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Define communication

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The nurse is doing a preoperative assessment and teaching session with Mrs. C. ... cultural roots when continuing with the preoperative teaching. 22. Interview ' ... – PowerPoint PPT presentation

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Title: Define communication


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  • Define communication
  • Describe a situation where you communicated
    effectively and the result.
  • Describe a situation in which you did not
    communicate effectively and the result.

3
Communication defined
  • The exchange of information which involves both
    sending and receiving messages between two or
    more people.(Timby, 2005)
  • The process of sending and receiving messages by
    means of symbols, words, signs, gestures, or
    other actions. (Smith, Duell, Martin, 2004)

4
Communication
  • Language is inherently ambiguous

5
Communication Patterns
  • Verbal
  • Nonverbal
  • Nurse-client relationship -Therapeutic
    Relationship
  • Client-centered

6
Case Study The First Encounter
  • Good Morning Mrs. T. My name is RN, and I will
    be the nurse caring for you today. Is it all
    right to call you Mrs. T.?
  • Mrs. T. is a 76 year-old woman with metastatic
    lung cancer being cared for by RN. It is her
    second day at the hospital. She is quiet, giving
    one- word responses to RNs questions. She thinks
    that RN is too aggressive, making her wash up and
    scheduling tests for later in the day. RN is
    beginning to wonder about why Mrs. T is reluctant
    to share information. When he comes in to bring
    her morning meds, he says, Mrs. ., I have your
    medications.
  • She responds, What am I supposed to do, take
    those now just because you say so? (Sheldon,
    2004)

7
Phases of Nurse-Client Relationship
  • Introductory phase - initiation or orientation
    phase
  • Working phase facilitating the relationship
  • Termination phase relationship comes to an end

8
Barriers to Nurse-Client (Therapeutic)
Relationship
  • Unkempt appearance
  • Failing to ID self verbally/name tag
  • Mispronouncing/avoiding clients name
  • Showing disinterest in client
  • Sharing personal history or work-related problems
    with the client/staff in clients presence
  • Using distasteful language
  • Revealing confidential info re other clients,
    staff in presence of client
  • Focusing on nursing tasks rather than client
  • Being inattentive to clients requests
  • Abandoning the client at stressful/emotional
    times
  • Failing to keep promises
  • Going on break without informing client

9
Case Study Resolution The First Encounter
  • RN responses
  • Mrs. T, it is difficult to be a patient. You
    havent had much time to yourself.
  • When would you like me to bring your medicine?
  • You sound upset this morning.
  • You dont have to take these, however (explain
    the purpose of the medications)

10
NonverbalsFace talks
11
Ingredients of Therapeutic Communication
  • Empathy
  • Active Listening
  • Trust
  • Respect

12
Interview
  • Patient I have some bad news. I started
    smoking again. I tried, really tired, but
    everyone at home was smoking.
  • Nurse I am glad that you tried to quit. Its
    tough, isnt it? Many people try to quit three or
    even five times before succeeding. If you stop
    smoking, you will help your chronic bronchitis.
    Lets talk about other strategies for quitting
    smoking. Where can your family smoke that is away
    from you? (Sheldon, 2004)

13
Therapeutic Communication Techniques
  • Acknowledgement
  • Clarification
  • Feedback
  • Focus
  • Incomplete sentences
  • Listening
  • Mutual fit or congruence
  • Minimum verbal activity
  • Nonverbal encouragement
  • Open-ended questions
  • Reflection
  • Restatement
  • Validation

SDM
14
Therapeutic Communication Techniques
  • Broad opening
  • Giving info
  • Direct questioning
  • Open-ended question
  • Reflecting
  • Paraphrasing
  • Verbalizing what has been implied
  • Structuring
  • Giving general leads
  • Sharing perceptions
  • Clarifying
  • Confronting
  • Summarizing
  • Silence

Timby, 2005
15
Blocks to Therapeutic Communication
  • Changing the subject
  • False reassurance
  • Giving advice
  • Incongruence
  • Assumptions
  • Invalidation
  • Overloading
  • Social response
  • Underloading
  • Value judgements

SDM
16
Blocks to Therapeutic Communication
  • Disagreeing
  • Demanding an explanation
  • Defending
  • Belittling
  • Patronizing
  • Changing the subject
  • False reassurance
  • Giving advice
  • Using clichés
  • Approving/disapproving
  • Agreeing

Timby, 2005
17
Case Study Cultural Diversity
  • Mrs. C. is a 68 year-old- woman who emigrated
    from China to America as a newlywed 40 years ago.
    Now she is scheduled to undergo a hysterectomy.
    The nurse is doing a preoperative assessment and
    teaching session with Mrs. C.
  • Although Mrs. C speaks and understands English
    well, she makes little direct eye contact and has
    no questions. She refuses the prescriptions for
    pain medicine.
  • The nurse is about to obtain informed consent for
    the procedure, but is not sure that Mrs. C
    understands what has been discussed. How would
    cultural awareness help in this situation?
    (Sheldon, 2004)

18
Cultural Diversity
  • Slang terms and colloquialisms
  • Stress of illness/Different meanings in various
    cultures
  • Direct eye contact/Touch/Personal space

19
Lets Communicate Transculturally!
  • Assess language needs
  • Approach patient slowly and greet respectfully
  • Do not raise your voice to be heard
  • Allow sufficient time and a quiet setting
  • Pay attention to nonverbals
  • Try to mirror pts style of communicating
  • Provide written material in patients language if
    available

20
Are you culturally competent?
  • learn the language that a majority of your
    clients speak this will give you insight into
    the culture(Gaskill, 2002)
  • Greet or say words and phrases in the clients
    language

21
Case Study Resolution Cultural Diversity
  • Recognize impact of her culture to communication
    style, health care and practices/beliefs
  • Consider cultural roots when continuing with the
    preoperative teaching

22
Interview
  • Mrs. R is a 47-year-old Hispanic woman who
    arrives in the emergency department one evening
    with her adult children. Her husband of 36 years
    passed away 2 months ago. Her children say she
    has been weepy since her husbands death. She has
    been holding her chest since this morning. She
    says the her heart aches since her husband died,
    and she does not want to eat. The emergency room
    nurse must now assess the patients symptoms.
    (Sheldon, 2004)

23
Interview Cont.
  • Nurse Hello Mrs. R. I am Stephen, and I am the
    nurse who will be taking care of you. How are you
    feeling tonight?
  • Mrs. R I am so sad without my husband..
    (weeping and holding a tissue to her chest)
  • Nurse I am sorry for your loss. You are holding
    your chest. Do you have pain in your chest?
  • Mrs. R My heart aches but it feels better when
    I stop and sit still.

24
  • Nurse Does anything else hurt?
  • Mrs. R My neck aches sometimes, and I feel sick
    to my stomach.
  • Nurse How long have you had pain in your chest,
    ache in your neck, and stomach problems?
  • Mrs. R Since my husband died, but I feel worse
    since I raked the lawn this morning. (Sheldon,
    2004)

25
Listen
  • A poem by
  • Anonymous

26
Anxiety and Communication
  • How can stress/anxiety affect your communication
    with your clients?
  • How can stress affect clients communication with
    you?
  • What techniques do you use to decrease your
    stress routinely? During exams?

27
Anxiety Communication
  • Levels of anxiety
  • Mild
  • Moderate
  • Severe
  • Panic
  • Communication styles
  • Passive
  • Aggressive
  • Assertive

28
A confrontation with Ms. Madd
  • You have just finished the change of shift report
    when Mrs. K confronts you at the nurses station.
    Due to a serious fall, Mrs. Ks sister M.L has
    sustained a cervical fracture that, in spite of
    numerous efforts, has not yet been stabilized.
    During the past few days.(retrieved from
    www.nurseweek.com 1/20/05)

29
Family Feud
  • Name ways to help the client with his/her anxiety

30
Rather than just defend yourself and face the
same problems over and over like Wiley Coyote,
say what you are really feeling! Ask for help
when you need it!
31
References
  • Timby, B. K. (2005). Fundamentals Nursing Skills
    and Concepts. 8th Ed. Lippincott Williams
    Wilkins Philadelphia, PA
  • Smith, S.F., Duell, D.J., Martin, B. C.,
    (2004). Clinical Nursing Skills Basic to
    Advanced Skills. 6th Ed. Pearson Education Inc.
    Upper Saddle River, NJ.
  • Sheldon, L.K. (2004). Communication for Nurses
    Talking with Patients. Slack Inc Thorofare, NJ.
  • www.nurseweek.com
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