COMMUNICATION

COMMUNICATION
A process by which humans meet their survival needs, build relationships, and experience emotion Interchange of information between two or more people; the exchange of ideas and thoughts Transmission of feelings or a more personal and social interaction between people

COMMUNICATION

INTENT :  to elicit a response

PURPOSE : influence others obtain information

OCCURS:  intrapersonal level Interpersonal level

Why is it necessary for nurses to communicate effectively?

communication process is built on a trusting relationship with a client and support persons  for the establishment of nurse- client relationship
 the

COMMUNICATION PROCESS

SENDER

RECEIVER

Encode

Message

Decode

Decode

Message (response)

Encode

the dashed arrows indicate intrapersonal communication the solid lines indicate interpersonal communication

MODES OF COMMUNICATION

VERBAL COMMUNICATION
Pace and intonation Simplicity Clarity and brevity Timing and relevance Adaptability Credibility Humor

NON VERBAL COMMUNICATION

Personal appearance Posture and gait Facial expression Gestures

ELECTRONIC COMMUNICATION
cellular phone e-mail

 consider the advantages and disadvantages

FACTORS INFLUENCING THE COMMUNICATION PROCESS

 Development  Gender  Values and perception  Personal space >intimate: touching to feet >personal: 1 to 4 feet >social: 4- 12 feet >public:12- 15 feet

 Territoriality  Roles and relationship  Environment  Congruence  Interpersonal attitude > caring and warmth > respect > acceptance

THERAPEUTIC COMMUNICATION

Therapeutic Communication
Promotes understanding Establish a constructive relationship between the nurse and the patient ATTENTIVE LISTENING Listening actively, using all the senses, as opposed to listening passively with just the ear. The most important technique in nursing and is basic to all other techniques

Technique
Using Silence

Description and Example

Accepting pauses or silences that may extend for several seconds or minutes without interjecting verbal response e.g. Sitting quietly and waiting attentively until the client is able to put thoughts and feelings into words Using statement or questions that encourage the client to verbalize, choose a topic of conversation, and facilitate continued verbalization e.g. Perhaps you would like to talk about Where would you like to begin? Providing in a simple and direct manner, specific, factual information the client may or may not request e.g. You will feel a pulling sensation when the tube is removed from your abdomen Asking broad questions that lead or invite the client to explore thoughts or feelings e.g. What is your opinion about How do you feel now?

Providing General Leads

Giving information

Using open- ended questions

Using touch

Providing appropriate forms of touch to reinforce caring feelings. The nurse must be sensitive to the differences in attitudes and practices of clients and self e.g. putting an arm over the clients shoulder Actively listening for the clients basic message and then repeating those thoughts and or feelings in similar words e.g. Client: I couldn't manage to eat any dinner last night- not even the dessert Nurse: You had difficulty eating yesterday? A method of making the clients broad overall meaning of the message more understandable e.g. Im puzzled Would you please say that again? A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of a message e.g. Client: My husband never gives me any present Nurse: You mean he has never given you a present for your birthday or Christmas? Suggesting ones presence , interest or wish to understand the client without making any demands or attaching condition that must comply with to receive the nurses attention e.g. Ill help you to dress to go home, if you like

Restating or paraphrasing

Seeking clarification Consensual Validation

Offering self

Acknowledging

Giving recognition in a non judgmental way, of a change in behavior, an effort the client has made or a contribution to a communication e.g. You walk twice as far today with your walker Helping the client clarify an event, situation or happening in relationship to time e.g. Client: I feel that I have been asleep for weeks Nurse: You had your operation Monday, and today is Tuesday Helping the client to differentiate the real from unreal e.g. That telephone ring came from the program on television

Clarifying time or sequence Presenting reality

Focusing

Helping the client expand on and develop a topic of importance. It is important for the nurse to wait until the client finishes stating the main concern before attempting to focus.

Reflecting

Directing ideas, feelings, questions or content back to clients to enable them to explore their own ideas and feelings about a situation e.g. Client: What can I do? Nurse: What do you think will be helpful for you? Stating the main points of a discussion to clarify the relevant point discussed. This is useful at the end of an interview or to review the health teaching session e.g. During the past hour we have talk ed about

Summarizing and Planning

BARRIERS TO COMMUNICATION

Technique
Stereotyping Agreeing and Disagreeing Being defensive

Description and Example

Offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to valid e.g. Two year old are brats Akin to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in position to judge this e.g. Client: I dont think Dr. Cruz is a very good doctor Nurse: No. Dr. Cruz is an excellent surgeon Attempting to protect the person or health care services from negative comments e.g. Client: Nurses didnt respond to my needs Nurse: Youre not the only client, you know Giving a response that makes clients prove their statement or point of view e.g. Client: I feel nauseated after the red pill Nurse: Surely, you dont think I gave you the wrong pill? Asking for information chiefly out of curiosity rather than with the intent to assist the client e.g. Client: I didnt ask the doctor when he was there. Nurse: Why didnt you?

Challenging

Probing

Rejecting

Refusing to discuss certain topics with the client. These responses often make clients feel that the nurse is rejecting not only their communication but also the client themselves. e.g. I dont want to discuss that. Lets talk about Directing the communication into areas of self interest rater than considering the clients concern is often a self protective response to a topic that causes anxiety e.g. Client: Im separated. Do you think I should have sexual relation with other woman? Nurse: What is your favorite food? Using clichs or comforting statements of advice as a means o reassure the client e.g. Im sure youll be better soon Giving opinions and approving or disapproving responses, moralizing, or implying own values e.g. You shouldnt do that Telling the client what to do e.g. Client: Should I move from my home to a nursing home? Nurse: If I were you, Id go to a nursing home, where youll get your meals cooked for you Asking questions that make the client admit to something. These responses permit the client only limited answers and often meet the nurses need rather than the clients e.g. Who do you think you are

Changing topics and Subjects

Unwarranted Reassurance Passing Judgment Giving common advice Testing

THE HELPING RELATIONSHIP

HELPING RELATIONSHIP
Nurse client relationship Helping is a growth facilitating process that strive to achieve two basic goals:
help client manage their problems in living more effectively and develop unused or underused opportunities more fully help client become better at helping themselves in their everyday life

PHASES OF THE HELPING RELATIONSHIP

Preinteraction Phase

Introductory Phase

Working Phase

Termination Phase

Opening the relationship Clarifying the problem Structuring and formulating the contract Exploring and understanding thoughts and feelings Facilitating and taking action

COMMUNICATION AND THE NURSING PROCESS

NURSING MANAGEMENT
ASSESSING Impairments to communication
Language Deficit Sensory Deficits Cognitive Impairments Structural Deficit Paralysis

Style of communication
Verbal communication Non verbal communication

IMPLEMENTING Manipulate the environment Provide support Employ measures to enhance communication Educate the client and support persons