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.