nurse and patient relationship

Chapter 14: Communication in the Nurse-Patient Relationship

Overview

• This chapter focuses on the nurse-patient communication techniques and their importance in establishing an effective healthcare experience. It emphasizes patient-centered approaches and the role of the nurse in facilitating therapeutic communication.

Goals of Therapeutic Communication

• The key goal of therapeutic communication is to center interactions on the patient, addressing their experiences, problems, and concerns. This approach helps ensure that patients feel understood and cared for, which ultimately enhances patient satisfaction.

The Communication Process

Establishing Connection

• In effective communication, a connection is established between the nurse and the patient. Together, they work to solve healthcare-related problems, promote health teaching, and involve family or significant others in the care process.

Communication Elements

• The essential elements of the communication process include:

  • Sender: The nurse or patient initiating the communication.

  • Encoding: The way the sender organizes and expresses the message.

  • Communication Channel: The medium through which the message is transmitted (e.g., spoken, written).

  • Receiver: The person receiving the message.

  • Decoding: The process by which the receiver interprets the message.

  • Feedback: The response from the receiver that confirms if the message was understood.

Types of Communication

• Written Communication: Involves information conveyed through written words.

• Verbal Communication: Information conveyed through spoken words.

• Nonverbal Communication: Information conveyed through non-verbal channels such as gestures, facial expressions, and body language.

• Metacommunication: Involves communication about the communication, where the context of the interaction is taken into account.

Relationships Among Types of Communication

• Congruent Relationships: Occur when verbal, nonverbal, and written communications send the same message, enhancing clarity.

• Incongruent Relationships: Occur when there is a mismatch between the different forms of communication, leading to mixed messages.

Understanding Incongruent Metacommunication

• A scenario illustrating incongruent metacommunication can occur when a patient verbally agrees with information but displays conflicting nonverbal cues (e.g., head nodding during a dietary consultation but later choosing a high-fat diet).

Elements of the Communication Process

Key Elements

• The communication process involves components such as sender, encoding, channel, receiver, decoding, and feedback. The absence or impairment in any of these elements can create challenges in effective communication.

Challenges to Effective Communication

• Various challenges can hinder communication, including:

  • Defensive or anxious behaviors.

  • Impulsive actions.

  • Somatic symptom exaggeration.

  • Grief responses.

  • Frequent healthcare visits without resolution of issues.

Importance of Language and Experience

• Language serves as a primary means of sharing experiences and shaping individual worldviews. Personal filters from an individual’s neurological makeup, cultural background, and personal history significantly impact their communication abilities and understanding.

The Nurse-Patient Relationship

• The nurse-patient relationship is described as a helping relationship that incorporates self-awareness, values, and communication styles.

Phases of the Nurse-Patient Relationship

1. Orientation Phase: Involves introductions and establishing mutual expectations between the nurse and patient.

2. Working Phase: Focuses on addressing issues and formulating solutions, assessed in later interactions.

3. Termination Phase: Involves reviewing the patient’s progress and planning for discharge.

Contracts in Nurse-Patient Relationships

• Contracts in this context refer to informal agreements that guide the relationship. Patients maintain control over personal decisions within the care plan, protecting both parties’ rights and values.

Professional versus Social Relationships

• Key differences separate professional nurse-patient relationships from social ones, including focus, relationship goals, boundaries, and self-reflection.

Ingredients of Therapeutic Communication

• Empathy: Understanding another's perspective.

• Positive Regard: Nonjudgmental acceptance and respect towards the patient.

• Self-Awareness and Self-Reflection: Enables nurses to recognize their own biases and influences in communication.

Implementation of the Nursing Communication Process

Assessment Phase

• Tasks during the assessment phase may include evaluating sensory deficits, understanding nonverbal cues, and identifying needed communication aids.

Implementation Techniques

• Effective communication techniques include:

  • Using open-ended questions.

  • Practicing active listening and reflection.

  • Leveraging silence and summarizing points as needed.

Nontherapeutic Responses to Avoid

• Nontherapeutic responses can be damaging, such as:

  • False reassurance.

  • Changing subjects abruptly.

  • Moralizing or making judgments.

Special Situations in Communication

• Nurses need to adapt their communication techniques to various patient populations, including children, older adults, and patients from diverse cultural backgrounds.

Final Thoughts

• Recognizing nontherapeutic responses, understanding metacommunication, and ensuring clarity in all forms of communication are critical in enhancing care outcomes and maintaining professional integrity.