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Nursing:
Nursing:
A Concept-Based Approach to Learning
A Concept-Based Approach to Learning
VOLUME
TWO
EDITION
VOLUME
TWO || SECOND
SECOND EDITION
MODULE
38
Communication
Nursing: A Concept-Based Approach to Learning
Volume Two, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
All Rights Reserved
The Concept of
Communication
Nursing: A Concept-Based Approach to Learning
Volume Two, Second Edition
Copyright © 2015, 2011 by Pearson Education, Inc.
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The Concept of Communication
• Human interaction
 Verbal and nonverbal
 Written and unwritten
 Planned and unplanned
• Conveys thoughts and ideas
• Transmits feelings
• Exchanges information
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The Meaning of Communication
• Communication is any means of
exchanging information or feelings
between two or more individuals.
• Basic component of human relationships,
including nursing
• Intended to elicit a response
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Modes of Communication
• Generally carried out in two modes
 Verbal
 Nonverbal
• Electronic communication
 Know when appropriate, not appropriate to
use e-mail to communicate with clients
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Verbal Communication
• Pace and intonation
• Simplicity
• Clarity and brevity
 Congruence
•
•
•
•
Timing and relevance
Adaptability
Credibility
Humor
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Nonverbal Communication
• Body language
 Gestures, movements, use of touch
• Essential skills: observation, interpretation




Personal appearance
Posture and gait
Facial expression
Gestures
• Cultural component
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Electronic Communication
• Advantages




Fast
Efficient
Legible
Improves communication, continuity of
care
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Electronic Communication, continued
• Disadvantages
 Client confidentiality risk
 HIPAA
 Socioeconomics
• When not to use e-mail
 Urgent information
• Jeopardy to client's health
 Highly confidential information
 Abnormal lab data
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Electronic Communication, continued
• Other guidelines




Agency-specific standards and guidelines
Consent of client
Identify as confidential
Part of medical record
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Written Communication
• Does not convey nonverbal cues
• Characteristics of effective written
communication




Appropriate language and terminology
Correct grammar, spelling, punctuation
Logical organization
Appropriate use and citation of resources
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Development
• Language and communication skills
develop through stages
• Communication techniques vary with
stage
 Infants and toddlers: use touch
 Older children: pictures as adjunct to words
 Adolescents and adults: verbal
communication
 Older adults: adjust methods to physical
changes of aging
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Personal Space
• Defined as distance people prefer in
interactions with others
• Proxemics
 Intimate distance  frequently used by
nurses
 Personal distance  less overwhelming
 Social distance  increased eye contact
• Out of reach for touch
 Public distance
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Territoriality
• Space and things individual considers as
belonging to self
• May be marked off in a visible way
 Curtains around bed unit
 Walls of private room
• Removing chair to use at another bed may
be seen as invading territory
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Environment
• Can facilitate effective communication
• Key factors
 Comfort
 Privacy
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Congruence
• Congruent communication
 Verbal and nonverbal aspects match
 Seen by nurse and clients
• Incongruence
 Sender's true meaning in body language
• Improving nonverbal communication
 Relax; use gestures judiciously
 Practice; get feedback on nonverbal
communication skills from coworkers
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Interpersonal Attitudes
• Attitudes convey
beliefs, thoughts,
feelings
• Caring, warmth,
respect, acceptance
 Facilitate
communication
• Condescension, lack
of interest, coldness
 Inhibit
communication
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• Effective nursing
communication
 Significantly related
to client satisfaction
• Respect, civility
important
 Avoid elderspeak
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Barriers to Communication
• Stereotyping
• Agreeing and
disagreeing
• Being defensive
• Challenging
• Probing
• Testing
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• Rejecting
• Changing topics
• Unwarranted
reassurance
• Passing judgment
• Giving common
advice
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Types of Communicators
• Aggressive
 Focus on own needs
 Recipient may see as attack
• Passive
 Focus on needs of others
• Assertive
 Declare and affirm opinions
 Respect rights of others
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Assertive Communication
• Direct, nonconfrontational
• Characteristics of assertive communicators
 Freedom to express oneself, awareness of
one's rights self-control over strong
emotions
 Able to receive feedback with willingness to
consider both positive, negative
perspectives
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Benefits of Assertive
Communication
•
•
•
•
•
Improves communication
Reduces stress
De-escalates conflict
Improves outcomes
Reduces likelihood of angry encounters
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Techniques for Assertive
Communication
•
•
•
•
•
"I" statements
Fogging
Negative assertion
Repetition
Confidence
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• Managing
nonverbal
communication
• Thinking before
speaking
• Avoiding
apologizing
whenever possible
• Performing a
postconversation
evaluation
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Assessment
• Determine communication barriers
• Language deficits
• Sensory deficits
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


Look for medical alert bracelet
Hearing aid
Reading lips
Sign language
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Assessment, continued
• Cognitive impairments
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CVD, Alzheimer disease, brain tumor/injury
Medications
Observe fluency of speech, word choice
Observe whether client can follow written
directions, read aloud
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Assessment, continued
• Structural deficits
 Cleft palate
 Artificial airways
 Extreme dyspnea
• Verbal
communication
 Content, themes,
verbalized emotions
 Pattern, vocabulary
 Verbalized emotion
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• Paralysis
 Blink, nod, shrug,
point
• Style of
communication
 Psychological
illnesses
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Diagnosis
•
•
•
•
•
•
Impaired Verbal Communication
Anxiety
Powerlessness
Situational Low Self-Esteem
Social Isolation
Impaired Social Interaction
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Planning
• Establish an effective means for the client
to communicate needs
• Maximize the client's ability to perceive
messages accurately
• Obtain resources as needed to optimize
the client's ability to communicate
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Implementation: Manipulate the
Environment
• Quiet, limited distractions
• Sufficient light
• Acknowledge and praise attempts
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Implementation: Provide Support
• Convey
encouragement
• Let client know if
you don't
understand
• Open-ended
questions
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Implementation: Employ Measures
to Enhance Communication
• Determine how client can best receive
messages
 Listening, looking, touching
 Through interpreter
• Enhance communication with individuals
who are hard of hearing
 Recognize, compensate for client's hearing
problems
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Implementation: Avoid Potential
Cultural Barriers to Communication
• Avoid slang, buzz words, medical
terminology
• Speak clearly, directly, at a normal pace
 Avoid speaking too slowly
• Select gestures with care
 Meanings not universal
 Smiling, eye contact in other cultures
 Greetings
• Use interpreters when necessary
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Implementation: Educate the
Client and Support People
• Prepare clients, support people in advance
when anticipating communication
problems
 Procedures that obstruct the throat, mouth
 Practice beforehand
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Evaluation
• Client
 Communicates
needs being met
 Begins to establish
a method of
communication
 Perceives the
message accurately
 Communicates
effectively
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 Regains maximum
communication
abilities
 Expresses minimum
fear, anxiety,
frustration
 Uses resources
appropriately
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Nursing Practice
• Communication is a dynamic process used
to:
Gather assessment data
Teach
Persuade
Collaborate with other healthcare
professionals
 Advocate for clients
 Express caring
 Provide comfort




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Exemplar 38.1
Groups and Group
Communication
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Levels of Group Formality
• Formal
 Rigidity of purpose, rules
 Managers a symbol of power, authority
• Semiformal
 Prestige, status often accrued from
membership
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Levels of Group Formality, continued
• Informal
 Not bound by any set of rules, regulations
 Ideal testing ground for leadership
techniques
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Characteristics of Effective Groups
• Group must achieve three main functions
 Accomplish goals
 Maintain cohesion
 Develop and modify structure to improve
effectiveness
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Group Communications
• Group dynamics
 How group functions, communicates, sets
goals, achieves objectives
 Commitment
 Decision-making methods
• Brainstorming
• Nominal group technique
• Delphi technique
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Group Communications, continued
• Group dynamics
 Member behavior
 Cohesiveness
 Power
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Group Communications, continued
• Group problems

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

Monopolizing
Groupthink
Scapegoating
Silence and apathy
Transference and countertransference
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Healthcare Groups
•
•
•
•
•
•
•
Committees or teams
Task forces
Teaching groups
Self-help groups
Self-awareness/growth groups
Therapy groups
Work-related social support groups
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Exemplar 38.2
Therapeutic Communication
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Overview
• Interactive process between nurse, client
• Integral part of therapeutic relationship
• Helps client




Overcome temporary stress
Get along with other people
Adjust to the unalterable
Overcome psychological blocks
• Nurse responds to content, feelings,
nonverbal cues
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Therapeutic Communication
Techniques
• Embrace techniques
• Adapt to each situation to improve
communication with clients
• Use a holistic approach to communicating
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Physical Attending
•
•
•
•
•
Face the person squarely
Adopt an open posture
Lean toward the person
Maintain good eye contact
Try to be relatively relaxed
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Techniques
•
•
•
•
•
•
•
•
•
Active Listening
Sharing Observations
Sharing Humor
Using Touch
Using Silence
Providing Information
Clarifying
Focusing
Self-Disclosure
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• Table 38-1
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Common Mistakes
•
•
•
•
•
Giving advice
Minimizing or discounting feelings
Deflecting
Interrogating
Sparring
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Barriers to Communication
• Failure to listen
• Improperly decoding intended message
• Placing the nurse's needs above client's
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Communication Examples
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The Therapeutic Relationship
• Growth-facilitating process
 Help client manage problems in living
• More effectively
• Develop unused, underused opportunities
fully
 Help client become better at helping self
• May develop over weeks or within minutes
• Influenced by nurse and client
 Personal and professional characteristics
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Characteristics of a Therapeutic
Relationship
• Intellectual and emotional bond
 Focused on client
•
•
•
•
Respects client as individual
Respects client confidentiality
Focuses on client's well-being
Based on mutual trust, respect,
acceptance
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Nurse-Patient Relationship
1. Preinteraction phase: preparing
2. Introductory or Orientation phase:
opening, clarifying, structuring
3. Working phase: facilitating, taking
actions
4. Termination phase: closure
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Developing Therapeutic
Relationships
• Set mutual goals with client
• Many ways of helping do not require
training
 Listen actively
 Help identify the client's feelings
 Be empathetic, honest, genuine, and
credible
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Communicating with Children and
Families, continued
• Establishing rapport with children
 Sit or lower self to child's eye level
 Show interest in what child is doing
 If appropriate, agree with child/share
feelings
 Compliment child
 Use calm tone of voice, appropriate
language
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Communicating with Children and
Families, continued
• Establishing rapport with children
 Pace discussion, procedure in nonhurried
manner
 Explain concepts in terms child can
understand
 Include adolescent in discussion
 Listen more than you talk
 Avoid distractions
 Be truthful with the child
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Establishing Trust
• Follow through with promises
• Respect confidentiality
• Be truthful, even if it isn't what they want
to hear
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Conclusion
• Nurse's role requires communication skills
• Effective communication large role
 Ability to deliver highest quality of care
• Nurse needs to be understood
• Nurse needs to understand messages
• Strong verbal, written communication
skills
• Monitor own nonverbal communication
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Exemplar 38.3
Documentation
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Overview
• Effective communication among
healthcare professionals vital to client care
 Discussion
 Report
 Record
• Recording
• Charting
• Documenting
• Record is a legal document
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Ethical and Legal Considerations
• American Nurses Association Code of
Ethics
 Access to client's record restricted
 HIPAA regulations
 Students bound by strict ethical code
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Ensuring Confidentiality of
Electronic Records
• Personal password
• Never leave terminal unattended logged
on
• Know policies of facility
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Purposes of Client Records
•
•
•
•
•
•
•
•
Communication
Planning care
Auditing health agencies
Research
Education
Reimbursement
Legal documentation
Healthcare analysis
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Documentation Systems
•
•
•
•
•
•
Source-oriented record
Problem-oriented medical record
Problems, interventions, evaluation (PIE)
Focus charting
Charting by exception (CBE)
Electronic documentation
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Nursing Care Plans
• JC requires clinical record include:





Evidence of client assessments
Nursing diagnoses and/or client needs
Nursing interventions
Client outcomes
Evidence of a current nursing care plan
• Traditional care plan written for each
client
• Standardized care plans save time
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Guidelines for Quality
Documentation and Reporting
•
•
•
•
•
Factual
Accurate
Complete
Current
Organized
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General Guidelines for Recording
• Date and time
• Timing
 NO recording prior to providing care
• Legibility
• Permanence
• Accepted terminology
 Approved by agency
 Joint Commission DO NOT USE LIST
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General Guidelines for Recording,
continued
• Correct spelling
• Signature
 Follow agency policy
• Accuracy
 Client's name, identifying information
 Observations and facts
 Recording a mistake
• Draw line through it and write "mistaken
entry"
• Name or initials
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General Guidelines for Recording,
continued
• Sequence
• Appropriateness
• Completeness
 Reflect nursing
process
 Omitted care must
also be recorded.
• What, why, who
• Conciseness
Nursing: A Concept-Based Approach to Learning
Volume Two, Second Edition
• Legal prudence
 Legal protection to
nurse, caregivers,
facility
• And client
 Admissible in court
as legal document
 Adhere to
professional
standards
 Follow agency
policy and
procedures
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Do's and Don'ts of Documentation
• Do





Chart changes
Show follow-up
Read prior notes
Be timely
Objective, factual
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Volume Two, Second Edition
 Correct errors
 Chart teaching
 Quotations from
client
 Responses
 Review notes
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Do's and Don'ts of Documentation,
continued
• Don't







Leave blank spaces
Chart in advance
Use vague terms
Chart for others
Use "patient" or "client" instead of name
Alter record
Record assumptions
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Reporting—38-4
• Hand-off report
 Occurs with transfer of patient care
 Provides continuity and individualized care
 Reports are quick and efficient.
• Telephone reports and orders
 Situation-background-assessment-recommendation
(SBAR)http://stonybrookmedicine.edu/patientcare/familyc
are/nursingvideo
 Document every call
 Read back
• Incident or occurrence reports
 Used to document any event that is not consistent with
the routine operation of a health care unit or the routine
care of a patient
 Follow agency policy
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