Communication

Last Updated: Friday January 24, 2003

Any means of exchanging information or feelings between 2 or more people
Process of sharing information

Communication

process of generating and transmitting meaning
Is a PROCESS
Messages sent are influenced by:

past experiences
feelings
position within sociocultural system
Messages received are influenced by:

knowledge
past experiences
feelings
position within sociocultural system

Purposes

to obtain and give information
to influence others

role as advocate, change agent

Kinds of communication

Verbal

spoken or written word

Nonverbal

"body language"
gestures, touch, expressions
tone, pitch, volume

Occur concurrently BUT majority are NONVERBAL

tends to reinforce OR contradict what is said
is there congruence?
Must observe and interpret
Must be aware of own

Types of Communication

Therapeutic

effective, conscious, planned
goal-oriented

Non-therapeutic

not effective

Factors influencing communication

Developmental considerations
gender
sociocultural differences
roles and responsibilities
Space and territoriality

physical, mental, emotional state
values
environment

FYI

You do not need to focus on the reading on p 321

abbreviations - covered in sophomore year

Therapeutic Communication as a Process

5 steps:

Assess - gather information
Diagnose - communicate to colleagues

Impaired Verbal Communication

Plan - set goals
Implement
Evaluate

Before/during Intervention

1. Consider factors which influence effective verbal communication

2. Use special communication aids prn

3. Use planned therapeutic communication techniques

4. Avoid nontherapeutic techniques

        1. Consider factors which influence effective verbal communication
                                e.g. developmental
                                personal space

Personal space

Intimate to 1 1/2 feet
Personal to 4 feet
Social to 12 feet
Public beyond 12 feet

2. Use special communication aids prn

Communication Aids

Pad and felt-tipped pen or magic slate
communication board with words, letters or pictures denoting basic needs
call bells or alarms
sign language
use of eye blinks or movement of fingers
flash card with common words or phrases
language cards for clients who don’t speak dominant language

3. Use planned therapeutic communication techniques

4. Avoid nontherapeutic communication techniques

Therapeutic Communication

Techniques

1. Attentive Listening

face the person

eye contact

open posture

remain relaxed

acknowledge

lean toward

be sensitive to use of touch

2. conveying acceptance

do not interrupt

provide verbal feedback

congruent verbal cues

do not argue

3. asking related questions

relevant

sociocultural context

closed questions - limited response

access specific information

open-ended questions- free response, clarify

explore feelings, elaborate

4. reflective questioning/paraphrasing

listen for the basic message

restate

encourages elaboration

clarifies for pt and nurse

5. Clarifying (meaning for pt and self)

make a guess and restate

confess confusion

verify implied

check accuracy of pt. perception, information

and nurse perception

clarify time, reality, sequence

6. Focusing

when pt vague, rambling

focus on one aspect

7. stating observations

feedback on perception, behavior

avoid confrontation

8. offering information

establishes trust

promotes health teaching

be simple, direct; avoid advising

State "I don’t know" as needed

9. maintaining silence

invites a response

allows time to organize, process

requires practice and timing

time for assessment, observe nonverbal

10. Using assertiveness

speak clearly

learn to say no

constructive criticism

11. Summarizing

review at end

recall at beginning

Therapeutic = Success!

Barriers to Effective Communication

1. Giving advice

takes DM away from pt

stalls problem solving

present as OPTIONS

2. Offering false reassurance

disregards pts needs, feelings

discourages communication

genuine reassurance OK

3. Being defensive

protects nurses feelings, ignores pts

destroys trust

listen for basic or deeper message

does not imply acceptance

good time for paraphrasing

4. Showing approval/disapproval

focuses on nurses standards

closes communication

5. Stereotyping

people: inhibits true assessment

responses: rote, meaningless cliches

minimizes problem

6. Asking "why"

can be interpreted as accusative, hostile

7. Changing the subject inappropriately

focuses on nurses tasks, feelings

may miss important info

8. FAILING TO LISTEN!

Evaluating communication

were goals accomplished?
What factors influenced the outcome?

Process recording

verbatim account of a conversation
includes verbal and nonverbal interactions
analyze in terms of: PROCESS
CONTENT
Was it therapeutic? Did it flow?
Were cues missed?

What would I do diferent the next time?

Client Records

Purposes
communication
care planning
quality review
research
decision analysis
education
legal documentation
reimbursement
historic documentation

Methods of Documentation

source oriented
problem oriented
PIE (Problem, Intervention, Evaluation
focus charting (Data, Action, Response)
charting be exception
case management model

critical pathway

computerized records

Guidelines for Effective Documentation

Agency policies, documentation forms

Accountability

Confidentiality

Confidentiality

ANA Code of Ethics

The nurse safeguards the client’s right to privacy by judiciously protecting information of a confidential nature.

USE PT INITIALS, not full name, on notes

AHA Patient’s Bill of Rights

The pt has the right to expect that all communications and records pertaining to his care should be treated as confidential.

NEED TO KNOW BASIS

Content

complete
accurate
relevant
factual (not inference, opinion)
timely, sequential
legally prudent

Sample

9/7/02 7:15 PM Verbalizes sharp, throbbing pain localized along radial side, R wrist. Onset 15 minutes ago. Pain increased with movement of wrist, relieved slightly with elevation of hand on pillow. Radial pulses = bilaterally. R wrist circumference 1 cm larger than L wrist. Dr. Kent notified at 7:10 PM. Percocet 2 tabs given for pain.---------MMcGovern RN

Developmental Guidelines

Infants, Toddlers

need tactile contact
need visual and auditory stimulation
carry around
things to handle, look at

Preschoolers

communicate thru play
use stuffed animal, act out scene

School age

have child draw picture, then describe
use puppet

Teenagers

peer group important
use group situation
avoid parent-child interactions
draw

Adults

evaluate sensory deficits
use above as appropriate

Next: Recording Guidelines