Transcript Communication for Nurses

Rachel Natividad, RN, MSN, NP
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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?
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Ever been bashed by comments and criticisms from
colleagues?
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How did you react?
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Did you gracefully defuse the situation?
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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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Describe a situation in which you did not
communicate effectively and the result.
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What could you have done differently?
Effective Communication in
Nursing
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Increases patient satisfaction and health
outcomes
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Decreases risk of complaints and litigation
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Increases level of job satisfaction
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Elements of Communication
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Sender
Message
Receiver
Feedback
Meaning (sender/receiver)
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Communication can be
confusing!!!
Ambiguous Picture
Language is inherently
ambiguous…
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Communication Patterns
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Verbal
Verbal
7%
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Tone
Tone
38%
Nonverbal 55%
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Nonverbal
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Facial expressions
Gestures
Eye contact
Body language
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Face talks…
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Communication in Nursing
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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 Therapeutic 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
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Attempt to identify the source of hostility
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Allow client to verbalize feelings, fears, concerns
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Offer explanations and explain the purpose of
the procedures/medications.
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Case Study Resolution: The First
Encounter
Acceptable responses:
 “You sound upset this morning.”
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“Mrs. T, it is difficult to be a patient. You
haven’t had much time to yourself.”
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“When would you like me to bring your
medicine?”
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Listen…
A poem by….
Anonymous
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Blocks to Therapeutic
Communication
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Changing the subject
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Invalidation
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False reassurance
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Overloading
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Giving advice
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Social Response
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Incongruence
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Underloading
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Assumptions
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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
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Case Study: Cultural
Diversity (2)
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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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Eye contact, touch personal space – meanings
vary among cultures
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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 her/him respectfully
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Try to mirror pt’s style of
communicating
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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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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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Case Study Resolution: Cultural
Diversity
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Recognize impact of the client’s culture to
communication style, health care and
practices/beliefs
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Consider cultural roots when continuing with
the plan of care
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Anxiety 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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Levels of Anxiety
Communication Styles
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Mild
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Passive
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Moderate
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Assertive
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Severe
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Aggressive
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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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Help the anxious client
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Be alert to s/s of anxiety
Assist pt to verbalize
feelings and concerns and
try to ID source 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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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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