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Communication

Communication is the key to successful nursing

Nursing Practice Communication

Communication is a dynamic process used to:

  • Establish and maintain therapeutic relationships

  • Convey information and provide education

  • Express caring and empathy

  • Advocate for patients

  • Make decisions and solve problems collaboratively

  • Ensure patient safety and quality of care

Communication Defined

  • Communication is any means of sending and receiving information or feelings between two or more people.

  • Communication is a basic component of nursing. It is essential for all aspects of patient care, from assessment to evaluation, and critical for building trust and ensuring effective treatment.

Communication Process
Modes of Communication
Verbal
Nonverbal
Electronic

  • Advantages:

    • Efficiency in information sharing (e.g., electronic health records, secure messaging)

    • Quick access to patient data and collaboration with other healthcare professionals

    • Documentation accuracy and legibility

    • Remote consultation (telemedicine)

  • Disadvantages:

    • Risk of misinterpretation due to lack of nonverbal cues

    • Concerns regarding privacy and data security

    • Potential for information overload and distraction

    • Depersonalization of patient interactions

    • Requires access to technology and digital literacy

Factors Influencing Communication
Types of Communicators
Aggressive Communicators

  • Focus on their own needs, often at the expense of others.

  • May be demanding, hostile, intimidating, or sarcastic.

  • Often interrupt, use a loud voice, and maintain rigid body language.

  • Can damage relationships and escalate conflict.

Passive Communicators

  • Tend to avoid conflict and put others' needs before their own.

  • May appear shy, hesitant, apologetic, or insecure.

  • Often speak softly, avoid eye contact, and have slumped posture.

  • Can lead to their own needs not being met and resentment.

Passive aggressive

  • Indirectly express their hostility or anger.

  • May use sarcasm, gossip, procrastination, or subtle sabotage instead of direct confrontation.

  • Often agree to tasks but then do not follow through.

  • Creates confusion and lacks direct resolution.

Assertive communicators

  • Declare & affirm: Clearly express their thoughts, feelings, and needs while respecting others.

  • CUS (Concerned, Uncomfortable, Safety Issue): A tool used to effectively voice concerns in a structured, non-confrontational manner, enabling clear communication about patient safety risks.

Assertive Communication

  • Professional composure

  • "I" Statements: Focus on expressing personal feelings and needs without blaming.

  • Focus on the issue: Address specific problems rather than making personal attacks.

  • Effective nonverbal language: Maintain eye contact, open posture, and confident tone.

  • Positive Responses: Acknowledge and validate others' perspectives.

  • Accept criticism: Listen actively to feedback and respond constructively.

  • Workable compromise: Seek mutually agreeable solutions.

  • Thinking before speaking: Process thoughts and plan communication for clarity and effectiveness.

Communication: The Nursing Process
Nursing Process: Assessment

  • Definition: The systematic collection of subjective and objective data about a patient's health status.

  • Key actions: Interviewing the patient and family, observing nonverbal cues, reviewing medical records, performing physical examinations, gathering information about communication patterns and barriers.

Nursing Process: Problem (diagnosis)

  • Impaired communication: The state in which an individual experiences a decreased or absent ability to use or understand symbols.

  • Impaired oral communication: The state in which an individual experiences a decreased or absent ability to use spoken language.

  • Readiness for enhanced communication: A pattern of exchanging information and ideas that is sufficient for meeting one's specific needs and can be strengthened.

Defining characteristics

  • Impaired verbal communication: Difficulty speaking, stuttering, slurring, difficulty forming words, inability to speak, inappropriate verbalizations, disorientation, refusal to speak.

  • Impaired receptive communication: Difficulty understanding, selective listening, inappropriate responses.

  • Nonverbal cues: Lack of eye contact, withdrawn, frustrated facial expressions.

Nursing Process: Planning

  • Definition: Developing a plan of care that includes patient-centered goals and expected outcomes related to communication.

  • Key actions: Setting realistic and measurable goals (e.g., "Patient will be able to express needs clearly by end of shift"), identifying specific communication strategies, collaborating with the patient and interdisciplinary team.

Nursing Process: Implementation

  • Use therapeutic communication techniques (e.g., active listening, open-ended questions).

  • Provide privacy and a comfortable environment.

  • Eliminate distractions.

  • Use simple language and short sentences.

  • Allow sufficient time for the patient to respond.

  • Use aids such as pictures, whiteboards, or sign language interpreters if needed.

  • Validate understanding through teach-back methods.

  • Key actions: Carrying out the planned interventions, continuously assessing the patient's response, providing instruction and support.

Nursing Process: Evaluation

  • Definition: Determining the effectiveness of the communication interventions and whether the patient's goals have been met.

  • Key actions: Comparing actual patient outcomes with desired outcomes, reassessing the patient's communication ability, modifying the care plan as needed, documenting the patient's response and any changes.

Therapeutic and Non-Therapeutic Communication Techniques
Therapeutic Communication Techniques

  • Active Listening: Fully concentrating on what is being said verbally and nonverbally.

  • Silence: Allowing time for the patient to think or compose thoughts; can convey acceptance.

  • Open-ended Questions: Encouraging detailed responses, not just yes/no answers (e.g., "Tell me more about…").

  • Clarifying: Asking for more information to ensure understanding when a message is unclear (e.g., "Could you explain what you mean by…").

  • Reflecting: Repeating the patient's words or feelings back to them to show understanding and encourage further expression.

  • Empathy: Communicating an understanding of the patient's feelings and experiences.

  • Offering Self: Making oneself available to the patient (e.g., "I'm available to talk if you need anything").

  • Sharing Observations: Commenting on observed behaviors to validate or prompt discussion (e.g., "You seem anxious").

  • Focusing: Concentrating on a single point or issue to guide discussion.

Barriers to Communication (Non-Therapeutic Techniques)

  • Giving False Reassurance: Dismissing the patient's feelings with insincere comfort (e.g., "Don't worry, everything will be fine").

  • Asking "Why" Questions: Can make the patient feel defensive or judged.

  • Changing the Subject: Avoiding sensitive topics, making the patient feel their concerns are unimportant.

  • Giving Personal Advice: Imposing one's own solutions rather than allowing the patient to find their own.

  • Approving/Disapproving: Imposing judgments of right or wrong, hindering open expression.

  • Stereotyping: Using generalizations about people, ignoring individual differences.

  • Being Defensive: Protecting oneself or others from criticism, which can shut down communication.

  • Excessive Questioning: Bombarding the patient with too many questions, making them feel interrogated.

  • Minimizing Feelings: Downplaying the patient's emotional experience.

Preparing for Interview

  • Prepare yourself: Be informed about the patient's history, mentally prepare for the interaction, and ensure you are free from personal biases.

  • Prepare the space: Ensure privacy, minimize distractions, adjust lighting and seating for comfort.

  • Prepare the patient: Explain the purpose of the interview, ensure they are comfortable, and address any immediate concerns.

Conducting the interview

  • Collecting Data

Therapeutic Communication

  • Open-ended questions (nondirective) vs. Closed-ended (directive)

Team Strategies and Tools to Enhance Performance and Patient Safety
Outcomes of Team Competencies

  • Knowledge:

    • Shared mental model

  • Attitudes:

    • Mutual trust

    • Team orientation

  • Performance:

    • Adaptability

    • Accuracy

    • Productivity

    • Efficiency

    • Safety

What Defines a Team?

  • Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership

Team Structure

  • Understanding a team’s structure and how multiple teams interact is critical for implementation planning

High-Performing Teams

Teams that perform well:

  • Hold shared mental models

  • Have clear roles and responsibilities

  • Have clear, valued, and shared vision

  • Optimize resources

  • Have strong team leadership

  • Engage in a regular discipline of feedback

  • Develop a strong sense of collective trust and confidence

  • Create mechanisms to cooperate and coordinate

  • Manage and optimize performance outcomes

Barriers to Team Performance

  • Inconsistency in team membership

  • Lack of time

  • Lack of information sharing

  • Hierarchy

  • Defensiveness

  • Conventional thinking

  • Varying communication styles

  • Conflict

  • Lack of coordination and follow-up

  • Distractions

  • Fatigue

  • Workload

  • Misinterpretation of cues

  • Lack of role clarity

Partnering With the Patient

Strategies for involving patients in their care:

  • Include patients in bedside rounds

  • Conduct handoffs at the patient’s bedside

  • Provide patients with tools for communicating with their care team

  • Actively enlist patient participation

Clinical Team Responsibilities

Embrace patients and their families as valuable and contributing partners in patient care:

  • Listen to patients and their families

  • Assess patients’ preference regarding involvement

  • Ask patients about their concerns ask for their feedback

  • Give them access to relevant information

  • Encourage patients and their families to proactively participate in patient care

Patient and Family Responsibilities
Communication

  • Effective communication skills are vital for patient safety

  • Enables team members to effectively relay information

  • The mode by which most TeamSTEPPS strategies and tools are executed

Importance of Communication

  • Joint Commission data continues to demonstrate the importance of communication in patient safety

  • 1995-2005: Ineffective communication identified as root cause for nearly 66 percent of all reported sentinel events*

  • 2013-2015: Ineffective communication among top 3 root causes of sentinel events reported**

Standards of Effective Communication
Information Exchange Strategies

  • Situation – Background – Assessment – Recommendation (SBAR)

  • Call-Out

  • Check-Back

  • Handoffs

SBAR Provides…

A framework for team members to effectively communicate information to one another
Communicate the following information:

  • Situation—What is going on with the patient?

  • Background—What is the clinical background or context?

  • Assessment—What do I think the problem is?

  • Recommendation—What would I recommend?

Call-Out

A strategy used to communicate important or critical information

  • It informs all team members simultaneously during emergency situations

  • It helps team members anticipate next steps

  • It directs responsibility to a specific individual assigned to carrying out the task

Check-Back

  • A closed-loop communication strategy to ensure that information conveyed by the sender is understood by the receiver as intended.

  • Sender initiates a message, receiver accepts and provides feedback, sender verifies the message was received.

Handoff is…

  • The transfer of information during transitions in care across the continuum.

Handoff Consists of…

  • The transfer of information during transitions in care across the continuum (e.g., shift changes, patient transfers between units or facilities).

  • Includes an opportunity to: Ask questions, clarify, and confirm information.

  • Consists of: A concise summary of the patient's condition, recent changes, anticipating care, and any necessary actions.

  • Transfer of: Responsibility and accountability for patient care.

  • Clarity of: Information, minimizing omissions and misunderstandings.

  • Verbal communication of information: Often supplemented by written or electronic documentation.

  • Acknowledgement by: The receiving care provider that they have received and understood the information, often by repeating key details, to ensure continuity and safety of care.