Communication

NUR 101: Unit Two - Communication, Nurse-Patient Relationship, Nursing Profession

Unit 2 Communication Student Learning Outcomes (SLO)

  • 1. Identify the basic elements of communication
  • 2. Identify effective communication techniques
  • 3. Identify factors that affect communication
  • 4. Identify components of the nurse-patient relationship
  • 5. Recognize the boundaries of therapeutic relationships while communicating with patients across the lifespan
  • 6. Follow communication practices that minimize risk associated with handoffs among providers
  • 7. Identify the core values of the National League for Nursing (NLN)
  • 8. Identify competencies of the NLN and QSEN
  • 9. Identify the roles and responsibilities of the professional nurse

Communication

Definition and Purpose

  • Communication: The exchange of information or feelings between two or more individuals.

Basic Elements of Communication

  • Sender: The source or encoder of the message.
  • Message: The content being communicated.
  • Receiver: The listener or decoder of the message.
  • Response/Feedback: The reaction of the receiver which can confirm understanding or signal misunderstanding.

Modes of Communication

  • Verbal Communication:
    • The use of spoken or written words.
  • Nonverbal Communication:
    • Body language, gestures, facial expressions, and physical appearance.

Verbal Communication

Key Attributes

  • Pace and Intonation: The speed and tone of voice used.
  • Simplicity: Using language that is easy to understand.
  • Clarity and Brevity: Keeping messages clear and concise.
  • Timing and Relevance: Ensuring messages are sent at appropriate times.
  • Adaptability: Being flexible based on the context and recipient’s needs.
  • Credibility: Establishing trustworthiness in the message conveyed.
  • Humor: Using humor appropriately to ease tension and foster connection.

Non-Verbal Communication

Elements

  • Personal Appearance: The physical presentation of the individual.
  • Posture and Gait: The way one carries themselves.
  • Facial Expressions: Nonverbal cues that convey emotions.
  • Gestures: Movements that communicate messages.
  • Touch: Can convey comfort and empathy, but must be appropriate.

Factors that Influence the Communication Process

  • Developmental Factors: Consideration of the patient’s developmental stage.
  • Physical Factors: Physical attributes affecting communication (e.g., hearing impairments).
  • Physiological Factors: Biological influences affecting communication ability (e.g., mental health issues).
  • Psychosociocultural Factors: The impact of culture, societal norms, and individual psychological factors on communication.

Limited English Proficiency (LEP)

Communication Strategies

  • Avoid using slang, complex medical terminology, and abbreviations.
  • Speak slowly and clearly.
  • Use appropriate non-verbal gestures to aid understanding.
  • Utilize interpreters or technology such as CryaCom or computer translation tools.

Distance in Communication

  • Intimate Distance: Touching to 1.5 feet (e.g., bathing a patient).
  • Personal Distance: 1.5 to 4 feet (e.g., discussing personal matters).
  • Social Distance: 4 to 12 feet (e.g., casual conversations with visitors).
  • Public Distance: Greater than 12 feet (e.g., teaching large groups).

Therapeutic Communication Techniques

  • Attentive Listening: Actively showing interest and understanding.
  • Paraphrasing: Restating the patient’s message in your own words.
  • Reflecting: Mirroring the patient's feelings.
  • Clarifying: Asking for more information to ensure understanding.
  • Open-ended Questions: Questions that encourage elaboration.
  • Focusing: Directing the conversation back to important topics.
  • Direct Questioning: Asking specific questions to obtain information.
  • Touching: Using appropriate touch to convey empathy.
  • Silence: Allowing pauses for thought and processing.
  • Summarizing: Recapping the conversation to reinforce understanding.

Interviewing Techniques

  • Directive Interview:
    • Purpose: Collecting data and gathering specific information.
  • Non-directive Interview:
    • Purpose: Therapeutic; meets patient needs through open exploration.

Non-Therapeutic Responses

  • Stereotyping: Generalizing patient experiences.
  • Agreeing/Disagreeing: Offering personal opinions rather than support.
  • Giving Advice: Imposing personal solutions rather than listening.
  • False/Unwarranted Reassurance: Offering comforting phrases that lack grounding in reality.
  • Defensiveness: Responding to criticism with denial instead of understanding.
  • Challenging: Questioning the patient’s perspective or feelings.
  • Probing/Testing: Persistently asking why certain feelings exist.
  • Changing the Subject: Diverting attention from the patient’s concerns.
  • Rejecting a Topic/Minimizing Feelings: Dismissing the significance of patient emotions.
  • Being Judgmental: Conveying disapproval that inhibits open communication.

Phases of the Helping Relationship

  • Pre-interaction Phase: Preparing for the interaction by gathering information.
  • Introductory Phase: Establishing rapport and explaining the purpose of the interaction.
  • Working Phase: Engaging in therapeutic communication to meet patient needs.
  • Termination Phase: Concluding the relationship and evaluating the process.

Example Case Study Communication Responses

  • Patient Statement: “I can’t take this pain anymore. The doctors can’t seem to find what is wrong. I don’t know what to do!”
    • Open-ended Response:
    • Paraphrasing Response:
    • Reflecting Response:
    • Clarifying Response:
    • Direct Question Response:
    • Nontherapeutic Response:

Professional Communication

Intradisciplinary Nursing Team Roles

  • RN (Registered Nurse)
  • LPN (Licensed Practical Nurse)
  • NA (Nursing Assistant)
  • Nurse Manager
  • Supervisor
  • Clinical Specialist
  • Nurse Practitioner
  • Director of Nursing
  • Nursing Students

Interdisciplinary Health Care Team Members

  • Physician
  • Nurse
  • Dietitian
  • Pharmacist
  • Physical/Respiratory Therapist
  • Social Worker
  • Lab Technician
  • Nursing Assistant
  • Clergy
  • Housekeeping Staff

SBAR: Intra/Interdisciplinary Communication Tool

  • Situation: Brief summary of the current situation.
  • Background: Relevant history to understand the context.
  • Assessment: Current assessment and diagnosis.
  • Recommendation: Suggested actions moving forward.

Intradisciplinary Communication Methods

I PASS

  • Introduction: Introduce yourself and your role.
  • Patient: Identify the patient being discussed.
  • Assessment: Provide a summary of the patient’s condition.
  • Situation: Describe the current situation or issue.
  • Safety: Highlight any safety concerns relevant to the patient.

BATON

  • Background: Provide relevant background information.
  • Actions: Describe actions taken.
  • Timing: Indicate the urgency or timing of actions taken.
  • Ownership: Clarify who is responsible for the oversight.
  • Next: Outline next steps or follow-up actions needed.

TeamSTEPPS

  • Description: A teamwork system designed for healthcare professionals to improve communication and teamwork skills.
  • Curriculum Components: Presentations, pocket guides, video vignettes, workshops.
    • Three Phase Approach:
    • Assessment for site readiness.
    • Training for onsite trainers and healthcare staff.
    • Implementation and sustainment processes.

Communication Among Health Professionals

Disruptive Behaviors

  • Incivility: Rude or unsupportive interactions.
  • Bullying: Aggressive communication that targets individuals.
  • Workplace Violence: Any act or threat of physical aggression.

Nurse-Physician Communication

Communication Styles

  • Emotional Intelligence (EI): The ability to understand and manage emotions in oneself and others.
  • Assertive Communication: Clearly expressing thoughts and feelings while respecting others.
  • Nonassertive Communication:
    • Passive: Avoiding conflicts, yielding to others.
    • Aggressive: Conveying emotions forcefully.

Health Insurance Portability and Accountability Act (HIPAA)

Key Points

  • Individuals have increased control over their health information.
  • Limits the use and release of health information to protect patients.
  • Health information must be kept confidential and secure.
  • Penalties for violations can be criminal or civil, detailing fines for infractions.

Interpersonal Roles of the Nurse

  • Caregiver: Providing care and support to patients.
  • Communicator: Facilitating clear and open communication.
  • Teacher: Educating patients about their health and care.
  • Resource: Acting as a resource person for patients and families.
  • Advocate: Representing the patient's needs and preferences.
  • Leader: Guiding team dynamics in healthcare.
  • Counselor: Offering support for emotional and mental wellness.
  • Change Agent: Promoting and implementing change in practices.
  • Manager: Overseeing care and managing nursing staff.
  • Researcher: Engaging in or applying research to practice.

Nursing as a Profession

  • New York State Nurse Practice Act: Defines the role of nurses in diagnosing and treating human responses to health problems through various services.
    • Services include case finding, health teaching, and counseling, as well as executing medical regimens prescribed by authorized physicians.

Nurse Practice Act Scope of Practice

  • Independent Practice: Performing nursing duties without a physician’s order.
  • Dependent Practice: Requiring a physician’s order to perform certain tasks.
  • Interdependent/Collaborative Practice: Actions taken under physician delegation that involve nursing judgment and clinical reasoning.

American Nurses Association (ANA) Standards of Practice

  • Core Standards Include:
    • Assessment
    • Diagnosis
    • Outcomes
    • Planning
    • Implementation
    • Coordination of Care
    • Health Teaching
    • Consultation
    • Prescribing
    • Evaluation

Additional Ethical Standards:

  • Education
  • Evidence-Based Practice
  • Quality
  • Communication
  • Leadership
  • Collaboration
  • Self-Evaluation
  • Resource Utilization
  • Environmental Health

ANA Code of Ethics

  • Key Principles
    • Compassion
    • Respect
    • Commitment
    • Patient Rights
    • Accountability
    • Collaboration
    • Professional Growth
    • Advancement of the Profession

National Student Nurses Association (NSNA)

Core Values

  • Advocacy
  • Leadership & Autonomy
  • Professionalism
  • Care
  • Diversity
  • Quality Education

NSNA Mission

  • NSNA's mission is to mentor nursing students preparing for initial licensure while conveying standards, ethics, and skills necessary for responsible leadership within the profession.
  • Founded in 1952, NSNA is a nonprofit organization for nursing students in various educational programs, focusing on professional development.

National League for Nursing (NLN) Core Values

  • Caring
  • Integrity
  • Diversity & Inclusion
  • Excellence

NLN Program Outcomes (2014)

  • Human Flourishing
  • Nursing Judgment
  • Professional Identity
  • Spirit of Inquiry

QSEN Competencies

Quality and Safety Education for Nurses

  • Patient-Centered Care
  • Teamwork & Collaboration
  • Evidence-Based Practice
  • Quality Improvement
  • Safety
  • Informatics

Aspects of New York State Patient Bill of Rights

  • 1. Considerate, respectful care
  • 2. Information regarding diagnosis, treatment, and prognosis
  • 3. Identification of health team members
  • 4. Financial implications of care
  • 5. Right to make decisions and participate in care
  • 6. Advance directive & proxy
  • 7. Privacy and confidentiality
  • 8. Review of own records
  • 9. Right to medically indicated care
  • 10. Continuity of care
  • 11. Right to consent to or decline participation in research

American Hospital Association (AHA) Patient Care Partnership

Key Aspects

  • High-quality hospital care.
  • Clean, safe environment.
  • Involvement in care.
  • Informed choices and decision-making.
  • Proper information exchange.
  • Establishing and agreeing to care goals.
  • Respect for spiritual beliefs.
  • Right to appoint a healthcare proxy.
  • Right to consent to care.
  • Assistance when leaving the hospital.
  • Understanding and following directions.
  • Support in resolving billing claims.

Advanced Directives

  • Types:
    • Living Will
    • Do Not Resuscitate (DNR)
    • Do Not Intubate (DNI)
    • Health Care Proxy
    • Organ Donation

Fundamentals Success Practice Questions

Example Scenarios

  1. Case Study: A patient states, “My wife is going to be very upset that my prostate surgery probably is going to leave me impotent.”
    • Best Response Options:
    • “I’m sure your wife will be willing to make this sacrifice in exchange for your well-being.”
    • “The doctors are getting great results with nerve-sparing surgery today.”
    • “Your wife may not put as much emphasis on sex as you think.”
    • “Let’s talk about how you feel about the surgery.”
  2. Rationale for Response:
    • Responses that provide false reassurance neglect patient concerns and may lead to misinterpretation.
  3. Effective Communication Factors: Effective communication depends on the abilities to send verbal messages, utilize interviewing skills, assertively collect data, and display sympathy when communicating.
  4. Interviewing Skill Usage:
    • Example: “You mentioned before that you are having a problem with your colostomy.”
    • Skill Used: Focusing.
  5. Establishing Relationship Phase in Interviewing:
    • The stage that creates rapport is the Opening phase, where trust and goodwill are developed.
  6. Reflective Technique:
    • This technique focuses on identifying and referring back to the patient's underlying feelings to promote clearer understanding.