nursing 50 week 4 - day 1 Flashcards
The Oxford American College dictionary defines communication
as
the successful conveying or sharing of ideas and feelings.”
Communication is vital in all nursing activities
such as
care planning, interventions,
discharge, education and health promotion
Generates trust
Enhances therapeutic relationship
Strong communication is required for patient
advocacy and safety
Effective communication is essential for
collaboration of care with the interdisciplinary
team
Intrapersonal: Communication that occurs within
an individual.
Also known as self-talk, self-verbalization, inner thought
• Provides mental rehearsal for difficult tasks or situations;
increase confidence.
• NURSING RELEVANCE: – internal critical thinking and planning
Interpersonal:
• Between 2 or more people
• A 1:1 interaction between the nurse and another person.
e.g patient, family, physician, colleague
• Meaningful interpersonal communication results in exchange of
ideas and goal accomplishment.
• NURSING RELEVANCE: Assessment, teaching, providing
comfort and support
Transpersonal:
Interaction that occurs within a spiritual domain.
Communication with a higher power/God
Nurses have a responsibility to assess a person’s spirituality
Group Communication
Group Communication: Between two or more people
• A. Group communication: Interaction that occurs when a small number of
persons meet – usually goal-directed and requires understanding of group
dynamics; exchanges of ideas
• E.g staff meetings, committee meetings, educational grps, self help grps,
goals of care meetings
• NURSING RELEVANCE: Provide patient advocacy
• B. Public speaking: Involves interaction with an audience with varying
degrees of interaction
• e.g. presenting scholarly work in conferences and lectures
• NURSING RELEVANCE: Educating nurses with evidence based studies,
change of practice or policies and procedures, lobbying for new legislation
Albert Mehribian’s Communication
Model
7-38-55 Formula
Research study in 1971; “ Silent
Messages”
Formula applies to communication
of feelings and attitudes; not to ALL
communications
Only 7% of meaning is in the words
that are spoken
38% of meaning is in the tone of
voice
55% of meaning is in facial
expression
Verbal Communication:
Uses spoken or written words:
Influenced by educational
background, culture, age and
experiences, influenced by:
Vocabulary
Clarity and Brevity – appropriate
words
Intonation - tone
Pacing -speed
Credibility
Humor-Use cautiously
Non Verbal Communication**
Facial expression
Gestures
Personal Appearance****always overdress just in case
provides clues to professionalism, culture, religion,
socioeconomic status, livelihood and feelings
Touch - ex - touch patient’s hand and he calmed down. also provides a lot of information, skin is warm, purfusion is good.
May convene affection, concern, or encouragement
Environment
Quiet, private, comfortable
Developmental differences
Physical and cognitive
development
Language skills
Level of Education
Maturity
Gender
Difference in
communicating and
interpreting
Males tend to be goal/task
focus
Females also seek to
establish personal
relationship
Personal Space (personal at 18)
Varies according to
relationship with the
other person
Intimate distance – <18”
Personal distance – 18”
to 48’’
Social distance – 4-12’;
formal or with a group
Public Distance - > 12’;
when communicating
loudly, focus on group
not on individual
Nurse-Healthcare team: (team is patient, family and community)
Teamwork and
collaboration
Nurse-Patient: Involve
patient in care
management
Nurse-Family: Involve
family in care of patients
and discharge teaching
Nurse-Community: health
fairs, public bulletin boards.
-Transition of Care (transition the meds and fatigue)
(shift change report)
-High-alert Medications
-Recognizing Fatigue
* Be assertive not aggressive
* Advocate for patients
* Advocate for yourself
* If needed, decline
respectfully and explain
* Use proper chain of
command - 1st charge nurse, then attendant. trust your instincts.
for a chest tube, check for bubbling when patients takes a deep breath. make sure tube is connected to suction. check site to make sure there is no bleeding, etc.
The client is the center of focus.
Therapeutic relationship focuses on improving the health of the
client.
Therapeutic communication is client-centered communication
directed at achieving client goals
- Pre-interaction Phase:
Before meeting patient
Review chart/pre-lab
Talk with caregivers/nursing handoff
As Student- prelab for clinical
As patient – anxiety may be high as pt acknowledges the need
for healthcare
Goal – Get info about patient to establish plan of care
Orientation Phase: hi, how are you?
When nurse and patient first meet
Introduce yourself
Ask how pt wants to be addressed
Set tone by adopting a warm and empathetic manner
Students often tentative and uncertain
Expect to test your competence and commitment
Goal – establish rapport and trust using verbal and non-
verbal communication; leads to more openness from patient
Clarify roles
Working Phase: (the therapy is working)
Bulk of therapeutic relationship occurs in this phase – active part
Goals: pt able to clarify feelings and concerns honestly
Mutual respect maintained
Active listening, providing clear instructions
Professional relationship requires trust, confidentiality mutual respect
Work together towards a goal
Termination Phase:
Evaluate goals achievement with the patient
Reviewing the care achieved and care needed to be passed on to
the next shift
Achieve a smooth transition for the patient to other caregivers
Prepares for future interaction
Affects patient outcome and nurses’ job satisfaction
Active Listening:
-Pay attention
-Show that you are listening
-Use clarification
-Respond appropriately
Share Observations (share questions and silence)
“You seem quiet today. What’s in your mind?”
3. Reflection of feeling: “I see that you are upset of the phlebotomist.”
4. Restating/Clarifying
5. Use open-ended questions
6. Focusing: pursing a topic until its importance is clear
7. Using silence – allows
person time to organize
thoughts
Excessive use of
closed-ended questions
Avoid asking “why”; Say “what concerns you” instead
Giving advice – giving solution negates pt’s participation in decision making
False reassurance: “everything will be alright”
Showing approval and disapproval- don’t impose your personal beliefs on someone else
Stereotyping: assumptions made based on patients background, education, culture etc.
Patronizing – communicates superiority or disapproval
“You should have called before getting up”
Medications that might interfere with speech, cognition, or LOC
Language barriers such as primary language, whether an interpreter (native language or sign language) is needed
Health literacy
Baseline cognitive function/LOC
Hearing, vision impairment
Expressive or receptive aphasia
Physiological barriers such as dyspnea, artificial airway, anxiety, pain
aphasia
Use yes/no answers
Visual cues
Communication aids such as a writing board or keyboard
Allow for extra time
Let patient know if you have not understood them
cognitive impairment
Use simple sentences
Present one question,
instruction, or statement at a
time
Involve the patient’s family
Allow for extra response time
mental health issues
Avoid denying or arguing with them about their reality
Use short sentences in a calm and non-threatening voice
Validate the person’s own experience of frustration or distress
Reflection of feelings
Re-direct focus to the person’s positive experience
Avoid denying or arguing with the person’s about their reality
if you see the word “why” on NCLEX,
this answer is WRONG
don’t give the patient
advise.
stage of patient and nurse relationship
termination phase
reconginze open and closed
statements
ineffective communicaiton techniques
stages of nurse
to patient relationship
list one example of ineffective techniques
giving hope, false reassurance etc.
Communication is the basic element of human interactions
allows people to establish, maintain, and improve contact with
one and other
Denotative Meaning (de note is literal)
literal
Connotative Meaning -
implied
when does orientation phase end? (I’m oriented to the role)
Once relationship/ role is defined, orientation phase ends
what phase affects future outcomes?
termination phase
