Communication in Nursing

Learning Objectives

• Describe the communication process and identify factors that influence communication.
• Describe ways in which people communicate nonverbally.
• Discuss professional responsibilities when using electronic communication and other communication technologies.
• Describe the interrelation between communication and the nursing process.
• Identify patient goals for each phase of the therapeutic nurse–patient relationship.
• Use appropriate communication techniques when interacting with patients from different cultures.
• Use a standardized communication technique (e.g., SBAR) to communicate with other nurses and healthcare providers.
• Evaluate yourself in terms of the interpersonal competencies needed in nursing.
• Describe how each type of ineffective communication hinders communication.
• Describe strategies that counteract disruptive professional communication and behaviors.
• Describe effective interventions for patients with impaired communication.

Process of Communication

• Definition: The process of exchanging information and generating and transmitting meanings between two or more people.
• QSEN (Quality and Safety Education for Nurses): Highlights that nurses must communicate with team members in a manner that promotes open communication and mutual respect.

Communication Process (Berlo)

• Source: The person or group who initiates or begins the communication process.
• Message: The actual content of communication.
• Channel: The medium selected by the sender to convey the message.
• Receiver: The person who must translate and interpret the message.

Types of Channels

1. Auditory:
   • Involves spoken words and cues; focuses on what individuals say.
2. Visual:
   • Involves sight, observations, and perceptions; prefers to see things written down or watch videos to comprehend.
3. Kinesthetic:
   • Involves touch and requires hands-on experiences to understand processes.

Forms of Communication

• Verbal (language) Communication: Involves spoken words.
• Nonverbal Communication:
  • Involves touch, facial expressions, eye contact, space, physical appearance (dress and grooming), body movements (gestures, posture), and silence.

Communication Technologies

• Electronic Communication:
  • Social Media: Nurses are accountable for their use of social media and can be reported for inappropriate use; guidelines exist from the ANA (American Nurses Association) and NCBSN (National Council of State Boards of Nursing).
  • Email/Text Messages: Risks include potential violations of privacy and confidentiality; healthcare agencies typically implement security measures to protect communications.
  • Telehealth/Telemedicine: Used to support long-distance clinical healthcare; telehealth nurses utilize clinical knowledge, technical skills, and communication skills to prioritize, initiate, and evaluate patient care.

Levels of Communication

• Self-talk: Internal communication within a person (e.g., self-reflection, imagination, meditation).
• Intrapersonal Communication: Occurs between two people aimed at exchanging messages (e.g., face-to-face, emails).
• Interpersonal Communication: Involves three or more people with a cooperative goal (e.g., staff meetings, support groups).
• Organizational Communication: Involves communication within larger groups such as interdisciplinary teams, emphasizing group dynamics and respectful interactions.

Factors Influencing Communication

• Developmental Level: Varies with age and cognitive understanding.
• Sociocultural Factors: Includes cultural background and social influences.
• Roles and Responsibilities: Professional dynamics impact communication styles.
• Space and Territoriality: Personal space preferences affect interactions.
• Physical, Mental, and Emotional State: Influences communication ability.
• Values: Personal beliefs shape communication behaviors.
• Environment: Setting and context can facilitate or hinder communication.

Documenting Communication

• Importance: Nursing documentation must accurately reflect patients’ needs and conditions for continuity of care.
• Effective documentation is crucial for optimal information exchange among healthcare providers.

Hand-Off Communication: SBAR

• Hand-off communication occurs when care responsibility is transferred from one provider to another.
• Structured communication is recommended by the Joint Commission and the Institute for Healthcare Improvement (IHI) using the SBAR method:
  • S: Situation
  • B: Background
  • A: Assessment
  • R: Recommendation

Phases of the Therapeutic Relationship

1. Orientation Phase:
   • Establishes rapport and clarifies roles and expectations.
2. Working Phase:
   • Active collaboration between nurse and patient.
3. Termination Phase:
   • Involves reflecting on progress and implementing closure.

Goals for Each Phase of the Therapeutic Relationship

• Orientation Phase:
  • Patient will call the nurse by name.
  • Patient will describe roles clearly.
  • Agreement on goals, locations, frequency, and duration of contacts.
• Working Phase:
  • Patient actively engaged and cooperative in achieving shared goals.
• Termination Phase:
  • Patient identifies goals achieved and reflects on the relationship’s end.

Factors that Promote Effective Communication

• Dispositional Traits:
  • Warmth, friendliness, openness, respect, empathy, honesty, authenticity, trust, caring, competence.
• Rapport Builders:
  • Clear objectives, a comfortable environment, privacy, patient-focused interactions, optimal pacing.

Nontherapeutic vs. Therapeutic Communication Example

• A brief dialogue between a nurse and a patient illustrating the potential pitfalls and benefits of communication dynamics.

Developing Conversation Skills

• Control vocal tone, maintain knowledge about discussion topics, be flexible, concise, and avoid ambiguous language. Be truthful and maintain an open mindset.

Listening Skills

• Importance of being alert and relaxed, maintaining eye contact, and appropriately using silence and humor.

Interviewing Techniques

• Techniques to gather accurate information:
  • Open-ended, closed, validating, clarifying, reflective, sequencing, and directing questions.

Communication Behaviors

• Assertive Behavior:
  • Standing up for oneself and others respectfully, using clear “I” statements and confidence.
• Aggressive Behavior:
  • Negative and threatening communication that violates others' rights.

Barriers to Communication

• Include failure to listen, nontherapeutic comments, abrupt changes of subject, and providing false assurances.

Disruptive Interpersonal Behavior

• Terms explaining workplace bullying and incivility, and strategies nurses should adopt to maintain professionalism in face of such disruptions.

Responses to Disruptive Behavior

• Discussion of increasing violence and the importance of workplace violence prevention programs and zero-tolerance policies.

Impaired Verbal Communication

• Describes potential reasons for verbal communication impairment and examples of circumstances like cognitive impairments or language barriers.

Questions

• Reference section for any concluding inquiries or follow-up items needing to be addressed.