Communication Techniques in Nursing

Communication techniques are very important in which ever profession you are, especially care giving professions. As such, communication techniques in nursing are very significant. The way in which a care giving professional communicates with the patient can bring about a sea change in how the patient feels. Hence, scroll down to know about therapeutic communication techniques for nursing. he way you communicate with others in personal and public arenas reflects a lot about your personality. If you are communicating positively then you would obviously get a same kind of response and vibes (unless you encounter a jerk!). Pertaining to all this, since the past few years, communication skills and techniques have gained a lot of importance in almost all the professions. It is more so with professions where you meet numerous people like hospitality, public relations, human resources, health care, media and so on. But the field where communication has an impact which can really make the other person's life better is nursing within health care. The way a nurse deals with the patients is extremely important for the well being of the patient, mentally and physically. The question which crops up here is, are there communication techniques in nursing? Well, yes there are. Find out what they are in the text below. Techniques of Communication in Nursing General Communication Techniques Speaking or Verbal Communication: If most of us would not have been able to speak, I wonder what we all would have done. I mean, just try and gauge the amount of time we spend speaking and talking in a day! But coming back to nursing, nurses or any other type of care givers need to speak clearly first of all. Maintaining slow, even tone helps the patient to understand what they want to say. Once they put across the point, wait for the patient to respond. Nursing requires you to be slow and gentle, so not rushing thorough is one of the techniques for communicating effectively. Non-Verbal Communication: When dealing with patients who cannot hear well, nurses ideally need to use hands along with speech to tell what they want to say. Further, they also need to look out for non verbal cues they are reflecting - the body language, voice and so on. Please say the things which you are convinced about. Use other methods like writing or drawing out pictures and the likes so that the patient gets to know what you want to say if he or she is unable to understand you. Even silence can work wonders when it is about non verbal communication. These are very important nursing communication strategies. Read more on qualities of a good nurse. These and the few other techniques like helpful behavior and positive mentality are important components of communication skills for nursing practice. Now, lets take a look at therapeutic communication techniques for nursing. Nursing Therapeutic Communication Techniques Attention: To attract and hold the patient's attention and to add a personal touch, use the name of the patient. Similarly, just as you would call the patient by his or her name, it is always nice to introduce yourself too. It adds a comfort level to the interaction and lays the foundation for a good rapport. Other things which can ensure a nurse the optimum attention from a patient are: checking out on their basic needs, avoiding distractions, having an eye contact and few other seemingly insignificant things, which are, however, very crucial. Behavior: While dealing with patients, a nurse should empathize and acknowledge the mentality of the patient. A nurse's behavior should reflect that and if that is not the case, it does communicate many things to the patient. Encouragement is another essential factor in case of communication techniques in nursing and patient care. Already the patient is sort of demoralized and if the nurse discourages the patient on top of it, the patient would have it. So, as therapeutic technique, encouragement works wonders. Generally being helpful, concerned, bright and friendly is the best therapeutic behavioral technique. Help in Dealing with Disorientation: Hospitalization is a very traumatic experience for the elderly and thus they might tend to get disoriented. So, if they say something which is not true, just calmly tell them the truth in a normal tone, without challenging what they have said. If patients are dealing with memory loss, give them gentle and polite reminders all the time. Show them or tell them how to do a particular thing. Be Interactive: Wherever and whenever possible, a patient should be included in decision making. After all, it is about the patient. Let the patient be communicated as if he or she is in control. Avoid talking about patients to

others as if they do not exist. Being interactive does not mean that you nag or pester the patient to open up. Let the patient open up and express his or her feelings only when they want to. Do not rush into that. Communication techniques in nursing are umpteen if you delve even deeper into the scheme of things. The above was just a glimpse of what are the fundamentals in it. There are many more therapeutic communication techniques for nursing like being patient, being clear, listening to the patient and so on. As one gains experience, he or she imbibes these qualities. To cut a long story short, the penultimate aim is to make the patient feel better and foster a feeling that he or she is going to be just fine. If you do that, there is nothing as satisfying as that for all the Florence Nightingales out there!

COMMUNICATION TECHNIQUES

We know that communication is the transfer of information between or among people. The practice of nursing utilizes constant communication between the nurse and the patient, the patients family, the nurses co-workers, supervisors, and many others. Communication in nursing can be a complicated process, and the possibility of sending or receiving incorrect messages frequently exists. It is essential that we know the key components of the communication process, how to improve our skills, and the potential problems that exist with errors in communication. Successful communication has three major components: a sender, a receiver, and a message. In nursing, we frequently have a great deal of information to send to others in a short period of time. To do this effectively, we need to know that there are factors which could influence how our message is interpreted. We must consider the setting in which the communication occurs, the past experiences and personal perceptions of both the sender and receiver, the timing of the message, etc. Breakdown in communication can cause negative outcomes. We all know how important it is to give a thorough patient report to the oncoming nurse at shift change. In situations where this does not occur and important information is not conveyed, treatments, medications, etc. may be missed. For example, in one situation an oncoming nurse was not informed that a patient had fallen on the previous shift. The nurse therefore did not know to assess the patient for injuries or other complications from the fall, or to initiate fall precautions. The patient fell once again and was injured. This possibly could have been prevented had the communication between the nurses been complete. We know that the trust of our patients and their families is an important part of providing effective nursing care. If they dont trust us, any communication that we attempt to send to them may be disregarded. We can take steps to ensure that we have their trust. They may seem simple and self-evident; however, in our busy practice they are not always followed. The first step towards effective communication is honesty. Dont tell a patient that you are going to do something unless you mean it, and if you cant follow through, explain why. Promises, if made, must be kept. Other important factors are availability and responsiveness. Patients and families become impatient and sometimes angry when they feel that they are being ignored. Sometimes these feelings are not reasonable, but sometimes they are justifiable. If we encounter this type of complaint, we need to take a look at the communication process, timing, etc. between the nurse and the patient. If it appears inadequate, take corrective action. It has been said that as much as eighty percent of our communication is non-verbal. We need to pay attention to our body language, eye contact, and tone of voice when addressing patients and families. This also is true when addressing co-workers, nursing supervisors, and virtually everyone else. Conflict among co-workers can impact patients, and sometimes can be prevented or corrected if we are aware of how our attitude may be interpreted. Also, cultural awareness can be an important part of the knowledge base that we need to have as nurses when communicating. For example, we may want to pat the arm or hold the hand of a patient or family member, but we need to make sure that this behavior is acceptable and not seen as inappropriate. Most importantly, we must appear to be empathetic with those in our care. We are the face of nursing and the face of the facility to our patients and their visitors. We will encounter many people in our professional lives. They may not remember our names, but they will remember how we treated them during a difficult time in their lives. Do you have any stories or tips you'd like to share about communication in nursing? Visit NurseTogether's Tips From Nurse to Nurse and On the Job forums

Psychiatric-Mental Health Nursing Chapter 6 Communication What is communication?

A personal, interactive system; a series of ever-changing, ongoing transactions in the environment.

What is therapeutic communication?

A meaningful relationship between the patient and professional helper. The patient-centered approach is influenced and directed by the professional.

What are the theories that influence nursings approach to therapeutic communication?

Therapeutic communication involves the patient and professional. Feedback Loop involves a response-stimulus interchange. Internalization involves patterned learning and behavior from influences of gender, culture and developmental needs. Transactional Analysis I involves using the functions of the ego as a way of relating and communicating.

Describe communication patterns.

Patterns of communication include parent, child or adult patterns (the different ego states). Adult patterns are most effective because they do not communicate rebellion (child pattern) or judgement (parent pattern).

Describe dysfunctional communication.

There are several patterns. Crossed dysfunctional communication is a message addressed to a specific ego state but not received in that state. Double messages in a double message the exchange seems to be adult to adult but the subtle relevant message may be coming from another ego state.

Facts on Communication.

Even if a person tried they could never not communicate lack of eye contact or not speaking communicates something. Communication is a personal, interactive system a series of ever-changing, ongoing transactions in the environment it is how we develop a sense of identity and being.

Communication involves what three essential steps?

The transmission of information (sending and receiving messages). The meaning of the transmission. And the behavioral effects of the transmission.

What communication model does nursing use?

A model of communication compatible with the nursing process is an adaptation of the Wenburg and Wilmot process model of communication. This is useful for nursing because it emphasizes behavioral aspects and internal and external influences on communication.

What are the components of the communication process (or model)?

A sender or encoder person sending the message - can be verbal or nonverbal. A receiver - or decoder gets the message. A message unit of information received. Message variables verbal and nonverbal communication. o Verbal - is written and spoken structural defects, malfunctioning due to disease, auditory and verbal impairments, sensory deprivation, overload or learning disabilities may affect or decrease accurate communication. Examples: A schizophrenic person, a stutterer, a mentally retarded or autistic person. o Voice pitch, voice quality (harsh, weak or strained), voice amplification (soft or loud), words, grammar and understanding are included in assessment. o Nonverbal - is gestures, facial expressions and dress and represents 65% of the communication. Examples of nonverbal behavior include: crying, screaming, laughing, moaning, giggling and sighing, facial expression, body posture, gait, tone of voice and gestures.

Space and territory are forms of nonverbal communication as well. Personal space is the space preferred for interactions. Territory refers to implied space such as a patients room or a specific seating arrangement. o Intrusion or violation of these areas can distract or distort communication. Noise sound interference can impair accurate transmission. Communication skills include being able to observe, listen, clarify and validate by both sender and receiver. Setting where communication takes place. Media refers to sensory channels that carry the message hearing, sight, touch, taste and smell. Example: You get the message a patient needs pain medication you hear (hearing)complaints of pain, you see (sight) tears in their eyes, they grasp (touch) your arm in pain. Feedback involves the continuous interpretation of response of the sender and receiver as messages are simultaneously encoded and decoded. Environment are the internal and external influences affecting the communication process. External examples: room temperature, smells and lighting. Internal examples: feeling cold, tired or experiencing pain.
o

Interpersonal Communication

Is the most direct and pertinent form of communication because through this transaction needs are met. The main focus of interaction occurs at the interpersonal and group levels. There are three basic interpersonal styles of communicating: o Nonassertive or passive letting others control behavior o Aggressive threatening, blaming and hostile o Assertive openly expressive, spontaneous, yet considerate of others.

Important elements in therapeutic communication

Empathy which is a communication skill and behavior. Attending being with the patient both in physical and psychological presence. Observing Listening

Congruence between verbal and nonverbal communication

There are two levels to every message content and feeling when content and feeling do not match this is termed incongruent. Example: A patient with a sad facial expression and tear filled eyes, tells you he is fine. Or a husband says he is supportive of his wifes therapy but will be too busy to attend family sessions with her.

Barriers to therapeutic communication

Lack of planning by the nurse. Poor data collection. Inappropriate Nursing Diagnosis and Outcome criteria. Lack of regard or respect for the patient. These are just examples review page 67 Table 6-2 and 6-3 for more examples.

Nontherapeutic communication techniques

Interrupting Approving Moralizing Social responding Belittling Changing the subject

Therapeutic communication interventions

Listening Observation Self-disclosure Cultural Sensitivity Communication Techniques: o Using Broad Openings
o o o o

Reflecting Feelings Clarifying Feelings Confronting Feelings Reflecting Content

o o o o o

Clarifying Content Confronting Content Directing Giving Information Questioning

Therapeutic Communication Techniques

To encourage the expression of feelings and ideas Active Listening Being attentive to what the client is saying, verbally and non- verbally. Sit facing the client, open posture, lean toward the client, eye contact, and relax. Sharing Observations-making observations by commenting on how the other person looks, sounds, or acts. Example: you look tired or I havent seen you eating anything today. Sharing Empathy- The ability to understand and accept another persons reality, to accurately perceive feelings, and to communicate understanding. Example It must be very frustrating to know what you want and not be able to do it. Sharing Hope- Communicating a sense of possibility to others. Encouragement when appropriate and positive feedback. Example I believe you will find a way to face your situation, because I have seen your courage in the past. Sharing Humor- Contributes to feelings of togetherness, closeness and friendliness. Promotes positive communication in the following ways; prevention, perception, perspective. Sharing Feelings- Nurses can help clients express emotions by making observations, acknowledging feelings, and encouraging communication, giving permission to express negative feelings and modeling healthy anger. Using Touch- Most potent form of communication. Comfort touch such as holding a hand, is especially important for vulnerable clients who are experiencing severe illness. Silence- Time for the nurse and client to observe one another, sort out feelings, think of how to say things, and consider what has been verbally communicated. The nurse should allow the client to break the silence. Providing Information-Relevant information is important to make decisions, experience less anxiety, and feel safe and secu re. Example Susie is getting an echocardiogram right now which is a test that uses painless sound waves to create a moving picture of her heart structures and valves and should tell us what is causing her murmur. Clarifying- To check whether understanding is accurate, or to better understand, the nurse restates an unclear or ambiguous message to clarify the senders meaning. Im not sure I understand what you mean by sicker than usual, what is different now? Focusing-Taking notice of a single idea expressed or even a single word. An example is On a scale of 0 to 10 tell me the level of the pain you are experiencing in your great toe right now.

Paraphrasing-Restating anothers message more briefly using ones own words. It consists of repeating in fewer and fresher words the essential ideas of the client. For example the client says I cant focus. My mind keeps wandering. The student nurse says, Youre having difficulty concentrating? Asking Relevant Questions- To seek information needed for decision making.Asking only one question at a time and fully exploring one topic before moving to another area. Open-ended questions allows for taking the conversational lead and introducing pertinent information about a topic. For example What is your biggest problem at the moment? or How has your pain affected your life at home? Summarizing-Pulls together information for documentation. Gives a client a sense you understand. It is a concise review of key aspects of an interaction. Summarizing brings a sense of closure. Example It is my understanding that your arm pain is a level 1 since youve taken a Vicodin one hour ago. Taking your pain medication before physical therapy seems to help you complete the activities the doctor wants you to do for your rehabilitation. Is this correct? Client responds Yes It really helps to take the medicine before I do my physical therapy because it helps reduce the pain in my arm. Self-Disclosure- Subjectively true personal experiences about the self, are intentionally revealed to another person for the purpose of emphasizing both the similarities and the differences of experiences. These exchanges are offered as an expression of genuineness and honestly by the nurse and disclosures should be relevant and appropriate. They are used sparingly so the client is the focus of the interaction: That happened to me once, too. It was devastating, and I had to face some things about myself that I didnt like. I went to counseling and it really helped..what are your thoughts about seeing a counselor? Confrontation-helping the client become more aware of inconsistencies in his or her feelings, attitudes, beliefs, and behaviors. Only to be used after trust has been established, & should be done gently, with sensitivity: You say youve already decided what to do, yet youre still talking a lot about your options.Non -therapeutic Communication Techniques Blocks to communication of feelings and ideas Asking personal questions Asking person questions that are not relevant to the situation, is not professional or appropriate. Dont ask questions just to satisfy your curiosity. Why arent you married to Mary? is not appropriate. What might be asked is How would you describe your relationship to Mary. Giving personal opinions- Giving personal opinions, takes away decisionmaking for the client. Remember the problem and the solution belongs to the patient and not the nurse. If I were you Id put your father in a nursing home can be reframed to say, Lets talk about what options are available to your father. Changing the subject- Lets not talk about your insurance problems its time for your walk Changing the subject when someone is trying to communicate with you is rude and shows a lack of empathy. It tends to block further communication, and seems to say that you dont really care about what they are sharing. After your walk lets talk some more about whats going on with your insurance company. Automatic responses-Administration doesnt care about the staff, or Older adults are always confused. These are generalizations and stereotypes that reflect poor nursing judgment and threaten nurse-client or team relationships. False Reassurance-Dont worry, everything will be all right. When a client is seriously ill or distressed, the nurse may be tempted to offer hope to the client with statements such as youll be fine. Or theres nothing to worry about. When a patient is reaching for understanding these phrases that are not

based on fact or based on reality can do more harm than good. The nurse may be trying to be kind and think he/she is helping, but these comments tend to block conversation and discourage further expressions of feelings. A better response would be It must be difficult not to know what the surgeon will find. What can I do to help? Sympathy-Sympathy focuses on the nurses feelings rather than the clients. Saying Im so sorry about your amputation, it must be terrible to lose a leg. This shows concern but more sorrow and pity than trying to understand how the client feels. Sympathy is a subjective look at another persons world that prevents a clear perspective of the issues confronting that person. A more empathetic approach would be The loss of your leg is a major change, how do you think this will affect your life? Asking for Explanations- Why are you so upset? A nurse may be tempted to ask the other person to explain why the person believes, feels or is acting in a certain way. Clients frequently interpret why questions as accusations. Why questions can cause resentment, insecurity and mistrust. Its best to phrase a question to avoid using the word why. You seem upset. Whats on your mind?Approval or Disapproval-You shouldnt even think about assisted suicide, its just not right. Nurses must not impose their own attitudes, values, beliefs, and moral standards on others, while in the professional helping role. Judgmental responses by the nurse often contain terms such as should, ought, good, bad, right or wrong. Agreeing or disagreeing sends the subtle message that nurses have the right to make value judgments about the clients decisions. Approving implies that the behavior being praised is the only acceptable one. Disapproving implies that the client must meet the nurses expectations or standards. Instead the nurse should help clients explore their own beliefs and decisions. The nursing response Im surprised you are considering assisted suicide. Tell me more about it gives the client a chance to express ideas or feelings without fear of being judged. Defensive Responses. No one here would intentionally lie to you When clients express criticism, nurses should listen to what they are saying. Listening does not imply agreement. To discover reasons for the clients anger or dissatisfaction, the nurse must listen uncritically. By avoiding defensiveness the nurse can defuse anger and uncover deeper concerns: You believe people have been dishonest with you. It must be hard to trust anyone. Passive or Aggressive Responses- Things are bad and there is nothing you can do about it. Or Being is sick is bad and its all your fault. Passive responses serve to avoid conflict or sidestep issues. They reflect feelings of sadness, depression, anxiety, powerlessness, and hopelessness. Aggressive responses provoke confrontation at the other persons expense. They reflect feelings of anger, frustration, resentment and stress. Assertive communication is a far more professional approach for the nurse to take. Arguing-How can you say you didnt sleep a wink when I heard you snoring all night long!! Challenging or arguing again perceptions denies that they are real and valid to the other person. They imply that the other person is lying, misinformed, or uneducated. The skillful nurse can provide information or present reality in a way that avoids argument: You feel like you didnt get any rest at all last night, even though I thought you slept well since I heard you snor

CHERRY JANE C. TORRRES BSN-IA