CSN NURS 101 Ch. 8

Communication

process of exchanging information and generating and transmitting meaningful information; a cycle

process of communication: source (encoder)

process initiated based on stimulus (patient needs) and begins by sender or source

stimulus

the reason to initiate conversation; in nursing its the assessment

process of communication: message

product of communication

example: conversation, nursing note, chart

process of communication: channel

medium used to send message (auditory, visual, touch)

process of communication: receiver (decoder)

translate and interpret message received

**if something is unclear ask!

process of communication: feedback

confirmation that message received

process of communication: noise

distractors

example: TV, pain, discomfort

verbal communication

exchange information using words (spoken or written)

language

the way of using words

**use certified health interpreter to translate medical jargon; it's okay to use without if not medical related

channel: visual

sight: visual stimulus

observation: interpreting stimulus

perception: putting meaning to visual

channel: auditory

hearing: auditory stimulus

listening: awareness/feelings about message

channel: kinesthetic

procedural touch: nursing procedure and techniques

caring touch: emotional support

nonverbal communication

communication without words, body language can confirm or deny verbal communication, more truthful than verbal

touch

most effective nonverbal way to express feelings:

can be reassuring and caring but be mindful of other person's reaction

children: normal development

older adults: may long for touch

eye contact

communication begins here

-some Asian and Native American cultures consider eye contact as rude, invasion of privacy, avoiding eye contact is form of respect

-some culture considers it as sign of respect and willingness to listen

facial expressions

face is most expressive part of body

posture

the way person holds themselves

good health and positive: good alignment

depressed or tired: slouch

pain: rigid, stiff

gait

body movement

appearance

changes in appearance is important to detect illness or evaluate effectiveness of therapy

dress and grooming

healthy: care about appearance

ill: doesn't care

sounds

crying: sadness

gasping: fear, pain, surprise

sigh: reluctance, relief

silence

gives time to understand or express anger

levels of communication: intrapersonal

self talk

levels of communication: interpersonal

regular conversation, problem solving, goal attainment, team building, not really a teaching session

levels of communication: small group

formal

examples: staff meetings, patience conferences, support groups, teaching session, orientation, professor-student teaching

levels of communication: organizational

people in organization communicate with each other to achieve goals, fellow employees

example: council meetings to review unit policies, interdisciplinary groups, professor talking to other faculty members

developmental level

children: simple terms

adolescents: more detailed and accurate

older adults: assess if they can hear or see, confusion, depressed, etc

biological sex

women: language is for confirmation, establish intimacy, maintain and develop relationships

men: pass a message, a tool, goal is to win conversation

sociocultural

recognize cultural differences to figure out mode of communication

first step of cultural competence is being aware of own cultural beliefs

roles and responsibilities

person's occupation and role may give generalization of their abilities to communicate

space and territoriality

proxemics: study of distance between people

4 feet is ideal distance

intimate zone 0-18 in

parents and children or people who desire close contact

personal zone 18in-4ft

close friend, patient interview

social zone 4ft-12ft

social setting

public zone 12ft-25ft

speaking to audience or small groups

physical, mental, emotional state

physical comfortable, mentally and emotionally free to interact

values

the way people value themselves, one another, purpose

example: nurse believes teaching is important will empower patients

environment

maintain calm and nonthreatening

change of shift report

- KNOW CODE STATUS

- Patient information

- Admitting diagnosis

- Physician

- Procedures with dates

- IV solutions, rates, when bag hung, how much left

- Medications

- Use of PRN meds

- Orders D/C'd or affecting next shift

- Response to treatment

- Special equipment

- Patient behavior

- Nursing assessments

- Referrals

- Teaching plans

- Discharge plans

Hand-off communication: SBAR

created by The Joint Commission and Institute of Healthcare Improvement; used to enhance clarity and efficiency of communication

Situation and Background: objective data

Assessment and Recommendation: subjective data

I-SBAR-R

I - Identification: Identify yourself and your patient (two identifiers to be used).

S - Situation: What is happening at the present time?

B - Background: What are the circumstances leading up to this situation?

A - Assessment: What do I think the problem is?

R - Recommendation: What should we do to correct the problem?

R - Read back or response: The receiver acknowledges the information given, and what is the response?

example of SBAR: patient admitted to hospital after mechanical fall. PMH of COPD. Had hip surgery yesterday. Now c/o SOB. RR-24, O2sat90%, wheezing. Oxygen and breaking treatment is needed

- Situation: shortness of breath

- Background: PMH of COPD, had hip surgery yesterday

- Assessment: RR-24, o2sat90%, wheezing

- Recommendation: oxygen and breaking treatment

CUS

speak up about patient safety

I am Concerned

I am Uncomfortable

This is a Safety issue

helping relationship

develop rapport and trust, be aware of nonverbal communication, does not occur spontaneously, specific purpose and person, dynamic, accountable to outcomes and honest

unequal sharing information, built on patient needs

social relationship

- spontaneous without purpose

- equal sharing of information

- both participants needs are considered

Goals of the helping relationship

Increased independence, greater feelings of worth, improved health and well-being, etc.

phases of helping relationship: orientation

relationship begins here, data gathering of nursing process

goals: introduce each other, agreement to achieve goals, patient has orientation to facility, services, admission routine

Phases of the Helping Relationship: Working Phase

when the nurse and the patient work together to solve problems and accomplish goals

goals: assist with ADL, implement health promotion, cooperate in care plan, nursing care

Phases of the Helping Relationship: Termination Phase

can happen during any change of shift, when patient is discharged, examine goals and progress

goals: identifying goals accomplished or progress made

dispositional traits: warmth and friendliness

pleasant greeting to begin orientation phase

dispositional traits: openness and respect

key factors to effective communication

dispositional traits: empathy

putting yourself in patient's shoes

dispositional traits: honesty, authenticity, trust

patient should trust nurse

dispositional traits: caring

helping relationship must be relation-centered not task-centered

dispositional traits: compentence

nurse must be skilled and meet needs, evaluate strengths and weakness to give effective care

communication: nursing observations

-be aware of nonverbal communication

-primary source of information is when patient is unwilling or unable to communicate verbally

-demonstrate caring and interest in patient

conversation skills

Control tone of voice, be knowledgeable, be flexible, be clear and concise, avoid words with different interpretations, be truthful, keep an open mind, and take advantage of opportunities

semantics: study of meaning of words

listening skills

- use body language to show you are listening

- take advantage of pauses to offer encouragement

- do not interrupt

- repeat or rephrase the speaker's thoughts and feelings

therapeutic touch

interest, promote comfort, relaxation, healing, sense of wellbeing

humor

interpersonal skill and healing strategy

interviewing techniques

tool to collect data during assessment, begin with purpose of interview

open-ended questions

questions that allow respondents to answer however they want

closed questions

questions that ask for specific information and elicit a short, one- or two- word answer, a "yes" or "no," or a forced choice

validating question

validate what the nurse thinks she heard or observed; if overused the patient may think nurse is not listening

clarifying questions

questions that seek to understand the meaning of particular words or phrases that the speaker used in the message

reflective question

repeating what the person has said or describing the person's feelings

sequencing question

used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events

directing question

used to obtain more information about a topic brought up earlier in the interview or to introduce a new aspect of a current topic

assertive

standing up for your rights in a firm but positive way

characteristics: confident, can work without supervision, remain calm, freedom to ask help, ability to give and receive compliments, honest about mistakes

aggressive

asserting one's rights in negative way, tension and anger

characteristics: angry tone, make accusations, intolerance, rude and threatening, hostile

blocks to communication: failure to see patient as human

focus on whole patient not patient diagnosis

blocks to communication: failure to listen

approach with close mind and focusing on own needs

blocks to communication: cliche

stereotypes, false assurance

blocks to communication: closed ended questions

cut conversations especially to seek more info

blocks to communication: why and how

intimidating, it's like accusing, patient can be defensive

blocks to communication: probe

pushing for anwsers the patient does not want to discuss

*follow patients lead in conversation

blocks to communication: leading questions

gives response speaker wants to hear so the patient is likely to not be honest

blocks to communication: giving advice

implies nurse knows what best for the patient

blocks to communication: judegmeental

impose nurse's standards on patient

blocks to communication: changing subject

quickest way to end conversation

blocks to communication: false assurance

nurse is not interested in their problems when outcome is not good

blocks to communication: gossip and rumor

"grapevine," blocks team building

incivility

rude, intimidating, and undesirable behavior directed at another person

example: refusing to help coworkers or shar information about patient care

bullying (lateral violence/professional incivility)

harassment, intimidating others, persistent and direct physical or verbal behavior

covert: withhold information, social isolation

overt: accusing nurse of errors made be others, humiliation

The Joint Commission's effort about disruptive behavior

o Education on respect, behavior, communication

o All staff accountable for behavior

o Zero tolerance and protection

o People in leadership positions must attend training to be positive role model

o Surveillance and reporting systems

o Emphasis on importance of documenting bullying behaviors and disruptive communication

impaired verbal communication

Decreased, delayed, or absent ability to receive, process, transmit, and/or use a system of symbols

hearing loss

chronic ear infections, heredity, birth defects, health problems at home, certain drugs, head injury, viral or bacterial infection, exposure to loud noise, aging, tumors

speech and language disorders

hearing loss, cerebral palsy, nerve and muscle disorders, severe head injury, stroke (brain attack), viral diseases, mental retardation, physical impairment, cleft lip or palate, vocal abuse, inadequate speech and language