Module 38 - Communication - "Nursing: A Concept-Based Approach to Learning"

communication

any means of exchanging information or feelings between two or more individuals

sender

an individual or group who wishes to convey a message to another, can be considered the source-encoder; this term suggests that the person or group sending the message must have an idea or reason for communicating (source) and must put that idea or reason into a form that can be transmitted

encoding

involves the selection of specific signs or symbols (codes) to transmit the message, such as which language and words to use, how to arrange the words, and what medium to use, which may involve tone of voice and gestures in oral commuication

message

the words actually spoken or written, the body language that accompanies the words, and how the words are transmitted

channel

the medium used to convey the message

receiver

the listener, who must listen, observe, and attend

response

the message that the receiver returns to the sender; also called feedback

verbal communication

uses the spoken or written word

nonverbal communication

uses other forms, such as gestures, facial expressions, and touch

electronic communication

Email is perhaps the most common form of electronic communication, although social networking, and text messaging are used frequently outside the workplace.

congruent communication

the nurse's behavior or nonverbal communication is congruent (consistent) with the words spoken

credibility

the quality of being truthful, trustworthy, and reliable

active listening

also known as attentive or mindful listening, involves fully concentrating on both the content and emotion of a person's message, rather than just passively hearing the words a person says

values

the standards that influence behavior

perceptions

the personal views of an event

personal space

the distance individuals prefer to keep between themselves and others during interactions

proxemics

the study of distance between individuals who are interacting

intimate distance

communication that is characterized by body contact, heightened sensations of body heat and smell, and vocalizations that are low

personal distance

is less overwhelming than intimate distance; voice tones are moderate, and body heat and smell are less noticable; physical contact such as a handshake or touching a shoulder is possible

social distance

characterized by a clear visual perception of the whole person; body heat and odor are imperceptible, eye contact is increased, and vocalizations are loud enough to be overheard by others

public distance

requires loud, clear vocalizations with careful enunciation; although face and forms of people are visible at public distance, individuality is lost

elderspeak

a style of speech similar to baby talk that sends the message to older adults that they are dependent and incompetent

aggressive communicators

Those who tend to focus on their own needs and become impatient when these needs are not met.

passive communicators

those who focus on the needs of others

assertive communicators

those who declare and affirm their opinions

group

three or more individuals who have a common purpose, interact with each other, influence each other, and are interdependent

primary group

a small, intimate group in which the relationships among members are personal, spontaneous, sentimental, cooperative, and inclusive; examples are the family, a play group of children, informal work groups, and friendship groups

secondary group

generally larger, more impersonal, and less sentimental than a primary group

Advocacy

Communication among nurses, patients, and physicians is a key component of effective healthcare. In addition to communication with patients, nurses directly or indirectly influence physician-patient communications

Advocacy (nursing implications)

* Assess what the healthcare provider has told the patient regarding the patient's condition.

* Encourage the patient to clarify the understanding with the healthcare provider.

*.Help the patient identify and access high-quality sources of healthcare information.

* Always advocate for the best interests of the patient and the patient's expressed wishes.

Comfort

Pain to communication ability. Impaired communication may decrease ability to report pain.

Comfort (nursing implications)

* Take patient's report of pain levels seriously.

*. Assess for nonverbal signs of pain such as wincing and guarding.

* Communicate equally with patients across the lifespan.

*.Use a pain management scale such as a numeric rating scale or the FACES pain rating scale that is appropriate for the patient's age and ability to communicate.

* Investigate palliative care care options for patients at the end of life.

Grief and Loss

Grief or loss can adversely affect the way in which an individual communicates. Not only does the person experiencing the loss have trouble communicating needs to others, but others often do not know how to communicate their condolences to those who have experienced a loss. Cultural differences can exacerbate communication issues.

Grief and Loss (nursing implications)

* Determine the effects of the loss on the patient. If the patient is grieving the loss of a primary caregiver or a spouse who provided financially for the patient, the patient may have a number of immediate needs.

* Consider the stages of grief when communicating with patients.

* Consider the cultural background of the patient and family related to expressions of grief and loss.

Intracranial Regulation

Impaired intracranial regulation to impaired communication. Traumatic brain injury to difficulty with word finding, sentence formation, and expression. patients with severe increased intracranial pressure may enter a coma state.

Intracranial Regulation (nursing implications)

* Recognize the communication difficulties cause by traumatic brain injuries early and respond appropriately.

* Help the patient with cognitive and/or physical limitations find an appropriate therapist to help them regain lost abilities.

* If patients have difficulty expressing their thoughts, calmly help them find ways of communicating.

Mood and Affect

A diagnosis of mental illness increases liklihood patient will experience discrimination/stigma, may increase reluctance to trust healthcare personnel. In addition, healthcare providers may miss signs that these patients are suffering from these disorders.

Mood and Affect (nursing implications)

* Be aware that people of all ages suffer from mental and psychiatric disorders.

* Do not assume that someone does not have one of these conditions because of their physical appearance.

* Screen patients for depression or other psychiatric illness by asking open-ended questions with empathy.

* Research medical records for histories of mental illness and cognitive issues and shape communication appropriately.

* Be consistent and predictable in your nursing practice and communication.

Oxygenation

Decreased O2 leads to hypoxemia which leads to decreased level of consciousness (LOC) which leads to decreased ability to communicate verbally (due to shortness of breath and LOC) and nonverbally (due to decreased LOC)

Oxygenation (nursing implications)

* Position patient in Fowler or semi-Fowler position as indicated to promote ease of breathing.

* Administer medications and supplemental oxygen as ordered.

* Consider other methods of communication for the patient (e.g. tablet, a family member)

Safety

Impaired communication increases risk for illness and injury.

Safety (nursing implications)

* Create a supportive environment that promotes communication and safety.

* Introduce opportunities for the patient to communicate needs and concerns.

* Be tactful and avoid abrupt, offensive, and accusatory statements.

* Maintain a nonthreatening approach and validate cooperation.

* Listen to the concerns of other members of the healthcare team.

* Apologize when needed.

* Agree when possible.

* Encourage the team to follow national standards.