Chapter 24
Communication
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
Communication and Nursing Practice
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A lifelong learning process for nurses
An essential attribute of professional nursing
practice
Builds relationships with patients, families,
and multidisciplinary team members
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Communication and Interpersonal
Relationships
Communication is the means to establish
helping-trust relationships.
The ability to relate to others is important
for interpersonal communication.
Developing communication skills requires
an understanding both of the
communication process and of
one’s own communication experience.
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Communication and Interpersonal
Relationships (cont’d)
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Therapeutic communication occurs within a
healing relationship between a nurse and a
patient.
The nurse’s communication can result in both
harm and good.
Skilled communication empowers others and
enables people to know themselves and to
make their own choices.
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Developing Communication Skills
Critical thinking
Perseverance and creativity
Self-confidence
Fairness and integrity
Humility
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Developing Communication Skills
(cont’d)
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Thinking is influenced by perception
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Five senses
Culture
Education
Perceptual bias
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Quick Quiz!
1. Match the levels of communication.
1. Intrapersonal
A. One-to-one interaction
between two people
2. Interpersonal
B. Occurs within an individual
3. Transpersonal
C. Interaction with an audience
4. Small group
D. Interaction within a person’s
spiritual domain
5. Public
E. Interactions with a small
number of people
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Copyright
by Mosby,
line. an imprint of Elsevier Inc.
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Levels of Communication
1. Intrapersonal
2. Interpersonal
3. Transpersonal
4. Small group
5. Public
B. Occurs within an individual
A. One-to-one interaction
between two people
D. Interaction within a person’s
spiritual domain
E. Interactions with a small
number of people
C. Interaction with an audience
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Quick Quiz!
2. You are invited to attend the weekly unit
patient care conference. The staff discusses
patient care issues. This type of communication
is
A. Public.
B. Intrapersonal.
C. Transpersonal.
D. Small group.
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Basic Elements of the
Communication Process
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Quick Quiz!
3. Match the basic elements of communication.
1. Referent
A. One who encodes and one
who decodes the message
2. Sender and receiver
B. The setting for senderreceiver interactions
3. Message
C. Message the receiver
returns
4. Channels
D. Motivates one to
communicate with another
5. Feedback
E. Means of conveying and
receiving messages
6. Interpersonal variables F. Factors that influence
communication
7. Environment
G. Content of the message
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Basic Elements of the
Communication Process
D. Motivates one to communicate
with another
1. Referent
2. Sender and receiver A. One who encodes and one who
decodes the message
3. Message
G. Content of the message
4. Channels
E. Means of conveying and
receiving messages
5. Feedback
C. Message the receiver returns
6. Interpersonal
variables
F. Factors that influence
communication
7. Environment
B. The setting for sender-receiver
interactions
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Forms of Communication
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Verbal aspects of communication:
Vocabulary Intonation
Pacing
Denotative Clarity and
and
brevity
connotative
meaning
Timing and
relevance
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Forms of Communication (cont’d)
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Nonverbal
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Personal appearance
Posture and gait
Facial expressions
Eye contact
Gestures
Sounds
Territoriality and personal space
Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc.
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Forms of Communication (cont’d)
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Symbolic
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The verbal and nonverbal symbolism used by
others to convey meaning
Metacommunication
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A broad term that refers to all factors that influence
communication
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Nurse-Patient Relationship
1. Preinteraction phase: occurs before meeting
the patient
2. Orientation phase: when the nurse and the
patient meet and get to know each other
3. Working phase: when the nurse and the
patient work together to solve problems and
accomplish goals
4. Termination phase: occurs at the end of a
relationship
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Professional Nursing Relationships
Nurse-patient helping relationships
Nurse-family relationships
Nurse-health team relationships
Nurse-community relationships
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Case Study
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Roberto Ruiz is a 44-yearold man of Puerto Rican
descent, suffering from
HIV/AIDS. He was near
death and in hospice, but
his condition has improved
and he is now home.
Suzanne is a 54-year-old
nurse dedicated to hospice
and committed to
maximizing quality of life in
end-of-life care.
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Quick Quiz!
4. Helping relationships serve as the foundation
of clinical nursing practice. Contracts for a
therapeutic helping relationship are formed
during the
A. Orientation stage.
B. Working stage.
C. Termination stage.
D. Preinteraction stage.
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Elements of Professional
Communication
Appearance,
demeanor, and
behavior
Courtesy
Use of names
Trustworthiness
Autonomy and
responsibility
Assertiveness
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Case Study (cont’d)
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As Suzanne works with Roberto, she
develops a helping relationship. Suzanne
knows that posing questions for the patient’s
reflection helps her assess his needs and
support his self-care strategies.
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Nursing Process: Assessment
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Through the patient’s eyes
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Gather information, synthesize, apply critical
thinking
Physical and emotional factors
Developmental factors
Sociocultural factors
Gender
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Case Study (cont’d)
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Suzanne learns that Roberto wants to travel
to New York to see his extended family.
Even though Roberto is in poor health and
the trip will be difficult, Suzanne expresses
her understanding of the importance of the
trip. She understands how important
extended family is in the Puerto Rican culture.
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Nursing Process: Diagnosis
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Nursing diagnosis for communication
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Many patients experience difficulty with
communication:
• Lacking skills in attending, listening, responding, or selfexpression
• Inability to articulate, inappropriate verbalization
• Difficulty forming words
• Difficulty with comprehension
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Nursing Process: Planning
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Goals and outcomes
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Specific and measurable
Setting of priorities
Teamwork and collaboration
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Case Study (cont’d)
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During her visit, Roberto tells Suzanne, “I
really want to go visit my uncles in New York,
but I’m not sure I’m up for the trip.”
Suzanne is understanding: “It sounds like you
miss your family. Let’s talk about your options
for maintaining contact.”
As they talk, Suzanne helps Roberto to
identify two methods of communicating with
his family in New York.
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Nursing Process: Implementation
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Therapeutic communication techniques
are specific responses that encourage the
expression of feelings and ideas and convey
acceptance and respect.
Active listening means being attentive to
what a patient is saying both verbally and
nonverbally.
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Use “SOLER”: Sit facing the patient; observe an
open posture, lean toward the patient, establish
and maintain intermittent eye contact; relax
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Nursing Process: Implementation
(cont’d)
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Therapeutic
communication
techniques
Nontherapeutic
communication
techniques
Adapting
communication
techniques
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Adapting Communication
Techniques
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Patients who cannot speak clearly
Cognitive impairment
Hearing impairment
Visual impairment
Unresponsive
Patients who do not speak English (or your
language)
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Quick Quiz!
5. While admitting a patient, during the initial
interview, a family member tells you, “My mom
really means that she does not understand her
medical diagnosis.” The communication form
used by the family member is
A. Focusing.
B. Clarifying.
C. Summarizing.
D. Paraphrasing.
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Nursing Process: Evaluation
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Through the patient’s eyes
Patient outcomes
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Nurses and patients need to determine whether
the plan of care has been successful.
Nursing interventions are evaluated to determine
which strategies or interventions were effective.
If expected outcomes are not met, the plan of care
needs to be modified.
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