Communication and Relationships in Nursing

Communication and Relationships

The Communication Process

• The communication process involves the exchange of information, feelings, needs, and preferences between two or more people.
• Key components include:
  • Listening
  • Observing
  • Processing
• The goal is to establish a mutual understanding of the meaning of a message.

Communication Process Diagram

The communication process involves a sender, a receiver, information and feedback.

Types of Communication

Verbal Communication

• Choice of words depends on factors like age, education, developmental level, and culture.
• Feelings can be expressed through changes in pitch, pace, and tone of voice.

Nonverbal Communication

• Includes facial expressions, posture, body position, behavior, gestures, touch, and general appearance.
• It's often less conscious and more indirect.
• Nonverbal cues convey more of a person's feelings, thoughts, and true meaning compared to spoken words.

Factors That Affect Communication

Personal Space & Proxemics

• Proxemics: The study of personal space and its impact on communication.
  • Intimate distance: Ranging from physical contact to 18 inches.
  • Casual-personal distance: 18 inches to 4 feet.
  • Social-consultative distance: 4 to 12 feet.
  • Public distance: 12 feet or more.

Body Position

Language

• Nurses must use clear, unequivocal, and unbiased language.

Culture

• Sensitivity to an individual's culture requires recognizing and respecting accepted communication patterns within that culture.

Attitude

• Attitude refers to the manner, disposition, feeling, or position toward a person or thing.

Emotion

• Denotative meaning: Literal meaning of a word.
• Connotative meaning: Emotional association with a word.

Active Listening

• Involves using all senses.
• Interpreting verbal and nonverbal messages.
• Focusing the mind on the interaction to detect feelings and spoken words.
• Builds trusting relationships between the nurse and the patient.

Styles of Communication

• Individuals develop a communication style based on personality and self-concept.

Passive or Avoidant

• Behaviors that avoid confrontation and the inability to share feelings or needs with others.

Aggressive

• Behaviors characterized by prioritizing one's own needs, rights, and feelings over others.

Assertive

• Behavior characterized by standing up for oneself without violating the basic rights of others.

Therapeutic Communication

• Patient-centered communication aimed to promote a greater understanding of a patient’s needs, concerns, and feelings.
• The nurse helps patients explore their own thoughts and feelings and encourages expression while avoiding communication barriers.

Therapeutic Communication Techniques

• Providing general leads
• Using silence
• Offering self
• Open-ended questions
• Restatement (validation)
• Seeking clarification
• Giving information
• Reflection
• Looking at alternatives
• Summarizing

Barriers to Therapeutic Communication

• Asking questions answerable with yes/no
• Giving false reassurance
• Asking too many personal questions
• Giving advice
• Belittling a patient’s feelings
• Expressing disapproval

Communication Crisis: ISBARR/ISBARQ

• A structured communication tool used in healthcare settings.
• Introduction: Identify yourself and your role.
• Situation: Briefly state the issue.
• Background: Provide relevant context.
• Assessment: Share your analysis of the situation.
• Recommendation: Suggest specific actions.
• Readback (or Questions): Confirm understanding or ask clarifying questions.
• Nurses must use focused communication with clear and concise language and organize thoughts to deliver information effectively.

Anger, Hostility, and Incivility in Communication

• Anger is a strong emotion comprising guilt and resentment, manifested through screaming, sarcasm, insults, etc.
• Incivility is interacting with a lack of courtesy and respect, verbally or nonverbally.
• Establish a culture of respect using strategies that inhibit incivility, per the American Nurses Association (ANA).

Humor in Communication

• It create a relaxed and sociable atmosphere and helps patients step out of their sick role, establish rapport/trust, pass time, and relieve anxiety.
• Nurses who use humor may seem more approachable.
• Inappropriate when dealing with highly emotional or difficult issues.

Communication With the Health-Care Team

• Nurses communicate with patients, families, and other members of the health-care team.
• Upward communication: Communication with people in positions of authority (e.g., team leaders, supervisors).
• Communication with healthcare providers regarding orders (written or verbal).

Downward Communication Techniques (Communication with those supervised by the nurse)

• Job instruction
• Job rationale
• Practices and procedures
• Feedback
• Role modeling

Shift Report

• Must remain confidential.
• Include appropriate data:
  • Basic patient data
  • Special safety issues
  • Sensory deficits
  • Scheduled procedures
  • Pertinent diagnostic results
  • Assistive equipment & Prosthetic devices
• The Joint Commission requires the oncoming shift to have the opportunity to ask questions.

Written Communication

• Write effectively by:
  • Knowing your audience
  • Identifying the purpose
  • Following the KISS principle: Keep It Short and Simple!

The Nurse-Patient Relationship

• To develop a good rapport, the nurse should establish:

Trust

• The heart of the relationship.

Empathy

• The ability to intellectually, not emotionally, identify with or experience the feelings, thoughts, or attitudes of others.

Patient-Centered Communication

• Encourage and empower patients to participate in their care through attentiveness, a friendly tone, and focusing on the patient rather than solely on tasks.

Communication During a Patient Interview

Directive

• Questions are structured to elicit specific data (Who, What, When, Where, How, Do, Is).

Nondirective

• Uses open-ended questions allowing the patient to explore their thoughts and feelings.

Communicating During a Patient Interview

Nonverbal communication

• Observe body language for unstated feelings or behaviors.
• Make eye contact with patient.
• Remain open and relaxed.
• Be sensitive while still obtaining factual information that you need.
• Assess health literacy and avoid bias.

Special Communication Needs

• Considerations for people who are deaf or hard of hearing, have speech and language impairments (e.g., aphasia), vision impairments, are on mechanical ventilation, or are unresponsive.