Communication
Objectives
 Describe the communication process, identifying factors that
influence communication
 List ways in which people communicate nonverbally
 Use a standardized communication technique (SBAR) to
communicate with physicians and transfer patient
information to other nurses
 Describe how each type of ineffective communication
hinders communication
Communication
 “Communication skills are the building blocks of professional
relationships between nurse and patient, nurse and nurse,
and nurse and other health-team members.”
 Def: the process of exchanging information and generating
and transmitting meanings between two or more individuals.
 Primary aspect of a nurse-patient interaction
 Ability to communicate is basic to human functioning and
well-being.
Communication Process
 Based on a stimulus (a patient’s need for: medication,
information, food or fluid)
 Involves:
1. Source (encoder) - Person who sends the message
2. Message - the physiologic product of the source (speech, gesture,
nursing note)
3. Channel- the medium used to send the message
4. Receiver (decoder) the person who receives and interprets the
message sent
Channels of Communication
Auditory: spoken words and cues
2. Visual - sight, observations, and perception
3. Kinesthetic - touch
1.
Communication Process
Forms of Communication
 Verbal: exchange of information using words; including
both the spoken and written word.
 Verbal communication depends on language
 Nursing depends on verbal language extensively
 Nonverbal: communication without the use of words; also
know as “body language”
 Can be an incongruence between verbal and nonverbal
message
 Generally, the non-verbal message is thought to be the one
that is more valid or true
Forms of Non Verbal Communication
1.
2.
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5.
6.
Touch: can express comfort, love, affection, security,
anger, frustration, excitement, empathy
Eye Contact: means different things in different cultures;
Eyes can carry expressions - anger, fear, happiness
Facial Expression: Some people have expressive faces,
others hide their emotions
Posture: the way a person holds the body; can indicate
depression, well-being, tension
Gait: Type of walk; can indicate energy level, debilitating
conditions
Gestures: Many gestures are understood across cultures
Non Verbal Communication
General Physical Appearance: Skin color, body size, muscle
tone
8. Mode of Dress and grooming: High self esteem individuals
pay attention to details of dress and grooming; those with
low self esteem pay less attention; Illness cause low energy
levels for grooming; Economic status
9. Sounds: crying, moaning, gasping, sighing
10. Silence: can have multiple meanings
7.
Levels of Communication
 Intrapersonal: “Self-Talk” communication within an
individual; can influence interactions with others
 Interpersonal: between two or more people with a goal to
exchange messages
 Group: small group and organizational group
communication
Question
A nurse who reassures herself that she is prepared to speak in
front of a group of her peers is using which of the following
types of communication?
A. Intrapersonal
B. Interpersonal
C. Group
D. Organizational
Answer
Answer: A. Intrapersonal
Rationale:
Intrapersonal communication is self-talk that happens within
the individual.
Interpersonal communication occurs between two or more
people to exchange messages.
Group communication includes small-group and
organizational group communication.
Group Dynamics
 Within a group, how individual group members relate to one
another during the process of working toward group goals.
 How effective or ineffective is the group in attaining its goals
 Requires effective leadership, but depends largely on the
behavior of the members of the group
 Example: Study Group
Group Dynamics
Roles of Group Members
 Task-oriented—focus on work to be done
 Group building or maintenance—focus on well-being of
people doing work
 Self-serving—advance the needs of individual members at
group’s expense
Factors Influencing Communication
 Developmental level
 Gender
 Sociocultural differences
 Roles and responsibilities
 Space and territoriality
 Physical, mental, and emotional state
 Values
 Environment
Developmental Level
Developmental Level
Environment
Personal Space
Personal Space
Hand off Communication: SBAR
Technique
 Involves the accurate presentation of all patient-related
information to another caregiver.
 Includes
1. Nurse - to - Nurse report
2. Nurse to physician report
3. Report to and from other hospital departments
 JCAHO - recommends a standardized method of
communication, including an opportunity to ask and
respond to questions
SBAR
 S = Situation
 B = Background
 A = Assessment
 R = Recommendations
 Developed by the US Navy and then implemented by Kaiser
Permanente in Colorado
SBAR
 Example:
Your patient has a temperature of 38.8. He does not have an
order for an antipyretic.
What would you say when you called the MD?
Nurse - Patient Interaction:
The Helping Relationship
 “ Of all the problems that can arise in nursing care, perhaps
the most common is failure to establish rapport and a helptrust relationship with the other person” (Watson, 1985)
Nursing Relationship vs. Social Relationship
 Does not occur spontaneously
 Characterized by an unequal sharing of information
 Built on the patient’s needs
Characteristics of the
Helping Relationship
 Dynamic: Both parties are actively participating
 Purposeful and time limited
 Person providing assistance is professionally accountable
for the outcomes
Goals of the Helping Relationship
 Goals are determined cooperatively between the nurse and
the patient
 Goals for the patient change as the patient’s condition
changes
 The patient’s goals are the focus of the relationship
Phases of the Helping Relationship
 Orientation phase:
1. includes data gathering
2. sets the tone for the remainder of the relationship
3. Patient and nurse learn each other’s name
4. Roles of both parties are clarified
5. Goals are established
6. Patient is oriented to facility, routines, other staff members
Orientation Phase
Phases of the Helping Relationship
 Working Phase
1. Longest phase; characterized by interaction
2. Nursing interventions
3. Patient teaching
4. Assistance with ADL’s
5. Nursing roles: teacher and counselor
6. Satisfactory working relationship is crucial
Working Phase
Phases of the Helping Relationship
 Termination Phase
Occurs when the conclusion of the initial agreement is
acknowledged (change of shift, patient is discharged)
2. Evaluations of progress toward initial goals should be done
3. Set the stage for transfer of the helping relationship to
another person or entity (home health, clinic)
1.
Factors that Promote Effective
Communication
 Dispositional traits
 Rapport builders
Factors Promoting Effective Communication Within
the Helping Relationship
 Dispositional Traits
1.
2.
3.
4.
5.
6.
Warmth and Friendliness
Openness and Respect
Empathy
Honestly, Authenticity and Trust
Caring
Competence
Rapport Builders
 Def: a feeling of mutual trust experienced by people in a
satisfactory relationship; facilitates open communication
1.
2.
3.
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6.
7.
8.
Specific Objectives
Comfortable Environment
Privacy
Confidentiality
Patient vs. task focus
Using nursing observations
Optimal pacing
Respecting personal space
Communication Skills
 Conversational Skills
 Listening Skills
 Silence
 Touch
 Humor
 Interviewing Techniques
Touch
Developing Conversation Skills
 Control the tone of your voice.
 Be knowledgeable about the topic of conversation.
 Be flexible.
 Be clear and concise.
 Avoid words that might have different interpretations.
 Be truthful.
 Keep an open mind.
 Take advantage of available opportunities.
Listening
Developing Listening Skills
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Sit when communicating with a patient.
Be alert and relaxed and take your time.
Keep the conversation as natural as possible.
Maintain eye contact if appropriate.
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.
Communication Skills
Interviewing Techniques
 Open-ended questions or comments: Allows the patient an
open field of responses “Tell me about that”
 Closed questions or comments: Allows the patient a limited
range of responses “Yes or No”
 Validating questions or comments: Validates what the nurse
believes she has heard “What I heard you saying was”
Interviewing Techniques
 Clarifying question or comment :Allows the nurse to gain
further understanding of the patient’s comment. “Could you
explain what you mean”
 Reflective questions or comments: Repeating what the
person has said in order to encourage him to elaborate “You
are worried about the surgery?”
 Sequencing questions or comments: In order to determine
cause and effect “When did this occur?
 Directing questions or comments: To gain more information
about something previously discussed, “You mentioned
earlier that………”
Developing Conversation Skills
 Control the tone of your voice.
 Be knowledgeable about the topic of conversation.
 Be flexible.
 Be clear and concise.
 Avoid words that might have different interpretations.
 Be truthful.
 Keep an open mind.
 Take advantage of available opportunities.
Developing Listening Skills
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Sit when communicating with a patient.
Be alert and relaxed and take your time.
Keep the conversation as natural as possible.
Maintain eye contact if appropriate.
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.
Basic Components of Assertiveness
 Having empathy
 Describing one’s feelings or the situation
 Clarifying one’s expectations
 Anticipating consequences
Blocks to Communication
 Failure to perceive the patient as a human being
 Failure to listen
 Inappropriate comments and questions
 Using clichés
 Using closed questions
 Using questions containing the words “why” and “how”
 Using questions that probe for information
Angry Nurse
Blocks to Communication (cont.)
 Using leading questions
 Using comments that give advice
 Using judgmental comments
 Changing the subject
 Giving false assurance
 Using gossip and rumors
 Using aggressive interpersonal behavior
Stressed Nurse
Impaired Verbal Communication
 Aphasia:
1.
2.
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Expressive: inability to speak
Receptive - inability to understand
Hearing Problems
Voice Problems
Dysarthria: inability to produce sounds, slurred speech
from strokes, parkinsonism etc
Other communications problems: brain impairment,
disorientation