Ch. 3: Communication

Referent

Event or thought that initiates the communication

-Includes sensation or observation

ex: body language

Tasting a strange flavor in medication and questioning the nurse about it

Referent Example

Referent Example

A patient feeling pain initiates communication by calling for the nurse or pressing the call button

Sender

Person who initiated and encodes the communication

-Can decide which mode of communication (verbal, written, or nonverbal) can most effectively convey the intended meaning of the message

A nurse calling a physician to report a change in condition on a patient

Sender

Message

Information that is communicated

-Factors that influence communication:

• timing of conversation

• educational levels of the people involved

• modes of communication used

• physical and emotional factors

Message example

Patient education handouts about diabetes management

Channel

Method of communication

-Can include the 5 senses

Channel Example

Feeling skin temperature to assess for fever

Receiver

Person who receives and decodes, or interprets, the communication

-Needs to:

• actively listen

• observe

• engage in conversation

Feedback

Response of the receiver

• asking to restate their message

The communication process

Nonverbal communication

wordless transmission of information

- 93% of communication is nonverbal

Body language

Makes up 55% of communication

- Posture, stance, and gait

- Facial expressions and eye movements

- Touch, gestures, and symbolic expressions

Proxemics

The study of spatial requirements of humans and animals

• In nursing, it is important because it:

  • Establish patient comfort

  • Build trust

  • Ensuring effective interactions

Theory of proxemics/ Edward Hall

4 distances that people interact with:

1. Intimate (0-1.5 ft)

2. Personal (1.5 to 4 ft)

3. Social (4-12 ft)

4. Public (12-+ ft)

Voice inflection

38%

Second most significant form of nonverbal communication

• Emphasized through tone, volume, and the rhythm or rate of speech

• Avoid sounding condescending

Verbal communication

Albert Mehrabian said that only 7% is verbal communication

- Setting, context, and content

- Setting influences what is or what can be shared

- Monitor context and content to avoid misinterpretation

- Written communication

- Effective at providing details and legal documentation; lacks nuance

ex: it may be difficult to perceive urgency when reading progress notes

- Electronic communication

- Can provide information quickly; validate and verify shared information

Intrapersonal communication

• Positive self-talk

• Negative self-talk

• Meditation

• Prayer

Positive self-talk

is internal conversation that provides motivation and encouragement

• Builds self-esteem and confidence

Negative self-talk

damage one’s ability to reach their greatest potential or overcome adversity

• May increase a patient’s perception of:

  • Pain

  • Anxiety

  • Inability to meet challenges of a poor prognosis

Interpersonal communication

Takes place b/t two or more people

• it can be formal or informal

Miscommunication contributes to:

- 82% of sentinel events or near misses

-is the cause of 60% of adverse patient events

• Interprofessional communication

• Ethical implications

  • HIPAA

SBAR Model

Situation: What is happening rn?

Background: What led to the current situation?

Assessment: What is the identified problem, concern, or need?

Recommendation: What actions or interventions should be initiated to alleviate the problem?

The CUS tool

1. State their Concern

2. State why they are Uncomfortable

3. identify the Safety issue

Small-group communication

- Small-group dynamics

• Forming: group members rely on the leader to identify the mission and goals of the group

  • Gound rules are identified, trust is established

• Storming: may involve some personality conflicts among the group participant

  • The group leader needs to work with members to resolve conflicts and build cohesion

• Norming: the group leader encourages participants of all group members, avoid sharing too much of their own thoughts or feelings, sharing accomplishments

  • Increased trust and openness, productivity and meaningful sharing info.

• Performing: Interdependence emerges, problem-solving occurs,

• Adjourning: takes place as the small group disperses, having achieved the group’s goals

Public communication

nurses educate on health care issues/wellness,

-Requires:

• Education

• Preparation

• Openness to diverse opinions

• communication skills

Nurse-patient relationship

• Building trust

• Demonstrating empathy

• Establishing boundaries

• Recognizing and respecting cultural influences

• Developing a comprehensive plan of care

Phases of the helping relationship

• Orientation: gathering assessment and diagnostic data can help you with your initial interaction with your patient

• Working: implement the plan of care

• Termination: concludes the relationship as you pass off to another caregiver

Nursing process in the helping relationship/ SHARE Model

The five steps of the nursing process are used in each phase of the helping relationship

1. Seek your patient’s participation

2. Help your patient explore and compare treatment options

3. Assess your patient’s values and preferences

4. Reach a decision with your patient

5. Evaluate your patient’s decision

Pain or anxiety

• Direct empathic communication is most effective

• Use short questions or specific instructions

• Extensive patient education or preoperative teaching should be provided at an earlier or different time

Location and distractions

• Provide privacy and confidentiality

• Minimize distractions

  • e.g. technology

Respect

for patients and their families is conveyed by nurses verbally and nonverbally

• Ensuring privacy, providing necessary health care information, fostering autonomy in decision making

• Controlling facial expressions and body language

Assertiveness

is the ability to express ideas and concerns clearly while respecting the thoughts of others

-communicate w/o hesitation

Collaboration

with other health care professionals is a key factor in communicating necessary health care information and providing comprehensive care

Delegation

is a multifaceted responsibility of the registered nurse

*important to be precise and assertive

-Communicating therapeutically with colleagues during the delegation process shows respect and recognizes the many stressors with which all members of the health care team cope while providing patient care

Advocacy

involves defending the rights of others, especially those who are vulnerable or unable to make decisions independently

-Nurse must be:

• knowledgeable

• organized

• able to communicate in a caring manner

Social Communication

Occurs among individuals who know each other or who are getting to know each other informally

- Involves mutual sharing of ideas, give advice, verbalize opinions, or make judgements on the behavior of others

Therapeutic Communication

Primary focus is b/t a patient and nurse is the patient

- Engaged in therapeutic conversation set their own opinions and judgements aside to listen more fully to their patients

such as:

• active listening

• open posture

• reflection

SOLER may appear on test

S- encourages the listener to sit (if possible) facing the patient

O- reminds the nurse to maintain an open stance or posture while listening

L- suggests that the listener lean toward the speaker, positioning the body in an open stance

E- refers to maintaining eye contact without staring

R- reminds the nurse to relax

Non-therapeutic communication

can be hurtful and potentially damaging to interaction

• Changing the subject

• sharing personal opinion

Compensation

Using personal strengths or abilities to overcome feeling of inadequacy

Compensation Example

A student who struggles academically becomes an excellent althelte

Displacement

Transferring emotional energy away from an actual source of stress to an unrelated person or object

Displacement Example

After being criticized by a boss, a worker goes home and yells at a family member

Introjection

Taking on certain characteristics of another individual’s personality

Introjection Example

A child starts acting and speaking like her favorite teacher

Projection

Attributing undesirable feelings to another person

Projection Example

A person who is angry accuses others of being hostile

Regression

Reverting to behaviors consistent with earlier stages of development

Regression Example

A toilet-trained child starts wetting the bed after a new sibling is born

Sublimation

Rechanneling unacceptable impulses into socially acceptable activites

Sublimation

A person with aggressive feelings becomes a boxer or martial artist

Supression

Choosing not to think consciously about unpleasant feelings

Suppression Example

A student worries about a family problem but decides to focus on studying until after the exam