Lecture #2 Communication
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Transcript Lecture #2 Communication
Nursing Management of Clients with
Stressors that Affect Communication
NUR101 Fall 2010
Lecture #2
K. Burger MSEd, MSN, RN, CNE
Therapeutic Communication
Different from Social Communication
Foundation of Nurse-Client Relationship
Planned
Directed toward a goal
Client-focused
Information sharing is unequal
Nurse guides the conversation
Elements of Communication
Source
(encoder)
Message
Channel- Auditory , Visual, Touch
Receiver (decoder)
Feedback
Nurses Role
Therapeutic
communication
Helping relationship
between nurse and
patient
Utilizes interviewing
techniques to gather
information
(assessing)
PHASES of
HELPING
RELATIONSHIP
Orientation
Working
Termination
Factors that Influence Communication
Developmental
Stage
Gender
Sociocultural
Role/Occupation
Time & Setting
Personal
Space
Physical Ability
Mental State
Emotional State
Effective Communication
Starts
with unconditional
acceptance of client and a nonjudgmental attitude
Friendliness, openness, respect
Empathy, trust, caring,
competence
Purpose, privacy, confidentiality,
comfortable environment, personal
space
Verbal Communication
Transmitting
a message using the
spoken or written word
Nurses
speaking to patients/
nurses/doctors or writing progress
notes/ nursing care plans
Nonverbal Communication
Transmission
without using
words - gestures
Body language
Touch
Eye contact
Facial expressions
Posture
Gait
Physical appearance
Dressing/grooming
Sounds
Silence
Techniques Facilitating
Communication
Conversational
skills-See Handout
Tone of voice
Knowledgeable
Confidence
Flexible
Clear/Concise
Avoid semantics
Listening skills
Alert/relaxed
Indicate
attentiveness
Think before you
speak
Listen for themes
Honesty/Authenticity
Facilitating Communication
Silence
Touch
Eye
contact
Watch your body
language
Humor
Assertive
Utilize
opportunities
Use of supportive
statements
Displaying
empathy
Blockers to Communication
Not perceiving pt.
as a human
Not listening
Changing the
subject
False reassurance
Being judgmental
Inappropriate
comments
Clichés
Asking yes/no
questions
Giving advice
Probing questions
See Handout
Interviewing Techniques
Used by nurses to obtain information
about pt.
Useful in the helping relationship
FIRST STEP = attentive listening!!!
ALSO NEED: privacy, comfortable environment
Open ended questions
“What brings you to the clinic today?”
Closed questions/comments – yes/no
Validating questions/comments
“Tell me whether my understanding of what you
said is correct…..”
Interviewing Techniques
Clarifying questions/comments
Used often in therapeutic communication
Reflective (re-stating) questions/comments –
use sparingly
Paraphrasing
Also conveys attentive listening
Direct questions
Good for history taking
Sequencing – helps with determining cause
effect relationships
Re-focusing
Guides conversation back to goal
AN EXAMPLE
During your shift in the ICU you have been
assigned to care for a man injured in a
motor vehicle accident in which he has
been charged with DWI.
The driver of the other car was killed.
The patient says to you:
“I feel so terrible about what has
happened”
Clarifying
“ARE YOU FEELING BAD ABOUT HAVING
BEEN DRINKING AND DRIVING?”
“ARE YOU FEELING BAD ABOUT HAVING
KILLED SOMEONE?”
“ARE YOU FEELING TERRIBLE ABOUT YOUR
INJURIES?”
“ARE YOU FEELING TERRIBLE ABOUT THE
FACT THAT YOU ARE GOING TO BE
ARRESTED AND GO TO JAIL?”
CONVEYING EMPATHY
USING CONGRUENT NON-VERBAL
COMMUNICATION TECHNIQUES:
TOUCH
EYE CONTACT
SILENCE
ALONG WITH:
SUPPORTIVE STATEMENTS
Impaired Communication
Hearing
impaired
Visually impaired
Language barriers
Physical barriers
Cognitively impaired
Unconscious
SEE P&P
p.1358
Box 49-9
Communicating with
Healthcare Team Members
Exchange of patient information
between healthcare givers must be
efficient, precise, and complete.
JCAHO Goal 2 of 2007 Patient Safety
Goals:
“Implement a standardized approach to “handoff” communications, including an opportunity
to ask and respond to questions”
SBAR
S
B
A
R
Situation
Background
Assessment
Recommendation
Can be used when:
Reporting patient condition to physician
Change of shift reports
Transfer to another unit or facility
SBAR Example: A call to a physician
Dr. Jones, this is Deb McDonald RN, I am calling from ABC
Hospital about your patient Jane Smith.
Situation: Here's the situation: Mrs. Smith is having
increasing dyspnea and is complaining of chest pain.
Background: She is 2 days post-op total knee replacement.
About two hours ago she began complaining of chest pain.
Her pulse is 120, blood pressure 128/54 and she is restless
and short of breath.
Assessment: My assessment of the situation is that she
may be having a cardiac event or a pulmonary embolism.
Recommendation: I recommend that you see her
immediately and that we start her on 02 stat.
Using SBAR for
Change of Shift Report