Lecture 1: Introduction to Interpersonal Communication and Nursing Therapeutic Relationships

Question 1

What is Depression?

Answer 1

a widespread emotional disorder in which the person has problems with sadness, changes in appetite, difficulty sleeping and a decrease in activities, interests, and energy

Question 2

As a nurse you will need to communicate - BUILD RELATIONSHIPS with…

Answer 2

Individuals of all ages
Families
Communities (homeless, mental health, acute care, long term care)
Health care team members
Peers

Question 3

What happens in health care if there is POOR communication?

Answer 3

• Patients misunderstand and do not follow the treatment/medication schedules
  
  • Patients not trusting us = don’t tell us the full story (drugs used or lifestyle)
  • Workflow breakdowns

Question 4

Communication:

Answer 4

A complex process that includes the sharing of info, ideas, and feelings aimed at a mutual understanding.
- requires a sender (person sharing), recipient (person receiving), and the transaction (way the message is delivered)

Question 5

Human Communication:

Answer 5

The process of making sense of the world AND sharing it with others via verbal and nonverbal communication. Includes the senses, variety of modes, & mixed media
- today’s technology has forced us to reconsider the definition of Face-to-face communication.

Question 6

Interpersonal Communication:

Answer 6

A distinctive form of communication that involves mutual influence between individuals and contains a true dialogue & honest sharing of self with others.
- occurs when you treat the other as a unique human being and not as an object

Question 7

Impersonal Communication:

Answer 7

occurs when we treat people as objects or when we respond to their roles rather than to who they are as a unique person.
- interaction is mechanical and stilted

Question 8

Intrapersonal Communication:

Answer 8

Communication with oneself; thinking; self-talk

Question 9

Intraprofessional Communication:

Answer 9

Formal communication with professions (your prof, physician, pharmacist, etc)
- Needs to be truthful, accuragte, clear, concise, and comprehensive

Question 10

Definition of Relationship:

Answer 10

Ongoing connection made with another person through interpersonal communication.

Question 11

Interpersonal Relationships:

Answer 11

Perception shared by 2 people through the development of relational expectations and connections.
- varies in interpersonal intimacy

Question 12

Interprofessional Relationships:

Answer 12

Teamwork or collaboration via communication between healthcare members of different departments to accomplish a common goal.

Question 13

5 Principles Common to ALL Interpersonal Communication:

Answer 13

1) Connects us to others
2) Is irreversible
3) Is complicated
4) Is governed by rules
5) Involves both content and relationship dimensions

Question 14

Symbols:

Answer 14

Words, sounds, or visual device that represents thoughts/concepts/objects
- Symbols can complicate messages.

Question 15

T/F The more communication there is = the more likely communication will succeed?

Answer 15

False.
The more communication there is = the more difficult it is for communication to succeed

Question 16

Rules:

Answer 16

A prescription to follow that indicates which behaviour is preferred/prohibited in communication situations or contexts.
(implicit or explicit)

Question 17

Implicit Rules:

Answer 17

We learn these rules from experience and observing others - prescription that we follow which indicates what behaviour is preferred or prohibited
(ex. hat off at dinner table; respect others privacy; etc.)

Question 18

Explicit Rules:

Answer 18

Clearly communicated rules and expectations wither verbally or written
(ex. syllabus)

Question 19

Content and Relationship Dimensions:

Answer 19

Content dimensions - The actual words and how you say them.
Relationship dimensions - How the message/content is said within a relationship (e.g., “dear”)

Question 20

Metacommunication:

Answer 20

The secondary expression of intent (non verbal’s) that either supports or conflicts with what you are verbally saying (helps you understand what people really mean)

Question 21

Principles of Interpersonal Power:

Answer 21

1) Power exists in all interactions and all relationships
2) Both people in a relationship have some power
3) Power is circumstantial
4) Power is negotiated

Question 22

5 Sources of Power in an Interpersonal Relationship:

Answer 22

1. Legitimate power
2. Referent power
3. Expert power
4. Reward power
5. Coercive power

Question 23

5 Sources of Power in an Interpersonal Relationship: Legitimate power

Answer 23

Comes from a respect for a position another holds (teachers, nurses, parents, police, company presidents)

Question 24

5 Sources of Power in an Interpersonal Relationship: Referent Power

Answer 24

Comes from our attraction to another person, or the charisma a person holds.
- we let people we like influence us

Question 25

5 Sources of Power in an Interpersonal Relationship: Expert power

Answer 25

Based on a persons knowledge and experience.
- we give power to those who know more than we do or have some level of expertise we don’t have.

Question 26

5 Sources of Power in an Interpersonal Relationship: Reward Power

Answer 26

Most common form of power in interpersonal relationships
Give power to others based on their ability to satisfy our needs with rewards of money, gifts, etc
- coercive power

Question 27

Coercive Power:

Answer 27

A subcategory of reward power.
Involves the use of sanctions or punishment (something they don’t want) or withholding rewards (like affection)

Question 28

Relationship of Circumstance:

Answer 28

interpersonal relationships that exist because of life circumstances (ex. trauma bonding)
- determines whether we then establish a relationship of choice

Question 29

Relationship of Choice:

Answer 29

Interpersonal relationships you CHOOSE to start, maintain, or end (friends, lovers, spouse)

Question 30

The Therapeutic Nursing Relationship:

Answer 30

It is considered a helping relationship with 2 main goals: (a) helping Pts manage their health and live effectively, and (b) promote optimal independence in their daily lives.
- varies in length
- requires both the science and art of nursing

Question 31

Why is Nursing both an Art and a Science?

Answer 31

Science - Nursing knowledge and skills
Art - Applying caring attitudes and behaviours = Empathy and being other oriented

Question 32

Basic Tenants of Hildegard Peplau’s Theory of Interpersonal Relationships:

Answer 32

• there is a relationship b/w the nurse and the Pt.
  
  • the nurse-patient relationship evolves and develops
  • the nurse utilizes communication skills to develop the relationship
  • self-reflection is necessary to support the relationship and ensure client focus.

Question 33

What does Hildegard Peplau’s Theory of Interpersonal Relationships emphasize?

Answer 33

Her model emphasizes that the nurse-patient relationship is an integral part of nursing practice.

Question 34

The 3 Phases of Peplau’s Theory of Interpersonal Relationships:

Answer 34

Orientation Phase
Working Phase
Termination Phase

Question 35

The 3 Phases of Peplau’s Theory of Interpersonal Relationships: Orientation Phase

Answer 35

• mostly 1 way
  
  • Aim is to set the tone for future interactions = Rapport
  • focus is on listening = hearing what is said and asking questions to stimulate descriptions and stories

Question 36

The 3 Phases of Peplau’s Theory of Interpersonal Relationships: Working Phase

Answer 36

• Major work occurs here = interventions
  
  • Nurses provide physical care (assisting w nutrition, toileting, dressing, washing, vital signs) and relevant education/teachings (discharge teaching, meds, safety, how to assess self, etc)

Question 37

The 3 Phases of Peplau’s Theory of Interpersonal Relationships: Termination Phase

Answer 37

• The summarizing and closure of the work that was accomplished in the working phase.
  
  • Discharge planning should be completed in this phase (begins in working phase)
  • Unlike other relationships - the nurse-patient relationship is limited and needs to/must end.

Question 38

5 components that should ALWAYS be present in the Nurse-Patient Relationship:

Answer 38

1. Trust (Critical component)
   
   • Pt is in a vulnerable position
   • At beginning of relationship trust is fragile = important to keep promises.
2. Respect
   
   • recognition of the inherent dignity, worth, and uniqueness of every individual regardless of socio-economic status, personal attributes, and the nature of the health problem
3. Professional Intimacy (closeness)
   
   • physical activities (bathing, certain procedures, etc)
   • also includes psychological, spiritual, and social elements (access to intimate personal details)
4. Empathy
   
   • ability to enter into Pt’s relational world to see/feel the world as the Pt does
   • what health/healthcare experiences mean for the Pt
5. Power
   
   • nurse has more power than Pt
   • includes interpersonal power

Question 39

Interpersonal Power:

Answer 39

the degree to which a person is able to influence or control his or her relational power (Nurse has more power than Pt)

Question 40

Empathy:

Answer 40

the ability to enter into the client’s relational world to see and feel the world as the client does, & explore the meaning for the client

Question 41

Respect:

Answer 41

the recognition of the inherent dignity, worth, and uniqueness of every individual regardless of socio-economic status, personal attributes and the nature of the health problem.

Question 42

What is a Boundary:

Answer 42

An invisible structure which protects rights, privacy, and functional integrity of the nurse-patient relationship

Question 43

What is a Boundary Crossing?

Answer 43

When a nurse crosses a boundary the nature and dynamic of the relationship changes from professional to unprofessional/personal (balance of power becomes more unequal = increases Pt’s vulnerability)

Question 44

Strategies to Improve Communication Competence:

Answer 44

1) Become Knowledgeable, Skilled, & Motivated
- Knowledgeable: learn about communication theory & other skills
- Skills: skills are practiced (labs)
- Motivated: must WANT to improve (self reflection)
2) Become Other-Oriented

Question 45

What does it mean to be Other-Oriented?

Answer 45

• Consider others needs, thoughts, experiences, emotions, desires, cultures, goals, etc.
  
  • Consider the interests of others
  • Empathize
  • Adapt
  • Be Ethical

Question 46

Key Elements of the Communication Process:

Answer 46

Source or Participants (encode/decode)
Message
Channel
Receiver
Noise (Interference)
Feedback
Context

Question 47

Source or participants (element of the communication process):

Answer 47

The senders/receivers of messages
- Encode: put ideas, thoughts, & feelings into communication
- Decode: the process of turning a communication message into thoughts

Question 48

Message (element of the communication process):

Answer 48

the verbal or nonverbal elements of communication

Question 49

Channel (element of the communication process):

Answer 49

the pathway or method through which messages are sent

Question 50

Receiver (element of the communication process):

Answer 50

the person who decodes the message

Question 51

Noise (element of the communication process):

Answer 51

the interference that keeps a message from being understood - needs to be minimized for accurate communication
(Can be physical or psychological)

Question 52

Feedback (element of the communication process):

Answer 52

verbal or nonverbal response to the message

Question 53

Context (element of the communication process):

Answer 53

emphasizes the Environment where communication occurs (physical, # of people, relationship, the goal, culture, etc)

Question 54

Physical/Literal Noise:

Answer 54

anything in the environment that is loud enough to prevent one communicator from hearing the other (depending on the channel - physical noise may or may not interfere)

Question 55

Psychological Noise:

Answer 55

“Noise within ourselves” - our thoughts and plans
(mind chatter)

Question 56

Contexts that Influence Communication:

Answer 56

1) Physical Context: the size, layout, temp, # of people, lighting of space, etc.
2) Psychological Context: Mental/emotional factors (stress, anxiety, love, anger, etc)
3) Social Context: stated rules/unstated norms (formal or informal)
4) Relational Context: previous interpersonal history + type of relationship (e.g. just met vs best friend)
5) Cultural & Language Context: cultural traditions/rituals that can result in unintentional insults or confusion (e.g. gender, ethnicity, sexuality, class, or ability)

Question 57

3 Models of Communication:

Answer 57

1) Message Transfer Model
2) Message Exchange (interaction) Model
3) Message Creation (transaction) Model

Question 58

Message Transfer Model:

Answer 58

This model sees communication as an Action (1-directional) and focuses on the sender and the message.
Main Elements: the channel, the sender, & the receiver.

Communication is a transferring of meaning from source to receiver (receiver is viewed as a target/end point rather than an ongoing process)

Question 59

Message Exchange (Interaction) Model

Answer 59

Describes communication as a process by sending and receiving feedback
- Feedback loop is incorporated as messages are sent in response to other messages (alternate roles of sender and receiver)
- includes physical and psychological context

Question 60

Message Creation (Transaction) Model

Answer 60

this model recognizes that the sender and receiver are acting simultaneously (senders and receivers are called Communicators) and the message of 1 communicator influences the message of the other

Requires a more complex understanding of context - social, relational, and cultural contexts.