Transcript Communication

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Communication
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Have you ever been
nailed by nasty remarks
from a hostile friend,
family member, or
stranger?
Ever been bashed by
comments and criticisms
from colleagues?
How did you react?
Did you gracefully
defuse the situation?
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Define
communication…
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Describe a situation in
which you did not
communicate effectively
and the result.
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Communication defined…
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“The exchange of information which involves
both sending and receiving messages between
two or more people…”.(Timby, 2005)
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“The process of sending and receiving
messages by means of symbols, words, signs,
gestures, or other actions”. (Smith, Duell, &
Martin, 2004)
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Elements of Communication
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Sender
Message
Receiver
Feedback
Meaning (sender/receiver)
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Communication Flow
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Communication
Language is inherently ambiguous
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Communication Patterns
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Verbal
Verbal
7%
Nonverbal
Tone
Tone
38%
Nonverbal
55%
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Nonverbal Communication
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Nonverbals…Face talks
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Nurse-client relationship -Therapeutic
Relationship
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Client-centered
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Case Study: The First Encounter
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Phases of Nurse-Client Relationship
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Introductory phase - initiation or orientation
phase
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Working phase– facilitating the relationship
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Termination phase– relationship comes to an
end
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Case Study Resolution: The First
Encounter
RN responses:
 “You sound upset this morning.”
 “Mrs. T, it is difficult to be a patient. You haven’t
had much time to yourself.”
 “When would you like me to bring your
medicine?”
 “You don’t have to take these, however…”
(explain the purpose of the medications)
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Ingredients of Therapeutic
Communication
Empathy
Trust
Respect
Active Listening
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Listen…
A poem by…
Anonymous
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Blocks to Therapeutic
Communication
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Changing the subject
False reassurance
Giving advice
Incongruence
Assumptions
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Invalidation
Overloading
Social response
Underloading
Value judgements
SDM
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Therapeutic Communication
Techniques
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Acknowledgement
Clarification
Feedback
Focus
Incomplete sentences
Listening
Mutual fit or congruence
Minimum verbal activity
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Nonverbal
encouragement
Open-ended questions
Reflection
Restatement
Validation
SDM
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Case Study: Cultural Diversity
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Cultural Diversity
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Slang terms and colloquialisms
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Stress of illness/Different meanings in various
cultures
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Direct eye contact/Touch/Personal space
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Are you culturally competent?
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“…learn the language that a majority of your
clients speak – this will give you insight into the
culture…”(Gaskill, 2002)
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Greet or say words and phrases in the client’s
language
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Let’s Communicate Transculturally!
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Assess language needs
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Pay attention to
nonverbals
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Approach patient slowly
and greet respectfully
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Try to mirror pt’s style
of communicating
Do not raise your voice
to be heard
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Provide written material
in patient’s language if
available
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Allow sufficient time and
a quiet setting
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Case Study Resolution: Cultural
Diversity
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Recognize impact of her culture to
communication style, health care and
practices/beliefs
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Consider cultural roots when continuing with
the preoperative teaching
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Interview
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“Mrs. R is a 47-year-old Hispanic woman who
arrives in the emergency department one
evening with her adult children. Her husband of
36 years passed away 2 months ago. Her children
say she has been weepy since her husband’s
death. She has been holding her chest since this
morning. She says the her heart aches since her
husband died, and she does not want to eat. The
emergency room nurse must now assess the
patient’s symptoms.” (Sheldon, 2004)
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Interview – Cont.
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“Nurse: “Hello Mrs. R. I am Stephen, and I am
the nurse who will be taking care of you. How
are you feeling tonight?”
Mrs. R: “I am so sad without my husband..”
(weeping and holding a tissue to her chest)
Nurse: “I am sorry for your loss. You are
holding your chest. Do you have pain in your
chest?”
Mrs. R: “My heart aches but it feels better when
I stop and sit still.”
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Nurse: “Does anything else hurt?”
Mrs. R: “My neck aches sometimes, and I feel
sick to my stomach.”
Nurse: “How long have you had pain in your
chest, ache in your neck, and stomach
problems?”
Mrs. R: “Since my husband died, but I feel
worse since I raked the lawn this morning.””
(Sheldon, 2004)
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Anxiety/Stress and Communication
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How can stress/anxiety affect your communication
with your clients?
How can stress affect client’s communication with you?
What techniques do you use to decrease your stress
routinely? During exams?
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Anxiety & Communication
Levels of anxiety
 Mild
Communication styles
 Passive
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Moderate
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Aggressive
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Severe
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Assertive
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Panic
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A confrontation with Ms. Madd
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You have just finished the change of shift report
when Mrs. K confronts you at the nurses station.
Due to a serious fall, Mrs. K’s sister M.L has
sustained a cervical fracture that, in spite of
numerous efforts, has not yet been stabilized.
During the past few days…….(retrieved from
www.nurseweek.com 1/20/05)
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Stress & Anxiety and
Communication
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Name ways to help the client with his/her
anxiety
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Help the anxious client
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Be alert to ss of anxiety
Be understanding of pt’s
feelings
Avoid becoming tense or
defensive
Speak slowly and briefly,
avoid empty phrases that
does not help the
situation
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Assist pt to verbalize feelings
and concerns and try to ID
source of anxiety
Offer explanations of info if
pt has misconceptions about
the situation
Assess the patient’s support
system
ID previously useful coping
mechanisms
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Rather than just defend yourself and
face the same problems over and
over like Wiley Coyote, say what you
are really feeling!
Ask for help when you need it!
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References
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Timby, B. K. (2005). Fundamentals Nursing
Skills and Concepts. 8th Ed. Lippincott Williams
& Wilkins: Philadelphia, PA
Smith, S.F., Duell, D.J., & Martin, B. C., (2004).
Clinical Nursing Skills: Basic to Advanced Skills.
6th Ed. Pearson Education Inc.: Upper Saddle
River, NJ.
Sheldon, L.K. (2004). Communication for
Nurses: Talking with Patients. Slack Inc:
Thorofare, NJ.
www.nurseweek.com
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