Lecture: Competency 5- Communication

What is communication?

The transfer or exchange of information between a sender and receiver through verbal communication, body language, emotions, technology, or other equipment.

Why is effective communication important in nursing?

It promotes client safety, improves relationships, and reduces misunderstandings and medical errors.

What are the six concepts of the Shannon-Weaver communication model?

Sender, Encoder, Channel, Decoder, Receiver, and Noise.

What is the sender in the communication process?

The person who starts or initiates the message.

What is the encoder?

The means by which the message is transmitted.

What is the channel?

The method through which the message is transmitted, such as a phone, computer, verbal conversation, or video.

What is the decoder?

The component that changes the transmitted signal back into a message the receiver can understand.

What is the receiver?

The person who receives the message.

What is noise in the communication process?

Any environmental distractor or interference that disrupts the message.

What are the three main components of Schramm's communication model?

Sender, receiver, and message.

How is Schramm's model different from a one-way communication model?

The sender and receiver exchange messages back and forth and provide feedback.

What is feedback?

A response from the receiver that helps the sender determine whether the message was received and understood.

Why is feedback important in nurse-client communication?

It allows the nurse to evaluate whether the client understood the message and determine how to proceed.

What is Newcomb's ABX model of communication?

A social communication model involving a sender (A), receiver (B), and topic (X).

What does Berlo's SMCR model stand for?

Sender, Message, Channel, Receiver.

What is an important limitation of Berlo's SMCR model?

It is a one-way communication process and does not include feedback.

What is an example of Berlo's one-way communication model?

Sending a client an instructional video when the client has no immediate way to ask questions.

What are the four modes of communication?

Verbal, Nonverbal, Electronic, and Written.

What is verbal communication?

Oral communication, such as face-to-face conversations or telephone conversations.

What is nonverbal communication?

Communication through body language and behaviors rather than spoken words.

What are at least eight ways people communicate nonverbally?

Facial expressions, gestures, posture, eye contact, touch, personal space, body language, voice tone/pitch, and overall appearance.

Why is nonverbal communication important?

Nonverbal messages can support or contradict what a person is saying verbally.

Which message tends to outweigh the other when verbal and nonverbal communication conflict?

The nonverbal or physical message.

What factors should the nurse consider when interpreting nonverbal communication?

Culture, age, language, physical deficits, and developmental level.

What is auditory communication?

What the receiver hears when the sender speaks, including the speed and tone of voice.

What is emotional communication?

Communication influenced by the speaker's emotional state and how those emotions affect the receiver.

What is energetic communication?

How a person projects themselves when communicating.

How should a nurse use energetic communication therapeutically?

Maintain a caring and compassionate attitude and demonstrate empathy.

What are examples of electronic communication in health care?

Email, texting, video conferencing, client portals, and social media.

What is a major risk associated with electronic communication?

Privacy and confidentiality violations.

What professional responsibility does a nurse have when using electronic communication?

Protect client privacy and confidentiality and follow HIPAA requirements.

What type of system should nurses use to electronically transmit client information?

A facility-approved, secure, HIPAA-compliant encrypted platform.

Should nurses share passwords for electronic health systems?

No. Passwords should never be shared.

What should a nurse do with an electronic client chart when it is not being used?

Close or secure it rather than leaving it open.

What safeguards should electronic communication containing PHI have according to the ATI material?

Personalized user login that can be monitored, automatic logoff when unattended, and PHI attachments that are indecipherable if intercepted.

Why can written communication cause misunderstandings?

It lacks nonverbal cues, making the sender's tone and emotions more difficult to interpret.

What client factors can interfere with written communication?

Literacy, language differences, and visual impairments.

Is a nurse's personal email or standard SMS appropriate for sending PHI?

No. PHI should be sent using secure, HIPAA-compliant methods.

What major factors can influence communication?

Cognitive/developmental, physiological, psychosocial, environmental/situational, cultural/demographic, language, emotional, educational, and personal factors.

What are examples of cognitive, intellectual, or developmental factors affecting communication?

Autism spectrum disorder (ASD), dementia, Down syndrome, and developmental stage.

What physiological factors can interfere with communication?

Hearing impairment, vision impairment, pain, and disease processes.

What environmental factors can interfere with communication?

Noise, extreme temperatures, poor or excessive lighting, and distractions.

What emotions can interfere with effective communication?

Fear, anxiety, and fatigue.

What cultural and demographic factors can influence communication?

Language, religion, sexual orientation, age, gender, cultural differences, and personal biases.

How can medical jargon interfere with communication?

It can confuse the client, create misunderstanding, and interfere with informed consent.

How should nurses communicate with clients who have developmental or cognitive communication difficulties?

Use short, clear, directive instructions and avoid slang, medical terminology, and abstract language.

What environmental modifications can improve communication with clients who have cognitive or developmental impairments?

Provide a well-lit, supportive environment with limited noise and distractions.

What is an open-ended question?

A question that encourages the client to elaborate rather than provide a one-word response.

What words commonly begin open-ended questions?

What, how, when, where, and who.

What are the purposes of open-ended questions?

To invite the client to talk, encourage elaboration, obtain examples of a problem, and assess understanding.

What is an example of an open-ended question?

"What is on your mind today?"

What is a closed question?

A question asking for a specific fact that can usually be answered with one word or a short phrase.

What words commonly begin closed questions?

Are, do, did, is, and can.

When can closed questions be useful?

When obtaining a specific fact, narrowing a discussion, or redirecting a client who is overtalking or rambling.

What is a focused question?

A question that narrows or defines a topic by requesting a specific response.

What is the purpose of a focused question?

To define a topic more specifically or obtain descriptive information about a symptom, sign, problem, or event.

What is a "laundry-list" question?

A question that provides several adjectives, descriptions, or choices from which the client can choose.

What is the purpose of a laundry-list question?

To obtain specific information by giving the client a series of choices and further identify a topic, event, or problem.

What are the cornerstones of a therapeutic relationship?

Compassion, caring, and empathy.

What is rapport?

A trusting, respectful connection between the nurse and client that promotes communication.

What are the four phases of the nurse-client helping relationship?

Orientation, Identification, Exploitation, and Resolution/termination.

What occurs during the orientation phase?

The client reaches out for help, the nurse meets the client, explains the nurse's role, and begins building rapport.

What occurs during the identification phase?

The nurse and client establish a mutually respectful relationship, assess problems, identify needs, and discuss goals.

What occurs during the exploitation phase?

The nurse and client actively work toward the goals through interventions and education.

What occurs during the resolution or termination phase?

The client's issue has been resolved and the nurse-client relationship ends until another event requires care.

What is the nurse's role throughout the helping relationship?

To act as a guide and help the client receive the care needed.

What is therapeutic communication?

Communication that uses listening, empathy, and professional relationship-building to provide holistic, patient-centered care.

What factors promote therapeutic communication?

Warmth, friendliness, openness, respect, empathy, honesty, authenticity, trust, caring, competence, privacy, confidentiality, open-ended questions, and a comfortable environment.

Should therapeutic communication be patient-focused or task-focused?

Patient-focused.

What are common therapeutic communication techniques?

Active listening, silence, open-ended questions, restating, paraphrasing, summarizing, reflection, accepting, giving recognition, and focusing.

What is active listening?

Focusing on and considering both the client's verbal and nonverbal messages to understand the true meaning of the communication.

What behaviors demonstrate active listening?

Facing the client, appropriate eye contact, attentive responses such as nodding, and minimizing distractions.

What is the therapeutic purpose of silence?

It gives the nurse and client time to absorb the conversation, organize thoughts, and encourages the client to disclose more information.

When is reflection particularly useful?

When a client asks the nurse for advice or the nurse's opinion.

What is accepting?

Acknowledging that the nurse has heard and understood the client.

What is giving recognition?

Acknowledging changes or accomplishments without giving biased compliments.

What is motivational interviewing (MI)?

A form of therapeutic communication that allows the nurse and client to develop plans that promote the client's health.

What does OARS stand for in motivational interviewing?

Open-ended questions, Affirmations, Reflective listening, and Summarizing.

What are affirmations in motivational interviewing?

Positive statements that encourage the client and help build confidence.

What is an example of an affirmation?

"You did very well with your food diary this week."

Why is motivational interviewing useful in nursing?

It can help clients make positive changes in behaviors and health status.

What is nontherapeutic communication?

Communication that interferes with the nurse-client relationship and can cause misunderstandings, increased stress, poor care, and decreased client satisfaction.

What factors can inhibit therapeutic communication?

Poor listening, clichés, changing the subject, "why" questions, closed-ended questions, false reassurance, judgment, disruptive behaviors, gossip, rumors, and unsolicited advice.

Why can asking "Why did you do that?" be nontherapeutic?

It can sound judgmental or challenging and make the client feel they must defend their actions.

Why is giving unsolicited advice nontherapeutic?

It can dismiss the client's feelings and take decision-making away from the client.

What should the nurse use instead of giving advice?

Reflection to help the client explore options and make their own decisions.

Why are clichés nontherapeutic?

They minimize the client's feelings and can cause frustration or shut down communication.

Why is false reassurance nontherapeutic?

It dismisses or minimizes the client's concerns rather than allowing them to express their feelings.

What is an example of false reassurance?

"Don't worry. Everything will be okay."

How does judgment hinder communication?

It can cause defensiveness and withdrawal and make the client less likely to communicate honestly.

How does interrupting a client hinder communication?

It can communicate disrespect, make the client feel unheard, and discourage further feedback.

How does changing the subject hinder communication?

It can make the client feel the nurse does not care about the client's concerns.

How does talking over or dominating a conversation hinder communication?

It leaves the client little opportunity to express thoughts or feelings.

How do assumptions hinder communication?

They can cause misunderstandings and prevent the nurse from identifying the client's actual concerns.

Why is closed body language nontherapeutic?

Behaviors such as crossed arms can communicate rejection or make the client feel unwelcome.

How do mismatched verbal and nonverbal messages affect communication?

They send conflicting messages and can cause confusion.

What are the four communication styles?

Passive, Assertive, Aggressive, and Passive-aggressive.

Which communication style is considered most effective?

Assertive communication.

What is passive communication?

A pattern of avoiding conflict, not expressing feelings or opinions, and not standing up for oneself when boundaries are crossed.

What is an example of passive communication?

"I'll do whatever you want," despite disagreeing.