What is the importance of Communication in Nursing?
Establish therapeutic relationships
Essential element of nurse-patient relationship
Dynamic Process- constantly changing
What do nurses use communication for?
1. Gather information
2. Teach, support, encourage-we do the teaching
3. Express caring and comfort
Three forms of communication:
What is verbal communication?
Expressing and Receiving
What is non verbal communication?
Posture, gait, personal appearance
Not always under our conscious control.
What is the nursing process?
Therapeutic (helping) communication
Nurse Patient Relationship can be described as:
Therapeutic-only reason why we are in a relationship with a patient
In the trenches! The nurse is constantly with the patient.
Helping VS Social relationship:
Does not occur spontaneously
Based upon patient’s needs, not ours.
Must permeate the relationship
Be careful what you share personally. Stop and think.
We are there for the patient and family
What would a reasonable and prudent nurse do?
Characteristics of Helping Relationship:
Purposeful-what would be the best thing for this patient?
Respects patient as individual-always try! A human being.
Based upon trust-implicit trust in the nurse
Person providing assistance presents his/her helping abilities honestly and completely
Goal of Helping Relationship:
Improved health and well-being
Helps patients/families manage problems
Help patients/families develop better ways to help themselves
Phases of Therapeutic Relationship:
Tone of relationship is established-when you first meet, could be a lot of different places
Roles identified-introduce yourself, tell your role
o Goals-how are they feeling, what are their goals
o Duration, frequency, location
TRUST BEGINS (Rapport)
Nurse provides nursing assistance
Nursing roles are performed:
Can occur at various times
Emotions associated-someone may be leaving to die, don’t make promises you can’t keep, don’t be offhand
Honesty is critical
Dispositional Traits of a good nurse:
Warmth and friendliness-speak to person, introduce yourself
Openness/respect-do not judge, do not react to bad behavior
Empathy-some level of understanding of what a person may be going through, deeper level than sympathy
Caring-constant polishing of this skill
Examples of good rapport builders:
Confidentiality-what patient’s say to you stays within the appropriate realm. Do not say: I won’t tell anyone. Adult patients have a right to speak with you alone. Use intuition and observation skills.
Focus not on nurse or her activity
Seeing and interpreting/communicates caring, “I noticed you aren’t very happy today……I noticed…” Be careful of cultural differences.
Providing Personal space
Nursing is an intimate profession!
The importance of Unconditional Positive Regard
Must permeate the nurse patient relationship
Recognize patient’s flaws as part of total picture
Respect not dependent upon patient’s behavior
Accepting their humanness without ridicule…remove self if situation gets out of hand, explain to quit talking like that and that you are going to leave.
Therapeutic Communication Skills:
Focuses on the patients concerns
1. Takes time and practice to acquire!
2. Does not occur quickly
3. Mark of a competent professional
1. Pacing-keep it steady
2. Tone of voice-neutral demeanor, calming
3. Clarity-try to be clear
4. Brevity-to the point, simplicity, no jargon, use lay terms when necessary, do not assume a casual relationship with patient
1. It is a SKILL
2. Most important technique
3. Basic to all other techniques
4. Active process
5. Requires concentration and energy
6. Silence-it is GOLDEN!
7. Different from social communication
8. Its OK! Communicates acceptance.
Do not have to fill as in a social dialogue
Prevents too much talking on part of nurse
Prevents filling in with social conversation
Open ended question/comment
Allows patient a range of possible responses
Prevents a simple yes/no when trying to encourage verbalization
“Tell me about….”
“What do you think about…”
Interviewing technique continued: Reflection
Mirroring a statement or statement fragment with a questioning tone
“Won’t be easy?” Using the patient’s own words
Ensuring what was “heard” was correct
What was the meaning of the words used
“So, what I am hearing you say is….”
“You are saying that you are worried about the test results?”
Make clear, more specific than validating
Helps nurse to understand what was said
“Are you taking your medicine every night, or just when you have trouble sleeping”
Places events, incidents in order
“You had the argument with you son after you saw the social worker?”
Focusing on a topic
“You were talking earlier about moving to assisted living”
Other methods of communication:
Touch-for comfort and out of necessity
Humor-no sarcasm, or difficult to understand
Happen when a nurse fails to view the patient as a human being
Not a diagnosis
Not a problem
Not the recipient of task
Nurse focuses on the WHOLE PERSON -distinguishes nursing from other professions!
Blocks-usually happens when we fail to look at the whole person
Failure to listen
LISTENING must occur throughout all interactions! Failure to do so may result in a communication block.
Other reasons for communication blocks:
Trite response- “Boys will be boys” Conversation killers
Can be answered with yes/no
Can be appropriate in certain situations when you need to glean information quickly
Can be intimidating or challenging, may put patient on defensive- “Why didn’t you discuss this with your doctor?”
Probing for information
Aggressive approach vs assertive
“What do you mean you don’t keep your appointments?”
Using leading questions
“You like the care you get here, don’t you?”
Nurse is an authority!
Must be very aware of own influence
People must be assisted and supported to make own decisions
Imposing own standards upon others
Does not convey acceptance
“You know you are not going to get well until you grow up and face this”
Changing the subject:
Shifts focus from patient centered dialogue to nurse controlled dialogue
Minimizes patients feelings/fears
Conveys non interest on part of nurse
Nurse may be the only one to whom patient can voice true fears and feelings
“I am sure everything will turn out OK”
Other helpful hints in communication:
Individualize for the patient with whom you are communicating
Vary the techniques used
Overuse of one technique will communicate that you are not listening
Use non verbal communication appropriately- body language, tone of voice etc
Patient should be talking more than the nurse
You will make mistakes, if genuine interest is expressed and the nurse is attempting to be therapeutic the relationship will be able to withstand an error or two!
As a novice, RELAX, realize that most patients want very much to talk with you