Why is communication important?
-to get people to understand what we are saying
-always doing it
-to coordinate care
-to collaborate with others
-to get cooperation
-legal obligation to do so
-to teach patient what they need to know
-to increase morale
-use in diagnosing
-communicate that we care
What are the four C's of initial direction?
1. Concise- to the point, no unnecessary info
2. Correct- do they follow procedure?
3. Complete- give all information?
4. Clear- understood?
What is health literacy?
"Ability to read, understand, and act on healthcare information".
- nurses need to evaluate/assess your patient's ability to understand
-Health literacy is a stronger predictor of health status than is socioeconomic status, age, or ethnic background
In the communication process, messages sent and received are influenced by what 4 things?
- past experience
- position within socioculture
What is a therapeutic relationship?
- helping relationship. the goal is be helpful
- it is a partnership between patient & nurse, nurse and doctor, etc
What are the 11 "P" words for helping relationships?
- Partnership (people communicating)
- Philosophy (underlying based on values & beliefs)
- Purposeful --> Productive (goal or objective)
- Pre-servation (preserving health)
- Palliation (↓ fears/stress/anxiety thru care/comfort)
- Psychic Boost (↑ morale & self-esteem)
- Practicality (give/offer useful solutions)
- Personal (individualized to the patient)
- Platonic - (it's not a social thing)
- Powerful (if it's all these "P" words)
How do you establish mutual trust? (7)
1. Establish objectives (purpose of encounter, what are the goals?)
2. establish environment = close door, patient comfortable, patient covered, warm, sit down
3. focus=pay attention
4. observe = assess (while multitasking)
5. pace= take your time, don't get really personal right away
7. care = compassion
What are the professional communication elements? (5)
1. Courtesy=knock on door, please, thank you, etc.
2. Privacy=can't talk about the patient HIPPA
3. Trustworthiness=honest, competent, consistent, reliable
4. Autonomy (self directed, doing things on own, personal responsibility)
5. assertiveness (confidant, trust feelings but respect opinions)
What are the 4 relationship phases?
1. Pre-orienatation=get from previous RN, aide or medical record. What we need to know, opposed to gossip.
2. Orientation= who are you? who am I? How long I'm going to be with you? set goals & establish roles.
3. Working= work together to meet goals, teaching, coping, etc. Most interactive & longest
4. Termination= establish and evaluate how it went. Close with patient. Transition goals with next RN.
What are the five communication levels?
1. Intrapersonal- communication with self.
2. Interpersonal- most common communication. face-face with another person
3. Transpersonal- communication within spiritual domain (used both intra & interpersonally)
4. Small group- communicating between 2-10 ppl
5. Public- over 10 people. eye contact, movement, voice inflection, etc.
What is the Verbal (Communication Process)?
- need common language
- may be written or spoken
- uses words
What is the Non-verbal (Communication Process)? (10)
Because no words are used you really need to validate what was communicated.
- Touch = nurses use a lot. caring, comfort
- Facial expressions = most expressive
- Posture = denotes mood
- Gestures = useful when you don't have language
- Physical appearance = can tell if sick
- Dress/Grooming = could reflect personality
What are the seven factors affecting communication?
1. developmental= babies→old age. might have disease processes that affect us developing
3. sociocultural= different languages
4. roles/responsibilities = in some cultures men may play a stronger role. Societal = can't make assumptions
5. physical/mental/emotional status = in pain is not a good time
6. values = do they value open communication, teaching, opinions
7. environnment = privacy, lighting noise, etc
What are some Communication Facilitators?
- active listening
- facilitation (encourage client to continue talking)
- confrontation (challenge bad behavior)
- self disclosure
- using silence
- requesting support
- focusing (helping patient expand on an idea)
- offering self
- placing events in time/sequence
- ask relevant questions
- sharing feelings/observations
- using empathy
- using touch
- reducing distance
- establishing guidelines
- seeking clarification
- seeking consensual validation
What is active listening?
- Receivers of active listening are provided with the knowledge that we know how they are feeling and understand why. Ex. Validate their concerns
- associated with being empathetic. Ex. put yourself in their place
What is facilitation?
- uses phrases to encourage patients to continue talking...'go on'.."uh huh"...etc
What is confrontation?
- Making others aware of the destructiveness or lack of productiveness in their behavior
Explain Care Confrontation
1. Clarify behavior that is a problem
2. Tell them why their behavior is a problem
3. Request a change in your pts or colleagues behavior
4. Encourage a change emphasizing positives that come of it or negative consequences of not changing
What is summarizing?
- a statement covering main points
Ex. summarize patient's condition & care when discharged or transferred
What is self disclosure?
- to share your feelings with someone, usually through personal experience, in order to gain his/her trust, make them comfortable, or put them at ease (you are using empathy)
What is focusing?
- Questions or statements to help the client develop or expand an idea. Ex. how long have you had pain?
What is placing events in time/sequence?
puts events/actions in better perspective and notes the cause/effect relationship. Ex. what lead up to...?
What is restatement (paraphrasing)?
Repetition to the client of what the nurse believes is the main thought or idea expressed
What is asking relevant questions?
Collecting information you need to provide the best nursing care. Always ask 6 questions- why, what, how, who, when, where
What is reflection?
Direction back to the client of his or her ideas, feelings, questions, or content
What is sharing feelings/ observations?
a style in which one person asks another person to share his/her own feelings, observations, hopes. Helps enlist their cooperation
ex. How does that make you feel?
What is using empathy?
Act of communicating to our fellow human beings that we understand how they are feelings and what makes them feel that way.
What is using touch?
Touch is way to affectionately transmit warmth, caring, compassion and understanding to a pt/family member. Important to be sincere.
What is planning?
mutual decision making regarding the goals (short & long term), direction and so forth, of future interactions. Reiterates the client's role within the relationship.
What is reducing distance?
diminishing of physical space between the nurse and client
ex. look to patient for clues if you are too far away or too close
What is establishing guidelines?
setting a clear understanding of what is expected from the nurse and pt
What is seeking clarification?
A clarifying question or comment allows the nurse to gain an understanding of a patients comment
ex. Clarify where the patient is having pain
What is Seeking consensual validation?
Attempts to reach a mutual meaning denotative, connotative of specific words
ex. Is the pain hot? cold? dull? sharp? continuous?
What are Communication Blockers?
-asking for explanations (Why are u afraid of a needle)
-defending (protect from negative feedback)
-giving advice (unilateral problem solving)
-Sterotyped responses (It's normal for old people)
-changing topics (when something uncomfortable)
-belittling feelings (unable to empathize of understand
-failure to listen
-failure to probe (not enough data collected)
-parroting (continual repetition of patient)
-rejecting (won't discuss topic w/patient)
-using professional terms (or abbreviations)
-asking personal questions
-sympathizing (nurse becomes too emotional)
-patronizing (condescending attitude)
-automatic responses (not tailored to patient)
- expressing values/judgements (approving or disapproving statements)
- passive/ aggressive responses (nurse denies own rights or puts their rights above patients)
- challenging (what the patient says)
- probing (asking things you don't need to know)
What are the tips for practicing presence?
1. Deep breath. Bring your attention to present moment
2. Posture s/b present. legs are even on floor, open your palms, face the person fully, aim your heart at their heart
3. lean in
4. tune in
5. smile & make eye contact
6. open your eyes, ears & heart. listen to their thoughts & feelings
7. if distracted re-focus on the patient
What are signs of not being present?
1. eyes wandering, looking away
2. maintain eye contact, but not really listening
3. doing something else while someone is talking
4. chatting with a co-worker
5. allow interruptions, phone calls
6. allow important interruption, but don't apologize
7. acting tired, bored or distracted
8. looking at your watch
9. interrupting the person who is talking
10. turning your back
11. walking away w/o saying goodbye