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What is the importance of Communication in Nursing?
- Establish therapeutic relationships
- Essential element of nurse-patient relationship
- Critical skill
- 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:
- Verbal Communication
What is verbal communication?
- o Words
- o Written
- Expressing and Receiving
What is non verbal communication?
- Body language
- Posture, gait, personal appearance
- Facial expressions
- 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
- Unequal sharing
- 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:
- Orientation Phase
- Working Phase
- Termination Phase
- 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)
- Longest phase
- 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
- Competence-technical, interpersonal,
- Caring-constant polishing of this skill
Examples of good rapport builders:
- Comfortable environment
- 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.
- Patient focus
- 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
- Be sensitive
- 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
- a. Silence
- 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 “work”
- 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
- Closed questions
- Can be answered with yes/no
- Can be appropriate in certain situations when you need to glean information quickly
- Asking why
- 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?”
- Giving advice
- 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:
- Conveys unacceptance
- 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