NUR1020 Communicating & Therapeutic Relation

Quality and safety education for nurses

effect. communcation about hazards, and errors to patient , family and healthcare team

• sharing meaning and obtain response
• building effective working realtionships
• verbal and nonverbal
• used to meet physical, psychosocial, emotional and spiritual needs

• intrapersonal communication:
• selftalk, can be positive or negative

• interpersonal communication:
• occurs between 2 or more people
• mostly 2 face to face
• to gather information during assessment
• to teach about health issues
• explain care, give comfort
• also communicate effectively with personnel

• among several people
• small group meeting, 2 or more e.g. staff meeting
• needs effective working skills and understanding of group processes

• speaker addresses a dozen t a hundred people with varying degrees of interaction
• speech, talk directly, open discussion
• public speeking often used to educate, to lobby, to address colleagues

actually said words or gestures

• act of sending, receiving , interpreting and reacting to a message
• five elements:
• sender/source/encoder

• encoding-> selecting the words, gestures, tones
• consciously or unconsciously
• affected by situational stressors

• message:
• effective : complete, clear, organized, ...
• apppropriate for situation and developmental level,

• medium used to send message
• face to face, touch
• writing...

• observer, listener, interpreter of the message
• interpretation is decoding
• relating message to past experience
• using the senses to receive
• if decoding matches-> effective communication
• sometimes not successful

• validates what was received and sending back
• verifying message avoids confusion

• education
• culture
• language
• age
• experiences
• -> goal: being understood

• technical terms and jargons-> not to lay persons
• our responsibility to send a message the patient can understand

denotation = dictionary meaning of a word

connotative= implied or emotional meaning of the word

e.g. the word "baby"

• pace and rythm can alter meaning of the message
• rapid-> hard to follow
• better slow, so the receiver
• can follow
• can respond
• fast enough to maintain interest

• tone of voice
• pitch (high and low)
• cadence (rising and falling of the pitch)
• volume (soft or loud)
• here you can see emotions
• too monotone- loosing interest
• no intonations on electronic messaging
• -> sometimes smiley faces used to give clues

• words should go conform with body language and intended meaning
• use fewest words possible
• if clear it holds interest and is effective

• timing is crucial
• assess before starting communication
• distracted by pain, hunger, coping with stressors, presence of others,
• effective when interesting and relevant for both

• depends on honest and timely response to patient concerns
• congruence of verbal and nonverbal messages
• I'll find out better than wrong answer
• never lie

• can have a positive influence on healing
• use cautiously, highly subjective and personal
• depends on cultural norms
• misused can have effect on self esteem, confidence,...

often not consciously done

• face and eyes are the most obvious forms of  nonverbarl message
• everybody understands smiling
• other facial expressions can differ  because of culture like eyecontact
• micmatch-> doubt, mistrust,

offer clues regarding attitude, wmotion, well-being, self-concept

• provide clues regarding feelings, status , culture, religion, values,
• think about own personal appearance

• should clarify spoke words
• vary among individuals and cultures
• use them with caution

affection, caring, concern, encouragement

avoid if someone is angry or mentally disturbed-> misinterpretation possible

use with conscious and awareness of culture, situation,...

• best if quiet, private, pleasant,
• be sensitive how patient experiences environment
• provide most comfortable environment possible

• physical and cognitive
• language skills
• education
• alter communication to fit patient's level
• with respect and effect with patients of all levels
• children with chronic diseases often more knowledgeable
• olders might be affectied by sensory alterations

• women:
• to form connections
• establish relationships
• be connected
• consensus

• men: maintaining independence
• positions in hierarchy
• be one
• win or loss

• vary in amount of physical space needed
• influenced by relationship
• setting
• cultural influences

• intimate distance: immediatly surrounding people/ personal space
• western around 18 inches
• body contact can occur
• performance of assessment

• 18 inches to 4 feet
• formal interaction
• communication with group
• no range of touch
• answer might be more impersonal than when being closer

• beyond 12 feet
• public speakers
• lack of individuality and focus on group

• space belonging to individual
• visible or unvisible bounding
• less at ease when away from territory
• ask for permission when e.g. moving furniture

• culture and status strongly influence communication
• male nurse might be no go for female patient
• reaction with physician different than with nurse...
• social distance-> evtl. no questions, concerns ...mentioned

• affect communication
• choice of words, tone, gestures,...
• claify roles to patient

• passive approach: avoids conflict and allows others to lead
• helpless, indecisive, apologetic, whining

• aggressive approach:
• forces others to lose
• goal is to win and be under control
• bossy, arrogant, sarcastic, manipulative, intolerant

• nonassertive style:
• men-women
• defferent status
• unclear indirect communication leads to errors

• assertive communication
• expression of wide range of positive and negative thoughts
• direct, open, spontaneous, responsible, non judgemental
• responsible for own actions without blaming others

• improving health of client
• to establish therapeutic relationship
• provide/obtain healthcare information
• express interest/concern

• pre-interaction
• gathering information about client
• no diret communication yet
• prepare for clinical days
• can be anxious time for client

• orientation phase
• introduction
• establish trust
• exchange of initial information - reason for visit or concerns
• in emergency very brief

• working phase
• active part of relationship
• thought, feelings, respect exchange, honest
• -> clarify feelings and concerns
• confidental, active listening