Unit 2

Communication Chapter 13

1Communication ProcessCommunication can be a complex process that can easilybreakdown

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.22Communication is essential. When there is a breakdown it is usually related to communication. And then leads to misunderstanding.

Breakdown in communication can be related to Verbal, Written and Non Verbal Communication.

Communication Personal communication is an integral part of your personal and professional worldCommunicationOne-way communication Sender controls the messageNo opportunity for feedback

Two-way communicationEach person contributes equally Involves feedback or discussion Which type communication is the usual form of communication? Two way Communication.

Another example of one-way communication: The doctor gives the nurse an order start an IV that is one way communication because the sender is not expecting feedback. However, . The nurse may need to clarify the order and it now can become two way communication.

Example of two-way communication: The instructor asks the class a question about the topic being covered. (This purposefully prompts feedback or discussion from students.)Is an open-ended question an example of one-way communication? (No, an open-ended question asks for a response.)

4CommunicationExample: Sara walks into the patients room without knocking on the door. I am going to take your blood pressure . Give me your arm. The patient gave her a quizzical look, but complied and put his arm out.

This was the patients first impression and interaction with his nurse. 5CommunicationWhat kind of communication did Sara engage in?

Was it one way communication or two way?

What else should Sara have done when interacting with her patient the first time? One Way Communication. A different approach certainly could make it a Two way communication6Announce (Knock on the door) Call the patient by name

Introduce self and role

Explain what your going to do

Thank the patient

This is an example of two way communication.

Factors that Affect CommunicationPersonal characteristics of sender and receiverAge, gender, income, life experiences, attitude, personal opinion etc.Cultural characteristicsLanguage, use and meaning of touch, manner good or bad, gestures, etc.Situational influencesPhysical and emotional state, background noise, interruptions, etc.ContextAppropriateness/inappropriateness of the messageElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.88We talked about age and the generational differences. The matures more formal, prefer more formal titles. Expect the MR, MRS. Dont like change, want their meals at a certain time, bath at a certain time. Do not like change. Grew up during the great depression. The country in depression, food rations, war. You will communicate differently with children and young adults.

Expressions will have different meanings to different generations an different cultures

When we talk about Cultural and Spiritual Differences in future chapters we will discuss different ethic groups, spiritual beliefs religious beliefs.. You will be able to do your Cultural awareness project on a Culture of choice identifying what their beliefs are as they related to illness. Choose something that interests you. Last rotation there were some different cultures presented. I will give you a examples, but you may have something from your own background that you may be interested in researching be creative but be able to answer the questions.

Language Barriers. Mention interpreters, in some cultures touch is perceived as inappropriate. Pain interpretation different in cultures Some belief they can not express. Chapter 16 will increase tour awareness of the diversity in people based on culture, ethnicity, religion, traditions.

Example of appropriateness in communication. The patient rings their call light. When the call light is answered the nurse tells the patient they are too busy and there is not enough staff. In appropriate .

Types of CommunicationVerbal NonverbalAffective (Refers to Mood or emotion)

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.99Ask the class for examples of nonverbal communication. ( facial expressions, body posture, eye contact, hand gestures, fidgeting, yawning, sighs, shoulder shrugging) Eye rolling. Common courtesy, non professional behavior. Non Verbal COMMUNICATIN CAN NEGATE VERBAL WORD. Example a nurse is taking care of a patient and is learning to deal with oders. The nurse is approaching the patient to care for them, the interaction may be appropriate verbally but the nurse is making a face.

You need to be aware of you non verbal communication and keep in check. Be able to identify if this is something you may have to work on.You will be exposed to patients with open wounds, drainage, incontinence, ostomies, vomitus, snd sputum. You will nee to learn to adapt to the environment you will be working in. Some of you are already taking care of patients and performing some basic care and have made some adjustment to this environment.

What is ones attitude? (manner or disposition toward a person or thing; a settled mode of thinking) Someone is going through the motions but is in a bad mood. This affects communication. Someone comes in on the wtong side of the bed. What is mood? (prolonged emotion that colors ones psychic life) What is ones personal space? (an imaginary comfort zone around a person)

Types of CommunicationVerbal communication: spoken messageThe spoken word is powerful

Think before your speak Speak clearlySpeak professionallyNo slang (May related to age groups)No medical jargon Examples: OOB, NPO Colloquial expressions may be appropriate example urinate, potty, bathroom, pass water. .

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.1010Think before you speak.If you do not know something, let the patient know that you will find out the answer or find someone who knows the answer.

In most acute care facilities, and rehab facilities every patient room may have a communication board

What are examples of medical jargon that we assume patients understand? (examples: NPO, OB, subq, analgesic, arrhythmia, bearing down, purulent)What words could we substitute for these so that the patient understands us?What are some acceptable colloquial (common) expressions we could use?What illnesses may affect a patients verbalization?

Speak only about what you know.

If a patient asks you a question and you dont know the answer what would be the appropriate response?I am unable to answer that for you but I will get you someone who can. Or I can find out and check with your nurse and get back to you. I am not sue about that but I will get you an answer.11CommunicationI dont know but I will be able to get you someone who may be able to help you.CommunicationMaintain professional boundaries but communicate with the patient

Patients trust the nursing staff more when they are communicated to0 effectively

Quality care is measured by positive patient outcomes which includes how the nurses and health team communicate with a patient.

See example next page of a sample communication board that is common in many facilities today.

Patients trust their nurses more when they are effectively communicated to.

13Stonehouse can also add detailed symbols and additional languages to your board.Image 7 of 12

14WASHINGTON, D.C. -- In 2014, Americans say nurses

Types of CommunicationNonverbal communication: body languageExpressions, posture, movements, gestures, physical appearance may say something different than the verbalClues to the truth of the spoken messageIndicators of patient discomfort Physical appearance is a part of nonverbal communication grimacing, wincing, cryingElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.1616Nonverbal communication pertains to behaviors displayed by an individual rather than his/her actual verbal communication.

What are some examples of body language? ( blushing, paleness, pupil dilation, and diaphoresis, facial expression.You look upset about something? Can I help?

What information can the patients personal appearance give the nurse?How can a patients body language tell you he or she is in pain? (facial grimacing; holding an affected body part; crying; slumped when sitting; face in hands; prayingrosary or reading Bible; pacing or leg jiggling)

Types of CommunicationAffective communication: feeling toneTone of communicationEmission of energyElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.17

17What could determine a nurses mood when she arrives at work? (traffic conditions, availability of parking, amount of sleep, family situations, mood of co-workers, hunger, work load, not feeling well.

How does affective communication differ from verbal and nonverbal communication? You may be going through the motions but your approach may be abrupt to a patient.

Remember perception to someone is their reality. Many times a message is received differently than intended, tone, facial expression. Sometimes we need clarity.

Truly honest communication integrates verbal, nonverbal, and affective communications so that they all express the same message.

CommunicationGive me an example of a time that you stepped into a room or approached a person and before anyone spoke a word, you experienced a feeling of excitement, happiness, sadness, anger?people emit energy good or bad and can transmit a vibe.18Communication StrategiesActive ListeningMost important part of any therapeutic communication Key factors include Purpose a reason for the communication to obtain information from the patientDisciplined attention pick up on things Focus ( Listen to what the patient says and clarify.)A common mistake is to listen to the words, but not really hear the words Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.19

19Purpose refers to the health-related reason for gathering data or giving information. Disciplined attention means that you do not assume accuracy of information without checking it out.Focus means that all your senses are alert to clues that the patient may be communicating. How can you clarify what a patient is saying to you? As further questions as needed to get more detail.Communication StrategiesActive Listening BehaviorsRestating- Repeating in a slightly different way what the patient said

Example: Patient: My chest hurts. I cant sleep at night. Youve been unable to sleep at night because of chest pain?

Gives the nurse more clarity and informationElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.2020Ask the class to identify each of the following statements:Nurse: In this hour you and I discussed. (summarizing)Nurse: I am not sure I follow that. (clarification)Patient: Its a waste of time to talk to anyone. Nurse: You dont think anyone understands? (paraphrasing)Nurse: Tell me whether my understanding is the same as yours. (validation)Nurse: Go onI see. (minimal encouraging)Patient: Should I have the surgery? Nurse: Do you think you should? (reflection)What may happen if you try to fill silence with chatter?Avoid making interruptions and doing busy work while the patient is speaking.

Therapeutic Communication

Clarifying Is asking a closed ended question in response to a patients statement to be sure you understand

Example:Patient: My chest hurts.Nurse: Exactly where does your chest hurt?Communication StrategiesTypes of QuestionsOpen-ended questions Permit variety of responsesOften begin with what, where, when, how, or whyWhat happened to your leg?Closed-ended questions Require a specific answerWhen did you first notice the pain?Focused questions Provide more definitive informationOn a scale of 1 to 10, with 10 as the worst possible pain, how would you rate your pain right now?

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Therapeutic CommunicationMinimal Encouraging Involves using sounds words or short phrases to encourage the patient to continue

Example: Patient: It happened so fast Nurse: Yes go on and then what hum uh really

Therapeutic CommunicationParaphrasing- Refers t0 expressing in your own words the information you are receiving from the patient.Example: Patient: I dont think I am being told the truth about my condition.Nurse: You think you may have other problems that have not been discussed with you?

CommunicationRemaining Silent- Involves using pauses effectively. Th normal tendency is to fill silence with chatter your speculation. This may shut a conversation down. Avoid interruptions and busy work and give the patient your attention.

Reflecting Is putting into words the information you are receiving from the patient at an affective communication level. Example: Patient: I am sick of seeing Doctors and not getting answers.Nurse: You are upset with not getting information about your health problems? Therapeutic Communication Summarizing- Means briefly stating the main data you have gathered

Nurse: Is what I heard you say correct?

Therapeutic CommunicationPatient: My knee hurts even while Im sitting in my chair.Nurse: So you are telling me you have pain in your left knee even at rest?RestatingRepeating in a slightly different way what the patient has said.28Validation- Provides the patient with an opportunity to correct information, if necessary at the time of summary.

Example: Patient: That is correct or no you got this part wrong. This allows the patient to correct what was said. Nurse: In this hour you and I discussed. SummarizingBriefly stating the main data you have gathered30

Therapeutic CommunicationPatient: Its a waste of time to talk to anyone. Nurse: You dont think anyone understands?Paraphrasing

Expressed in your own words what you think the patient means.31Nurse: Tell me whether my understanding is the same as yours. ValidationProvides the patient with the opportunity to correct information if necessary at time of summary32Nurse: Go onI see. Minimal encouragingUses sounds words or short phrases to encourage the patient to continue33Patient: Should I have the surgery? Nurse: Do you think you should? Reflection

Putting into words the information you are receiving from the patient at an affective communication level.tone energy 34Communication StrategiesNurse/Patient CommunicationEvaluation Communication is far more complex than just talkingEvaluate the characteristics that are working for you and those you need to work onElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.3535Blocks to CommunicationFalse reassurance guarantees positive outcomeProbing pushes for information beyond medical necessity Chiding or scolding for behavior such as smokingBelittling, mimicking, or making fun of the patient, downplaying symptomsGiving adviceProviding pat answers negates individuality of the situationElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.3636What reasons may cause the nurse to slip into communication styles that block communication? Ask the class to identify the following statements:What else do you dislike about your doctor? (probing)Just keep your chin up. (providing pat answers)Its bad to (chiding)I wouldnt worry about . (false reassuring)You wont die that soon. (belittling)What are some additional blocks to communication? (giving approval, rejection, agreeing/disagreeing, challenging, testing, defending, requesting an explanation, using denial, interpreting, and introducing an unrelated topic)

Male/Female DifferencesMost males and females follow certain patterns with regard to:ConversationHead movementsSmilingPostureDifferences in patient communication have important nursing implications

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.3737Are men more or less likely to express feelings honestly or openly? Ask the class to demonstrate how a man and woman might answer the same question in a different manner.Why are male opinions often valued more highly without validation?Would it be easier or more difficult for a nurse to communicate with a patient of the same sex?Patterns of communication may differ between people of the same sex, so it is important for nurses to ask probing questions.How can you be sure that you understand what a patient is communicating?

Cultural DifferencesUnderstanding cultural differences will help nurses respond respectfully and therapeuticallyDifferences apply generally to groups as a wholeIndividual patient differences should still be identified

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.3838What is the difference between a culture and an ethnicity? (Culture: total way of life of a people; social legacy of norms and values the individual acquires from his/her group. Ethnicity: affiliation due to shared linguistic, racial, or cultural background)Differences exist within each cultural group, ranging from extremely conservative or orthodox to very liberal and reformed. Be aware of where your patient falls in his or her cultural group.

Role Changes for the PatientDependent positionSet tone by providing respect and information; do not use first name unless specifically requested by patientAvoid medical jargonAsk if patient has questionsBe sensitive to personal or environmental factors that may cause anxiety

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.3939How might a patient, who normally leads a very independent life, react to being in the hospital? (increased anxiety and disturbance in self-esteem)Baby boomers (born post-WWII through the 1960s) and younger usually prefer to be called by first name, but always ask. How would you introduce yourself to a patient?What may a patient be fearful of?How can environmental factors be adjusted to better met a patients needs?

Communication CharacteristicsImportant in All CommunicationsRespectTrustHonestyEmpathySensitivityHumorKnowledge PatienceCommitmentSelf-esteemElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4040Respect gives patient sense of worth.What may signal a patient that you either respect or disrespect them?Honesty: Never make up an answer if you are not sure of it. Let the patient know you do not know, but will return with the correct answer.When you are sympathetic, as you would be with a family member or dear friend, you actually experience the emotion.When is humor not appropriate? Lack of patience with a patient can lead to increased anxiety.Commitment: Why are you really in nursing?

Communication CharacteristicsSelf-esteemEarned, not learned Gives you permission to recognize that you have something very special to offer in nursing communication ThoughtsRandom thoughts usually pass through, unless you pick a thought and change it into an active thought Straightforward communicationBe direct in your conversation, remembering that language is never innocent Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4141 If your thoughts are not serving you, change them.Thoughts also set the feeling tone for how you communicate with patients and other staff.Life Span Communication Each age group has differentcommunication needsInfantsCries have different meaningsInfluenced by the sound of the voiceRespond to calm, low tonesPreschoolCannot verbally express frustration, leading to tantrumsCommunicate by pointingCan help if coached

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4242If your thoughts are not serving you, change them.Thoughts also set the feeling tone for how you communicate with patients and other staff.

Life Span CommunicationSchool-ageCan be part of many discussionsCan use drawings or pictures to explain an illnessTeenageExtend same courtesy as to adultsEncourage expression of feelings

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4343Validation of school-age childrens perceptions is especially importantWhat would you say to a nine-year-old to elicit feedback on a procedure you just explained to her? (Now you tell me what is going to happen to you. Then, clear up any misperceptions.) Remember that younger children think well in the afternoon. Use of teen slang generally does not work out. Without real knowledge of the meaning, you may end up appearing foolish instead of cool.

Life Span CommunicationAdultCollect data at all three communication levelsLimit questions to medical areasElderlyCheck which side is best for hearingRead directions aloud

Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4444Written information seems to be more neutral and does not evoke the emotional reaction that words would have. Which eye has more visual acuity in the male?When communicating with the elderly:Be aware of a possible diminishment of senses.Use a matter-of-fact, yet gentle, approach.Do not patronize or talk to them as if they are children. Include the elderly patient in communication even if family members are there.

Conflict ResolutionAccept conflict as a natural part of lifeShift your own attitude and behaviorTake time to think critically before reactingTreat conflict as an opportunity to voice your own opinion and listen to the other side of the storyChoose your approachListen and learnDiscover what is importantRespect each otherFind common ground, generally the patients highest good Elsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4545Conflict can be related to diversity, English as a second language, differences in gender, generation, and personality. How do physicians and nurses communication techniques differ? Electronic CommunicationFax machinesComputer patient chartingE-mailKeep sentences and paragraphs short; check spelling, punctuationSkip a line to separate topicsSend message to the right personWrite subject line carefullyBe specificBe cautious with humorAvoid all CAPSElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4646Why are we including electronic communication in this chapter?Additional e-mail tips:Answer swiftly.Answer all questions and preempt further questions.Do not attach unnecessary files.Do not overuse the high priority option.Do not copy or attach a message without permission.Do not use e-mail to discuss confidential information.Keep your language gender neutral.Avoid using Urgent and Important.

Electronic CommunicationCell Phones and Text Messaging Shut off cell and text messaging phones during class and clinicalAvoid behaving in ways disruptive to the instructor and other studentsElsevier items and derived items 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.4747