Fundamentals of Nursing

Authors
  • Patricia A. Potter, RN, MSN, PhD, FAAN
  • Anne Griffin Perry, RN, MSN, EdD, FAAN
  • Patricia A. Stockert, RN, BSN, MS, PhD
  • Amy Hall, RN, BSN, MS, PhD, CNE
  • Wendy R. Ostendorf, RN, MS, EdD
Chapter 24: Communication
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Communication and Nursing Practice

Importance of Communication

  • Communication is a lifelong learning process.
  • Competent communication:
    • Maintains effective relationships within the entire sphere of professional practice.
    • Meets legal, ethical, and clinical standards of care.

Interpersonal Relationships

  • Caring relationships:
    • At the core of nursing practice.
  • Importance of relating to others for effective interpersonal communication.
  • Therapeutic communication:
    • Occurs within a healing relationship between nurse and patient.

Developing Communication Skills

  • Nurses who develop critical thinking skills and clinical judgment:
    • Are the best communicators.
  • Critical thinking helps:
    • Overcome perceptual biases or stereotypes.
    • Accurately perceive and interpret messages from others.

Levels of Communication

  • Different levels include:
    • Intrapersonal communication: Self-talk and reflection.
    • Interpersonal communication: Interaction between two or more individuals.
    • Small-group communication: Interaction among a small group.
    • Public communication: Interaction with larger audiences.
    • Electronic communication: Use of technology to convey messages.

Elements of the Communication Process

  • Circular transactional model includes:
    • Referent: Stimulus that motivates communication.
    • Sender and receiver: The individuals involved in communication.
    • Message: The information conveyed during communication.
    • Channels: The medium through which the message is sent.
    • Feedback: Response from the receiver back to the sender.
    • Interpersonal values: Influences on communication based on personal beliefs.
    • Environment: Context in which communication occurs.

Forms of Communication

Verbal Communication (1 of 2)

  • Key components include:
    • Vocabulary: Choice of words used.
    • Denotative and connotative meaning: Literal and implied meanings of words.
    • Pacing: Speed of speech.
    • Intonation: Variation of pitch in speech.
    • Clarity and brevity: Need for clear and concise communication.
    • Timing and relevance: Importance of context in communication time.

Nonverbal Communication (2 of 2)

  • Aspects include:
    • Personal appearance: Impact of physical presentation on communication.
    • Posture and gait: Body language as a form of communication.
    • Facial expression: Nonverbal cues conveyed through expressions.
    • Eye contact: Importance of visual engagement during communication.
    • Gestures: Hand movements that supplement verbal communication.
    • Sounds: Nonverbal signals conveyed through vocal tone or pitch.
    • Territoriality and personal space: The physical distance maintained in communication dynamics.
    • Metacommunication: Communication about communication; how messages are interpreted beyond words.

Professional Nursing Relationships

  • Types of relationships include:
    • Nurse-patient caring relationships: Foundation of therapeutic relationships.
    • Motivational interviewing: Strategies to encourage patient engagement.
    • Nurse-family relationships: Importance of family dynamics.
    • Nurse-health care team relationships: Collaboration among professionals.
    • Lateral violence: Addressing conflicts within nurse-team dynamics.
    • Nurse-community relationships: Importance of understanding community context in care.

Elements of Professional Communication

  • Key elements include:
    • Courtesy: Respectful communication.
    • Use of names: Personalizing communication by using names.
    • Trustworthiness: Building credibility in communication.
    • Autonomy and responsibility: Encouraging independence while recognizing accountability.
    • Assertiveness: Communicating feelings and needs openly.

Nursing Process

Assessment (1 of 6)

  • Components of assessment include:
    • Through the patient’s eyes: Understanding the patient's perspective.
    • Environmental factors: Impact of surroundings on health communication.
    • Physical and emotional factors: Recognizing individual health statuses.
    • Gender: Understanding how gender may affect communication.
    • Developmental factors: Adapting communication based on developmental stage.

Analysis and Nursing Diagnosis (2 of 6)

  • Planning and outcomes identification: Focus on identifying expected outcomes and ensuring patient-centered care.
    • Outcomes: Goals to aim for during patient care.
    • Setting priorities: Determining which aspects of care are most critical.
    • Teamwork and collaboration: Emphasizing interdisciplinary cooperation.

Implementation (3 of 6)

  • Therapeutic Communication Techniques include:
    • Active listening: Engaging fully in conversation and understanding.
    • Sharing observations: Providing feedback on nonverbal cues or patient remarks.
    • Sharing empathy: Showing understanding and compassion towards the patient.
    • Sharing hope: Encouraging a positive outlook.
    • Sharing humor: Using humor to ease situations appropriately.
    • Sharing feelings: Being open about one's own emotions as appropriate.
    • Using touch: Physical touch to convey support or compassion.
    • Using silence: Allowing pauses for reflection in conversations.
    • Providing information: Clearly conveying needed information.
    • Clarifying: Ensuring understanding of messages received.
    • Focusing: Directing conversation towards relevant themes.
    • Paraphrasing: Restating messages for clarity.
    • Validation: Confirming the accuracy of the received message.
    • Asking relevant questions: Using inquiry to promote deeper understanding.
    • Summarizing: Recapping conversations for clarity.
    • Self-disclosure: Sharing personal insights as a tool for connection.
    • Confrontation: Addressing issues directly in a helpful way.

Nontherapeutic Communication Techniques (4 of 6)

  • Techniques to avoid include:
    • Asking personal questions: Inappropriate inquiries into personal life.
    • Giving personal opinions: Overstepping professional boundaries.
    • Changing the subject: Diverging from the patient's topic of concern.
    • Automatic responses: Generic responses that lack depth.
    • False reassurance: Offering overly optimistic feedback without basis.
    • Sympathy: Failing to maintain a professional distance through excessive emotional expressions.
    • Asking for explanations: Questioning patients in a confrontational manner.
    • Approval or disapproval: Judging or criticizing the patient's feelings.
    • Defensive responses: Reacting protectively instead of openly.
    • Passive or aggressive responses: Unhelpful and detrimental communication styles.
    • Arguing: Engaging in conflicts counterproductive to healing.

Sociocultural Considerations (5 of 6)

  • Communication is influenced by culture, including:
    • Cultural influences: Affecting how individuals think, feel, behave, and communicate.
  • Speech and language considerations: Tailoring interventions based on patient needs to adapt communication techniques.

Evaluation (6 of 6)

  • Through the patient’s eyes: Evaluating successful patient outcomes involves assessing their perception of care.
  • Patient outcomes: Monitoring if expected care outcomes were met; if not, discerning factors influencing the outcome and modifying the care plan accordingly.