Define communication

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(No Transcript)
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• 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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Communication

• Language is inherently ambiguous

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Communication Patterns

• Verbal
• Nonverbal

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

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Case Study The First Encounter

• Good Morning Mrs. T. My name is RN, and I will
  be the nurse caring for you today. Is it all
  right to call you Mrs. T.?
• Mrs. T. is a 76 year-old woman with metastatic
  lung cancer being cared for by RN. It is her
  second day at the hospital. She is quiet, giving
  one- word responses to RNs questions. She thinks
  that RN is too aggressive, making her wash up and
  scheduling tests for later in the day. RN is
  beginning to wonder about why Mrs. T is reluctant
  to share information. When he comes in to bring
  her morning meds, he says, Mrs. ., I have your
  medications.
• She responds, What am I supposed to do, take
  those now just because you say so? (Sheldon,
  2004)

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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
• 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
• 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 sound upset this morning.
• You dont have to take these, however (explain
  the purpose of the medications)

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NonverbalsFace talks
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Ingredients of Therapeutic Communication

• Empathy
• Active Listening

• Trust
• Respect

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Interview

• Patient I have some bad news. I started
  smoking again. I tried, really tired, but
  everyone at home was smoking.
• Nurse I am glad that you tried to quit. Its
  tough, isnt it? Many people try to quit three or
  even five times before succeeding. If you stop
  smoking, you will help your chronic bronchitis.
  Lets talk about other strategies for quitting
  smoking. Where can your family smoke that is away
  from you? (Sheldon, 2004)

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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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Therapeutic Communication Techniques

• Broad opening
• Giving info
• Direct questioning
• Open-ended question
• Reflecting
• Paraphrasing
• Verbalizing what has been implied

• Structuring
• Giving general leads
• Sharing perceptions
• Clarifying
• Confronting
• Summarizing
• Silence

Timby, 2005
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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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Blocks to Therapeutic Communication

• Disagreeing
• Demanding an explanation
• Defending
• Belittling
• Patronizing

• Changing the subject
• False reassurance
• Giving advice
• Using clichés
• Approving/disapproving
• Agreeing

Timby, 2005
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Case Study Cultural Diversity

• Mrs. C. is a 68 year-old- woman who emigrated
  from China to America as a newlywed 40 years ago.
  Now she is scheduled to undergo a hysterectomy.
  The nurse is doing a preoperative assessment and
  teaching session with Mrs. C.
• Although Mrs. C speaks and understands English
  well, she makes little direct eye contact and has
  no questions. She refuses the prescriptions for
  pain medicine.
• The nurse is about to obtain informed consent for
  the procedure, but is not sure that Mrs. C
  understands what has been discussed. How would
  cultural awareness help in this situation?
  (Sheldon, 2004)

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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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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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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 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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Listen

• A poem by
• Anonymous

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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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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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Family Feud

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

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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