Rachel Natividad, RN, MSN, NP

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Rachel Natividad, RN, MSN, NP
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Communication

• Have you ever been nailed by nasty remarks from a
  hostile friend, family member, or stranger?
  
• Ever been bashed by comments and criticisms from
  colleagues?
  
• How did you react?
• Did you gracefully defuse the situation?

• Define communication
• Describe a situation where you communicated
  effectively and the result.
  
• Describe a situation in which you did not
  communicate effectively and the result.

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Communication defined

• The exchange of information which involves both
  sending and receiving messages between two or
  more people.(Timby, 2005)
  
• The process of sending and receiving messages by
  means of symbols, words, signs, gestures, or
  other actions. (Smith, Duell, Martin, 2004)

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Effective Communication in Nursing

• Increases patient satisfaction and health
  outcomes
  
• Decreases risk of complaints and litigation
• Increases level of job satisfaction

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Elements of Communication

• Sender
• Message
• Receiver
• Feedback
• Meaning (sender/receiver)
• Communication Flow

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Communication can be confusing!!!
Ambiguous Picture

• Language is inherently ambiguous

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Communication Patterns

• Verbal
• Tone
• Nonverbal
• Facial expressions
• Gestures
• Eye contact
• Body language

Verbal 7
Tone 38
Nonverbal 55
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Face talks
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Communication in Nursing

• Nurse-client relationship - Therapeutic
  Relationship-
  
• Client-centered

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Case Study The First Encounter
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Phases of Therapeutic Relationship

• Introductory phase - initiation or orientation
  phase
  
• Working phase facilitating the relationship
• Termination phase relationship comes to an end

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Barriers to Therapeutic Relationship

• Unkempt appearance
• Failing to ID self verbally/name tag
• Mispronouncing/avoiding clients name
• Using clients first name without permission
• Showing disinterest in client
• Sharing personal history or work-related problems
  with the client/staff in clients presence

• Using distasteful language
• Revealing confidential info re other clients,
  staff in presence of client
  
• Focusing on nursing tasks rather than client
• Being inattentive to clients requests
• Abandoning the client at stressful/emotional
  times
  
• Failing to keep promises
• Going on break without informing client

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Case Study Resolution The First Encounter

• Attempt to identify the source of hostility
• Allow client to verbalize feelings, fears,
  concerns
  
• Offer explanations and explain the purpose of the
  procedures/medications.
  

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Case Study Resolution The First Encounter

• Acceptable responses
• You sound upset this morning.
• Mrs. T, it is difficult to be a patient. You
  havent had much time to yourself.
  
• When would you like me to bring your medicine?

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Listen

• A poem by.
• Anonymous

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Blocks to Therapeutic Communication

• Changing the subject
• False reassurance
• Giving advice
• Incongruence
• Assumptions

• Invalidation
• Overloading
• Social Response
• Underloading
• Value judgements

SDM
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Therapeutic Communication Techniques

• Acknowledgement
• Clarification
• Feedback
• Focus
• Incomplete sentences
• Listening
• Mutual fit or congruence
• Minimum verbal activity

• Nonvrebal encouragement
• Epon-ended questions
• Reflection
• Restatement
• Validation

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Case Study Cultural Diversity (2)
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Cultural Diversity

• Slang terms and colloquialisms
• Stress of illness different meanings in various
  cultures
  
• Eye contact, touch personal space meanings vary
  among cultures

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Lets Communicate Transculturally!

• Assess language needs
• Approach patient slowly and greet her/him
  respectfully
  
• Do not raise your voice to be heard
• Allow sufficient time and a quiet setting

• Pay attention to nonverbals
• Try to mirror pts style of communicating
• Provide written material in patients language if
  available

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Are you culturally competent?

• learn the language that a majority of your
  clients speak this will give you insight into
  the culture(Gaskill, 2002)
  
• Greet or say words and phrases in the clients
  language

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Case Study Resolution Cultural Diversity

• Recognize impact of the clients culture to
  communication style, health care and
  practices/beliefs
  
• Consider cultural roots when continuing with the
  plan of care

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Anxiety and Communication

• How can stress/anxiety affect your communication
  with your clients?
  
• How can stress affect clients communication with
  you?
  
• What techniques do you use to decrease your
  stress routinely? During exams?

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Levels of Anxiety
Communication Styles

• Mild
• Moderate
• Severe

• Passive
• Assertive
• Aggressive

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A confrontation with Ms. Madd

• You have just finished the change of shift report
  when Mrs. K confronts you at the nurses station.
  Due to a serious fall, Mrs. Ks sister M.L has
  sustained a cervical fracture that, in spite of
  numerous efforts, has not yet been stabilized.
  During the past few days.(retrieved from
  www.nurseweek.com 1/20/05)

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Help the anxious client

• Be alert to s/s of anxiety
• Assist pt to verbalize feelings and concerns and
  try to ID source of anxiety
  
• Be understanding of pts feelings
• Avoid becoming tense or defensive
• Speak slowly and briefly, avoid empty phrases
  that does not help the situation
  

• Offer explanations of info if pt has
  misconceptions about the situation
  
• Assess the patients support system
• ID previously useful coping mechanisms

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Rather than just defend yourself and face the
same problems over and over like Wiley Coyote,
say what you are really feeling!
Ask for help when you need it!
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References

• Timby, B. K. (2005). Fundamentals Nursing Skills
  and Concepts. 8th Ed. Lippincott Williams
  Wilkins Philadelphia, PA
  
• Smith, S.F., Duell, D.J., Martin, B. C.,
  (2004). Clinical Nursing Skills Basic to
  Advanced Skills. 6th Ed. Pearson Education Inc.
  Upper Saddle River, NJ.
• Sheldon, L.K. (2004). Communication for Nurses
  Talking with Patients. Slack Inc Thorofare, NJ.
  
• www.nurseweek.com

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