Communication In Nursing

Communication -the process by which people affect one another through exchange of information, ideas, and feelings.

Modes of Communication Verbal Communication- uses spoken or written words Nonverbal Communication- uses gestures, facial expression, posture/gait, body movements, physical appearance (also body language), eye contact, tone of voice.

Characteristics of Communication 1. Simplicity- includes use of commonly understood words, brevity and completeness.

2. Clarity- involves saying exactly what is meant. The nurse also needs to speak slowly and enunciate words well. Repeat words as needed. Reduce distractions
3. Timing and relevance- require choice of appropriate time and consideration of the clients interest and concerns. Ask one question at a time. Wait for an answer before making another comment.
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4. Adaptability- involves adjustment on what the nurse says and how it is said depending on moods and behavior of the client.

5. Credibility- means worthiness of belief. To become credible, the nurse requires adequate knowledge about the topic being discussed. The nurse should be able to provide accurate information, to convey confidence and certainly in what she says. More importantly, she should be a good role model about what she is saying.

Components of Communication
Sender/ Encoder Message Receiver/ Decoder

Channels

Response/ Feedback

Sender- the person who encodes and delivers the message Receiver- is the person who receives and decodes the message. Message- is the content of the communication. It may contain verbal, nonverbal, symbolic language. Channels- are means of conveying and receiving messages through visual, auditory and tactile senses. Facial expressions send visual messages, spoken words, are perceived through auditory channels and touch uses tactile channels.
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Feedback- is the message returned by the receiver. It indicates whether the meaning of the senders message was understood.

Communication is the basic component of human relationships. Non-verbal Communication is more accurate expression of a persons thoughts and feelings than verbal communication.
Effective communication is reciprocal interaction (two-way process) based on trust and aimed at identifying client needs and developing mutual goals.
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Trust is the foundation of a positive nurse client relationship. Therapeutic Communication is a fundamental component in all phases of the nursing process, and for establishing effective nurse-client relationship.

Criteria for Effective Verbal Communication 1. Vocabulary -the sender and the receiver should be able to translate each others words and phrases. 2. Denotative and Connotative -a single word can have several meanings -nurses should carefully use words that cannot be misinterpreted by clients or their families. 3. Pacing

4. Intonation

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5. Clarity and Brevity -effective communication is simple, brief and direct -fewer words may result to confusion -Clarity is achieved by speaking slowly, enunciating clearly, and using examples to make explanations easier to understand. -repeating important parts of the message also clarifies communication. -Brevity is achieved by using short sentences and words that expresses an idea simply and directly. 6. Timing and Relevance
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Guidelines for Active and Effective Listening Active Listening means to be attentive to what the client is saying both verbally and nonverbally With active listening, trust is enhanced because the nurse communicates acceptance and respect for the client. Non verbal skills that facilitate for active listening:
S- sit facing the client O- observe an open posture L- lean towards the client E- establish and maintain eye contact R- relax

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Guidelines for Use of Touch Touch is one of the nurses most potent form of communication. Many messages such as affection, compassion, empathy, emotional support , encouragement, tenderness, and personal attention are conveyed through touch. Touch should be gentle and non-threatening There are times when touch should be withheld; for example, suspicious or delusional or angry patients may respond negatively or even violently to the nurses touch.
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Zones of Personal Space and Touch a. Zones of Personal Space 1. Intimate Zone (0-18 inches) -holding a crying infant -performing P.A -bathing, grooming, dressing, and toileting a patient 2. Personal Zone (18 inches-4 feet) -sitting at a clients bedside -taking the clients nursing history -teaching an individual client 3. Social Zone (4 feet-12 feet) -making rounds w/ a physician -conducting a family support group
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3. Public Zone (12 feet and greater) -speaking at a community forum -testifying at legislative hearing -lecturing to a class of student b. Zones of touch a. social zones (permission not needed) -hands, arms, shoulders, back b. consent zone (permission needed) c. vulnerable zone (special care needed) -face, neck, front of the body d. intimate zone (great sensitivity needed) -genetalia, rectum
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A.
a. b. c. d. e.

Developmental Considerations in Communication Communicating in Older Adults who have Communication Needs/ Barrier Always start the communication process by checking for hearing aid. Amplify your voice if necessary. Get the clients attention before speaking. Face him/ her so he/she can see your mouth. Minimize visual and auditory distractions. When caring for elderly clients with communication disorders, remember their deficit. Dont assume a communication breakdown is the result of the client being uncooperative.
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f. Supplement your words with visual gestures. g. Match your body language with your speech. h. Summarize the most important point of conversation. j. Give clients plenty of time to ask and answer questions. k. Allow them to make errors. Dont constantly correct them. Suppress the desire to finish sentences. l. Be a good listener despite the constraints that makes listening difficult. m. Stick to one topic at a time. n. Whenever possible, have a family member or caregiver in the room with you.
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B. Communicating with infants a. Use firm touch and gentle physical contact such as coddling, patting or rocking. b. Hold infants so he or she can see parents. c. Talk softly to the infants.

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C. Communicating with Toddlers and Preschoolers a. Interact with parents before communicating with the child. b. Assume a position that is at the childs eye level. c. Allow the children to touch and examine objects that will come in contact with them. d. Offer a choice only when one exist. e. Focus communication on the child, not on the experience of others. f. Use simple words and short sentences. g. Keep unfamiliar equipment out of view until it is needed.
h. Communicate through transition objects such as dolls, puppets, stuffed animals before questioning young children directly. 19

D. Communicating with School Age Children a. Allow for the child to feel comfortable. b. Avoid sudden or rapid advances, broad smiles, staring, or other threatening gestures. c. Talk to the parents if the child is initially shy. d. Give older school children the opportunity to discuss concerns without the parents present. e. Speak in quiet, unhurried and confident voice. f. Be honest and let the child know what to expect and how to participate. g. Allow the child to express concerns and fears; allow time to question. h. Use a variety of communication such as drawing or play.
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E. Communicating with Adolescents. a. Give undivided attention. b. Listen, listen, listen c. Be courteous, calm and open-minded. d. Avoid judging or criticizing. e. Choose important issues when taking a stand. f. Make expectations clear. g. Respect their privacy and views. h. Praise good points and tolerate differences. i. Encourage expression of ideas or feelings.

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F. Communicating with Clients With Special Needs a. Physically Challenged (e.g. px who cannot speak clearly- aphasia, dysarthria, muteness) -listen attentively, be patient and not interrupt -ask simple questions that require yes or no answers. -allow time for understanding and response. -encourage client to converse. -let the client know if you did not understand him or her. -use communication aids (e.g. eye blinks, call bells or alarms, communication boards denoting basic needs)
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b. Cognitively Impaired -reduce environmental distraction while conversing. -get the clients attention prior to speaking. -use simple sentences and avoid long explanations. -ask one question at a time. -allow time for client to respond. -be an attentive listener. -include family and friends in conversation, especially on subjects known to client.

c. Unresponsive -call client by name during interaction -communicate both verbally and by touch. -speak to the client as though he or she could hear.

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-provide orientation to person, place and time. -avoid talking about client to others in his or her presence.

d. Aggressive -keep the door of the room open and be in clear view of the staff. -help the patient bring aggression under control. -be calm, non-confronting -talk and listen to the clients concerns

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Therapeutic Communication -promotes understanding and can help establish a constructive relationship between the nurse and the client. Guidelines for Therapeutic Communication -be polite and formal. -pronounce the name correctly. Use proper titles of respect as Mr., Mrs., Dr., etc. Greet the person using the last or complete name. -use any words that you might know about the persons language. This shows that u respect his culture. -use simple words, avoid medical jargon, slang -proceed in an unhurried manner
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-speak in a low moderate voice. Avoid talking loudly. Shouting may perceived as anger. -know the pxs heritage and culture. -provide translator as needed.

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Techniques in Therapeutic Communication Using Silence -accepting pauses or silences that may extend for several seconds or minutes w/o interjecting any verbal response. Providing General Leads -using statements or questions that encourage the client to verbalize, choose a topic of conversation, and facilitate continued verbalization. Perhaps you would like to talk about Would it help to discuss your feelings? And then what? Where would you like to begin?
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Being Specific and Tentative -making statements that are specific rather general, and tentative rather then absolute. Rate you pain scale form 0-10 specific Are you in pain?- general You seem unconcerned about your DM- tentative You dont seem concerned about your DM, you will never will.- absolute Using Open-Ended Question How do you feel lately? Tell me about What is your opinion? How have you been feeling lately?

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Using Touch Restating or Paraphrasing Px: I couldn't eat any dinner last night. Nx: You had difficulty eating yesterday. Seeking Clarification -the nurse restates the basic message or confess confusion and ask the client to repeat or restate the message. I am not sure I understand that. Would you please say that again. Would you tell me more?
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Consensual Validation -a method of clarifying that verifies the meaning of specific words rather than overall meaning of a message. Px: My husband never gives me any present. Nx: You mean he has never given you a present for your b-day or Christmas? Offering Self

Giving Information -providing in a simple and direct manner, specific and factual information the client may or may not request.
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Acknowledging -giving recognition, in nonjudgmental way, of change in behavior, an effort the client has made, or a contribution to the communication. Clarifying Time Sequence

Presenting Reality
Focusing Reflecting

Summarizing and Planning

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Barriers to Communication Stereotyping -offering generalized and oversimplified belief about groups of people that are base on experience too limited to be valid. Two years olds are brats. Women are complainers. Men dont cry. Agreeing and Disagreeing Being Defensive

Challenging

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Probing -Asking for information out of curiosity rather than with the intent to help a client.

Testing -Asking question to make the client admit to something. Nx: Do you think I am not busy? Nx: Who do you think you are? Rejecting -refusing to discuss certain topics to the client. Changing Topics and Subjects
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Unwarranted Reassurance Nx: You will better soon. Nx: Im sure everything will be alright.

Passing Judgment -giving opinions and approving or disapproving responses, moralizing or implying ones own values. This responses imply that the client must think as the nurse thinks. Giving Common Advices -telling the client what to do. These responses deny the clients rights to be an equal partner.
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The Characteristic Of An Effective Nurse-Client Relationship: 1. An intellectual and emotional bond between the nurse and the patient and is focused on the patient. 2. Respects the client as individual-his ability to participate I his care, ethnic and cultural factors, family relationships and values. 3. Respects the clients confidentiality. 4. Focuses on the clients well being. 5. Based on mutual trust, respect and acceptance.

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Documenting and Reporting Documentation serves as the permanent record of the clients information Reporting takes place when two or more people share information about client care, face to face or telephone.

Purpose of Clients Record/Chart:

1. 2. 3. 4. 5. 6. 7. 8. Communication Legal Documentation Research Statistics Education Audit and Quality Assurance Planning for patient care Reimbursement

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The Helping Relationship Key to a good Helping Relationship: 1. The development of and acceptance between the nurse and the client. 2. Underlying belief that the nurse cares about and wants to help the client.

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Phases of Helping Relationship Preinteraction Phase -the nurse reviews pertinent assessment data and knowledge, considers potential areas of concern and develops plans for interaction. -Skills: organized data gathering, recognizing limitations and seeking assistance as required.

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 Introductory Phase 1.Opeining the Relationship -both the client and the nurse identify each other by name -the nurse gives an idea what to expect -the nurse helps the client to express concerns and reasons for seeking help. -putting the client at ease

2.Clarifying the Problem

3.Structuring and formulating the contract -nx and the px develop a degree of trust and verbally agree about the location, frequency and length of meetings; overall purpose of meeting; how confidential materials should be handled; tasks to be accomplished; duration 39 and termination of the relationship.

 Working Phase -the nx and the px accomplishes the tasks outlined in the introductory phase, enhance trust and rapport, and develop caring 1.Exploring and understanding the thoughts and feelings 2.Facilitating and taking action Termination Phase -the nx and the px accepts feelings of loss. The px accepts the end of the relationship w/o feelings of anxiety and dependence
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