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Nursing Communication and SBAR: Study Notes

Active Listening and Empathy

  • Sympathy vs. empathy
    • Sympathy = feeling sorry for someone; not truly putting yourself in their shoes to understand their perspective.
    • Empathy = understanding and sharing the patient’s perspective to build trust and a stronger relationship.
  • Empathy in nursing practice
    • Empathy is used to build a trusting bond with patients; sympathy is distinct and less effective in forming that connection.
  • Active listening behaviors (based on the ATI clip referenced)
    • Nurse pulls up a chair, sits next to the patient, faces the client, and sits at the same level.
    • Posture: avoid crossing legs or arms to prevent appearing closed off or disinterested.
    • Be relaxed and non-tense; tense postures convey unease and can make patients anxious.
    • Eye contact: maintain eye contact when culturally appropriate; adapt if eye contact is disrespectful in some cultures.
    • Touch with permission; reach out if the patient invites touch (e.g., holding a hand).
    • Use intuition: gut feelings often reflect past experiences and guide appropriate actions (trust your clinical intuition).
    • Intuition can be built through experience; it often aligns with what you feel is right.
  • Mnemonics and naturalization
    • Purity (mnemonic) to remember active listening skills, though you don’t have to memorize it.
    • With practice, active listening becomes second nature and integrates into all patient interactions.
  • Personal example and habit formation
    • Put the phone away and give full attention when the patient is speaking; turn away from computer screens and demonstrate presence.

Therapeutic vs Non-Therapeutic Communication Techniques

  • Therapeutic techniques (active listening in practice)
    • Being present for the patient; sharing observations (e.g., "I see you seem anxious").
    • Sharing empathy and hope; acknowledging despair and offering support.
    • Humor (when appropriate) to heal; laugh with the patient and laugh at yourself if you make mistakes.
    • Touch with permission; appropriate use of silence; providing information when needed.
    • Clarifying misperceptions and asking patients to clarify when necessary.
    • Focusing on the patient; avoid distractions.
    • Paraphrasing (restate in your own words to show understanding).
    • Validate feelings; acknowledge that the patient’s emotions are real.
    • Asking relevant questions; summarizing the conversation; self-disclosure when appropriate (e.g., admitting uncertainty and offering to find out).
    • Self-disclosure builds trust when used honestly (e.g., "I don’t know, but I’ll find out").
    • Confrontation (not as fighting; as guiding and correcting when needed).
  • Non-therapeutic techniques to avoid
    • Asking personal questions that aren’t necessary for care.
    • Giving personal opinions about what you would do in their place.
    • Changing the subject to avoid uncomfortable topics.
    • Encouraging disrespect or letting unacceptable behavior continue.
    • Automatic responses or generic answers to every patient.
    • False reassurance or overpromising outcomes.
    • Sympathy in place of genuine empathy; asking for explanations in a way that puts the patient on the defensive (e.g., "Explain yourself").
    • Approval or disapproval; being judgmental.
    • Defensive responses or arguing with the patient.
    • Passive/aggressive communication; attempting to win an argument.
  • Boundaries and safety in communication
    • Don’t pick fights; maintain patient safety and support.
    • If a patient is disrespectful or sexually inappropriate, address it immediately and set boundaries.
    • If a patient is defensive, step back, breathe, and deescalate rather than escalating the interaction.

Language Barriers and Interpreters

  • Language as a major communication barrier in a multicultural setting.
  • Interpreting resources
    • CRICOM/Blue phone interpreter system (landline in patient room). Speaker notes:
    • You connect with an interpreter; they provide an operator ID and a transcript number.
    • Document the transcript number and operator ID in nurse’s notes; summarize the interpretation, not verbatim.
    • This documentation becomes part of the legal charting.
    • Use of family members for interpretation is acceptable only for non-medical terms; for medical terminology use a hospital-approved interpreter.
    • Certified interpreters are required to ensure accuracy and confidentiality.
    • Do not rely on housekeeping or maintenance staff to interpret; use trained professionals.
  • Deaf and hard-of-hearing patients
    • ASL interpreters or video-remote interpreting services are used; sign language interpreters may stay with the patient and accompany nurses.
    • In some settings, laptops with sign-language interpreters may be used.
  • HIPAA and legal considerations
    • Interpreting must be documented to protect patient rights and clinician licensure.
  • Practical tips
    • Ask for the interpreter to convey questions and responses succinctly; avoid long, complicated dialogues through translation.
    • If you can speak more than one language, consider volunteering for interpretation bank; be mindful of day-to-day reliability.

Fear, Anxiety, Cognitive Disorders, and Special Needs

  • Anxiety and fear
    • Highly anxious patients may shut down; strategies include calming conversation, relaxation techniques, and possibly anxiolytics if medically ordered (e.g., ext{Xanax} ext{ (alprazolam)} or ext{Valium} ext{ (diazepam)}).
  • Cognitive disorders and decision-making capacity
    • Include the patient in communication as much as possible.
    • Often there is a medical proxy (family member or guardian) who makes decisions when the patient lacks capacity.
  • Depression and psychiatric considerations
    • Depression may require psychiatric consultation; ensure patient is receiving medications as prescribed.
  • Nonverbal patients and communication tools
    • Use whiteboards or other tools to facilitate expression when speech is not possible.
  • Special needs and comprehension levels
    • If a patient has limited comprehension, speak at their level and involve primary caregivers as needed.
  • Dealing with overly talkative patients
    • Set boundaries; inform patient how long you have in the room; use staff (e.g., secretary) to manage interruptions; offer to take a message if you must step out.
  • Inappropriate sexual or harassing behavior
    • Stop immediately and clearly state that the behavior is unacceptable; do not tolerate ongoing harassment.
  • ER-specific considerations
    • Patients may be under the influence or otherwise uncooperative; prioritize safety first, then attempt communication once stabilized.
  • Noncompliance and disengagement
    • If a patient is unwilling to listen, document attempts and continue to offer information as appropriate.

Nurse-Client Relationships and Communication Alignment

  • Verbal and nonverbal messages must align
    • Do not send mixed messages; ensure your tone, posture, and expressions match what you say verbally.
  • Trust and rapport
    • Consistent, respectful, and clear communication builds trust and improves outcomes.

Intraprofessional vs Interprofessional Communication

  • Intraprofessional communication
    • Involves the nursing team: RN, LPN, CNAs, nurse managers, charge nurses; all work toward a common patient-care goal.
  • Interprofessional communication
    • Involves professionals from other disciplines: physical therapy, dietitian, social worker, respiratory therapist, pharmacist.
  • Grand rounds
    • Multidisciplinary meetings where each discipline discusses a patient’s plan of care to revise and optimize the plan.
  • Why nursing is pivotal
    • The nurse often coordinates information and plans: you summarize needs, share updates, and ensure everyone understands the patient’s care plan.

Elements of Professional Communication

  • Be courteous and respectful
  • Names and addressing patients appropriately
    • Do not assume using first names; typically use last name unless accessing special circumstances (child or cognitive impairment).
    • When appropriate or at patient’s request, ask how they would like to be addressed; you can ask directly (e.g., "Would you prefer to be called Mr. Smith or John?").
  • ID badge etiquette and privacy
    • ID badges may display only first name and first initial of last name for security and privacy; patients may ask for last name—if you’re comfortable sharing, you may, but privacy concerns apply.
    • Consider hospital policy on displaying personal information and consent.
  • Avoid demeaning terms and maintain professionalism
    • Do not call patients labels like honey, dear, sweetie.
  • Social media and professional boundaries
    • Be cautious about posting pic’s or information that could identify patients; follow hospital policies and maintain confidentiality.

Test Your Emotional Intelligence (EI) Activity

  • Online EI exercises in the PowerPoint (link provided in the slides)
  • Purpose: interpret facial expressions and emotions to improve reading cues:
    • Examples include identifying sadness, contempt, disgust, anger, pain, compassion, amusement, desire, embarrassment, etc.
  • Practical takeaway
    • EI is challenging; even experienced nurses may misread expressions—practice improves accuracy and empathy.
  • Related media
    • TV show Lie to Me demonstrates how expressions can signal internal states and deception (for educational context).

SBAR Tool and Doctor’s Orders (TOVR) – Structured Communication

  • What is SBAR?
    • SBAR stands for Situation, Background, Assessment, Recommendation (some slides spell out Background explicitly as part of the B).
    • Purpose: provide concise, standardized information when communicating with physicians or transferring care.
  • When to use SBAR
    • Especially important when calling a doctor, particularly during nighttime hours when orders are needed quickly.
    • Helps reduce medication errors and ensures all critical information is conveyed.
  • How SBAR adapts to units
    • Different units (postpartum, NICU, ER, med-surg) may use slightly different templates; the concept remains the same.
  • Example SBAR (well-structured)
    • Situation: A brief statement of the issue (e.g., new admission restlessness and agitation).
    • Background: Relevant patient history (e.g., traumatic brain injury on Feb 1; no known drug allergies).
    • Assessment: Your latest assessment (e.g., agitation increasing over the last 30 minutes; potential need for a PRN medication).
    • Recommendation: A concrete next step (e.g., consider one-time dose of Seroquel 12.5 mg or an alternative; ask for orders).
  • Real-world example: good vs poor report
    • Poor example: Disorganized, mentions family trouble, vague data, no actionable plan, and asks the doctor what to do.
    • Good example: A nurse introduces themself, states the situation succinctly, provides background, shares a concrete assessment, and offers a clear recommendation (e.g., order PRN Seroquel 12.5 mg; confirm plan).
  • The “idiot sheet” (report sheet) concept
    • A personal, evolving sheet used during shift handoffs to capture essential data quickly.
    • It helps avoid missing critical details when reports are given.
  • TOVR – Telephone Order Verbal Readback
    • If the doctor cannot enter orders directly into the EHR, you must read back the exact order to confirm accuracy.
    • Document the readback: write the order exactly as given and note the readback (TOVR) in the chart.
  • Decimal dosing safety reminder
    • Decimals and leading zeros are critical: e.g., 0.06 vs 0.6 can represent very different doses; ensure proper leading zeros and decimal placement.
    • Many ERs have satellite pharmacies to expedite verification and reduce errors since pharmacy verification times can be lengthy; accuracy remains paramount.
  • Practical takeaway for next week
    • You will be assigned an SBAR-based clinical scenario in Canvas; you will fill in the SBAR template.
    • The tool can be tailored to your unit (ER vs med-surg vs NICU).

Practical Notes and Real-World Takeaways

  • Communications in hospital settings are foundational to patient safety and trust.
  • Align verbal, nonverbal, and written communication to prevent misunderstandings.
  • Prepare and document formally when communicating orders, particularly in high-stakes situations.
  • Always seek to involve the patient in discussions when possible, while respecting capacity and proxies when needed.
  • The clinical environment requires a balance of empathy, professionalism, and structured communication tools (SBAR, TOVR).

Next Steps and Exam Preparation Tips

  • Review the difference between empathy and sympathy and when to apply each in patient interactions.
  • Practice active listening behaviors in role-play: appropriate seating, eye contact, posture, and open-ended questions.
  • Memorize the core elements of SBAR and practice writing a sample SBAR entry based on a hypothetical patient (Situation, Background, Assessment, Recommendation).
  • Be familiar with interpreter procedures: when to use CRICOM/Blue Phone, how to document, and why family members should not be used for medical interpretation.
  • Understand the importance of decimal accuracy in dosing; recognize the role of leading zeros and proper dose transcription.
  • Review professional communication etiquette (naming conventions, treating patients with respect, and privacy considerations).