Basic Nursing: Foundations of Skills & Concepts Chapter 8 COMMUNICATION
Communication • The sending and receiving of a message.
Aspects of Communication (i) • Sender - the one who conveys the message to another person. • Message - the thought, idea, or emotion conveyed. • Channel - how the message is sent.
Aspects of Communication (ii) • Receiver - physiological/ psychological components. • Feedback - the receiver’s response to the sender. • Influences - Culture, education, emotions and other factors involved.
Methods of Communication • Verbal - Speaking, Listening, Writing, Reading. • Nonverbal - Gestures, Facial Expressions, Posture and Gait, Tone of Voice, Touch, Eye Contact, Body Position, Physical Appearance.
Age Education Emotions Culture Language Attention Surroundings Influences on Communication
Congruency of Messages • Verbal and nonverbal communication must be congruent, or in agreement.
Listening and Observing • Listening and observing are two of the most valuable skills a nurse can have. • These two skills are used to gather the subjective and objective data for the nursing assessment.
Active Listening • The process of hearing spoken words and noting nonverbal behavior. • Active listening takes energy and concentration.
Therapeutic Communication • Sometimes called effective communication, it is purposeful and goal-oriented, creating a beneficial outcome for the client.
Goals of Therapeutic Communication • To obtain or provide information • To develop trust • To show caring • To explore feelings
Enhancing Communication • Self-Disclosure. • Caring. • Genuineness. • Warmth. • Active Listening. • Empathy (the capacity to understand another’s feelings). • Acceptance and respect.
Communication Techniques • Clarifying/validating. • Asking open questions. • Using indirect statements. • Reflecting. • Paraphrasing. • Summarizing. • Focusing. • Silence.
Barriers Communication Some barriers include: • Closed questions. • False reassurance. • Judgmental responses. • Defensive reflex. • Agreeing/Disagreeing or Approving/ Disapproving. • Giving advice. • Requesting an explanation. • Changing the subject.
Psychosocial Aspects of Communication • Style. • Gestures. • Meaning of time. • Meaning of space. • Cultural values. • Political correctness.
Style Three types of style: • Passive - apologetic, weak, makes little eye contact, often fidgety. • Aggressive - haughty, angry, demanding, shows no concern for anyone else’s feelings • Assertive - honest, direct, firm, makes eye contact, confident, respectful of others.
Gestures • Movements of the hands and arms. • Nurses must be sensitive to cultural variances with regard to gestures.
Meaning of Time • In the U.S., great emphasis is placed on time and schedules. Being on time is very important. • In other cultures, such emphasis is not placed on time.
Meaning of Space • Human beings all observe rules around comfort zones—the distance observed between two people. Such comfort zones include: • Intimate: touch to 18 inches • Personal: 18 inches to 4 feet • Social: 4 feet to 12 feet • Public: 12 feet or more
Cultural Values • A nurse should be familiar with the cultural values of the people in the nurse’s region of employment. • A nurse needs to be aware of those times when her values differ from the values of the dominant culture.
Political Correctness • To be politically correct in communication means to use language sensitive to those who are different from oneself.
Nurse-Client Communication • Almost every nurse-client interaction should involve therapeutic communication. • Nurse-client communication is influenced by both the nurse and the client.
Three Phases of Nurse-Client Communication • Introduction: Fairly short; expectations clarified; mutual goals set • Working: Major portion of the interaction; used to accomplish goals outlined in introduction; feedback from client essential. • Termination: Nurse asks if client has questions; summarizing the topic is another way to indicate closure.
Determinant Factors in Communication A nurse’s communication is affected by: • Past Experience • State of Health • Home Situation • Workload • Staff Relations • Self-Awareness
Determinant Factors in Communication A client’s communication is affected by: • Social Factors • Religion • Family Situation • Level of Consciousness • Stage of Illness • Visual, Hearing and Speech Ability • Language Proficiency
Communication within the Health Care Team • Providing care is a team effort. • To ensure efficiency and effectiveness, effective communication is necessary. • This communication may be oral or written.
The Nurse’s Ways of Communication • Oral • Written • Self-Reflection
Oral Communication Nurses communicate within many different relationships, each with their own rules. • Nurse-Nurse • Nurse-Nursing Assistant • Nurse-Student Nurse • Nurse-Physician • Nurse-Other Health Professionals • Group Communication (I.e. client-care conferences)
Written Communication Nurses’ communications are often written: • On charts • Requisitions for x-rays and other tests and services • Electronic communications, via computer • Telemedicine: the use of communications technology to transmit health information from one location to another.
Self-Reflection Nurses often engage in internal dialogue: • Positive self-talk: Saying positive thoughts aloud; thinking, saying and hearing positive statements about yourself • Negative self-talk: Self-destructive. Your self-image is lowered by your own criticism.
Communicating With Yourself • Positive self-talk: Saying positive thoughts aloud; thinking, saying and hearing positive statements about yourself • Negative self-talk: Self-destructive. Your self-image is lowered by your own criticism.