Understanding the Communication Process: Skills and Techniques

The Communication Process Communication occurs when one person sends a message and another person receives it, processes it, and indicates that the message has been interpreted Is a continual circular process Can be either verbal or nonverbal Verbal communication: spoken or written words Nonverbal communication: without words Nonverbal communication may be by: Gesture Body posture Intonation General appearance Factors Affecting Communication Cultural differences Past experiences Emotions and mood Attitude of the individual Cultural Differences -Personal space -Eye contact Averting eyes is normal in some cultures -Meanings of words “Yes” may not mean yes -Cultural norms Older adults may not want instructions from younger people -Religious beliefs Past Experience and Communication How we perceive what is communicated

to us depends on: Cultural values Level of education Familiarity with the topic Occupation Previous life experiences Emotions and Mood Anxious patients may not hear all that is said or may not interpret it correctly An upset person may speak more loudly than usual A depressed person may communicate minimally A person’s attitude may affect how a message is received Communication Skills Active listening Requires concentration and focused energy Uses all the senses to interpret verbal and nonverbal messages (feedback) Listens for feelings as well as words Maintains eye contact without staring and makes a conscious effort to block out distractions Interpreting Nonverbal Messages Observe for: Posture Gestures Tone Facial expression Smiling or frowning Eye contact Obtaining Feedback A vital part of communication is checking

to see if you interpreted a message in the way the speaker meant it Accomplished by rephrasing the meaning of the message or directly asking a feedback question Focusing Keeping attention focused on the communication task at hand Continually check to see that the patient is still the topic of the interaction Adjusting Style Patient’s style and level of usual communication should be considered when interacting If the person is a slow, calm communicator, adjust to that pace If a response is slow in coming, allow plenty of time for consideration and a response Therapeutic Communication Techniques Promoting communication between sender and receiver, obtaining feedback Focusing on the communicator Using silence and open-ended questions Restating the message Clarifying Using therapeutic touch Giving general leads Offering self Encouraging elaboration Giving information Looking at alternatives Summarizing Blocks to Effective Communication Changing the subject

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Offering false reassurance Giving advice Making defensive comments Asking prying or probing questions Using clichés Listening inattentively Interviewing Skills Establish a rapport The nurse-patient relationship Empathy Becoming nonjudgmental Maintaining hope Truth telling Application of the nursing process Nurse-patient communication Communicating with the Hearing-Impaired Speak very distinctly Do not shout Speak slowly Get the person’s attention Maintain a good distance (2 1/2 to 4 feet) Watch for nonverbal feedback Use short sentences Paraphrase for clarification Communicating with an Aphasic Patient This patient requires specialized nursing interventions A speech therapist can identify methods to facilitate communication for these patients Refer to Box 8.1 for specific techniques useful for communicating with a patient with aphasia

Communicating with Older Adults Assess for hearing deficits Assess for visual deficits Give time for elders to formulate responses Wait for an answer to one question before asking another Obtain feedback Communicating with Children Approach at eye level Use a calm, friendly voice Keep parent in the room when possible Use short sentences Give simple explanations and demonstrations Allow child to handle equipment Assisting Older Adults from Other Cultures Determine the language spoken Obtain an interpreter if necessary Enlist the aid of a family member if appropriate Give printed materials if available and answer questions Beware of cultural differences in: Eye contact Personal space Communication within the Health Care Team Nurses’ notes Physician’s orders and progress notes Dietitian’s notes OT, PT, and speech therapy notes Shift report Radiology and laboratory findings

End-of-Shift Report Walking Rounds Audiotape Computerized sheets ISBAR-R Telephoning Primary Care Providers Have patient data on hand: laboratory data, vital signs, urinary output, medication received Keep chart handy and anticipate information that the physician may request Know patient allergies and perform a quick assessment before calling Prepare a concise problem statement Document the call and physician’s response Assignment Considerations and Delegating Give clear, concise messages and listen carefully to feedback Include the result desired and the time line for completion along with the task assignment Ask person to whom you are assigning a task if any questions about what is to be done, and ask for a summary of what is understood about the task to be done Computer Communication Ability to use a computer for communication is essential for today’s nurse Transmit requests for laboratory, dietary, radiology, physical therapy, respiratory therapy, and other services Medication orders Supplies for patient care Update patient care plans Computerized form of charting

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Communication in the Home and Community Essential to state when instructions are about to be given so active listening can occur Leave written step-by-step instructions with the patient whenever possible Office and clinic nurses often assess patients who call in to see if they have an urgent need for medical attention Purposes of Patient Education Preventing illness or promoting wellness Nurses teach patients about their: Disease or disorder Diet and medications Treatment and self-care Prior to discharge, the patient must be taught how to care for himself at home Patient teaching begins at time of admission Assessment of learning needs Prepare a plan, assess learning needs Factors affecting learning Cultural values, confidence and abilities, readiness to learn Form a teaching plan Collaborate with other health professionals Visual learning Through what they see Auditory learning Through what they hear Kinesthetic learning By actually performing a task or handling items

Assessment of Learning Needs To prepare a teaching plan, assess patient for: Knowledge of his disease Diet (if related to disease or condition) Activity regimen or limitations Medications (prescription and OTC) Self-care at home Prioritize learning needs so you can concentrate on teaching essential knowledge first Factors Affecting Learning Assess for factors that might interfere with the patient’s ability to learn Poor vision or hearing, impaired motor function, illiteracy, and impaired cognition Age may interfere with the strength or dexterity for performing certain tasks Readiness to Learn Assess patient’s readiness to learn Motivation plays a large role in effective learning Work with patients to show them the advantages of learning what they need to know Cultural Values and Expectations Need to work within patient’s values and cultural system Values and expectations can interfere with patient’s ability to cooperate and learn needed skills for self-care Confidence and Ability Often patients express a lack of self-confidence Teaching may need to be broken down into very small steps Assess what patients already know about the skills they need to learn so that you can build on their current knowledge base

Special Considerations When Teaching Older Adults Provide good lighting Provide printed teaching materials in large type Encourage patient to wear glasses if needed Encourage patient to wear and adjust hearing aids Use short sentences and pause frequently Keep medical terms to a minimum Ask questions at frequent intervals The Patient Education Plan Preparing the teaching plan includes: Analyzing assessment data Establishing behavioral objectives Creating a plan to assist patient in reaching the goals in a timely and effective manner Essential that teaching plan be developed collaboratively, with input from all of the disciplines involved in the patient’s care Resources for Patient Education Books, audiovisual materials, pamphlets, and hands-on equipment Local government agencies often provide printed and online listings of community public service programs Hospital social workers and patient representatives also good sources of information Implementing the Plan Teaching done when visitors, physician rounds, and treatments will not cause interruptions One-on-one or in a group setting Patient should be comfortable Keep teaching session short Involve patient in the process You may need to incorporate teaching

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into daily care Evaluation Involves obtaining feedback from the patient regarding what was taught Use this feedback to determine whether effective learning has in fact taken place Documentation Every staff nurse legally responsible for providing patient education: documentation is essential Patient education flow sheet may be used Nurse’s notes should include: Specific content taught Method of teaching used Evidence of evaluation with specific results Coordination with Discharge Planning Specific learning needs should be discussed with all involved parties, including the patient, and the plan for teaching shared Primary physician’s office Home health services Family or significant others Printed plan must be sent home with the patient

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