Nursing 204 Lecture Notes
Chapter 24 P+P
Chapter 32 ATI
Levels of Communication
● Intrapersonal: self talk (inner thoughts and self talk affects behavior, self esteem,
etc.)
● Interpersonal: 2 or more people
● Small Group: Staff meeting, support group
● Public: seminars
● Electronic: Patient portal files
Elements of Communication
I.
Circular Transactional Method
A.
B.
C.
D.
E.
F.
G.
H.
Referent: Motivates one to communicate with the other
Sender: Encodes and sends the message
Receiver: Receives and decodes the message
Message: Verbal and nonverbal information sender expresses and intends
for the receiver
Channel: Means of conveying and receiving the message (i.e auditory,
tactile, visual, body language and facial expressions)
Environment: setting where the communication takes place
Feedback: “Teach back” receivers conveys back to the sender the message
they received
Interpersonal variables: factors that influence communication b/t sender
and receiver (i.e educational/developmental levels)
Methods of Communication
I.
Verbal Communication
*In hospital setting, always use
hospital appointed translator
A. Vocabulary
B. Denotative and connotative meaning:
1. Denotative: words mean the same to most people
2. Connotative: interpretation of meaning of word (i.e Shrewd is
negative to some but positive to others)
C. Clarity and Brevity
D. Timing and relevance
E. Pacing
F. Intonation
II.
Nonverbal communication
A. Appearance, posture and gait
B. Facial Expressions, eye contact and gestures
C. Sounds
D. Territoriality and personal space
1. 4 distances
a) Intimate: 0-18 in (physical, bathing, feeding)
b) Personal: 18-40 in (sitting at bedside)
c) Social: 4-10 ft (giving directions to visitors in hallway)
d) Public: 12 ft-beyond (lecturing)
2. Special Zones
a) Social (Permission not needed)
(1) Hands, arms, shoulders, back
b) Consent (Permission needed)
(1) Mouth, wrist, feet
c) Vulnerable (Special Care)
(1) Face, neck and front of body
d) Intimate (Permission and Sensitivity)
(1) Genitalia and rectum
III.
Metacommunication: All influencing factors
Nursing-Patient Caring Relationships
I.
Phases of Caring Relationships
A. Pre Interaction Phase: Before meeting the patient,
1. Review medical history
2. Talk to caregivers
3. anticipate issues or concerns
B. Orientation Phase: When you and the patient meet
1. Introduce yourself
2. Set the tone by being empathetic, warm, etc.
3. Closely observe patient
4. Assess health status
5. Prioritize their problems and establish goals
6. Clarify roles and form contracts with pt that specify who will do
what
C. Working Phase
1. Encourage and help patient: Express feelings, self-explore, set goals
2. Provide information to help pt change behavior
3. Therapeutic communication skills
D. Termination Phase
1. Remind pt terminations near
2. Eval goal achievement
3. Achieve smooth transition to other caregiver
Motivational interviewing: Encourages patients to share their thoughts, beliefs, fears,
and
concerns with the aim of changing their behavior
Nurse-family relationships: uses the same principles as one on one techniques
Nurse-health care team relationships:
I. Affects pt safety and work environment
A. Acronym SACCIA: Sufficiency, accuracy, Clarity, contextualization and
interpersonal adaptations
B. Use hand out reports:
C. SBAR Technique:
1. Situation
2. Background
3. Assessment
4. Recommendation
II.
Lateral violence
A. Calmly address the behavior when it occurs.
B. Describe how the behavior affects your functioning.
C. Ask for the abuse to stop.
D. Notify the manager to get support for the situation.
E. Plan for taking action in the future.
F. Document the incidents in detail.
Nurse-Community Relationships
I. Form by participating in local organizations, volunteering or political activism
Elements of Professional Communication
I. Courtesy
II. Use of names
III. Trust worthiness
IV. Autonomy and responsibility
V. Assertivness:AIDET
A. Acknowledge
B. Introduce
C. Duration
D. Explain
E. Thank you
Nursing process
I.
Assessment
A. Through the Patient's eyes: Gather information, synthesize and apply
critical thinking
B. Physical and emotional factors:
C. Developmental:
D. Sociocultural factors:
E. Gender:
● Assessment Factors Influencing Communication
II.
○ Psychophysiological Context
○
Nursing Diagnosis
A. Nursing diagnosis for communication:
1. Communication Barrier
2. Difficulty coping
3. Powerlessness
4. Impaired Socialization
B. Planning
1. Involve the family
2. Allow adequate time for practice
3. Goals and outcomes
a) Specific and measurable
4. Setting priorities
5. Teamwork and collaboration
C. Implementation
1. Therapeutic Communication Techniques:
a) Active listening
(1) SURETY Method
(a) Sit with angle facing the pt
(b) Uncross legs and arms
(c) Relax
(d) Eye Contact
(e) Touch
(f) Your Intuition
b) Silence: meaningful reflection
c) Presenting Reality: pt distinguishes b/t what's real from
whats not; dispel delusions, hallucinations, faulty beliefs
d) Asking Questions
e) Open-ended questions: facilitates spontaneous responses;
explores feelings and thoughts; avoids yes/no questions
f) Clarifying techniques: help determine whether message
client received was accurate
(1) Restating: Use exact words
(2) Reflecting: direct focus back to client for them to
examine feelings
(3) Paraphrasing: Restates pt feelings and thoughts for
confirmation of what they said
(4) Exploring: nurse able to gather more information
about impt. topics
g) Offer general leads and broad opening statements: pt
starts and continues talking
h) Show acceptance and recognition: acknowledges nurses
interest and nonjudgmental attitude
i) Focusing: pt focuses on whats impt
j) Giving Information: factual details pt needs for decision
making
k) Summarizing: emphasizes impt points and reviews what
you've discussed
l) Offering self: willingness to spend time with pt
m) Touch: Communicates caring and provides comfort
n) Sharing feelings: ask clients to express feelings and help pt
identify feelings
2. Nontherapeutic Communication Techniques
a) Asking irrelevant personal questions
b) Personal opinions
c) Stereotyping
d) Advice
e) False reassurance
f) Minimizing feelings
g) Changing topic
h) Asking why or for explanations
i) Challenging
j) Value judgements
k) Probing
l) Responding approvingly or disapprovingly
m) Being defensive
n) Testing
o) Judging
p)
q)
r)
s)
Sympathy
Arguing
Automatic Responses
Passive or aggressive responses
3. Communicating with Special Needs Patient: Use thought and
sensitivity; Adapt to unique circumstances
PG 338: Box 24.9 (Incomplete examples below)
a) Pt who cannot speak clearly (Aphasia, dysarthria,
muteness)
(1) Listen, no interruption, patience
(2) Simple yes/no questions
(3) Collaborate with speech pathologist
(4) Communication aids
b) Pts who have cognitive impairment
(1) Simple sentences
(2) Pictures or gestures
(3) Include family and friends in convo
c) Pts who have hearing impairment
(1) Check for hearing aid and glasses
(2) Reduce environmental noise
(3) Speak at normal volume
(4) Sign language interpreter if needed
d) Pts who are visually impaired
(1) Check for glasses and contacts
(2) Do not rely on gestures or nonverbal comm
(3) Use 14pt print
e) Pts who are unresponsive
(1) Verbal and tactile communication
(2) Explain all procedures and sensations
f) Pts who do not speak english
(1) Establish method for pt to ask for assistance (i.e call
button or light)
(2) Interpreter
(3) Avoid using family or friends as interpreter
D. Evaluation
1. Through pts eyes
a) Evaluate pt outcomes together
2. Patient outcomes
3. Nurses and patients need to determine whether the plan of
4. care has been successful.
5. Nursing interventions are evaluated to determine which
6. strategies or interventions were effective.
7. If expected outcomes are not met, the plan of care needs
8. to be modified.