Transcript Lecture Notes on Communication and Nursing Process – by

Lecture Notes of Communication
and Nursing Process
Spring 2009
By
Daniel Nanguang, R.N., M.Ed.
COMMUNICATION
• Learn the key terms or the terminologies of
communication in chapter 26 of Kozier & Erb
(2008).
• Communication – its meaning depends on the
setting and the context of its use. Basically,
however, it is a necessary component in human
relationships, and, therefore, means or is used
for thought/information exchange between or
among two or more people as well as intrapersonally (self-talk).
A. Modes of Communication.
• The three main ways it is used in communication
are: verbal, non-verbal and electronic methods.
• Verbal communication = both spoken (type
words and tone of voice, speed),written (words
and the meaning they convey), timing and clarity
of the message.
• Non-verbal communication = body language,
facial expressions, appearance, posture, gait
(manner of walk) gestures, nods, etc.
• Electronic communication = computer messages,
i.e. e-mail, etc.
B. Process of Communication.
• Effective communication involves either a
personal (face to face) communication or some
means of an encounter that requires the
following four necessary components: a sender,
a message, a receiver and a response.
• Sender = may one, two or a group of people with
a message to send/convey and a system of
sign(s) or symbol(s) (code, i.e. – language, etc.)
to use in transmission/sending (encoding) it.
• Message (from sender) and (from receiver) = contents
or meaning, language (words arrangement and use)
and the tone which the message is meant to convey.
• Receiver = the recipient/listener of the message
decodes (i.e. – relates to or understands message) and
returns communication. Refer to Figure 26-2 picture
representation in Kozier & Erb, (2008), page 461.
• Response = the message or feedback (non-verbal cues,
i.e. winks nods, etc.) that the receiver sends back to
the sender.
C.
Factors That Influence
Communication.
• A variety of factors influence the process of
communication: perception, attitudes,
relationships, values, roles, development,
gender, and space.
• The level of development – helps in
modifying both the message and the
response. Example: a message to an
astronaut requires modification if sent to
either a lay person or a ten years old child.
• Gender – males and females develop
differently and so have some difference
communicate, even in adulthood.
• Values = the standards (personal, communal
and societal) that influence behavior –
therefore, personal value traits and
experiences do influence the perception of
communication and behaviors of others as
well as the response to them.
• Perception = is a personal view of any
situation, which in effect, influences the
perception and response to events.
• Attitude = of caring, concern, interest, etc.,
are portrayed or betrayed by either good or
bad mood.
• Example: Elderspeak = To speak knowingly or
unknowingly, and believing that are
conveying caring, but the patient sees it as
demeaning or patronizing.
– Caring – indication of deep emotional warmth.
– Warmth – an indication of emotional closeness.
– Respect – an attitude that conveys individual
worth and respect for his/her wishes, regardless
what the wishes are.
– Acceptance – places emphasis on neither
approval nor disapproval.
• Personal space (proxemics – study of the
distance between people in interaction).
Example of distances in communication:
– Intimate = 1&1/2 ft – is characterized by body
contact, etc.
– Personal = 1&1/2 – 4ft – characterized by more
space, less overwhelming, with a moderate tone
of voice.
– Social distance = 4-12 ft and characterized by a
clear view of the whole individual with clear and
louder tone of voice.
– Public = 12-15 ft, requires careful enunciation, a
louder tone of voice and a clearer vocality.
• Territoriality = is also about space a domain that
one considers as personal i.e. a client’s room or
space around the bed with a demarcating curtain.
• Roles = student/teacher, father-mother/sondaughter, roles etc.
• Relationships = this is a similar role as the
teacher/student relationship above.
• The environment = a comfortable surrounding
with controlled temperature, and noise-free, etc.
• Congruence = this refers to compatibility of verbal
and non-verbal messages – that they both match
and not seen as giving two or more different
messages.
D. Use of Communication.
Communication is used to: get a response,
influence or obtain information.
•
•
•
Therapeutic Communication. Therapeutic
communication helps in promoting understanding and
constructive relationship – understanding of both the
content and feelings expressed by responding in kind.
Refer to Therapeutic Techniques in Table 26-2 of Kozier
& Erb, (2008), pp.469-471.
Attentive Listening. This is an active listening without
giving the impression of either selective listening or not
listening, that the message is not all that important to
you or that you are in a hurry and would rather be
somewhere else.
Physical Attending. This portrays a physical presence
with full attention span and interested. Refer to Box 26-1
Ibid., p. 469 for more on the topic.
E. Barriers to Communication.
Barriers to communications occur
principally as a result of non-therapeutic
communication. Good examples to this
failure include:
• Wrong or improper decoding of the
message.
• Poor choice of words.
• Wrong tone – raised voice, etc.
• Failure to listen – not listening by looking
away or doing other things as a sign of
disinterest.
• Wrong environment or poor
environmental control – noisy
surrounding or environment.
• Wrong timing – while or when client is
eating or doing something or in pain.
• Inconsideration by the nurse or health
professional- client eating or sleeping,
with nurse not willing or ready to wait.
II.
THERAPEUTIC RELATIONSHIP
The therapeutic relationship or helping
relationship is typified by the relationship
between a health professional and a client, but
especially between nurses and their patients. Of
great importance are:
• Trust – the development of trust facilitates
acceptance of the nurse by patient.
• Belief – allows client to believe that the
nurse cares about him/her and his/her needs.
Phases of Therapeutic Relationship.
This type of relationship goes/progresses though
stages:
• Pre-interaction phase – similar to planning the
interview stage when information about client is
obtained and planning of visit with some level of
anxiety.
• Introductory (or pro-helping) phase – during this
time that the tone for relationship is set, and
client may display some level of resistance. This
initial resistance can be alleviated by a genuine
caring attitude by the nurse.
• Working phase – when both nurse and client
view each other as individuals with separate but
important roles and start to explore feeling and
act towards accomplishing a set goal with
empathy and:
-
Respect.
Genuine concern and rapport.
Giving of correct information.
Friendly confrontation as nurse points out areas of
discrepancies.
• Termination phase – a summary, by reviewing the
process and accomplishment of the interview
session.
B. Developing Therapeutic Relationship.
This is commonly achieved by:
• Attentive listening – not only paying
attention, engaged with body language.
• Identifying with the feelings of client, i.e.
“You seem angry about the unfairness of…”
• Empathy - by putting yourself their shoes
and showing that you understand.
• Honesty - by admitting that you do not know
some of the answers to some of the questions
that you are being asked.
• Genuineness and credibility - about being
truly concerned.
• Maintain an understanding of Cultural
differences – as this fosters client- nurse
interaction.
• Ingenuity – by employing some other
means/avenues in handling the situation.
• Confidentiality – maintain patient’s rights of
privacy as confidential on all information.
• Remaining within the boundaries of
professional role – seek help if you need it,
and clarify the functions of your role.
GROUP COMMUNICATION.
• Group Dynamics. Communication with any given
group is known as group dynamics as
determined by a variety of factors as each
member affects the dynamics, depending on
goal, feelings and the level of participation of
each member, motivation and maturity of the
group.
•
Types of Health Care Groups. These usually include:
task, teaching, self-help, self-awareness, growth,
therapy work related social support groups.
– Task group = most common of work-related
groups that nurses belong, with chairperson: i.e.
health planning committees, nurse team
meetings, nursing care conference, etc.
– Teaching group = main purpose is to impart
information: i.e. continuing education, client
health care groups, etc.
– Self-help group = usually small and composed of
volunteers with similar health problems and
similar beliefs in self-help, etc.
–
–
–
Self-awareness = purpose is to develop interpersonal strength
for improving functioning.
Therapy group = for self-satisfaction and stress relief.
Work-related = form to provide support and encourage
members in dealing with work related stress.
COMMUNICATION & NURSING PROCESS.
The principal and overriding concerns are:
professional conduct, clarity, attentive listening
and a caring attitude in:
• Assessment. Be aware of barriers to
communication; cultural influence, level of
development and anxiety; make sure to have a
clear communication; and to seek clarification
on statements that are ambiguous.
• Diagnosis. Follow the same line of approach as
above.
• Plan of care. Provide clear and effective
communication in the use of language; by using
every available means to have no anxiety or
decreased levels of it; and consult with
appropriate resources.
• Implementation. Make every effort to facilitate
clear communication; and effectively control the
environment in a therapeutic setting of the
interview.
• Evaluation. Share information about the progress
being made by patient with him/her.
COMMUNICATION AMONG HEALTH PROFESSIONALS.
Communication is an important aspect within
and between the various health professions and
their practitioners, but especially between the
nurse and the physician as well as between the
nurse and patient.
Communication Between Nurses and
Physicians.
There are no available guidelines for verbal
communication between doctors and nurses. As a
consequence, this has contributed or resulted in
many medications’ errors. There’s virtually no
difference, or very little it, between the
communication styles of nurses and doctors.
Nurses’ prefer to focusing their communication
more on the “narrative and descriptive” aspect;
while physicians focus mainly on the “need or
problem” of patients by “ruling out alternatives”.
Assertive Communication.
An assertive communication’s hallmark is that it
seeks to promote patient safety in reducing
miscommunication by seeking clarification for
medical orders from doctors as well as with
colleagues through the “I” and “you’
statements.
Example: “I’m worried /concerned about this
medication order” ; or, “…you did this/that in
that way”, etc.
Nonassertive Communication.
There are two types/kinds of non-assertive
communication:
• Submissive type (believed to be due to insecurity or
low self-esteem) = people who allow their rights to
be violated by seeking to meet the demands made by
others with no or little regard to their own needs and
feelings.
• Aggressive type (assertive aggression) = assert and
defend legitimate rights, but using such aggressive
behavior (as sarcasm, jokes rude behavior or
downright insults, etc.) in disregard for the feelings,
rights and or opinion of others around them.
References.
• Kozier, B. et al, Fundamentals of Nursing,
Concepts, Process and Practice. 8th Ed., Upper
Saddle River, N.J.: Pearson Education, Inc.,
2008.