Communication

Why is communication important?

• Nurse to Pt

• Nurse to Nurse/UAP/Tech

• Nurse to provider

• Nurse to Family

• build trust, pt feels heard, reduce mistunderstandings, encourage pt to report sx/concerns and changes

• Reduce risk of errors, ensure all members understand pt condition, timely reporting, continuty of care

• Ensure accurate info, treatment plans, decision-making, plan of care current, reduce delays/harm

• involve family in care/understanding pt condition/treatment plan/discharge/ emotional support

Closed loop communication:

Verbal communication with workers strategy:

Verbal communication with patients & family members strategy:

Nonverbal communication with patients:

• ALL healthcare workers when sender gives a message and receiver repeats it back

• SBAR

• AIDET; word choice, simple, be mindful

• volume, posture, eye contact, facial expressions

Therapeutic communication

• Goal:

• Techniques

Influencers of communication:

• Build trust and gather accurate information

• Active listening, open ended questions, reflection, Focusing, summarizing

Cultural factors (language, religion), Age, generation

Recognize cues with communication

• Verbal cues

• Nonverbal cues

• BIg takeaway

Analyze cues with communciation

• What happens?

• Examples

• What are they saying? Are they reporting pain/confusion? Are their words understandable? Able to express their needs?

• Facial expressions, posture, eye contact, agitation, crying/withdrawal

• Pts may communicate distress through behaviors before through words

• What do these communication cues mean (Is there a language barrier? Is there a sensory impairment?)

• Difficulty speaking after a stroke → Possible aphasia

Prioritize Hypotheses

• What does it mean?

• Examples?

• Patient who only speaks spanish and needs discharge instructions? or Patient with new slurred speech and facial droop?

Generate Solutions

• What does it mean?

• examples

• Patient has expressive aphasia:

Take Action

• What does it mean?

• Examples?

• What communication issue is most important?

• Sudden confusion, New inability to speak

• New neurologic symptoms

• How can i improve communication

• Simple language, one question, interpreter, reduce distractions

• Take your time. Point to what you need

• Implement the communication strategy

• Reorient, boards, interpreter, speech therapy

Motivational Interviewing

• Define

• Mnemonic with examples/purpose

• nurse and client develop plans to promote client communication

1. Open-ended questions→ “how are you feeling today”

2. Affirmations → “You shown a lot of courage by talking about this today”

3. Reflective listening → “It sounds like you’re overwhelmed but still hopeful”

4. Summarizing → Reinforces key points

Special Communication Situations

• Hearing loss

avoid?

• Nonverbal

• Dementia

avoid?

• Language differences

avoid?

• Face, eye contact, background noise, low pitch

Shouting, covering mouth, turning away

• boards, writing, tech, yes/no questions

• calm, simple, one question, no distractions

arguing, interrupting, correcting repeatedly

• interpreter, speak directly, verify understanding

using family members, children or assuming

Communication Styles

• Passive

• Assertive

• Aggressive

• Passive Aggressive

• want to avoid conflict, so say nothing or simply agrees (misunderstandings/lies)

• Clear, honest, and respectful

• verbally/physically abusive (intimidating)

• demonstrating anger in a subtle or secretive way

Communication Barriers Examples

• Language differences→

• Speech or hearing impairments →

• Developmental/cognitive disorders →

• Medication effects →

• Recreational drug effects:

• Distress →

• Environmental factors →

• interpreters and visual aids

• sign language and assistive devices

• repetition and patience

• Assess mental status and responsiveness

• Calm demenaor and ensure safety

• Validate feelings and provide comfort

• private settings and minimize distractions

1. Uses an interpreter for a patient with limited english proficiency and provides education using simple language

2. Determines the patient may be experiencing anxiety, pain, fear, or depression based on verbal and nonverbal behaviors

3. Decides to use therapeutic communication, ask open-ended questions, and perform a more thorough assessment

4. Notices a patient avoiding eye contact, speaking very little and appearing tearful despite saying “Im fine”

5. Patient correctly demonstrates inhaler use after teaching and can explain when to use it at home

6. Prioritizes new confusion and slurred speech over a routine request for a blanket because they may indicate a stroke

1. Take action

2. Analyze cues

3. Generate solutions

4. Recognize cues

5. Evaluate outcomes

6. Prioritize Hypotheses