Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 5

COMMUNICATION

Communication

The sending and receiving of a message.

Aspects of Communication (i)

Sender - the one who conveys the message to another person.

Message - the thought, idea, or emotion conveyed.

Channel - how the message is sent.

Aspects of Communication (ii)

Receiver - physiological/ psychological components.

Feedback - the receiver’s response to the sender.

Influences - Culture, education, emotions and other factors involved.

Methods of Communication

Verbal - Speaking, Listening, Writing, Reading.

Nonverbal - Gestures, Facial Expressions, Posture and Gait, Tone of Voice, Touch, Eye Contact, Body Position, Physical Appearance.

Influences on Communication

Age Education Emotions Culture

Language Attention Surroundings

Congruency of Messages

Verbal and nonverbal communication must be congruent, or in agreement.

Listening and Observing

Listening and observing are two of the most valuable skills a nurse can have.

These two skills are used to gather the subjective and objective data for the nursing assessment.

Active Listening

The process of hearing spoken words and noting nonverbal behavior.

Active listening takes energy and concentration.

Therapeutic Communication

Sometimes called effective communication, it is purposeful and goal-oriented, creating a beneficial outcome for the client.

Goals of Therapeutic Communication

To obtain or provide information To develop trust To show caring To explore feelings

Enhancing Communication

Self-Disclosure. Caring. Genuineness. Warmth. Active Listening. Empathy (the capacity to understand another’s

feelings). Acceptance and respect.

Communication Techniques

Clarifying/validating. Asking open questions. Using indirect statements. Reflecting. Paraphrasing. Summarizing. Focusing. Silence.

Barriers Communication

Some barriers include: Closed questions. False reassurance. Judgmental responses. Defensive reflex. Agreeing/Disagreeing or Approving/ Disapproving. Giving advice. Requesting an explanation. Changing the subject.

Psychosocial Aspects of Communication

Style. Gestures. Meaning of time. Meaning of space. Cultural values. Political correctness.

Style

Three types of style: Passive - apologetic, weak, makes little eye contact,

often fidgety.

Aggressive - haughty, angry, demanding, shows no concern for anyone else’s feelings

Assertive - honest, direct, firm, makes eye contact, confident, respectful of others.

Gestures

Movements of the hands and arms.

Nurses must be sensitive to cultural variances with regard to gestures.

Meaning of Time

In the U.S., great emphasis is placed on time and schedules. Being on time is very important.

In other cultures, such emphasis is not placed on time.

Meaning of Space

Human beings all observe rules around comfort zones—the distance observed between two people. Such comfort zones include: Intimate: touch to 18 inches Personal: 18 inches to 4 feet Social: 4 feet to 12 feet Public: 12 feet or more

Cultural Values

A nurse should be familiar with the cultural values of the people in the nurse’s region of employment.

A nurse needs to be aware of those times when her values differ from the values of the dominant culture.

Political Correctness

To be politically correct in communication means to use language sensitive to those who are different from oneself.

Nurse-Client Communication

Almost every nurse-client interaction should involve therapeutic communication.

Nurse-client communication is influenced by both the nurse and the client.

Three Phases of Nurse-Client Communication

Introduction: Fairly short; expectations clarified; mutual goals set

Working: Major portion of the interaction; used to accomplish goals outlined in introduction; feedback from client essential.

Termination: Nurse asks if client has questions; summarizing the topic is another way to indicate closure.

Determinant Factors in Communication

A nurse’s communication is affected by: Past Experience State of Health Home Situation Workload Staff Relations Self-Awareness

Determinant Factors in Communication

A client’s communication is affected by: Social Factors Religion Family Situation Level of Consciousness Stage of Illness Visual, Hearing and Speech Ability Language Proficiency

Communication within the Health Care Team

Providing care is a team effort.

To ensure efficiency and effectiveness, effective communication is necessary.

This communication may be oral or written.

The Nurse’s Ways of Communication

Oral

Written

Self-Reflection

Oral Communication

Nurses communicate within many different relationships, each with their own rules.

Nurse-Nurse Nurse-Nursing Assistant Nurse-Student Nurse Nurse-Physician Nurse-Other Health Professionals Group Communication (I.e. client-care conferences)

Written Communication

Nurses’ communications are often written:

On charts Requisitions for x-rays and other tests and services Electronic communications, via computer Telemedicine: the use of communications

technology to transmit health information from one location to another.

Self-Reflection

Nurses often engage in internal dialogue:

Positive self-talk: Saying positive thoughts aloud; thinking, saying and hearing positive statements about yourself

Negative self-talk: Self-destructive. Your self-image is lowered by your own criticism.

Communicating With Yourself

Positive self-talk: Saying positive thoughts aloud; thinking, saying and hearing positive statements about yourself

Negative self-talk: Self-destructive. Your self-image is lowered by your own criticism.