Communication

1. Communication Unit I Nursing 103

2. Nurses are Healers

3. Communication: Objectives • List key characteristics of a nurse/client helping relationship. • Define the terms caring and empathy. • Describe the phases of a helping relationship. • Describe types of communication used nursing care. • Practice therapeutic communication skills.

4. The Helping Relationship • Nurse-Client Relationship referred to as interpersonal, therapeutic, and helping • Strives to achieve two major goals • Help clients manage their problems in living more effectively • Help clients become more effective at helping themselves

5. The Helping Relationship • Caring • Comforting • Communicating

6. Caring • Madeleine Leininger (1984): The essence of nursing and the dominant, distinctive, and unifying feature of nursing. • Jean Watson (1985): A set of universal human values;kindness, concern, love of self and others. • Miller (1995): “Intentional action that conveys physical and emotional security and genuine connectedness to another person…”

7. Empathy • Nurses develop attentive listening • Respond in ways that indicate understanding of how client feels • Egan (1998), Empathy “can be seen as an intellectual process that involves understanding correctly another person’s emotional state and point of view” • Communicate understanding to client.

8. Comforting • Morse (1996): A complex process that includes discrete, transitory actions, such as listening” • The comforting process is client-led • It occurs in response to those cues presented by a client. • Clients themselves are attempting personal comfort—the nurse supports these attempts.

9. Physical Comfort Relates to Body Sensations and medical Dx Psycho spiritual Comfort Self esteem, sexuality, and meaning in their life Belief in a higher being Social Comfort Relates to interpersonal, family, and social relationships Environmental Comfort The external part of the human experience Cultural Specific Comfort Needs: Kolcaba (1991, 1995)

10. Phases of Helping • Four sequential phases • Progress in succession • Build on the one before • Nurse needs to identify and understand these phases • Able to identify the progress of the relationship

11. Preinteraction Phase • Similar to the planning stage before an interview • Nurses have information before the face to face • Nurse needs to recognize her own feelings • Focus on plan for information to be discussed

12. Organize Data Recognize Limitations Seek Assistance Nursing Skills for Preinteractive Phase

13. Introductory Phase • Sets the tone for the rest of the relationship. • Closely observe each other and form judgments about each others behavior. • Opening relationship, clarifying the problem, building trust.

14. Put client at ease. Use relaxed , attentive attitude. Not easy for clients to accept help in many situations. Resistive Behaviors Develop Trust Respectful Culture Concerned Maintain Confidentiality Mutual participant in plan of care Nursing Skills for Introductory Phase

15. Working Phase • The client and nurse begin to see each other as unique individuals. • Begin to explore thoughts and feelings • Begin to take action to meet goals • Nurse helps client form long and short term goals • Nurse reinforces successes and helps client to deal realistically with failure.

16. Empathetic Listening Respect Genuineness Concreteness Confrontation Decision making and Goal setting Nursing Skills for Working Phase

17. Termination Phase • Nurse and client accept feelings of ending the relationship • The client has developed independence and and has no feelings of anxiety or dependence

18. Summarize or review the hospitalization with a focus on accomplishments Express feelings about termination Allows time for client to adjust to independence Follow up support may be needed Follow up phone calls Ease clients transition to independence Nursing Skills for Termination Phase

19. Communication “Any means of exchanging information or feelings between two or more people. It is a basic component of human relationships, including nursing.”

20. Collect data Initiate Interventions Evaluate Outcomes Initiate Change Prevent Legal Problems The communication process: Intended to elicit a response Sender Message Receiver Response Communication

21. Verbal Mode Pace and Intonation Simplicity Clarity Timing and Relevance Adaptable Credible Humor Nonverbal Mode Personal Appearance Posture/Gait Facial Expression Gestures Modes of Communication

22. Therapeutic Communication • Promotes understanding • Establishes a constructive relationship between the nurse and the client • Therapeutic helping relationship is client and goal directed • Respond to words and feelings • Strong emotions require more time

23. Therapeutic Communication • Attentive Listening: • Uses all senses—note key themes • Most important technique in nursing • Basic to all other techniques • Requires energy and concentration • Receives total message—verbal and nonverbal

24. Daily Communication • 80% of working day is spent conversing • Talking is not the same as communicating • Be clear and concise • Let the silence sit • State your point up front, and back it up • Be aware of body language • Good communication takes practice!

25. “Be a Bridge, Not a Wall”