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Rachel Natividad, RN, MSN, NP

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CommunicationCommunication Have you ever been nailed by nasty Have you ever been nailed by nasty

remarks from a hostile friend, family remarks from a hostile friend, family member, or stranger?member, or stranger?

Ever been bashed by comments and Ever been bashed by comments and criticisms from colleagues?criticisms from colleagues?

How did you react?How did you react?

Did you gracefully defuse the situation?Did you gracefully defuse the situation?

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Communication defined…Communication defined… ““The exchange of information which The exchange of information which

involves both sending and receiving involves both sending and receiving messages between two or more messages between two or more people…”.(Timby, 2005)people…”.(Timby, 2005)

““The The processprocess of sending and of sending and receiving messages by means of receiving messages by means of symbols, words, signs, gestures, or symbols, words, signs, gestures, or other actions”. (Smith, Duell, & other actions”. (Smith, Duell, & Martin, 2004)Martin, 2004)

Describe a situation in which you did Describe a situation in which you did not communicate effectively and the not communicate effectively and the result.result.

What could you have done What could you have done differently?differently?

Effective Communication Effective Communication in Nursingin Nursing

Increases patient satisfaction and Increases patient satisfaction and health outcomeshealth outcomes

Decreases risk of complaints and Decreases risk of complaints and litigationlitigation

Increases level of job satisfactionIncreases level of job satisfaction

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Elements of Elements of CommunicationCommunication

SenderSender MessageMessage ReceiverReceiver FeedbackFeedback Meaning (sender/receiver)Meaning (sender/receiver)

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Language is Language is inherently inherently ambiguous…ambiguous…

Ambiguous PictureCommunication can be confusing!!!

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Communication PatternsCommunication Patterns Verbal Verbal

ToneTone

Nonverbal Nonverbal Facial expressionsFacial expressions GesturesGestures Eye contactEye contact Body languageBody language

Tone38%

Verbal 7%

Nonverbal 55%

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Face talks…Face talks…

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Communication in Communication in NursingNursing

Nurse-client relationship - Nurse-client relationship - Therapeutic Relationship-Therapeutic Relationship-

Client-centered Client-centered

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Case Study: The Case Study: The First EncounterFirst Encounter

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Phases of Therapeutic Phases of Therapeutic RelationshipRelationship

Introductory phase - initiation or Introductory phase - initiation or orientation phaseorientation phase

Working phase– facilitating the Working phase– facilitating the relationshiprelationship

Termination phase– relationship Termination phase– relationship comes to an endcomes to an end

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Case Study Resolution: The Case Study Resolution: The First EncounterFirst Encounter

Attempt to identify the source of Attempt to identify the source of hostilityhostility

Allow client to verbalize feelings, fears, Allow client to verbalize feelings, fears, concernsconcerns

Offer explanations and explain the Offer explanations and explain the purpose of the procedures/medications.purpose of the procedures/medications.

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Case Study Resolution: The Case Study Resolution: The First EncounterFirst Encounter

Acceptable responses: Acceptable responses: ““You sound upset this morning.”You sound upset this morning.”

““Mrs. T, it is difficult to be a patient. Mrs. T, it is difficult to be a patient. You haven’t had much time to yourself.”You haven’t had much time to yourself.”

““When would you like me to bring your When would you like me to bring your medicine?”medicine?”

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Listen…Listen…A poem by….A poem by….

AnonymousAnonymous

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Blocks to Therapeutic Blocks to Therapeutic CommunicationCommunication

Changing the Changing the subjectsubject

False reassuranceFalse reassurance

Giving adviceGiving advice

IncongruenceIncongruence

AssumptionsAssumptions

InvalidationInvalidation

OverloadingOverloading

Social ResponseSocial Response

UnderloadingUnderloading

Value judgementsValue judgementsSDM

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Therapeutic Therapeutic Communication TechniquesCommunication Techniques AcknowledgementAcknowledgement ClarificationClarification FeedbackFeedback FocusFocus Incomplete sentencesIncomplete sentences ListeningListening Mutual fit or Mutual fit or

congruencecongruence Minimum verbal Minimum verbal

activityactivity

Nonverbal Nonverbal encouragementencouragement

Open-ended Open-ended questionsquestions

ReflectionReflection RestatementRestatement ValidationValidation

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Case Study: Case Study: Cultural Cultural

Diversity (2)Diversity (2)

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Cultural DiversityCultural Diversity Slang terms and colloquialismsSlang terms and colloquialisms

Stress of illness – different meanings Stress of illness – different meanings in various culturesin various cultures

Eye contact, touch personal space – Eye contact, touch personal space – meanings vary among culturesmeanings vary among cultures

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Let’s Communicate Let’s Communicate Transculturally! Transculturally!

Assess language needsAssess language needs

Approach patient Approach patient slowly and greet slowly and greet her/him respectfullyher/him respectfully

Do not raise your voice Do not raise your voice to be heardto be heard

Allow sufficient time Allow sufficient time and a quiet settingand a quiet setting

Pay attention to Pay attention to nonverbalsnonverbals

Try to mirror pt’s Try to mirror pt’s style of style of communicating communicating

Provide written Provide written material in patient’s material in patient’s language if availablelanguage if available

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Are you culturally Are you culturally competent?competent?

“…“…learn the language that a majority learn the language that a majority of your clients speak – this will give of your clients speak – this will give you insight into the you insight into the culture…”(Gaskill, 2002)culture…”(Gaskill, 2002)

Greet or say words and phrases in Greet or say words and phrases in the client’s languagethe client’s language

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Case Study Resolution: Case Study Resolution: Cultural DiversityCultural Diversity

Recognize impact of the client’s Recognize impact of the client’s culture to communication style, culture to communication style, health care and practices/beliefshealth care and practices/beliefs

Consider cultural roots when Consider cultural roots when continuing with the plan of carecontinuing with the plan of care

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Anxiety and Anxiety and CommunicationCommunication

How can stress/anxiety affect your How can stress/anxiety affect your communication with your clients?communication with your clients?

How can stress affect client’s How can stress affect client’s communication with you?communication with you?

What techniques do you use to decrease What techniques do you use to decrease your stress routinely? During exams?your stress routinely? During exams?

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MildMild

ModerateModerate

SevereSevere

PassivePassive

AssertiveAssertive

AggressiveAggressive

Levels of Anxiety

Communication Styles

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A confrontation with Ms. A confrontation with Ms. MaddMadd

You have just finished the change of You have just finished the change of shift report when Mrs. K confronts shift report when Mrs. K confronts you at the nurses station. Due to a you at the nurses station. Due to a serious fall, Mrs. K’s sister M.L has serious fall, Mrs. K’s sister M.L has sustained a cervical fracture that, in sustained a cervical fracture that, in spite of numerous efforts, has not spite of numerous efforts, has not yet been stabilized. During the past yet been stabilized. During the past few days…….(retrieved from few days…….(retrieved from www.nurseweek.com 1/20/05) 1/20/05)

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Help the anxious client Help the anxious client Be alert to s/s of Be alert to s/s of

anxietyanxiety Assist pt to verbalize Assist pt to verbalize

feelings and concerns feelings and concerns and try to ID source of and try to ID source of anxietyanxiety

Be understanding of Be understanding of pt’s feelingspt’s feelings

Avoid becoming tense Avoid becoming tense or defensiveor defensive

Speak slowly and Speak slowly and briefly, avoid empty briefly, avoid empty phrases that does not phrases that does not help the situationhelp the situation

Offer explanations of Offer explanations of info if pt has info if pt has misconceptions about misconceptions about the situationthe situation

Assess the patient’s Assess the patient’s support systemsupport system

ID previously useful ID previously useful coping mechanismscoping 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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ReferencesReferences Timby, B. K. (2005). Timby, B. K. (2005). Fundamentals Fundamentals

Nursing Skills and ConceptsNursing Skills and Concepts. 8. 8thth Ed. Ed. Lippincott Williams & Wilkins: Lippincott Williams & Wilkins: Philadelphia, PAPhiladelphia, PA

Smith, S.F., Duell, D.J., & Martin, B. C., Smith, S.F., Duell, D.J., & Martin, B. C., (2004). (2004). Clinical Nursing Skills: Basic to Clinical Nursing Skills: Basic to Advanced SkillsAdvanced Skills. 6. 6thth Ed. Pearson Ed. Pearson Education Inc.: Upper Saddle River, NJ.Education Inc.: Upper Saddle River, NJ.

Sheldon, L.K. (2004). Sheldon, L.K. (2004). Communication Communication for Nurses: Talking with Patientsfor Nurses: Talking with Patients. Slack . Slack Inc: Thorofare, NJ.Inc: Thorofare, NJ.

www.nurseweek.com

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