Communication

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Communication

• Potter, Chapter 24

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Types of Communication

• Verbalspoken and written
• Nonverbal
• Eye contact
• Facial expression
• Posture, gait
• Gestures
• Touch
• General appearance, dress, grooming
• Sounds
• Voice inflection
• Silence

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Factors Affecting Communication

• Developmental level
• Gender
• Credibility
• Affect/Attitude
• Emotional state
• Special needs (357)
• Environment
• Distance

• Role
• Timing
• Territoriality
• Culture
• Knowledge level
• Values
• Perceptions
• Expectations

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Responses That Hinder Communication

• Lack of eye contact
• Hurried gestures
• Closed body language
• False reassurance
• Judgmental responses
• Changing subject
• Negating feelings

• Giving advice
• Using clichés
• Closed questions
• Leading questions
• Stereotyping
• Treating client as object or dx
• A-la-moding

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The Helping Relationship

• Focuses on client needs and helps client identify
  problems
• Promotes client growth and self-care
• Conveys kindness, concern, warmth, genuineness,
  acceptance
• Is empatheticseeing situation from clients
  point of viewbeing receptive without losing
  objectivityable to communicate to client that he
  is understood
• Is confidential without being a sick contract
• Phases on p. 347---covers entire stay

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The Nursing History

• Different from medical historymore holistic
• Utilizes therapeutic communication skills
• Happens during orientation phase
• Need organized tool developed by agency
• Patients have right to refuse to answer
  questions if they agree to answer questions they
  need to understand the scope of confidentiality
• Students are reluctant at firstfeel like they
  are prying

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Therapeutic Communication

• A learned skill that improves with practice
• Planned, deliberate, purposeful, helpful
• Sometimes the only skill a nurse can offer
• Part of the therapeutic relationship
• Used with interviews

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Components of Therapeutic Communication

• Listening attentivelyface client, eye contact,
  open body language, no distracting movements, nod
  appropriately, read verbal and nonverbal
• Demonstrating acceptanceuse persons name,
  listen without interrupting, avoid arguing,
  expressing doubts, or attempting to change
  clients mind

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Types of Therapeutic Interaction

• Open-ended vs. closed-ended
• Non-directive comments Oh? mm.Yes
• Reflection You feelbecause
• Restating (paraphrasing) What I hear you
  saying is.
• ClarifyingIm not sure I understand.
• FocusingTell me more about..
• Stating observationsYou look tired.
• ConfrontationYou say this, but
• Summarizing

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Therapeutic Communication

• Examples of Good and Bad Techniques

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Open Closed Questions

• Closed Are you happy about this?
• Open How does this make you feel?
• Closed Do you get along with your husband?
• Open How is your relationship with your
  husband?
• Closed Does this make you sick to your
  stomach?
• Open Describe the feeling you are having.

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Reflective Statements

• Client Sometimes Im happy about having a new
  baby, but I dont know if I can handle it at
  home.
• Nurse You sound anxious about caring for your
  baby after you leave here.
• Client I wish I was dead.
• Nurse You sound depressed.
• Client I wish I could be somewhere else.
• Nurse Somewhere else?

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Paraphrasing

• Client Ive had it! My doctor wont tell me
  whats going on. He doesnt seem to care what I
  think!
• Nurse Youre frustrated because you and your
  doctor havent talked about your diagnosis.

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Summarizing

• Mr. Jones enters the clients room and says,
  Good morning, Mrs. Raymond. Ive come to talk
  with you more about your diabetes. If you
  recall, yesterday we discussed the purpose of
  insulin, its side effects, and how to give an
  injection.

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Avoid Using Clichés

• Client I slept poorly last night. My
  incision seemed to be pulling.
• Nurse You cant win them all. At least the
  incision is healing well.
• Client I am so sad about losing my baby.
• Nurse It was Gods will.

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Avoid Changing the Subject

• Nurse Good morning, Mr. Smith. How are you
  feeling?
• Client (Facial expression shows discomfort.)
  Oh, not so good. My incision is rather sore.
• Nurse Well, lets get you up in the chair. We
  need to discuss your exercises.

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Being Defensive

• Client I hope I dont have to see Dr. Warren
  today.
• Nurse I dont understand. Is something wrong?
  Dr. Warren has been your doctor for some time.
• Client I dont care. She was the one who put
  me in this hospital, and that was a waste of
  time
• Nurse Thats silly. Dr. Warren is an
  excellent doctor.
• Client You think so, huh? He hasnt put you
  in the hospital for no reason!
• Nurse You were very ill, Mr. Locke. I know
  Dr. Warren made the right decision.

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Better

• Client I hope I dont have to see Dr. Warren
  today.
• Nurse You seem upset. Would you like to talk
  about it?
• Client I just dont think she shouldve put me
  in the hospital.
• Nurse You believe hospitalization was
  unnecessary?
• Client Yes, they really didnt do much of
  anything. They took a few tests and did some
  x-rays.
• Nurse Mr. Locke, did Dr. Warren tell you what
  the tests showed?
• Client No, not really. Thats why Im so
  angry.

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Giving Advice

• Nurse Mr. Jones, you really look like youre
  in deep thought.
• Client Oh no, not really. I was just thinking
  about whether my daughter was coming to see me.
• Nurse Well, if you ask me, she shouldve been
  here before now. It would mean so much to you.

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False Reassurance

• Client Im so afraid of becoming dependent on
  my wife. I feel like Im never going to get any
  better.
• Nurse Theres no reason to be afraid.
  Everything is going to turn out fine.

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Showing Approval/Disapproval

• Client Ive decided that when I leave the
  hospital Ill stay with my son. He doesnt want
  me to be alone.
• Nurse Oh, Im glad to hear that. I think you
  definitely made the right decision. Its best
  for you to be with your son so he can look after
  you.
• Client Oh, I feel good. I was able to get up
  in the chair once today.
• Nurse Only once? You going to have to do
  better than that!

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Therapeutic Communication Practice

• Change the following to open-ended ?s
• Are you feeling better?
• How are you feeling?
• Are you having pain?
• Tell me about the pain you are having.

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Practice contd

• Client Ive had this funny feeling for a
  week.
• Nurse Funny feeling?
• Client Nothing ever goes right for me.
• Nurse You sound depressed.
• Client Ive had enough of your questions.
• Nurse You seem upset.

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Professional Communication for Students Clients
and Families

• Always inform them you are a student
• Helping and therapeutic
• Dont pretend to know things you dontfind out
• Dont coerce patient into cooperating
• Dont tell your problems to your patient
• Dont gossip or degrade other professionals
• Avoid accepting tips, gifts, etc.
• Do not give test results or a new dx

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With Physicians

• Collaborative thru instructor or primary nurse
• May answer questions if aware of answers
• May not take orders
• Follow orders
• May assist with PEs, dsg changes, procedures
  (dont give meds without instructor)
• Dont flirt!

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With Nursing Staff

• Introduce yourself and get report
• Collaborative
• Dont criticize, gossip, or degrade one to
  another
• Nurse may advise or assist you but may not
  supervise invasive procedures or any meds except
  in specialty areas
• Give report before leaving floor

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With Instructors

• Always be honest!
• Dont overstep bounds
• Inform instructor if you have never done a
  procedure or dont feel comfortable
• If unsure about anything, ask
• No invasive procedures or meds without instructor
• Maintain respect controlask for privacy if
  have a problem
• Inform instructor of unsafe practices you seeno
  matter who it is