COMMUNICATION
Module D
Communication
 Definition
 Consists of five elements
– Encoder, or sender
– Message
– Sensory channel
– Decoder
– The feedback, or return
• This indicates the degree of understanding of the
message
Communication (cont.)
 Levels of Communication
– Intrapersonal
– Interpersonal
– Public
Forms Of Communication
 Verbal
– Vocabulary
– Denotative meaning
– Connotative meaning
– Pacing
– Intonation
– Clarity & Brevity
– Timing & Relevance
Forms of Communication (cont.)
 Non-verbal
– *adds cues & meaning to verbal
communication
– Personal appearance
– Posture & gait
– Facial expression
– Eye contact
– Gestures
– Territoriality & Space
Forms of Communication
 Therapeutic- Communication that is
beneficial in developing a nurse-client
helping relationship (Ex. Active listeningSOLER, empathy, humor, touch)
 Non-Therapeutic- Communication that is
not beneficial or helpful to people involved
Ex. Personal questions, personal opinions,
changing the subject.
Zones of Personal Space
 Intimate (0-18 in)
 Personal (18-4ft)
 Social (4- 12 ft)
 Public (12 ft or greater)
Zones of Touch
 Social ( permission not needed)
 Consent (permission needed)
 Vulnerable (special care needed)
 Intimate (great sensitivity needed)
The Nurse-Client Helping
Relationship
 The Nurse-Client Helping Relationship
 Helping relationships are created through
the nurse’s:
– Application of scientific knowledge
– Understanding of human behavior and
communication
– Commitment to caring
 *Therapeutic communication doesn’t
happen. You have to work at it.
Building and Maintaining NurseClient Helping Relationships
 Pre-interaction Phase
 Orientation Phase
 Working Phase
 Termination Phase
Pre-interaction Phase
 Before meeting client
 Review data available ( diagnosis, medical
history
 Assign appropriate room
 Anticipate concerns or needs
Orientation Phase
 Introduce yourself
 Clarify client’s and
 Set a positive tone
your roles
 Let the client know
when to expect the
relationship to end
with a warm
empathetic manner
 Assess client health
status
 Prioritize needs and
goals of your client
Working Phase
 Encourage and help the client express
feelings
 Encourage and help client set goals
 Take action to meet the goals set the client
Termination Phase
 Remind client that termination is near
 Evaluate goal achievement
 Help to achieve a smooth transition to other
caregivers
Techniques for improved
therapeutic communication
 Professionalism
 Acceptance
 Courtesy
 Respect
 Confidentiality
 Silence
 Availabilty
 Hope
 Trust
 Encouragement
 Empathy
 Socializing
 Sympathy
 Gender/Cultural
sensitivity
Barriers to Effective
Communication
 Inattentive listening
 Medical vocabulary
 Giving personal
opinions
 Being defensiveness
 Showing disapproval
 Cultural differences
Be aware of language
barriers
Sensory impairments
 WHAT CAN WE DO TO OVERCOME
THESE BARRIERS?
Documentation- What is it and
why do we do it??????
 Documentation is defined as anything
written or printed within a client record.
 A record is a permanent legal written
document.
 NOT CHARTED NOT DONE!!!!!!!!!
 Documentation provides written record of
the care given to the patient.
Documentation:
 Financial record of care.
 Used for clinical research
 Used for professional development
What do we chart?
 Assessment
 Vital signs
 Any change in pt
condition
 If verbal order taken
 Procedure done
 PRN medication
 Intake & output
What is in “The Chart”?
 Admission sheet-
 Graphic/ Flowsheet-
demographic data, in
case of emergency,
etc..
 Physician’s order
sheet- record of MD
orders( meds, Tx,etc.)
 Nurses admission
assessment- Nsg
summary of Hx &
Physical
VS, Daily wts, I/O
 Med Hx & ExamInitial exam and hx
taken by MD
 RN notes- record of
RN assessments,
treatments, etc. What
we did!!!
“The Chart” cont
 Med Record- MAR
 Physician’s progress
Tells Who, What,
When, and Where!!
 Client education
recordDocumentation of
teaching done,
response, if
reinforcement needed,
how it was done.
notes- Updated record
of how the pt is
doing,response to tx,
and any changes.
 Healthcare discipline
records- all areas of
healthcare have a
place to chart their
specifics (resp, PT)_
More…
 Discharge summary Summary of the pt’s
condition upon D/C,
meds, prognosis, F/U
care, teaching needs,
etc.
Types and Categories of
Information
 Flowsheets
 POMR
 Graphics Sheets
 PIE
 Computerized charting
 Focus charting
 Charting by exception
 Critical pathways
 SOAP
 DRGS-for
 Narrative
reimbursement
 Kardex
 Careplans
Reporting and Documenting
 REPORTING – Change of Shift Report
 Types
 Purpose
 Information to include
 Information to omit
REPORTING – Transfer Report
 Name, age, primary physician, medical dx
 Summary of medical progress up to time of
transfer.
 Current health status (physical & psychosocial)
 Current nsg. Dx or problems & care plans
 Any critical assessments or interventions
 Need for any special equipment
Telephone Orders and Reports
 Complete info given to MD
 Verbal or telephone order- given to RN by
MD and written by RN that takes order.
Note as TO or VO. Repeat order back to
MD After receiving it. MD must sign w/in
24hrs or by hosp policy
 TO should be used only when necessary not
for convenience. WHY?
Professional Communication
 Courtesy
 Use of names
 Privacy
 Confidentiality
 Trustworthiness
 Autonomy
 Responsibility
 Assertiveness