physiological responses, such as perspiring, breathing rapidly, blushing • Appearance, such as dress. Rev 1/2018 Nursing Readiness-Communication 36
Five Listening Skills • Building rapport Attending Behavior • Open questions • What, Why, HowQuestioning • Identifying mixed messages Confrontation • Finding broader aspects and possible solutions Focusing • Deeper meaning or thoughts Reflection Rev 1/2018 Nursing Readiness-Communication 37
Attending Behavior Building rapport •Be at eye level •Use person’s name •Smile •Encourage talking about self and concerns Skills that demonstrate listening • Reflecting • Acknowledging • Summarizing • Empathizing • Making educated guesses • Paraphrasing • Checking Rev 1/2018 Nursing Readiness-Communication 38
Exercise Attending Behavior • You are meeting for the first time Louisa Gomez, a 24 year old woman who has just given birth to twin boys • How would you approach her? •Identify self •Identify reason for meeting Louisa •Ask how she is feeling •Discuss the babies •Answer questions Rev 1/2018 Nursing Readiness-Communication 39
Questioning Skills Rev 1/2018 Nursing Readiness-Communication 40
Questioning Building understanding • Ask open ended questions • Why • What • Where • Ask closed questions • Yes/no • Ask for clarifications • Restate answers for accuracy Bad Questioning •Do not bombard •Do not ask multiple questions •Do not make questions as statements •Understand cultural differences Rev 1/2018 Nursing Readiness-Communication 41
Skills that assist with information giving • Checking what information the person knows already. • Giving small amounts of information at a time, using clear terms and avoiding jargon. • Avoiding detail unless it is requested – do not assume people want to know. • Checking understanding using an open question. For example: ‘I’ve gone through some difficult information, what sense have you made of it?’ • Pausing and waiting for a response to what you have said before moving on. • Checking, with sensitivity, the effect of the information you have given on the patient or caregiver. • For example: ‘There has been a lot of information to take in today, how are you feeling?’ Rev 1/2018 Nursing Readiness-Communication 42
Exercise Questioning • Gabriel Popowloski, age 57, is ready for discharge after coronary bypass. • What questions might you ask? • How does he feel? • Does he have transportation? • post-operative home care • Do you have a list of post-operative resources to home • Home health • Therapy • Do you understand your medications • Do you understand your wound care • Do you understand your critical issues he should seek immediate help • How much you and the hospital appreciate by his trust in them Rev 1/2018 Nursing Readiness-Communication 43
Confrontation Helping bring awareness to the patient over something they do not accept or are overlooking • Thoughts and feelings • Thoughts and actions • Feelings and actions or • A combination of thoughts, feelings and actions • Good confrontation is gentle • Acknowledge feelings • Reduces defensiveness • Pay attention to non- verbal cues • Offer alternative views and options Rev 1/2018 Nursing Readiness-Communication 44
Focusing Keeping the conversation flowing in a certain direction •Helping understand condition and treatment •Helping understand why •Helping see a broader picture Rev 1/2018 Nursing Readiness-Communication 46
Skills that assist in keeping the focus on the patient • Looking and listening for cues. • Asking open questions. • For example: ‘How are you?’ • Asking open directive questions. • For example: ‘How are you since I last saw you?’ • Asking open questions about feelings. • Exploring cues. • For example: ‘You said you are not with it, can you tell me more about that?’ • Using pauses and silence. • Using minimal prompts. • Screening. • For example: asking the question ‘Is there something else?’ before continuing with the discussion. • Clarifying. • For example: asking the question ‘You said you are not with it, from what you say, it sounds like it is hard to concentrate?’ Rev 1/2018 Nursing Readiness-Communication 47
Scenario Focusing • Heather Broadsande, age 16, is pregnant and is worried about her future: school, friends, church, and keeping the baby. • She is having a difficult time focusing on the prenatal care. • What do you do? a) Validate her worries b) Help her put priorities to these worries a) Baby’s health b) Mother’s health c) Go over each care issue d) Have her repeat the care issue e) Explain why it is important f) Have her repeat the importance g) Be patient and redirect Rev 1/2018 Nursing Readiness-Communication 48
Influencing Changing the way a person thinks or reacts •Everyone experiences and reacts to things differently •Helps redirect thinking toward condition •Reframe Rev 1/2018 Nursing Readiness-Communication 49
Giving Information Giving Information • Provide data or facts relevant to the patient’s needs. • Ensure that the patient is receptive to the information. • Be direct, clear, specific, concise and concrete. • Break the information into units that the patient can utilize. After giving information • Check that the patient has attended to the data and facts provided. • Have the patient repeat back. • Evaluate for distortions and use other interviewing skills to correct them. Use information giving • To provide instructions or directions. • To present feedback. • To provide alternative perspectives. • To direct patients to other resources. Rev 1/2018 Nursing Readiness-Communication 50
Scenario Influencing • Matt Shorenstein, age 45, is a noncompliant diabetic. • This is his third hospital stay this year for complications from his diabetes. • How do you influence him to be compliant? a) Try to discover why he is noncompliant b) Factually state the risks of his noncompliance c) Have him restate the risk d) Ask if he is willing to live with the risk e) Tell him he is an adult and it is his choice Rev 1/2018 Nursing Readiness-Communication 51
Giving Bad Information • Establish an appropriate setting. • Check the patient's perception of the situation prompting the news regarding the illness or test results. • Determine the amount of information known or how much information is desired. • Know the medical facts and their implication before initiating the conversation. • Explore the emotions raised during the interview. • Respond with empathy. • Establish a strategy for support Rev 1/2018 Nursing Readiness-Communication 52
Scenario Bad News • Hudsen Rivera, 18, was in a serious car accident and lost his left leg. He has a football scholarship. • What do you say? a) Ask what he remembers about the accident b) State the results clearly c) Allow time to process d) Be prepared to answer unanswerable questions e) Be patient f) Offer professional resources Rev 1/2018 Nursing Readiness-Communication 53
SOLAR Position • S—sitting facing the client squarely, at an angle • O—open adopting an open posture, arms and legs uncrossed • L—leaning (at times) towards the person • E—eye contact, without staring • R—relaxed posture Rev 1/2018 Nursing Readiness-Communication 54
Barriers to Effective Communication Patient • Environment – noise, lack of privacy, no control over who is present or not present (staff or relatives). • Fear and anxiety – related to being judged, being weak, or breaking down and crying. • Other barriers – difficulty explaining feelings (no emotional language to explain feelings), being strong for someone else, or communication cues being blocked by healthcare professionals. Healthcare professional barriers • Environment – high workload, lack of time, lack of support, staff conflict, lack of privacy or lack of referral pathway. • Fear and anxiety – related to making the patient more distressed by talking and/or asking difficult questions. • Other barriers – not having the skills or strategies to cope with difficult reactions, questions and/or emotions. Thinking ‘it is not my role’, and ‘the patient is bound to be upset’. (Wilkinson 1991, Booth et al 1996, Heaven and Maguire 1998, Maguire 1999) Rev 1/2018 Nursing Readiness-Communication 55
Role Play Rev 1/2018 Nursing Readiness-Communication 56
Role Play Your task is to document the cause of injury •Hugh Grant Rev 1/2018 Nursing Readiness-Communication 57
Role Play Your task is to obtain a social history. •Clarence Stelton. Rev 1/2018 Nursing Readiness-Communication 58
Role Play Your task is to find out why she is upset •Marybeth Creamsworth Rev 1/2018 Nursing Readiness-Communication 59
Summary • Effective communication is essential to quality patient care • Nurse need to effectively communicate in writing • Nurses need to listen carefully and ask critical questions Rev 1/2018 Nursing Readiness-Communication 60
Resources Rev 1/2018 Nursing Readiness-Communication 61
Resources 1 • Australian Institute of Professional Counsellors. (2017). Five Counselling Microskills. Retrieved July 13, 2017, from http://www.aipc.net.au/articles/five-counselling-microskills/ • Bramhall, E. (2014, September 1). Effective communication skills in nursing practice. Retrieved from http://journals.rcni.com/doi/pdfplus/10.7748/ns.29.14.53.e9355 • Case Tompkins, J., Tompkins, E., & Angeli, E. (2017). Purdue OWL Writing as a professional nurse. Retrieved July 12, 2017, from https://owl.english.purdue.edu/owl/owlprint/922/ • Counselling Academy. (2010). Counselling micro skills. Retrieved from https://www.aipc.net.au/student_bonuses/Counselling%20Micro%20Skil ls.pdf Rev 1/2018 Nursing Readiness-Communication 62
Resource 2 • Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Mater Sociomed, 26(1), 85-87. doi:10.5455/msm.2014.26.65- 67 • Mikanowicz, C., & Gmeiner, A. (2017). Communication strategies. Retrieved from https://www.nursece.com/courses/48 • Morrissey, J. (2011). Core communication skills in mental health nursing. In Communication skills for mental health nurses (pp. 1-16). Retrieved from https://www.colleaga.org/sites/default/files/attachments/core%20commu nication%20skills.pdf • Rosenzweig, M. Q. (2012). Breaking bad news. The Nurse Practitioner, 37(2), 1-4. doi:10.1097/01.npr.0000408626.24599.9e Rev 1/2018 Nursing Readiness-Communication 63
Resource 3 • Sacramento State College. (n.d.). Helpful guide for writing In nursing. Retrieved July 12, 2017, from http://online.annamaria.edu/rn-bsn/resource/why-nurses-need-good-writing- skills • Stanford School of Medicine. (2017). Palliative care: Examples of common clinical situations that are emotionally charged:. Retrieved from https://palliative.stanford.edu/communication-breaking-bad-news/examples-of-common- clinical-situations-that-are-emotionally-charged/ • Taylor, D. B. (2013). Writing skills for nursing and midwifery students. Retrieved from https://books.google.com/books?hl=en&lr=&id=ACkA3W5y4SEC&oi=fnd&pg=PP1&dq=W riting+Skills+for+Nursing+and+Midwifery+Students&ots=SUx5NaFxYM&sig=zlVsvQgel3xi Ro82Tub2q6JibZI#v=onepage&q=Writing%20Skills%20for%20Nursing%20and%20Midwi fery%20Students&f=false • Vertino, K. A. (2014). Effective interpersonal communication: A practical guide to improve your life. Online Journal of Issues in Nursing, 18. doi:10.3912/OJIN.Vol19No03Man01 Rev 1/2018 Nursing Readiness-Communication 64

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Communication skills

  • 1.
  • 2.
    Areas Written Listening &Speaking Rev 1/2018 Nursing Readiness-Communication 2
  • 3.
    Table of Content Whatis Communication Professional Writing Skills Effective Listening Effective Questioning Scenarios Resources Rev 1/2018 Nursing Readiness-Communication 3
  • 4.
    Objectives • Understand thetwo requirements of effective communication • Describe the communication paradigm • Explain the elements of professional written communication • Discuss the needs for good listening skills for nurses • List key listening skills • Develop good questioning strategies • Demonstrate good listening and questioning strategies Rev 1/2018 Nursing Readiness-Communication 4
  • 5.
    What is communication? Rev1/2018 Nursing Readiness-Communication 5
  • 6.
    Communication • Communication isthe conveying of information. •How is communication done? Rev 1/2018 Nursing Readiness-Communication 6
  • 7.
    Exercise What isin the bag? 1 Gestures only Rev 1/2018 Nursing Readiness-Communication 7
  • 8.
    Communication Paradigm Talking Listening WritingReading Rev 1/2018 Nursing Readiness-Communication 8
  • 9.
    Exercise What isin the bag? 2 Limited vocabulary a)Big b)Small c)Black d)White e)One f) Two g)Many h)Round i) Square j) Not Rev 1/2018 Nursing Readiness-Communication 9
  • 10.
    Four Areas ofCommunication As a College Student As a Professional As a Citizen As a friend/family Rev 1/2018 Nursing Readiness-Communication 10
  • 11.
  • 12.
    Purpose and Audience Purpose •Whatis the goal of the communication? •The purpose will influence all other considerations Audience • Who is going to the message? • What is his or her language skills? • What is his or her vocabulary level? • What is his or her general knowledge? Rev 1/2018 Nursing Readiness-Communication 12
  • 13.
    Meaning and Structure Meaning •Looks at what is being said • Determines why it needs to be said • Asks if what is being said is what is meant • Drives the structure, formality, vocabulary and grammar Structure • How the information is put together • The layout of the communication • E-mail • Documentation • Research paper • Conversation • Meeting • Teaching Rev 1/2018 Nursing Readiness-Communication 13
  • 14.
    Formality • Formality ishow casual the writing is • This is determined by the purpose and the audience • It is a matter of degree not yes or no. Formal Informal Buttock Rump Behind Caboose Ass Rev 1/2018 Nursing Readiness-Communication 14
  • 15.
    Vocabulary •It is throughwords that ideas are expressed •The more words one has the better able to express one’s ideas •Not everyone has the same vocabulary Grammar • The basic rules of language • Used to understand vocabulary • All languages have grammar, including computer languages • A brigant was bending toward the wind. • Man the dog big the bit. Rev 1/2018 Nursing Readiness-Communication 15
  • 16.
    Exercise Acceptable orUnacceptable 1. Samantha is a well groomed African American woman. 2. Charles stinks from poor personal hygiene because he is fat and cannot reach all body areas. 3. Zanem, an effeminate male, cried when given the flu shot. 4. Quill because she is heavily tattooed requires extra caution with blood draws. Rev 1/2018 Nursing Readiness-Communication 16
  • 17.
    Professional Writing Skills Rev 1/2018Nursing Readiness-Communication 17
  • 18.
    Exercise Bad MedicalWriting—Why? “The greater pain caused by larger-sized tubes was the result of increased pain during the insertion of the tube and pain while the tube was in situ, with no pain difference during tube removal ” •Is this clear writing. •When is the pain? •“Greater pain was experienced with a larger tube during insertion, while in situ and during removal.” Rev 1/2018 Nursing Readiness-Communication 18
  • 19.
    Why Writing Matters •Better Patient Care • Clear Communication • Expanded Career Opportunities Rev 1/2018 Nursing Readiness-Communication 19
  • 20.
    Audience To Doctors To Co-Workers •Supervisors • Peers • Subordinates Patients To Family Rev 1/2018 Nursing Readiness-Communication 20
  • 21.
    Professional Writing Expectations Types • Emails •Reports • Physician orders • Charting/Documentation • Shift Summaries • Care plans • Case studies Quality • Full sentences • Solid grammar • Clear organization • Formal style • Be Precise • Be Objective • Remember the reader • Accurate information • Accurate use of medical terms • Accurate spelling Rev 1/2018 Nursing Readiness-Communication 21
  • 22.
    Emails Rev 1/2018 NursingReadiness-Communication 23
  • 23.
    Definition Email is theelectronic transmission of messages through a computer network Not everything is appropriate for emails HIPPA requirements Rev 1/2018 Nursing Readiness-Communication 24
  • 24.
    Basics of GoodCommunication • Know your audience • Write to that audience • Emphasize clarity over cleverness • Emphasis content over expansiveness • Use standard fonts • Keep bolds, underlines, and italics to a minimum • If using a priority system, be honest. • Avoid backgrounds or stationary that detract from the message Rev 1/2018 Nursing Readiness-Communication 25
  • 25.
    Signature Block • Sender’sinformation • Include • Name • Job title • email address • Company, Department • Separate from text by two or three lines Rev 1/2018 Nursing Readiness-Communication 26
  • 26.
    Before Sending • Checkspelling • Check grammar • Check for clarity • Check Addressee's name • Don’t send emails when angry • Remember telephones still exist – Is email the best way to respond? • HIPPA and emails • If patient initiates the email • If patient prior consents to email • If information emailed is included in the consent • Patient should be advised about the risks in emails Rev 1/2018 Nursing Readiness-Communication 27
  • 27.
    Email and Security •Emails and email attachments are a primary entry method for computer viruses • Viruses can spread extremely fast • Computer crime is the growth sector of organized crime • Be skeptical • Open an email from an unknown sender with caution • Never open email attachments from an unknown sender • Never give out passwords, social security numbers, bank account numbers, etc. Rev 1/2018 Nursing Readiness-Communication 28
  • 28.
    Email Security Terms •Virus – A type of software that run without your knowledge, replicates itself and spreads to other computers • Trojan Horse– A type of virus that is intended to do harm to the computer. It is usually hidden inside something attractive, such as a cartoon • Worm – a type of virus that spreads by Email • Zombie—Unauthorized use of a computer by others for their personal reasons • Bot—A web site that automatically transfers the user to another undesired website • Spam—Mass mailings to know email users • Phish—Requests for personal information from what appears to be a trusted organization; e.g. personal bank • Ransomware-is a type of malicious software that threatens to publish the victim's data or perpetually block access to it unless a ransom is paid Rev 1/2018 Nursing Readiness-Communication 29
  • 29.
    Security Measures • Havea good anti-virus program • Use a firewall • Have good spyware and adware filters  Update regularly • Have a good spam filter • Update programs frequently and quickly • Do not open emails with multiple forwards • Be cautious in downloading free or shareware programs • Be cautious in opening emails from unknown senders • Be wary of attachments Rev 1/2018 Nursing Readiness-Communication 30
  • 30.
    Exercise Bad MedicalEmail—Why? From: Mabel Lean, RN To: Cmesoon@Hotmail.com RE: Lab results Dear Ms. Didledump, Since your son is covered under your insurance. I am notifying you about the lab results for him after he went to the college health center. He tested positive for gonorrhea and is being treated. I suggest you have a discussion with your son about his sexual behavior. Thanks Nurse Lean Rev 1/2018 Nursing Readiness-Communication 31 HIPPA violation
  • 31.
    Exercise Bad MedicalEmail—Why? From: doctorawesome@aol.com To: orthorules@hotmail.com Hey THIS IS JOE FROM THE ER. GOT A PT FOR U!! HAHA I KNO U ORTHO DOCS LOVE A BROKE BONE, AND THIS ONE HAS 2 LOL! TIB/FIB FRACS. 60 yo named Ned Carson, fall dwn stairs Later Joe DR. JOE ACULA ER PHYSICIAN “A flower cannot blossom without sunshine, and man cannot live without love.” —Max Muller Rev 1/2018 Nursing Readiness-Communication 32 • Too informal for the workplace • All caps • Acronyms
  • 32.
    Listening Skills Rev 1/2018Nursing Readiness-Communication 33
  • 33.
    Listening helps clients •Feel cared about and accepted • Feel significant and respected • Feel heard and understood • Feel connected with other people • Feel less isolated and alone • Establish a sense of trust with helper(s) • Make sense of their current situations and/or past experiences ask for help • Give feedback about their care express emotions and release tensions • Participate in their care planning Rev 1/2018 Nursing Readiness-Communication 34
  • 34.
    Listening involves • Providingtime for the person to tell his/her story offering a quiet and private space, • free from distractions to listen to the person listening • with the purpose of understanding the person’s message giving full attention • by focusing on what the person is saying tuning out external distractions, such as background noises tuning out internal distractions, such as thoughts about what to say next. Rev 1/2018 Nursing Readiness-Communication 35
  • 35.
    Listening to non-verbal communication •Eye contact such as staring, avoiding eye contact • Facial expressions such as frowning, smiling, clenching or ‘biting’ lips, raising eyebrows • Voice, such as tone, volume, accent, inflection, pauses • Body movement, such as posture, gestures, fidgeting • Physiological responses, such as perspiring, breathing rapidly, blushing • Appearance, such as dress. Rev 1/2018 Nursing Readiness-Communication 36
  • 36.
    Five Listening Skills •Building rapport Attending Behavior • Open questions • What, Why, HowQuestioning • Identifying mixed messages Confrontation • Finding broader aspects and possible solutions Focusing • Deeper meaning or thoughts Reflection Rev 1/2018 Nursing Readiness-Communication 37
  • 37.
    Attending Behavior Building rapport •Beat eye level •Use person’s name •Smile •Encourage talking about self and concerns Skills that demonstrate listening • Reflecting • Acknowledging • Summarizing • Empathizing • Making educated guesses • Paraphrasing • Checking Rev 1/2018 Nursing Readiness-Communication 38
  • 38.
    Exercise Attending Behavior •You are meeting for the first time Louisa Gomez, a 24 year old woman who has just given birth to twin boys • How would you approach her? •Identify self •Identify reason for meeting Louisa •Ask how she is feeling •Discuss the babies •Answer questions Rev 1/2018 Nursing Readiness-Communication 39
  • 39.
    Questioning Skills Rev 1/2018Nursing Readiness-Communication 40
  • 40.
    Questioning Building understanding • Askopen ended questions • Why • What • Where • Ask closed questions • Yes/no • Ask for clarifications • Restate answers for accuracy Bad Questioning •Do not bombard •Do not ask multiple questions •Do not make questions as statements •Understand cultural differences Rev 1/2018 Nursing Readiness-Communication 41
  • 41.
    Skills that assistwith information giving • Checking what information the person knows already. • Giving small amounts of information at a time, using clear terms and avoiding jargon. • Avoiding detail unless it is requested – do not assume people want to know. • Checking understanding using an open question. For example: ‘I’ve gone through some difficult information, what sense have you made of it?’ • Pausing and waiting for a response to what you have said before moving on. • Checking, with sensitivity, the effect of the information you have given on the patient or caregiver. • For example: ‘There has been a lot of information to take in today, how are you feeling?’ Rev 1/2018 Nursing Readiness-Communication 42
  • 42.
    Exercise Questioning • GabrielPopowloski, age 57, is ready for discharge after coronary bypass. • What questions might you ask? • How does he feel? • Does he have transportation? • post-operative home care • Do you have a list of post-operative resources to home • Home health • Therapy • Do you understand your medications • Do you understand your wound care • Do you understand your critical issues he should seek immediate help • How much you and the hospital appreciate by his trust in them Rev 1/2018 Nursing Readiness-Communication 43
  • 43.
    Confrontation Helping bring awarenessto the patient over something they do not accept or are overlooking • Thoughts and feelings • Thoughts and actions • Feelings and actions or • A combination of thoughts, feelings and actions • Good confrontation is gentle • Acknowledge feelings • Reduces defensiveness • Pay attention to non- verbal cues • Offer alternative views and options Rev 1/2018 Nursing Readiness-Communication 44
  • 44.
    Focusing Keeping the conversationflowing in a certain direction •Helping understand condition and treatment •Helping understand why •Helping see a broader picture Rev 1/2018 Nursing Readiness-Communication 46
  • 45.
    Skills that assistin keeping the focus on the patient • Looking and listening for cues. • Asking open questions. • For example: ‘How are you?’ • Asking open directive questions. • For example: ‘How are you since I last saw you?’ • Asking open questions about feelings. • Exploring cues. • For example: ‘You said you are not with it, can you tell me more about that?’ • Using pauses and silence. • Using minimal prompts. • Screening. • For example: asking the question ‘Is there something else?’ before continuing with the discussion. • Clarifying. • For example: asking the question ‘You said you are not with it, from what you say, it sounds like it is hard to concentrate?’ Rev 1/2018 Nursing Readiness-Communication 47
  • 46.
    Scenario Focusing • HeatherBroadsande, age 16, is pregnant and is worried about her future: school, friends, church, and keeping the baby. • She is having a difficult time focusing on the prenatal care. • What do you do? a) Validate her worries b) Help her put priorities to these worries a) Baby’s health b) Mother’s health c) Go over each care issue d) Have her repeat the care issue e) Explain why it is important f) Have her repeat the importance g) Be patient and redirect Rev 1/2018 Nursing Readiness-Communication 48
  • 47.
    Influencing Changing the waya person thinks or reacts •Everyone experiences and reacts to things differently •Helps redirect thinking toward condition •Reframe Rev 1/2018 Nursing Readiness-Communication 49
  • 48.
    Giving Information Giving Information •Provide data or facts relevant to the patient’s needs. • Ensure that the patient is receptive to the information. • Be direct, clear, specific, concise and concrete. • Break the information into units that the patient can utilize. After giving information • Check that the patient has attended to the data and facts provided. • Have the patient repeat back. • Evaluate for distortions and use other interviewing skills to correct them. Use information giving • To provide instructions or directions. • To present feedback. • To provide alternative perspectives. • To direct patients to other resources. Rev 1/2018 Nursing Readiness-Communication 50
  • 49.
    Scenario Influencing • MattShorenstein, age 45, is a noncompliant diabetic. • This is his third hospital stay this year for complications from his diabetes. • How do you influence him to be compliant? a) Try to discover why he is noncompliant b) Factually state the risks of his noncompliance c) Have him restate the risk d) Ask if he is willing to live with the risk e) Tell him he is an adult and it is his choice Rev 1/2018 Nursing Readiness-Communication 51
  • 50.
    Giving Bad Information •Establish an appropriate setting. • Check the patient's perception of the situation prompting the news regarding the illness or test results. • Determine the amount of information known or how much information is desired. • Know the medical facts and their implication before initiating the conversation. • Explore the emotions raised during the interview. • Respond with empathy. • Establish a strategy for support Rev 1/2018 Nursing Readiness-Communication 52
  • 51.
    Scenario Bad News •Hudsen Rivera, 18, was in a serious car accident and lost his left leg. He has a football scholarship. • What do you say? a) Ask what he remembers about the accident b) State the results clearly c) Allow time to process d) Be prepared to answer unanswerable questions e) Be patient f) Offer professional resources Rev 1/2018 Nursing Readiness-Communication 53
  • 52.
    SOLAR Position • S—sittingfacing the client squarely, at an angle • O—open adopting an open posture, arms and legs uncrossed • L—leaning (at times) towards the person • E—eye contact, without staring • R—relaxed posture Rev 1/2018 Nursing Readiness-Communication 54
  • 53.
    Barriers to Effective Communication Patient •Environment – noise, lack of privacy, no control over who is present or not present (staff or relatives). • Fear and anxiety – related to being judged, being weak, or breaking down and crying. • Other barriers – difficulty explaining feelings (no emotional language to explain feelings), being strong for someone else, or communication cues being blocked by healthcare professionals. Healthcare professional barriers • Environment – high workload, lack of time, lack of support, staff conflict, lack of privacy or lack of referral pathway. • Fear and anxiety – related to making the patient more distressed by talking and/or asking difficult questions. • Other barriers – not having the skills or strategies to cope with difficult reactions, questions and/or emotions. Thinking ‘it is not my role’, and ‘the patient is bound to be upset’. (Wilkinson 1991, Booth et al 1996, Heaven and Maguire 1998, Maguire 1999) Rev 1/2018 Nursing Readiness-Communication 55
  • 54.
    Role Play Rev 1/2018Nursing Readiness-Communication 56
  • 55.
    Role Play Your taskis to document the cause of injury •Hugh Grant Rev 1/2018 Nursing Readiness-Communication 57
  • 56.
    Role Play Your taskis to obtain a social history. •Clarence Stelton. Rev 1/2018 Nursing Readiness-Communication 58
  • 57.
    Role Play Your taskis to find out why she is upset •Marybeth Creamsworth Rev 1/2018 Nursing Readiness-Communication 59
  • 58.
    Summary • Effective communicationis essential to quality patient care • Nurse need to effectively communicate in writing • Nurses need to listen carefully and ask critical questions Rev 1/2018 Nursing Readiness-Communication 60
  • 59.
    Resources Rev 1/2018 NursingReadiness-Communication 61
  • 60.
    Resources 1 • AustralianInstitute of Professional Counsellors. (2017). Five Counselling Microskills. Retrieved July 13, 2017, from http://www.aipc.net.au/articles/five-counselling-microskills/ • Bramhall, E. (2014, September 1). Effective communication skills in nursing practice. Retrieved from http://journals.rcni.com/doi/pdfplus/10.7748/ns.29.14.53.e9355 • Case Tompkins, J., Tompkins, E., & Angeli, E. (2017). Purdue OWL Writing as a professional nurse. Retrieved July 12, 2017, from https://owl.english.purdue.edu/owl/owlprint/922/ • Counselling Academy. (2010). Counselling micro skills. Retrieved from https://www.aipc.net.au/student_bonuses/Counselling%20Micro%20Skil ls.pdf Rev 1/2018 Nursing Readiness-Communication 62
  • 61.
    Resource 2 • Kourkouta,L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Mater Sociomed, 26(1), 85-87. doi:10.5455/msm.2014.26.65- 67 • Mikanowicz, C., & Gmeiner, A. (2017). Communication strategies. Retrieved from https://www.nursece.com/courses/48 • Morrissey, J. (2011). Core communication skills in mental health nursing. In Communication skills for mental health nurses (pp. 1-16). Retrieved from https://www.colleaga.org/sites/default/files/attachments/core%20commu nication%20skills.pdf • Rosenzweig, M. Q. (2012). Breaking bad news. The Nurse Practitioner, 37(2), 1-4. doi:10.1097/01.npr.0000408626.24599.9e Rev 1/2018 Nursing Readiness-Communication 63
  • 62.
    Resource 3 • SacramentoState College. (n.d.). Helpful guide for writing In nursing. Retrieved July 12, 2017, from http://online.annamaria.edu/rn-bsn/resource/why-nurses-need-good-writing- skills • Stanford School of Medicine. (2017). Palliative care: Examples of common clinical situations that are emotionally charged:. Retrieved from https://palliative.stanford.edu/communication-breaking-bad-news/examples-of-common- clinical-situations-that-are-emotionally-charged/ • Taylor, D. B. (2013). Writing skills for nursing and midwifery students. Retrieved from https://books.google.com/books?hl=en&lr=&id=ACkA3W5y4SEC&oi=fnd&pg=PP1&dq=W riting+Skills+for+Nursing+and+Midwifery+Students&ots=SUx5NaFxYM&sig=zlVsvQgel3xi Ro82Tub2q6JibZI#v=onepage&q=Writing%20Skills%20for%20Nursing%20and%20Midwi fery%20Students&f=false • Vertino, K. A. (2014). Effective interpersonal communication: A practical guide to improve your life. Online Journal of Issues in Nursing, 18. doi:10.3912/OJIN.Vol19No03Man01 Rev 1/2018 Nursing Readiness-Communication 64