Communication

Communication

  • Definition: An exchange of information, thoughts, emotions, and perceptions from one person to another individual or group.

  • Purpose: To influence others to respond and to obtain information.

Learning Outcomes

  • Define and describe the concept of communication as it applies to nursing practice.

  • Describe the scope and categories of communication.

  • Describe the various modes of communication and justify when a specific mode of communication may be most useful.

  • Describe barriers to successful communication and suggest strategies to reduce the risk of each barrier.

  • Compare and contrast techniques that enhance communication to techniques that hinder communication.

Scope and Categories of Communication

Three Primary Categories

  1. Linguistic Communication: Spoken words or written symbols.

  2. Paralinguistic Communication: Nonverbal messages (e.g., gestures, eye contact, facial expressions).

  3. Metacommunication: Context of the message.

Modes of Communication

Modes of Communication

  • Electronic Communication

  • Verbal Communication

  • Nonverbal Communication

  • Written Communication

Communication Competence

  • Effective Communication: Communication that is successfully received and understood by the participant.

  • Appropriate Communication: Contextually suited communication that aligns with the situation.

  • Includes skills for communicating clearly and accurately with the patient and family, and other members of the health care team, beginning early in nurses’ education and evolving with experience.

Attributes of Effective Communication

Concept of Effective Communication has Three Attributes

Attribute #1: Process for Complementary Exchange

  • Each participant acts as either a sender or a receiver.

  • The receiver perceives the message, interprets symbols, and responds using symbols, completing the communication cycle.

Attribute #2: Correct Context

  • Importance of context in communication quality, influenced by:   - Characteristics of the environment.   - Relationships of participants.   - Internal mood states (e.g., anxiety).   - Mental and physical conditions.   - Experience and education.   - External noise.   - Culture.

Context: Hierarchical Relationships

  • Relationships affect the communication process.

  • Power and status affect communication between participants (e.g., Chief Nursing Officer to Nurse Manager, Nurse Manager to Staff Nurse).

Attribute #3: Learned Skill

  • Communication is a learned skill developed over time through interactions.

  • Unique patterns exist in healthcare settings, such as using medical terminology and adapting communication with patients, nurses, and the healthcare team.

Barriers to Successful Communication

Barriers Include:

  • Stereotyping

  • Agreeing and disagreeing

  • Being defensive

  • Challenging

  • Probing

  • Testing

  • Using cell phones while attending patients.

  • Rejecting messages

  • Changing topics abruptly

  • Providing unwarranted reassurance

  • Passing judgment

  • Giving common advice.

Therapeutic Communication

  • Definition: An interactive process between the nurse and the client that helps the client overcome temporary stress, enhances relations, and aids in overcoming psychological blocks.

  • Significance: Important for healing, promotes trust/caring, and builds relationships for positive patient outcomes.

Therapeutic Communication Techniques

  • Empathizing

  • Attentive/Active Listening

  • Physical Attending

  • Using Silence

  • Reflecting

  • Imparting Information

  • Avoiding Self-disclosure

  • Clarifying

  • Paraphrasing

  • Open-ended Questions

  • Showing Acceptance

  • Touch

  • Giving Feedback

  • Presenting Reality

Types of Communication

Interpersonal Communication

  • Embedded in relationships.

  • Verbal and nonverbal interaction among individuals.

  • Occurs one-to-one or in groups (e.g., friendships, nursing practice, nurse-patient relationships).

Intrapersonal Communication

  • Internal dialogue within an individual, also known as self-talk.

  • Can be positive or negative affecting thoughts, behaviors, and nursing practice.

  • Example:   - Student Nurse's Self-Talk: "I hope my patient assignment turns out okay today."   - Patient's Self-Talk: "I don’t know why my daughter hasn’t called."

Role of Communication in Phases of Therapeutic Relationship

  • Preinteraction Phase: Preparation before meeting the client.

  • Introductory Phase: Initial contact and building rapport.

  • Working Phase: Collaborative work between nurse and client.

  • Termination Phase: Ending the relationship appropriately.

Communication in Nursing Process (ADPIE)

Assessment

  • Consider physical status and determine assessment style (verbal and non-verbal communication).

  • Needs for client-centered care include considerations for clients with hearing, vision, or cognitive impairments.

  • Cultural values/traditions/beliefs play a role in effective communication.

Assessment Techniques for Specific Populations

Children

  • Use simple, straightforward language.

  • Acknowledge nonverbal communication due to sensitivity in children.

  • Get at the child’s eye level; incorporate play into interactions.

Older Adult Clients

  • Recognize the need for sound amplification; provide assistive devices.

  • Minimize distractions and face clients when speaking.

  • Speak in short, clear sentences; allow response time.

  • Involve caregivers for insight.

Cultural Considerations

  • Provide interpreters.

  • Address clients directly in presence of an interpreter.

  • Supply materials and instructions in the client’s language.

Nursing Diagnosis

  • Examples include “Impaired Verbal Communication” (NANDA-2004): decreased ability to perceive, process, or transmit symbols and messages; also “Fear” or “Anxiety.”

Planning

  • Minimize distractions.

  • Maintain privacy.

  • Identify mutually agreed-upon outcomes.

  • Collaborate with healthcare professionals as necessary.

  • Plan sufficient time for interventions.

Implementation

  • Establish a trusting nurse-client relationship for ease during interventions.

  • Provide empathetic responses through observations, information, conveying hope, and humor.

  • Create suitable interventions like word boards or electronic communication devices.

Evaluation

  • Evaluate if communication-related patient outcomes are met; the overarching goal is to diminish or eliminate communicative barriers.

  • Example of effective outcome: “Effectively uses a picture board to indicate needs.”

Interprofessional Communication

  • Communication among healthcare staff must be clear, respectful, and professional.

  • Poor communication can negatively impact work environment and patient outcomes.

  • Issues such as incivility, bullying, and lateral violence can arise from faulty communication.

Collaborative Practice

  • All healthcare disciplines should engage cooperatively, along with patients and their support systems.

  • Effective interprofessional communication supports patient-centered goals.

  • It optimizes clinical decision-making and promotes trust, respect, quality, and safety in healthcare.

ISBAR Communication

  1. Identify: Who you are and your role.

  2. Situation: Describe the issue.

  3. Background: Provide relevant medical history and reasons for admission.

  4. Assessment: Offer your assessment or findings.

  5. Recommendation: Clearly state what is needed (e.g., treatment, transfer).

Collaboration and Interrelated Concepts

  • Key Concepts Include:   - Health Care Quality   - Communication   - Care Coordination   - Safety   - Culture