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 people.
• Key components: Listening, observing, and processing.
• Goal: To establish a mutual understanding of the meaning of a message.

Communication Model

• Sender transmits information to the receiver.
• Receiver processes the information.
• Feedback is provided from the receiver back to the sender.

Types of Communication

Verbal Communication

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

Nonverbal Communication

• Includes facial expressions, posture, body position, behavior, gestures, touch, and general appearance.
• Less conscious and more indirect.
• Conveys more of what a person feels, thinks, and means than what is stated in words.

Factors That Affect Communication

Personal Space (Proxemics)

• Intimate: Ranging from physical contact to 18 inches.
• Casual-personal: 18 inches to 4 feet.
• Social-consultative: 4 to 12 feet.
• Public: 12 feet if possible.

Body Position

Language

• Nurses need to ensure they use language that is clear, unequivocal, and free of bias.

Culture

• To be sensitive to an individual’s culture, you must recognize and respect the accepted patterns of communication in that culture.

Attitude

• The manner, disposition, feeling, or position toward a person or thing.

Emotion

• Denotative meaning: Literal meaning.
• Connotative meaning: Emotional association.

Active Listening

• Uses all senses.
• Interprets verbal and nonverbal messages.
• The mind focuses on the interaction and detects feelings as well as the spoken words.
• Builds trusting relationships between the nurse and the patient.

Styles of Communication

Passive or Avoidant

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

Aggressive

• Behaviors characterized by putting one’s own needs, rights, and feelings before those of others.

Assertive

• Behavior style characterized by standing up for one’s self without violating the basic rights of others.

Therapeutic Communication

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

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 that can be answered with a “yes” or “no” response.
• Giving false reassurance.
• Asking too many personal questions.
• Giving advice.
• Belittling a patient’s feelings.
• Expressing disapproval.

Communication Crisis

• ISBAR/ISBARR/SBAR/SBARR (Introduction, Situation, Background, Assessment, Recommendation, Readback/Questions)
• The nurse must use focused communication, with language that is very clear and concise.
• Organize thoughts to deliver clear and concise information.

Anger, Hostility, and Incivility in Communication

• Anger is a strong emotion made up of guilt and resentment
  • Screaming, sarcasm, rudeness, belittling comments or jokes, and direct personal insults
• Incivility is interacting with a lack of courtesy and respect toward others
  • Can be verbal and nonverbal
• Establish a culture of respect using strategies that inhibit incivility
  • The American Nurses Association (ANA)

Humor in Communication

• Humor helps to create a relaxed and sociable atmosphere
  • Allows patients to step out of their sick role, establish rapport, trust, passes time, and helps to relieve anxiety
  • Nurses who use humor may appear more approachable
• Although humor has its place, it is not appropriate 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 (team leaders, supervisors)

Communication with Health-Care Providers

• Orders
  • Written
  • Over the phone

Downward Communication Techniques

• 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 that the oncoming shift must have the opportunity to ask questions

Written Communication

• Write effectively
  • Know your audience
  • Identify the purpose
  • KISS: Keep It Short and Simple!

The Nurse-Patient Relationship

• To develop a good rapport the nurse should establish:
  • Trust (the heart of the relationship is trust)
  • Empathy: 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
• Attentiveness
• Friendly tone of voice
• Focus on patient, not solely on task

Communication During a Patient Interview

Directive

• Who
• What
• When
• Where
• How
• Do
• Is

Nondirective

• Open-ended questions
• Patient explores thoughts and feelings

Nonverbal communication

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

Special Communication Needs

• People who are deaf or hard of hearing
• Speech and language impairments
  • Aphasia
• Vision impairments
• Mechanical ventilation
• Unresponsive