Communication

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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 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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Elements of Communication

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

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Communication

• Language is inherently ambiguous

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Communication Patterns

• Verbal
• Nonverbal
• Tone

Verbal 7
Tone 38
Nonverbal 55
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Nonverbal Communication
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NonverbalsFace talks
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• Nurse-client relationship -Therapeutic
  Relationship
• Client-centered

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Case Study The First Encounter
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Phases of Nurse-Client 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 Nurse-Client (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

• RN 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?
• You dont have to take these, however (explain
  the purpose of the medications)

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Ingredients of Therapeutic Communication

• Empathy
• Trust
• Respect
• Active Listening

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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

• Nonverbal encouragement
• Open-ended questions
• Reflection
• Restatement
• Validation

SDM
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Case Study Cultural Diversity
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Cultural Diversity

• Slang terms and colloquialisms
• Stress of illness/Different meanings in various
  cultures
• Direct eye contact/Touch/Personal space

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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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Lets Communicate Transculturally!

• Assess language needs
• Approach patient slowly and greet 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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Case Study Resolution Cultural Diversity

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

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Interview

• Mrs. R is a 47-year-old Hispanic woman who
  arrives in the emergency department one evening
  with her adult children. Her husband of 36 years
  passed away 2 months ago. Her children say she
  has been weepy since her husbands death. She has
  been holding her chest since this morning. She
  says the her heart aches since her husband died,
  and she does not want to eat. The emergency room
  nurse must now assess the patients symptoms.
  (Sheldon, 2004)

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Interview Cont.

• Nurse Hello Mrs. R. I am Stephen, and I am the
  nurse who will be taking care of you. How are you
  feeling tonight?
• Mrs. R I am so sad without my husband..
  (weeping and holding a tissue to her chest)
• Nurse I am sorry for your loss. You are holding
  your chest. Do you have pain in your chest?
• Mrs. R My heart aches but it feels better when
  I stop and sit still.

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• Nurse Does anything else hurt?
• Mrs. R My neck aches sometimes, and I feel sick
  to my stomach.
• Nurse How long have you had pain in your chest,
  ache in your neck, and stomach problems?
• Mrs. R Since my husband died, but I feel worse
  since I raked the lawn this morning. (Sheldon,
  2004)

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Anxiety/Stress 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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Anxiety Communication

• Levels of anxiety
• Mild
• Moderate
• Severe
• Panic

• Communication styles
• Passive
• Aggressive
• Assertive

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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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Stress Anxiety and Communication

• Name ways to help the client with his/her anxiety

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Help the anxious client

• Be alert to ss 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

• Assist pt to verbalize feelings and concerns and
  try to ID source of anxiety
• 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