NURSING AS AN ART IN COMMUNICATION

COMMUNICATION (INTERPERSONAL)

➢     Definition: A two- way process involving the sending and the receiving of a message thereby exchanging information or feelings between 2 or more people.

➢     Communication in Nursing

○      Process of transmitting thoughts, feelings, information and other verbal and non-verbal behavior.

○      The vehicle for establishing a therapeutic relationship with a client. (Trusting relationship)’

➢     Critical Skills to Develop

○      Nurses spend more time with patients.

○      Nurses must be able to recognize subtle cues from silent patients.

○      Integral part of helping relationships

➢     Main Purpose of Communication

1.     Influence others - teaching, express caring and comfort , influencing others may be helpful or non-helpful.

2.     Obtain information- assessment data, interview

COMPONENTS OF THE COMMUNICATION PROCESS

1. SENDER

●      source-encoder; person or group who convey messages.

●      person has a thought, idea, or emotion to convey to another person.

●      messages stem from a person’s need to relate to others, create meaning & to understand various situations

●      decides on what language and words to use, arrange the words , tone and gestures

2. MESSAGE

●      is the thought, idea, or emotion one person sends to another person.

●      it is the stimulus produced by the sender

●      alteration in the message depends on the person’s perception

●      What is actually said or written

3. CHANNEL

●      medium through which a message is transmitted.

●      Major Channels:

1.     VISUAL- sight, observation, perception - drawing, painting, pictures

2.     AUDITORY- spoken words and cues, requires active listening - singing

3.     KINESTHETIC- experiencing situations, procedural touch, caring touch - gestures (nodding, tapping feet etc), this involves feelings.

●      Channel should be appropriate for the message

4. RECEIVER OR DECODER

●      interprets, sort out the meaning of the message

●      person or group to whom the message is sent

●      Components involved:

a)     physiological- sensory dysfunction(eyes,ears,taste, nose etc...), mental dullness

b)     b) psychological - emotional character - fear of expressing one's ideas to others, excitement, emotional instability

c)     c) cognitive - thinking or social skills , trouble making decisions, reasoning, Effective communication - meaning of the decoded message matches the intent of the sender

d)     Ineffective communication - occurs when receiver misinterprets the sent messageorganization, insight

●      Effective communication - meaning of the decoded message matches the intent of the sender

●      Ineffective communication - occurs when receiver misinterprets the sent message

5. FEEDBACK OR RESPONSE

●      the response from the receiver that enables the sender to verify that the message received was the message sent.

●      allows the sender to correct or reword a message

6. INFLUENCES

●      they are the person’s frame of reference

●      involves: culture, age, emotions, education, language and attention

METHODS OF COMMUNICATION

●      VERBAL COMMUNICATION

●      NON-VERBAL COMMUNICATION

●      ELECTRONIC COMMUNICATION

VERBAL COMMUNICATION

➢     The use of words, either spoken or written, to send a message.

METHODS OF VERBAL COMMUNICATION

1. Speaking/ Listening

●      for communication to take place, both speaking & listening must occur

●      simple - use of commonly understood words

●      clear - direct precisely what is meant

●      brevity -fewest words necessary

●      timing and relevance - be sensitive to the needs and concerns of the patient, avoid asking several questions at a time

2. Pace and Intonation

●      the manner of speech modifies the feeling and impact of the message

●      rate of speech: indicates interest, anxiety, boredom, or fear.

●      tone of voice: may be pleasant, sincere, sorrowful, sarcastic, joyful or angry.

3. Writing/ Reading

●      the receiver reads the words.

●      reader must understand the words &then attach meaning to them.

●      Ex. Bad communication – Nurse charts “Patient uncooperative”. & Good communication – Nurse charts “Patient refused to eat lunch, refused to get out of bed and sit in chair.”

NONVERBAL COMMUNICATION / BODY LANGUAGE

●      transmission of message without the use of words.

●      partly learned behavior partly instinct.

●      generally done unconsciously

●      can either reinforce or contradict what is said verbally.

●      clarify any observation to validate

●      * Essential skill to learn - observing and interpreting the client's non-verbal bahavior

WAYS OF COMMUNICATING NONVERBALLY

1. Gestures

●      often referred to as “talking with hands”

●      may be used to clarify a verbal message, to emphasize an idea, to hold another’s attention, or to relieve stress.

●      Sign language

●      pacing back and forth, tapping of the hands and feet

2. Facial Expressions

●      some people have very expressive faces, others do not.

○      big smile = happy

○      “curled up” nose = displeasure

○      raised eyebrows?

○      emoji's (part of conveying facial expressions in text messages)

3. Posture and Gait

●      good posture, with head held up, & a purposeful gait = self-confidence, competence & positive self-image

●      stooped shoulders, downward-held head & shuffling gait= convey low self-esteem, depression, lack of confidence or apathy.

4. Eye Contact

●      Generally interpreted as indicating interest & attention

●      Lack of eye contact = indicate avoidance, disinterest or discomfort.

5. Body Position

●      crossed arms = indicate withdrawal or cold behavior

●      open position (arms held freely at the sides) = receptive attitude

6. Physical Appearance

●      clean, neat, appropriately dressed = conveys a positive image, knowledge, & competence

●      dirty, sloppy or inappropriately

●      dressed =conveys the message of “I don’t care how I look”.

7. Touch

●      Touch is a simple yet powerful means of non-verbal communication

●      Purposes of touch:

○      Connects people

○      Provides affirmation (verification/confirmation)

○      Gives reassurance hope & encouragement

○      Shows warmth

○      Communicates caring

○      Provides stimulation (inspiration/motivation)

○      Decreases loneliness

○      Increases self esteem

●      Guidelines in the use of touch as a means of communication between nurse and patient

○      Exhibit ability and sureness when touching the patient or when performing nursing procedure.

○      Seek permission before touching the client.

○      Touching a client must bring about a sense of security, rather than anxiety.

ELECTRONIC COMMUNICATION

➢     type of communication with the use of electronic devices.

Examples of electronic communication devices that can be used in the care of clients.

●      telephone – simplest form of telecommunication system

●      cell phone – load information to be synchronized with the hospital’s IT system

●      computers

●      Televisions

●      EMAILS

USES OF ELECTRONIC COMMUNICATION IN HEALTH CARE

●      Send requisitions to other depts. in the hospital

●      Show safe dosages & drug interactions in hospital pharmacies

●      Aid physicians in diagnosing and treating some conditions.

●      Online documentation of patient care

●      Electronic medical records (EMR)

●      EMAILS - schedule and confirm appointments, report lab results, conduct client education

●      Disadvantages:

○      client's privacy, confidentiality and potential misuse of information

○      not all have access to computer

THERAPEUTIC COMMUNICATION

●      Sometimes called “effective communication”

●      A purposeful & goal-directed communication creating a beneficial outcome for the client  “helping relationship”

●      Is safe, confidential, reliable, and consistent

●      People usually need to deal with feelings before they can cope with other matters, such as learning new skills or planning for the future.

GOALS OF THERAPEUTIC COMMUNICATION

1. Develop trust

●      introduce self & call client by name

●      dress professionally & appropriately

●      show client that you are listening

●      be honest & keep your word

●      show respect for client at all times

2. Obtain or provide information

●      identify the most important need/s of the patient

3. Explore feelings

●      assess the patient’s perception of the problem

●      facilitate the patient’s expression of emotions

●      Ask patient how they feel generally, specific health concerns, why he feels that way

●      patient outcomes tend to improve when patients are well-informed about their health and feel empowered to make decisions

4. Show caring

●      implement interventions designed to address the patient’s needs

●      sharing deep and genuine concern about the welfare of another person

ELEMENTS OF THERAPEUTIC COMMUNICATION

●      Warmth - makes the patient feel relaxed, welcomed & unjudged

●      Caring - makes client feel important

●      Genuiness - builds a trusting relationship, honest with another

●      Empathy - understanding client with compassion

●      Acceptance & Respect - lets clients know that they can be themselves, comfortable

●      Self- Disclosure - encourages a reciprocal trust between nurse and client

●      Active Listening - pay attention/ give time , the MOST EFFECTIVE

●       - be mindful, use all senses

PHASES OF A THERAPEUTIC RELATIONSHIP

1. Preinteraction phase (Planning Stage)

●      Nurse has information about the patient before the meeting(name, age, address, medical history, social history)

●      Nurse may become anxious during the planning stage

2. Orientation phase (Introductory Phase)

●      Nurse and client observes each other and form judgments about each other’s behavior

●      Goal: develop trust and security within the N-P relationship

●      It sets the tone for the rest of the relationship

●      Agree about - location, frequency and length of meeting, purpose, confidentiality, tasks, goals, duration

3. Working Phase

●      Nurse & client begin to appreciate each other’s uniqueness

●      They begin to care about each other

●      Nurse and patient accomplish tasks

●      Nurse helps the client to explore thoughts, feelings and action

●      Nurse helps the client plan a program for action

4. Termination Phase

●      Expected to be difficult & filled with ambivalence

●      helpful for both nurse & client to express their feelings about termination openly and honestly.

●      feeling of loss in this stage is normal

THERAPEUTIC COMMUNICATION TECHNIQUES

1. Clarifying/ Validating

●      A method of making the client’s broad overall meaning of the message more understandable.

●      To clarify the message, the nurse can restate the basic message or confess confusion and ask the client to repeat or restate the message.

●      Nurses can also clarify their own message with statements.

●      Verify the meaning of specific words.

2. Open-ended questions

●      Asking broad questions that lead or invite the client to explore thoughts or feelings.

●      Open-ended questions specify only the topic to be discussed and invite answers that are longer than one or two words.

3. Giving information

●      Providing, in a simple and direct manner, specific factual information the client may or may not request.

●      When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it.

4. Reflecting

●      Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation.

5. Paraphrasing/ Restating

●      Actively listening for the client’s basic message and then repeating those thoughts and/or feelings. Because tactile contacts vary considerably among individuals, families and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self.

6. Summarizing

●      Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview or to review a health teaching session. It often acts as an introduction to future care planning.

7. Focusing

●      Helping the client expand on and develop a topic of importance. It is important for the nurse to wait until the client finishes stating the main concerns before attempting to focus.

8. Silence

●      accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response.

9. Active Listening

●      The process of listening attentively while someone else speaks, paraphrasing, and reflecting back what is said and withholding judgment and advice.

●      LEAN FORWARD AND FACE THE SPEAKER

BARRIERS TO COMMUNICATION

●      CLICHÉS – phrases or statements used without thinking of the impact on the other person

●      FALSE REASSURANCE – assurances which are not founded in reality.

●      JUDGMENTAL RESPONSES – giving opinions based on the nurse’s personal value system & imply right or wrong

●      GIVING COMMON ADVICE – offering personal rather than professional opinion. Telling the client what he should do which may not be an expert advice.

●      STEREOTYPING – categorizing the client & ignoring individual differences

●      BELITTLING – conveying to the person that his thoughts or feelings really have no value

●      BEING DEFENSIVE – attempt to protect self or another person from negative comments

●      PROBING – asking for information chiefly out of curiosity rather than with the intent to assist the client.

●      CHANGING THE SUBJECT – directing the communication into areas of self-interest rather than client’s concerns

EFFECTIVE COMMUNICATION CAN RESULT TO:

●      Collection of Assessment data

●      Initiation / application of intervention

●      Evaluation of outcomes of intervention

●      Initiation of changes that promotes Health

●      Prevention of Legal Problems