Chapter 8
Communication
Copyright
© 2011
Wolters
Kluwer
Health
| Lippincott
Williams & Wilkins
Copyright
© 2019
Wolters
Kluwer
• All
Rights Reserved
Objectives/Outcomes
• Students will increase their understanding about the
communication process in the HC setting
• Students will be able to distinguish between verbal and
non-verbal communication
• Students will develop stronger communication skills
with their patients and cross-functional teams
• Students will gain a stronger understanding of the
barriers that restrict/limit/impair proper
communication with their patients
• Students will be able to explain the importance of the
teach-back method to assess patients understanding of
information
• Students will learn to communicate with compassion
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Communication
Communication does not just occur when a person is speaking.
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Communication Definition
Communication is
the process of
exchanging
information and
generating and
transmitting
meanings between
two or more people.
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Communication Importance
A nurse who wishes to be an
effective caregiver must first
learn how to be an effective
communicator.
Good communication skills
enable nurses to get to know
their patients and, ultimately,
to diagnose and meet their
needs for nursing care.
This Photo by Unknown Author is licensed under CC BY-ND
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Forms of Communication 150-153
• Verbal-What is spoken
• Non-verbal communication
1.
_
2.
_
3.
_
4.
_
5.
_
6.
_
7.
_
8.
_
9.
_
10.
_
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Copyright © 2019 Wolters Kluwer • All Rights Reserved
What can you
observe from
non-verbal
communication?
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Try This:
• Put on one of your favorite
movies
• Turn off the sound
completely
• What do you notice that you
did not notice before?
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Electronic Communication
p. 153
• Social media
• Both the American
Nurses Association
(ANA) and the
National Council of
State Boards of
Nursing (NCSBN) have
issued guidelines for
RNs regarding use of
social media.
• E-mail and text messages
• The risk for violating
patient privacy and
confidentiality exists
any time a message is
sent electronically.
• Health care agencies
usually have security
measures in place to
safeguard e-mail and
text communications.
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Electronic Communication
From Chapter 19
“The primary
purpose of the
[client] record is
to help health
care
professionals
from different
disciplines
communicate with
one another.”
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Factors Influencing Communication 156
What are the factors influencing communication?
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Intimate zone: interaction between
parents and children or people
who desire close personal contact
Space and
Proximity
Personal zone: distance when
interacting with close friends
Social zone: space when
interacting with acquaintances
such as in a work or social setting
Public zone: communication when
speaking to an audience or small
groups
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Dutch Bros Zone!
Copyright © 2019 Wolters Kluwer • All Rights Reserved
SBAR
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Dispositional
Traits 163-165
• Warmth and friendliness
• Openness and respect
• Empathy
• Honesty, authenticity,
trust
• Caring
• Competence
• Rapport Builders 165
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Specific objectives
Comfortable environment
Rapport
Builders
p.165-166
Privacy (verbalizing what you are doing and why)
• Saying why you are doing what you are doing verbally and
not just doing the action (closing the curtain)
Confidentiality and discreteness
Patient vs. task focus
Utilization of nursing observations
Optimal pacing
Why is rapport building essential?
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Conversation Skills 167-168
Conversation
Listening
Silence
Humor
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Touch
Interviewing Techniques
• Open-ended question or comment
• Example:
• Why is this appropriate when gathering medical
history?
Conversation
Skills 167168
• Closed-ended question or comment
• Example:
• When would this be appropriate?
• Validating
• Clarifying
• Reflective question or comment
• Sequencing
• Direction
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Cultural
Considerations
Q: How does culture
play a role in personal
space? (Ch 5, p. 86)
and Relating to
Patients from Different
Cultures box 8-4*
Example: Juan, 55 yo burn victim
Copyright © 2019 Wolters Kluwer • All Rights Reserved
BARRIERS / BLOCKS
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Barriers and Blocks
Why is it important to
identify barriers?
What negative
outcomes may be
experienced due to
blocks in
communication?
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Definition: A phrase or opinion that is
overused and betrays a lack of original
thought.
When you assess do NOT make assumptions!
Clichés
Type your
“un-favorite”
cliché in the
chatbox.
Assessments are based on objective and
subjective data.
Does NOT build rapport with patients
Can be viewed as shallow and over-used
List examples of clichés used in healthcare
https://prowritingaid.com/art/21/List-ofClich%C3%A9s.aspx
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Barriers to Communication
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Impaired Verbal
Communication
176 & Box 8-6
• Avoid “elderspeak” with the older adult
(mimics baby talk)
• Terms of endearment such as “honey”
“granny” or “sweetie”
• Cognitively impaired
• Hearing loss or hearing impaired
• Visually impaired
• Speech and language disorders
• Patients who are unconscious
• Physical barrier (endotracheal tube or
laryngectomy)
• Language
Copyright © 2019 Wolters Kluwer • All Rights Reserved
How do you
communicate
with…..
• A person who cannot hear?
• A person who cannot hear or speak?
• A person who can hear but cannot speak?
• How do you know your patient cannot
talk?
• How would you chart your
communication with a person who
cannot speak?
• How is COVID-19 influencing how clients
are able to understand what we say?
• Page 176 box 8-6
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Nurse and
Outside
Organizations
Q: Why is effective
communication
necessary for
improved client
outcomes?
Copyright © 2019 Wolters Kluwer • All Rights Reserved
The Joint Commission
Language barriers
• The mission of the Joint Commission on
Accreditation of Healthcare Organizations is to
continuously improve the safety and quality of care
provided to the public through the provision of health
care accreditation and related services that support
performance improvement in health care
organizations.
• What are the legal requirements regarding the use
of video translators and certified translators?
• What they have to say about medical translators:
https://www.jointcommission.org/standards_information/
jcfaq.aspx?ProgramId=0&ChapterId=0&IsFeatured=Fal
se&IsNew=False&Keyword=Language%20Access
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Nurse and
Interdisciplinary
Teams
MDs
Case
Management
Ancillary Services
Supervisors
Q: What are the
risks of poor
communication?
The Story of Julia
Copyright © 2019 Wolters Kluwer • All Rights Reserved
An Actual CaseLanguage Barrier
• A Spanish-speaking male patient entered the
emergency department at Anne Arundel Medical
Center in Annapolis, Md., in December 2012
suffering from vomiting, abdominal pain and
shortness of breath. Over two days in the
hospital, he had blood drawn, underwent an
abdominal CT scan, received IV fluids and had a
urinary catheter inserted. But it's possible that he
never fully understood that fluid was building up
in his abdomen and lungs and that his condition
could be fatal.
• According to a hospital inspection report, no
one discussed his care plan with him in Spanish,
the only language he understood, until an hour
and a half before he died.
Copyright © 2019 Wolters Kluwer • All Rights Reserved
• Sit when communicating with a patient
(how if they are standing?)
• Get to their level
• Be alert and relaxed and take your time
Developing
Listening Skills
• Maintain eye contact if appropriate
• This is not always appropriate for some
cultures
• Use appropriate facial expressions and body
gestures
• Think before responding to the patient
• Do not pretend to listen
• Listen for themes in the patient’s comments
• Use silence, therapeutic touch, and humor
appropriately
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Compassionate
Communication
• Sometimes not saying
anything; silence, spending
time with the patient, touch
• Anticipating patient’s needs
• Showing empathy in our tone,
facial gestures and actions
The story of the clergy at the ER
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Shorting or
Ending a
Conversation
How do I end this
conversation?
Why would we need
to do that?
Practice how to end a
conversation with a
person who wants to
talk and talk.
Copyright © 2019 Wolters Kluwer • All Rights Reserved
How do we
know our
patient
understands
what we
taught?
Teach back method
• https://www.youtube.com/watch
?v=bzpJJYF_tKY
• https://www.youtube.com/watch
?v=eNIbpEAVk4g
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Never forget:
If it wasn’t charted
it wasn’t done
Copyright © 2019 Wolters Kluwer • All Rights Reserved
Reference
• Taylor: Fundamentals of Nursing: The
Art and Science of Person-Centered Care, Ninth Edition
Copyright © 2019 Wolters Kluwer • All Rights Reserved