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process of exchanging info and generating and transmitting meanings between 2 or more individuals. It's the foundation of society and the most primary aspect of the nurse-pt interaction.
the communication process based on this; initiated on this. In this case, a pt. need that must be addressed. The need might be due to a pt.'s discomfort, a desire for info, or to address any uncertainty the pt. may be experiencing.
The source (encoder)
aka sender of the message, is a person/group who initiates/begins the communication process.
the actual physiologic product of the source. it might be a speech interview, conversation, chart, gesture, memorandum, or nursing note.
the medium the sender has selected to send the message. The channel might target any of the receiver's senses.
Name three senses the channel might target
- 1. auditory- spoken words and cues
- 2. visual- sights, observations, and perceptions
- 3. kinesthetic- touch
Reciever (aka decoder)
must translate and interpret the message sent and they must make a decision about the message.
To be an effective communicator, the nurse needs to be considerate of the receiver, and select a message that appeals to the pt's interests and that requires minimal effort and time to decode.
confirmation of the message provides this, (i.e. evidence) that the receiver has understood the intended message.
factors that distort the quality of a message; can interfere with communication at any point in the process. Might be from TV, or from pain/discomfort experience by the pt.
an exchange of info using words, including both the spoken and written word. Depends on language.
a prescribed way of using words so that ppl can share info effectively. Includes a common definition of words and a method of arranging the words in a certain order.
the transmission of info w/o the use of words, aka body language. It often helps nurses to understand subtle and hidden meanings in what is being said verbally. (Pt's tone of voice is nonverbal.)
Communication begins with this. A glance is often an attention-getting method to open conversation. In many cultures, eye contact suggests respect and a willingness to listen and to keep communication open. Its absence often indicates anxiety or defenselessness, or avoidance of conversation. Some view eye conctact as the non-verbal communication that reveals a person's true nature. However, some Asian and Native American culture view it as an invasion of their privacy. In other cultures, ppl are taught to avoid eye contact or, out of respect, not to make eye contact with a superior. In addition, the eyes carry other nonverbal messages, such as disgust or fear. A blank stare can indicate daydreaming or inattentiveness.
most expressive part of the body is the face. nurses need to learn to control their own facial expressions.
the way a person carries themselves creates a nonverbal message. ppl in good health and with a positive attitude usually hold their bodies in good alignment. Depressed or tired ppl are more likely to slouch. Posture often provides nonverbal clues concerning pain and physical limitations, for instance, a rigid, stiff appearance might be a good indicator of tension and pain.
a bouncy, purposeful walk usually carries a message of well-being. A less purposeful, shuffling gait often means the person is sad/discouraged. Certain gaits are associated with illness.
using various parts of the body can carry numerous messages. Are often used extensively when two people speaking in different languages attempt to communicate with each other.
general physical appearance
most illnesses cause at least some alterations in general physical appearance. observing for changes in appearance is an important nursing responsibility for detecting illness or evaluating the effectiveness of care and therapy.
mode of dress and grooming
a person's clothing and grooming practices carry significant nonverbal messages. for example, healthy ppl with high self-esteem tend to pay attention to details of dress and grooming, whereas those with low self-esteem often show much less interest to them. ppl feeling ill often demonstrate little interest in personal appearance, and it is often a sign of returning health when interest in their physical appearance and mode of dress returns.
Crying, moaning, gasping, and sighing are oral, but nonverbal forms of communication. Such sounds can be interpreted in numerous ways. (For example, a person might cry because of sadness or joy. Gasping often indicates fear, pain or surprise. A sigh might be a sign of reluctant agreement to do something or of relief.)
periods of silence during a conversation often carry important nonverbal messages. A silence between 2 ppl might indicate complete understanding of each other, that the individuals are thinking, or it might mean that they are angry with each other.
a personal behavior and means different things to different people. Familial, regional, class, and cultural influences largely shape tactile experiences. Factors such as age and sex also play a key role in meanings associated with touch. Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others.
aka self talk, is communication that happens within the individual. This communication is crucial because it affects the nurse's behavior and has the ability to enhance/detract from positive interactions with the pt and family.
occurs between 2 or more ppl with a goal to exchange messages.
includes small group and organizational group communication. (When making a determination about the effectiveness/ineffectiveness of a group, one studies the group dynamics.)
occurs when nurses interact with 2 or more individuals. To be functional, members of the small group must communicate to achieve their goal. The more ppl involved in the communication process, the more complex it becomes.
occurs when individuals and groups within an organization communicate to achieve established goals. Nurses on a practice council meeting to review unit policies, or nurses working with interdisciplinary groups on strategic planning/quality assurance will use organizational communication to achieve their aims.
how individual group members relate to one another during the process of working toward group goals
variables of effectiveness in groups
- - group identity
- - cohesiveness
- - patterns of interaction
- - decision making
- - responsibility
- - leadership
- - power
three ways individual group-member roles can be categorized
- 1. task-oriented roles: focusing on the work to be done. For example, information giver, information seeker, clarifier, coordinator, delegator, energizer, or evaluator.
- 2. Group-building or maintenance roles: focusing on the well-being of ppl doing the work. For example, active listener, harmonizer, trust builder, tension reliever, or supporter.
- 3. Self-serving roles: which advance the needs of individual members at the group's expense. For example, attention seeker, dominator, blocker, special pleader, withdrawer, or aggressor.
Factors influencing communication
- - level of development
- - gender
- - sociocultural differences
- - roles and responsibilities
- - space and territoriality
- - physical, mental, and emotional state
- - environment
refers to the common lifestyles, languages, behavior patterns, traditions, and beliefs that are learned and passed from one generation to the next. The first step towards cultural competence requires becoming aware of your own personal cultural beliefs and identifying "prejudices or attitudes that could be a barrier to good communication." Likewise, understanding a pt's culture assists in understanding nonverbal communication and enables the delivery of accurate nursing care to the pt and family.
this urge to maintain an exclusive right to certain space.
NIC/NOC Cognitive: Stimulation Activities and Cognitive Orientation
- - Consult with family to est. pt's preinjury cognitive baseline
- - Inform pt. of nonthreatening news events
- - Offer environmental stimulation through contact with varied personnel
- - Provide a calender
- - Orient to time, place, and person
- - Provide planned sensory stimulation
- - Use TV, radio, or music as part of planned stimuli program
- - Reinforce/repeat info
- - Present info in small, concrete portions
- - Provide verbal and written instructions
- - Cognitive orientation:
- - Identifies significant current events
- - Identifies self
- - Identifies significant others
- - Identifies current place
- - Identifies current day
- - Identifies current month
- - Identifies current year
improves hand off communication reports. Stands for Situation, Background, Assessment, and Recommendation, provides a consistent method for hand-off communication that is clear, structured, and easy to use. (was originally developed by the US Navy to accurately transmit critical info and then implemented by HC personnel at Kaiser Permanente in Colorado.) S & B provides objective data, and A & R allow for presentation of subjective data. SBAR format can be modified to meet the specific situation related to shift report conversations with physicians, and transfer of pts.
Helping relationship vs. social relationship
- Helping relationships contain many of the same qualities of a social relationship--they have in common the components of care, concern, trust, and growth. They are also different:
- - Helping relationship does not occur spontaneously, as do most social relationships. It occurs for a specific purpose with a specific person.
- - The helping relationship is characterized by an unequal sharing of information. The pt shares information related to personal health problems, whereas the nurse shares information in terms of a professional role. In a friendship, information sharing is more likely to be similar in quantity and type.
- - Helping relationship is built on the pt's needs, not on those of the helping person. In a friendship, needs of both participants are generally considered. A friendship might grow out of helping relationship, but this is separate from the purposeful, time-limited interaction described as a helping relationship.
exists among ppl who provide and receive assistance in meeting human needs sets the climate for the participants to move towards common goals.
when a nurse and pt are involved in a helping relationship. The nurse is the helper, and the pt is the person being helped. The quality of the relationship between these individuals is the most significant element in determining helping effectiveness.
a way of being/commitment to secure the interests and welfare of those entrusted to one's care.
Pts and the public are more likely to trust and value nurses who appear competent and confident and who are focused on the pts entrusted to their care.
3 characteristics of a helping relationship
- 1. It's dynamic. Both the person providing the assistance and the person being helped are active participants to the extent each is able.
- 2. It's purposeful and time limited. This means there are specific goals that are intended to be met within a certain period.
- 3. Although both parties in the helping relationship have responsibilities, the person providing the assistance is professionally accountable for the outcomes of the relationship and the means used to attain them. The helping person should present his/her helping abilities as honestly as possible and not promise to provide more assistance than he/she can offer.
Pt goals for the 3 phases of the helping relationship
- Orientation phase:
- - pt will call the nurse by name
- - pt will accurately describe the roles of the participants in the relationship
- - pt and nurse will est. an agreement about:
- - goals of the relationship
- - location, frequency, and length of the
- - duration of the relationship
- Working phase:
- - pt will actively participate in the relationship
- - pt will cooperate in activities that work toward achieving mutually acceptable goals
- - pt will express feelings and concerns to the nurse
- - the pt will participate in identifying the goals accomplished or the progress made toward goals
- - pt will verbalize feelings about the termination of the relationship
a characteristic or customary way of behaving. Nurses who consistently demonstrate warmth and friendliness; openness and rapport; empathy, honesty, authenticity and trust; caring; and competence are well disposed to communicate effectively.
warmth and friendliness
A pleasant greeting and friendly smile can facilitate this phase and place the pt at ease.
openness and respect
w/o prejudice. when a pt feels judge, he/she holds info.
is identifying with the way another person feels. An empathetic nurse is sensitive to the pt's feelings and problems, but remains objective enough to help the pt work to attain positive outcomes. By retaining this quality, you can est. successful helping relationships w/o appearing cold/stern. Sympathy differs from empathy because it shifts the emphasis from the pt to the nurse as he/she shares feelings and personal concerns and projects them onto the pt limiting ability to focus objectively on the pt's needs.
honesty, authenticity, and trust
pts should be able to trust the nurses
pts quickly sense they are merely a "task to be performed."
a person of worth who is both cared about and cared for
competent nurses are skilled in all aspects of basic nursing and can meet their pts' HC needs through their technical, cognitive, interpersonal, and ethical/legal skills. Take responsibility for evaluating your own strengths and weaknesses so that your pt will receive optimal care. Consequently, your pts will develop trust in and respect for you as their nurse, facilitating helping relationships and good communication.
a feeling of mutual trust experienced by people in a satisfactory relationship, facilitates open communication. Good rapport can be achieved by paying attention to the following variables: specific objectives, comfortable environment, privacy, confidentiality, pt vs. task focus, using nursing observations, optimal pacing, and respecting personal space.
having a purpose for an interaction provides guidance toward achieving a meaningful encounter with the pt. Be flexible at all times, and follow the pt's cues to work toward meeting all needs.
helps promote interactions. Suitable furniture, proper lightning, and a moderate temp are important. Also, effective relationships are enhanced when the atmosphere is relaxed and unhurried. If you seem preoccupied and on the run, or if the pt is ill at ease for fear of missing visitors or because of another commitment, communication is impaired.
might not always be possible to carry on conversations alone with the pt in a room, but every effort should be made to provide privacy and to prevent conversations from being overheard by others.
indicate with whom the info that the pt gives will be shared. the pt should know about the right to specify who might have access to the info. Failure to consider this factor can be considered a breach of the pt's right to privacy.
pt vs task focus
communication in the nurse-pt relationship should focus on the pt and pt needs, not on the nurse or an activity in which the nurse is engaged.
using nursing observations
- observations, which involve both seeing and interpreting, are especially useful for validating info. Observing the pt's behavior helps validate the nurse's suspicion. Observation serves several important purposes:
- - It helps increase awareness of a pt's nonverbal messages
- - It's the primary source of info when a pt is unwilling or unable to communicate verbally
- - It demonstrates caring and interest in the pt. (pts often recognize when a nurse is unobservant and, rightly or wrongly, usually conclude that the nurse does not care.)
consider the pace of any conversation or encounter with a pt. Let the pt know at the beginning of the interaction if time is limited so that pt does not feel that you are rushing because of a lack of concern or personal interest.
respecting personal space
perceptions of personal space vary. Assess a pt's personal space through careful observations of nonverbal communication. It's important to be sensitive to personal space so that the pts feel comfortable during interactions.
communication skills specifically designed to gather and validate info
open-ended question technique
allow the pt a wide range of possible response when obtaining a nursing hx. It encourages free verbalization. Greatest advantage of this technique is that it prevents the pt from answering with a simple yes or no.
provides the receiver with limited choices of possible responses and might often be answered by one or more words, "yes" or "no." They are used to gather specific info from a pt and to allow the nurse and pt to focus on a particular area. Closed questions are often a barrier to effective communication.
this type serves to validate what the nurse believes is heard/observed. Overusing validating questions and comments might lead the pt to think the nurse is not listening.
use of the clarifying question/comment allows the nurse to gain an understanding of a pt's comment. When used properly, this technique can avert possible misconceptions that could lead to an inappropriate nursing diagnosis. However, overuse of clarifying questions/comments can lead the pt to believe that the nurse is not listening or lacks appropriate knowledge.
reflective question technique
involves repeating what the person has said or describing the person's feelings. It encourages the pt to elaborate on his/her thoughts and feelings.
sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence.
might become necessary at times to obtain more info about a topic brought up earlier in the interview or to introduce a new aspect of the current topic. In such an instance, the nurse has gained additional valuable info to consider in assessing the pt's health status and educational or counseling needs.
which are one hallmark of professional nursing relationships, need to be distinguished from aggressive (i.e., harsh, injurious, or destructive) behaviors. They also differ greatly from avoidance or acquiescent behaviors. The key to assertiveness is open, honest, and direct communication. "I" statements--"I feel..." and "I think..."--play an important role in assertive statements.
four basic components of the assertive response/approach
- 1. having empathy
- 2. describing one's feelings/the situation
- 3. clarifying one's expectations
- 4. anticipating consequences
a stereotyped, trite, or pat answer. Most HC cliches suggest that there is no cause for anxiety or concern, or they offer false assurance. Their use tends to be interpreted as a lack of real interest in what has been said.
Using questions requiring only a yes or no answer
questions that can be answered by simply saying yes/no tend to cut off discussion, even when the person might wish to continue. The problem with yes/no questions arises when seeking more detailed info or when the question might create difficulty.
Using questions containing the words why and how
questions using why and how are intimidating to many pts
using questions that probe for infomation
questions that too obviously probe for info might cut off communication. pts who are made to feel as though they are receiving the "third degree" become resentful and usually stop talking and try to avoid further conversation. Although more info might be needed, it's better to follow the pt's lead. Letting the pt take initiative allows you to delve more deeply at a time when the pt is ready. A nurse who says, "let's get to the bottom of this" is likely to destroy conversation, unless the pt is ready to face the real cause of the problem.
Using leading questions
A leading question suggests what response the speaker wishes to hear. Leading questions tend to produce answers that might please the nurse but are unlikely to encourage the pt to respond honestly w/o feeling intimidated. These questions direct the pt to give an answer that pleases the nurse rather than to express his/her own thoughts.
Using comments that give advice
Giving advice often implies that the nurse knows what is best for the pt and denies him/her the right ot make decisions and have feelings It also tends to increase the pt's dependence on caregivers. However, advice does have a rightful place when it's requested and when the person giving the advice has expert knowledge that the pt does not.
Using judgmental comments
Using judgmental comments tends to impose the nurse's standards on the pt.
Changing the subject
A quick way to stop conversation is to change the subject. The pt might be at a point of readiness to discuss something and can be expected to feel frustrated if put off by a change in the topic of conversation. A nurse might also change the subject when feeling uncomfortable about the topic of conversation.
it's easier and more pleasant to deal with positive outcomes than negative outcomes. As such, nurses might try to convince the pt that things are going to turn out well even when knowing the chances are not good. False assurance might give pts the impression that the nurse is not interested in their problems. Use of cliches gives a pt false assurance. Communication might be impeded when providing the pt and family with false assurance. If you advertently do use false assurance, then you should explain with an apology and implement effective communication techniques.
AACN est. 6 standards that support excellence in nursing practice
- 1. skilled communication
- 2. true collaboration
- 3. effective decision making
- 4. appropriate staffing
- 5. meaningful recognition
- 6. authentic leadership
anger and aggressive behavior between nurses, or nurse-to-nurse hostility. It can take the form of bullying, criticizing, blaming, or bickering. Failure to address this disruptive communication can result in anger, frustration, and a feeling of vulnerability. Nurses who refuse to be a victim can help break this cycle of violence. Proactive behavior includes learning how to react professionally and protectively "in the moment," documenting and reporting the incident, and insisting that this abuse is addressed. Nurses who have always cared for others need to also care for themselves and their peers.
Nursing diagnoses for communication
- - Impaired verbal communication
- - Disturbed energy field
Nurses and other caregivers need to avoid it. "Elderspeak" involves using speaking patterns and words that mimic "baby talk" that imply that the older person is not competent. It's actually a form of ageism and used more commonly with the frail elderly in nursing homes. Communication adjustments may be necessary but must be respectful, positive, and individualized.
communicating with pts who are visually impaired
- - acknowledge your presence in the pt's room
- - ID yourself by name
- - remember that the visually impaired pt will be unable to pick up most nonverbal cues during communication. Speak in a normal tone of voice.
- - Explain the reason for touching the pt before doing so.
- - Indicate to the pt when the conversation has ended and when you are leaving the room.
- - Keep a call light or bell within easy reach of the pt.
- - Orient the pt to the sounds in the environment and to the arrangement of the room and its furnishings
- - Be sure eyeglasses are clean and intact or that contacts are in place.
communicating with pts who are hearing impaired
- - orient the pt to your presence before initating conversation. This may be done by gently touching the pt. or moving so you can be seen.
- - talk directly to the pt while facing him/her. If the pt is able to lip read, use simple sentences and speak in a quiet, natural manner and pace. Be aware of nonverbal communication.
- - Do not chew gum or cover your mouth when talking with the pt.
- - Demonstrate or pantomime ideas you wish to express, as appropriate
- - Use sign language or finger spell, as appropriate.
- - Write any ideas that you cannot convey to the pt in another manner
- - Be sure that hearing aids are clean, functioning, and inserted properly
communicating with pts with a physical barrier (Laryngectomy or Endotracheal Tube)
- - Select one or more simple means of communication that the pt is physically able to use. Options include eye blinks or hand squeezes to communicate yes or no; writing pads or magic slates; communication boards with words, letters, or pictures; flash cards; sign language.
- - Be sure that everyone communicating with the pt--family friends and caregivers--understand and is able to use the communication devices selected
- - Demonstrate patience with the time needed to communicate effectively, and reinforce the efforts made by the pt.
- - Ensure that the pt has an effective means of signaling need of assistance, such as call bells or alarms.
communicating with pts who are cognitively impaired
- - establish and maintain eye contact with the pt to hold attention
- - communicate important information in a quiet environment where there is little to distract the pt's attention
- - keep communication simple and concrete. Break down instructions into simple tasks and avoid lengthy explanations. Do not use pronouns or abstract terms. Use pictures or drawings when appropriate.
- - whenever possible, avoid open-ended questions. Ask "would you like to wear the brown pants or the gray pants?" instead of "what would you like to wear?"
- - Be patient and give the patient time to respond. if the patient does not respond after 2 minutes, repeat what you said. If there is still no response, take a break before continuing the conversation so that neither you nor the pt becomes frustrated.
communicating with pts who are unconscious
- - be careful of what is said in the pt's prescence. Hearing is believed to be the last sense lost; therefore, the unconscious pt is often liekly to hear even though there is no apparent response.
- - assume the pt can hear you. talk in a noraml tone of voice about things you would ordinarily discuss.
- - speak with the pt before touching. remember that touch can be an effective means of communication with the unconscious pt.
- - keep environment noises at as low a level as possible. this helps the pt focus on the communication.
communicating with pts who do not speak english
- - use an interpreter whenever possible
- - use a dictionary that translate words from one language to another so that you can speak at least some words in the pt's language
- - speak in simple sentences and in a normal tone of voice
- - demonstrate or pantomime ideas you wish to convey, as appropriate
- - be aware of nonverbal communication. remember that many nonverbal communication cues are universal.
A nurse who suspects a speech, language, or hearing problem should refer the pt to a speech-language pathologist or audiologist.
professional educated in the study of human communication, its development, and its disorders.
a professional educated in the study of normal and impaired hearing
a complex problem which may result, in varying degrees, in a reduced ability to understand what others are saying, to express oneself, or to be understood. Some individuals with this disorder may have no speech, while others may have only mild difficulties recalling names or words. Others may have problems putting words in their proper order in a sentence. The ability to understand oral directions, to read, to write, and to deal with numbers may also be disturbed. Strokes are the major cause of aphasia in the older population. It has been estimated that there are over one million adults with aphasia in the US today. many can be helped to communicate more effectively.
it interferes with normal control of the speech mechanism. Speech may be slurred or otherwise difficult to understand due to lack of ability to produce speech sounds correctly maintain good breath control, and coordinate the movements of the lips, tongue, palate, and larynx. Diseases such as parkinsonism, multiple sclerosis, and bulbar palsy, as well as strokes and accidents, can cause dysarthria. Many individuals with dysarthria are over 65. Their communication skills often may be improved by appropriate treatment.
The hearing loss observed as a part of the aging process. many of those with presbycusis describe the problem as being able to "hear" what others are saying, but being unable to understand what is being said. This condition can lead to withdrawal from personal interactions of all types. Family or friends may confuse the disorder with "forgetfulness" or "senility." A hearing aid can often improve communication for older people with hearing loss.
the surgical removal of the larynx (voice box) due to cancer, affects approx. 9,000 individuals per year, most of whom are older. They can usually learn to speak again by learning esophageal speech, by using an electronic device or by surgical implant of voice prosthesis.