COMMUNICATING NCM 103 FUNDA

is a critical skill of nursing - process by which humans meet their survival needs, build relationships and experience emotions.

Communication

a dynamic process used to gather assessment of data, to teach, and persuade and to express caring and comfort-integral part of the helping relationship

Communication

interchange of information or feelings between 2 or more people, in other words, the exchange of ideas or thoughts, either spoken or written words and gestures or body actions- like in talking, listening, writing and reading or like in painting, dancing and storytelling

Communication

is a process that intents to obtain a response- helpful (sharing of information, thoughts or feelings between 2 or more people) or unhelpful (hinders or blocks the transfer of information and feelings).

is a process built on a trusting relationship that is essential for the establishment of a nurse-client relationship.

Effective communication

Nurses who ______ effectively are better able to collect assessment data, initiate interventions, evaluate outcome of interventions, initiate change that promote health and prevent the safety and legaproblems associated with nursing practice. - Communication can occur on an intrapersonal level (with yourself) and interpersonal level (with others)

communicate

person or group who wishes to communicate a message to another. The sender must have an idea or reason for communicating (source) and must put the idea or feeling into a form that can be transmitted.

Sender or Source Encoder

selection of specific signs or symbols (codes) to transmit the message like-language, how to arrange the words, tone of voice, gestures and cope of language levels (layman's term and medical jargons).

Encoding

- second component of the communication process

- said or written, the body language that accompanies the words, and how the message is transmitted.

- it is important for the method to be appropriate for the message, and it should help make the intent of the message clearer.

Message

- third component of the communication process

- is the listener, who must listen, observe, and attend.

- this person is the decoder ( must perceive what the sender intended)

Receiver

means to relate the message perceived to the receivers’ storehouse of knowledge and experience and to sort out the meaning of the message.

Decode

fourth component of the communication process

- can either be verbal, nonverbal, or both.

- feedback allows the sender to correct or reword a message

Response/Feedback

CHARACTERISTICS OF COMMUNICATION

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1. Clarity

2. Consideration

3. Conciseness

4. Concreteness

5. Completeness

6. Correctness

7. Coherence

8. Courtesy

ultimate characteristic of communication. Use precise language and no beating around the bush.

Clarity

your goal is to communicate your message as quickly and directly as possible, saving time and trouble.

Conciseness

proper grammar and syntax, accurate information.

Correctness

comprehensive but concise.

Completeness

- logical, relevant and organized.

Coherence

empathetic, polite and in a professional tone.

Consideration

courteous and prudent.

Courtesy

tangible or substantial.

Concreteness

MODES OF COMMUNICATION

1. verbal communication

2. non verbal com

3. electronic com

4. therapeutic com

- Uses the spoken or written word

1. Verbal Communication

Verbal Communication components

manner of speech, rate (may indicate interest, anxiety, boredom or fear), rhythm and tone (expresses enthusiasm, sadness, anger or amusement). Example - speaking slowly and softly to an excited client may help calm him.

Pace and Intonation

use of commonly understood words, brevity (concise and exact use of words) and completeness. Convey it in a layman's level of understanding and avoid medical jargons. Example - catheterization

Simplicity

y (precise) and brevity (using fewest words necessary) - simple, clear, direct, congruent or consistent (verbal to nonverbal) and careful enunciation

Clarity

timing needs to be appropriate to ensure that words are heard and the messages need to relate and be sensitive to the person's interests and concerns. Also, to not ask several questions at once or a related pattern of poor timing. Example: Let the student read the one in the book.

Timing and relevance

- the need to alter spoken messages in accordance with behavioral cues from the client, meaning what the nurse says and how it is said must be individualized and carefully considered

Adaptability

means worthiness of belief, trustworthiness and reliability. This is the most important criterion of effective communication-being consistent, dependable, honest, knowledgeable, with accurate information, convey confidence and certainty with limitations (like I don't know the answer to that, but I will find someone who does)

Credibility

can be a positive and powerful tool but must be used with care. This can be used to help clients adjust to difficult and painful situationsphysical act of laughter can be emotional and physical release, reduces tension, provides different perspectives and promotes a sense of well-being. Also, it is important to consider the client's perception of what is considered humorous and timing.

Humor

Aka body language-gestures, body movements, use of touch and physical appearance.

Nonverbal Communication

Often tells others more about what a person is feeling than what is actually being said, because nonverbal behavior is controlled less consciously than verbal behavior

Nonverbal Communication

Either reinforces or contradicts what is said verbally. Example-let the student read the one in the book

Nonverbal Communication

As nurses, we should develop the essential skill to observe and interpret client's nonverbal behavior with caution-this requires systematic assessment of the person's overall physical appearance, posture, gait, facial expressions and gestures.

Nonverbal Communication

Criteria for Nonverbal Communication:

1. Personal appearance

2. Posture and gait -

3. Facial expression

4. Gestures

clothing and adornment can be sources of information about a person. How a person dresses is often an indicator of how the person feels.

Personal appearance

the ways people walk and carry themselves are often reliable indicators of selfconcept, current mood and health. The posture of people when sitting and lying can also indicate feelings or mood. So, validate the observation

1. Posture and gait

the face may express the person's genuine emotions, it is also possible to control these muscles so the emotion expressed does not reflect what the person is feeling. When the message is not clear, it is important to get feedback to be sure of the intent of the expression. Many facial expressions convey a universal meaning. Nurses need to be aware of their own expressions and what they are communicating to others. Eye contact is another essential element of facial communication.

Facial expression

- hand and body ____ may emphasize and clarify the spoken word, or they may occur without words to indicate a particular feeling or to give a sign.

Gestures

- the most common form of electronic communication.

- Email

Interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information.

THERAPEUTIC COMMUNICATION

- All nurses need skills in therapeutic communication to effectively apply the nursing process and to meet standards of care for their clients.

THERAPEUTIC COMMUNICATION

Communication is the means by which a therapeutic relationship is initiated, maintained and terminated.

THERAPEUTIC COMMUNICATION

purposes of THERAPEUTIC COMMUNICATION

a. Establish a therapeutic nurse-client relationship

b. Identify the most important client concern at that moment (client-centered goal)

c. Assess the client's perception of the problem

d. Facilitates the client's expression of emotions

e. Teachthe client and family necessary self-care skills

f. Recognize the client's needs

g. Implement interventions designed to address the client's needs

h. Guide the client toward identifying a plan of action to a satisfying and socially acceptable resolution.

- This is the most important technique in nursing and is basic to all other techniques

- Listening with mindfulness, using all the senses and paying attention to what the client says, does and feels as opposed to listening with just the ear (passive).

ACTIVE AND EFFECTIVE LISTENING

Guidelines in ACTIVE AND EFFECTIVE LISTENING

• 
  An active process that requires energy and concentration.

• It involves paying attention to the total message.

• Means absorbing both the content and the feeling the person is conveying, while putting aside your judgments and ideas to really hear and focus on the client's needs.

• Conveys an attitude of caring and interest.

• Involves listening for key themes in the communication.

• Careful to not react quickly to the message.

• Should not interrupt the speaker and the nurse.

• The nurse also should ask questions either to obtain additional information or to clarify.

• Nurses must be aware of their own biases.

- As intimacy increases, the need for distance decreases

- Touching a client can be comforting and supportive when it is welcome and permitted.

TOUCH

The nurse should observe the client for cues that show whether touch is desired or indicated

_____ can be comforting and therapeutic, it is an invasion of intimate and personal space.

TOUCH

TYPES OF TOUCH

F2 S2 L

• 1. Functional Professional Touch

• 3. Friendship warmth Touch

• 2. Social Polite Touch

• 5. Sexual-Arousal Touch

• 4. Love-intimacy Touch

used in examinations or procedures such as when the nurse touches a client. example: to assess skin turgor or a masseuse performs a massage

1. Functional Professional Touch

used in greetings like your handshake and air kisses some women use to greet acquaintances or when a gentle hand guides someone in the correct direction

2. Social Polite Touch

- involves a hug in greeting, an arm thrown around the shoulder of a good friend, or the backslapping some men use to greet friends and relatives

3. Friendship warmth Touch

involves a hug in greeting, an arm thrown around the shoulder of a good friend, or the backslapping some men use to greet friends and relatives

4. Love-intimacy Touch

- used by couples or lovers

5. Sexual-Arousal Touch

- Language, psychosocial and intellectual development move through stages across the lifespan.

Developmental Consideration in Communication

- knowledge of a client's developmental stage will allow the nurse to modify the message accordingly.

- The ability to communicate is directly related to the development of thought process the presence of intact sensory and motor systems, and the extent and nature of an individuals opportunities to practice communication skills. As children grow, their communication abilities change markedly.

Developmental Consideration in Communication

Examples:

- The use of dolls and games with simple language may help explain a procedure to an 8-year-old.

- Adolescents with developed abstract thinking skills may need a more detailed explanation

. - Well educated, middle-aged business executives may wish to have detailed technical information.

Developmental Consideration in Communication

Communicating with people who are:

use a normal tone of voice, do not raise your voice unless asked to, be polite and patient, do not rush the conversation, speak directly to the person rather than the person with them

1. Physically Challenged

keep it short and simple

Cognitively Challenged

- acceptance, understand the ‘why’', look into the reasons for passive aggressive behavior, accept the situation, set boundaries, approach them with vulnerability and empathy, be kind to them and do not negate their emotions

3. Aggressive

THERAPEUTIC COMMUNCATION TECHNIQUES

Using silence

• Accepting pauses or silences that may extend for sev eral seconds or minutes without interjecting any verbal response

• Sitting quietly (or walking with the client) and wart attentively until the client is able to put thoughts feelings into words

• Using statements or questions that (a) encourage the client to verbalize, (b) choose a topic of conversation, and (c) facilitate continued verbalization

• "Can you tell me how it is for you?" "Perhaps you would like to talk about "Would it help to discuss your feelings? "Where would you like to begin?" "And then what?

Providing general leads

Making statements that are specific rather than general and tentative rather than absolute

Being specific and tentative

"Rate your pain on a scale of 0 to 10." (specific statement) "Are you in pain?" (general statement) "You seem unconcerned about your diabetes." (tenta tive statement

Being specific and tentative

Asking broad questions that lead or invite the client to explore (elaborate, clarify, describe, compare, or illustrate) thoughts or feelings. Open-ended ques- tions specify only the topic to be discussed and invite answers that are longer than one or two words.

Using open-ended questions

- "I'd like to hear more about that."

- "Tell me more."

- "How have you been feeling lately?"

- "What brought you to the hospital?"

- "What is your opinion?"

- "You said you were frightened yesterday. How do you feel now?"

Using open-ended questions

Providing appropriate forms of touch to reinforce car- ing feelings. Because tactile contacts vary considerably among individuals, families, and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self.

Using touch

Putting an arm over the client's shoulder. Placing yar hand over the client's hand.

Using touch

Actively listening for the client's basic message and then repeating those thoughts or feelings in similar words. This conveys that the nurse has listened and understood the client's basic message and also offers clients a clearer idea of what they have said.

Restating or paraphrasing

Client: "I couldn't manage to eat any dinner last night, not even the dessert."

Nurse: "You had difficulty eating yesterday?"

Client: "Yes, I was very upset after my family left."

Restating or paraphrasing

A method of making the client's broad overall meaning of the message more understandable. It is used when paraphrasing is difficult or when the communication is rambling or garbled. To clarify the message, the nurse can restate the basic message or confess confusion and ask the client to repeat or restate the message. Nurses can also clanty their own message with statements,

Seeking clarification

- "I'm puzzled."

- "I'm not sure I understand that."

- "Would you please say that again?"

- "Would you tell me more?"

- "I meant this rather than that."

- "I'm sorry, that wasn't very clear. Let me try to explain another way."

Seeking clarificationPerception check- ing or seeking con sensual validation

A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of a message

Perception checking or seeking con sensual validation

Client: "My husband never gives me any presents."

Nurse: "You mean he has never given you a present for your birthday or Christmas?"

Client: "Well, not never. He does get me something for my birthday and Christmas, but he never thinks of giving me anything at any other time."

Perception checking or seeking con sensual validation

Suggesting one's presence, interest, or wish to under- stand the client without making any demands or attaching conditions that the client must comply with to receive the nurse's attention

Offering self

- "I'll stay with you until your daughter arrives."

- "We can sit here quietly for a while, we don't need to talk unless you would like to."

- "I'll help you to dress to go home, if you like."

Offering self

Providing, in a simple and direct manner, specific fac- tual information the client may or may not request. When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it

Giving information

Providing, in a simple and direct manner, specific fac- tual information the client may or may not request. When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it

Giving information

- "Your surgery is scheduled for 11 a.m. tomorrow."

- "You will feel a pulling sensation when the tube is removed from your abdomen."

- "I do not know the answer to that, but I will find out from Mrs. King, the nurse in charge."

Giving information

Giving recognition, in a nonjudgmental way, of a change in behavior, an effort the client has made, or a contribu- tion to a communication. Acknowledgment may be with or without understanding, verbal or nonverbal.

Acknowledging

- "You trimmed your beard and mustache and washed your hair."

- "I notice you keep squinting your eyes. Are you having difficulty seeing?"

- "You walked twice as far today with your walker."

Acknowledging

Helping the client clarify an event, situation, or happen- ing in relation to time

Clarifying time or sequence

- Client: "I vomited this morning."

Nurse: "Was that after breakfast?"

- Client: "I feel that I have been asleep for weeks."

Nurse: "You had your operation Monday, and today is Tuesday."

Clarifying time or sequence

Helping the client to differentiate the real from the unreal

Presenting reality

- "That telephone ring came from the program on television."

- "Your magazine is here in the drawer. It has not been stolen."

Presenting reality

Helping the client expand on and develop a topic of importance. It is important for the nurse to wait until the client finishes stating the main concerns before attempting to focus. The focus may be an idea or a feeling; however, the nurse often emphasizes a feel ing to help the client recognize an emotion disguised behind words

Focusing

Client: "My wife says she will look after me, but I don't think she can, what with the children to take care of, and they're always after her about something - clothes, homework, what's for dinner that night."

Nurse: "Sounds like you are worried about how well she can manage."

Focusing

Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation

reflecting

Client: "What can I do?"

Nurse: "What do you think would be helpful?"

Client: "Do you think I should tell my husband?"

Nurse: "You seem unsure about telling your husband."

reflecting

Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview or to review a health teaching session. It often acts as an introduction to future care planning.

summarizing and planning

- "During the past half hour, we have talked about..."

- "Tomorrow afternoon, we may explore this further."

- "In a few days, I'll review what you have learned about the actions and effects of your insulin."

- "Tomorrow, I will look at your feeling journal."

summarizing and planning

barriers to communication:

1. stereotyping

2. challenging

3. being defensive

4. agreeing and stereotyping

5. probing

6. testing

7. rejecting

8. changing topics and subjects

9. unwarranted reassurance

10. passing judgment

11. giving common advice

Offering generalized and oversimplified beliefs about groups of people that are based on experiences too lim ited to be valid. These responses categorize clients and negate their uniqueness as individuals.

stereotyping

Similar to judgmental responses, agreeing and disagree ing imply that the client is either right or wrong and that the nurse is in a position to judge this. These responses deter clients from thinking through their position and may cause a client to become defensive

Agreeing and dsagreeng

Client: "I don't think Dr. Broad is a very good doctor. He doesn't seem interested in his clients."

Nurse: "Dr. Broad is head of the department of surgery and is an excellent surgeon."

Agreeing and dsagreeng

Attempting to protect an individual or healthcare services from negative comments. These responses prevent the client from expressing true concerns. The nurse is saying, "You have no right to complain." Defensive responses protect the nurse from admitting weaknesses in health care services, including personal weaknesses.

being defensive

Client: Those night nurses must just sit around and tak all night. They didn't answer my light for over an hour"

Nurse: "I'll have you know we literally run around on nights. You're not the only client, you know

being defensive