Chapter 4
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| 🇬🇧 | 🇬🇧 |
| Communication | Exchange of information |
| Sender | One who conveys the message |
| Receiver | Person or people to whom the message is conveyed |
| One way communication | Limited use in the nurse-patient relationship |
| Two way communication | Requires that sender and the receiver participate in the interaction |
| Verbal communication | Involves the use of spoken or written words or symbols |
| Connotative meaning | Subjective and reflects the individual"s perception or interpretation |
| Denotative meaning | Refers to the commonly accepted definition of a particular word |
| Jargon | Common place "language" or terminology unique to people in a particular work setting |
| What are 2 ways of communication? | Verbal and Nonverbal communication |
| Nonverbal communication | Messages transmitted without the use of words(oral or written) |
| What are ways of nonverbal communication | Voice, Eye Contact,& physical appearance |
| Gestures | Movement people use to emphasize the idea they are attempting to communicate |
| Posture | Way that individual sits, stands, and move |
| Open posture | When taking a relaxed stance with uncrossed arms and legs while facing the other individual |
| Closed posture | More fomral, distance stance, generally with the arms, and possibly the legs, tightly crossed |
| Assertiveness | One's ability to confidently and comfortable express thoughts and feelings while she stilll respecting the legitimate rights of the patient |
| Assertive communication | Interaction that considers the feelings and needs of the patient yet honors the nurse's rights as an individual |
| Aggressive communication | When an individual interacts with anther person in an overpowering and forceful manner |
| Unassertive communication | The nurse agrees to what the patient request |
| What will unassertive communication cause? | Problems for the nurse and resentment |
| What is the largest consent of use of communication? | Non verbal communication |
| One of the most important aspects of care in nursing | Communication |
| What are the 2 requirements for communication | Sender & receiver |
| What way of communication is limited in nursing? | 1 way communication |
| What way of communication establishes a trusting relationship? | 2 way communication |
| What is the purpose of 2 way communication? | To meet needs of nurse to patient relationship |
| Tone or Volume | Voice |
| Provides interaction | Eye Contact |
| Gestures or Postures | Physical appearance |
| What are the type of styles of communication? | Assertive, Aggressive, Unassertive |
| Communication assertively means | Being able to express your needs while being aware of others' needs |
| What does an assertive nurse do? | Appears self-confident |
| In which ways does a nurse demonstrate a therapeutic relationship? | Caring, sincerity, empathy,& trustworthiness |
| Making sure a patient is focused of each interaction is what? | Establishing a therapeutic relationship |
| What is also a must in a therapeutic relationship? | Confidentiality |
| Being distant, not connected or genuine | Is not building a therapeutic relationship |
| What are the two techniques of communication? | Therapeutic and non therapeutic communication |
| Therapeutic communication | An exchange of information that facilitates the formation of a positive nurse-patient relationship and actively involves patient in all areas of care |
| Nontherapeutic communication | Blocks the development of a trusting and therapeutic relationship |
| What are some non therapeutic communication techniques? | Listening, Silence & Touch |
| What are 2 types of listening? | Active & Passive |
| Active Listening | Full attention to what patient is saying |
| Passive Listening | Indicates nonverbal eye contact & nodding as 'uh-huh' & 'I see' |
| What does passive listening show? | Nurse is interested and listening to what is being said |
| Silence | Also part of passive listening & nonverbal therapeutic |
| Touch | An example of non verb therapeutic showing understanding & comfort |
| Conveying Acceptance | Nurse acceptance & willingness to listen to patient without judgement is key to therapeutic nurse patient relations |
| Provides opportunity to bring about change in health behaviors while helping the patient to maintain personal integrity | Conveying Acceptance |
| Minimal encouragement | Subtle therapeutic technique that communicates to the patient that the nurse is interested and wants to hear more |
| What does minimal encouragement involve? | Nonverbal cues, maintain appropriate eye contact, nodding occasionally and verbal comments such as "yes go on" to encourage the patient to continue |
| What are the therapeutic communication techniques? | Closed Questioning |
| Closed Questioning | Seeking particular answer (1 or 2 word answers) |
| Open Ended Question | Do not require specific response, Allows patient to explain ("How do you feel?") |
| Restating | Let patient know you heard what was said |
| Paraphrasing | Restating patient message in your own words; verification you understand |
| Clarifying | Allows patient to verify that the message received was understood |
| Focusing | To gather more specific info when patient is too vague |
| Reflecting | Making the patient feel their message is important; promotes independent decision making |
| Summarizing | Focus on key issues and patient planning |
| Use of humor | Can help put nurse & patient at ease: never laugh at patient but with |
| Factors That Affect Communication | Posturing & Positioning |
| Posture & Positioning | Patient and nurse should be at same level for communication; can reveal patients current mood |
| What are the 4 zones of space? | Intimate, personal, social, & public |
| Intimate space | Face to 18 inches away |
| Personal space | 18 inches to 4 feet |
| Social space | 4 to 12 feet from face |
| Public space | Beyond 12 feet |
| Environment | Surrounding an interaction often has a significant intact on the interaction's effectiveness; privacy |
| Level of Trust | To provide positive experience; effective nurse-patient interaction |
| Language Barrier | Speak slowly, using images, remain eye level, no jargon; can pose a major threat to effective nurse-patient relationship |
| Culture | Understand beliefs & regulations |
| Age & Gender | Using correct identification; different barriers for different ages |
| Physiologic Factors | May interfere with the patient being able to communicate effectively; if in pain may make it hard to focus |
| Psychosocial Factors | A multitude of factors placing patients under stress |
| Altered Cognition | Another physiologic factor that frequently hinders effective communication; dementia, stroke, etc. |
| Impaired hearing | Another common physiologic factor that impedes communication |
| What are some things you should do with patients who are cognitively impaired? | Speak slowly, ask one question at a time, be attentive, use simple sentences, no distractions while talking with patient, be attentive |
| Communication with patients who have hearing impairment | Patient's attention, wearing proper hearing equipment, lip reading, face patient, no other noises, rephrase, speak at a normal volume, lower tone of voice, sign language |
| Grieving | Result of actual or perceived lost; psychosocial factor |
| Block communication | Techniques enhance the quality of an interaction |
| What are some ways of Block Communication? | False Reassurance |
| False assurance | Using false comforting phrases in an attempt to other reassurance; "it will be okay" |
| Giving advice or personal opinions | Making a decision for a patient; offering personal opinions; telling a patient what to do with phrases such as "if I were you I would..." |
| False Assumptions | Making an assumption without validation; jumping to conclusions "your husband isn't very supportive." |
| Approval or disapproval | Trying to impose the nurse's own attitudes, values, beliefs, and moral standards on a patient about what is right and wrong "you shouldn't even think that" |
| Automatic responses | Stereotyped or superficial comments that do not focus on what the patient is feeling or trying to say "the doctor knows best" |
| Defensiveness | Responding negatively to criticism; often in response to feelings of anger or hurt on your part; usually involves making excuses "I'm doing the best I can" |
| Arguing | Challenging or arguing against the patient's statements or perceptions "how can you say you didn't sleep all night? you were sleeping every time I came into your room" |
| Asking for explanations | Asks the patient to explain her or his actions, beliefs, or feelings with "why" questions; "why do you feel that way" |
| Changing the subject | Inappropriately focusing the discussion on something other than the patient's concern "we'll worry about that later. it's time for you to go to physical therapy" |
| You promise something that will not occur or is unrealistic | False reassurance |
| Takes decision making away from the patient; impairs decision making; creates doubt; encourages blaming the nurse if decision has unwanted outcome | Giving advice or personal opinions |
| Easily leads the patient to doubt personal values; creates feelings of guilt and resentment; causes friction between you and the patient | Approval or disapproval |