Module #3: Communication

What are some examples of effective therapeutic communication techniques?

There are several techniques that can be used to improve nurse-client communication. Examples include using silence, engaging in active listening, asking open-ended questions, accepting, giving recognition, restating, summarizing, and reflecting. When used correctly, these techniques can help build trust in the nurse-client relationship and encourage open communication. In active listening, the nurse considers both the client's verbal and nonverbal messages to understand the true meaning of the exchange. Asking open-ended questions encourages communication between the nurse and client because it requires more interaction than a simple yes or no answer. Restating, paraphrasing, and summarizing all require the nurse to repeat the message back to the client to ensure there was no misunderstanding between the participants. Reflection is comparable to restating, but instead of repeating the client's message back to them, the nurse attempts to reveal the client's feelings behind the message. Other therapeutic communication techniques a nurse can use include accepting, which is acknowledging that the nurse has heard and understood the client; giving recognition of changes without compliments, which can be seen as bias; and offering to spend time with the client by simply sitting with them.

What Nursing considerations should be taken regarding written communication?

These modes of communication lack the nonverbal cues that face-to-face interactions possess, leading some users to view them as detached. This lack of body language and other nonverbal cues can make it difficult for the recipient to determine tone and may lead to misunderstandings even if the sender resorts to the use of emoticons and avatars to represent emotions. Other shortcomings to written communication include the receiver's need to be able to read the words. Literacy, language differences, and visual impairments may all present a barrier to effective written communication.

What factors affect auditory communication?

This can be affected by many factors, such as physical and intellectual disabilities or outside disruptors like noise from medical equipment. If the client does not participate in the discussion, there may be a barrier that prevents the client from hearing the nurse or causes a misunderstanding. The client should be assessed for hearing or cognitive deficits that would prevent understanding; if any are found, alternative tools should be used.

What six concepts laid the groundwork for the first communication model (Shannon-Weaver)?

This model was very linear and comprised six concepts: sender, encoder, channel, decoder, receiver, and noise. The sender is the one who starts the message. The encoder is the means by which the message is transmitted, and the channel is how the encoder transmits the message such as a phone line. The decoder changes the signal back to the message. The receiver is the one who receives the message. Noise is any environmental distractor that can interfere with the message.

What Nursing considerations should be taken when determining physiological factors affecting communication?

This plan offers strategies for hearing-impaired clients, such as face-to-face communication, communication in writing, or using an assistive device. Strategies such as varying volume and slowing speech to accommodate for a client's hearing impairment and environmental distractions can be useful. The nurse should also be aware that this impairment may be worsened due to health care workers' use of masks.

How should the nurse promote effective nonverbal communication?

To promote effective nonverbal communication the nurse should:Be aware of their facial expression. Demonstrate an open posture. Ensure that touch is therapeutic and acceptable by the client.

How should the nurse promote effective written communication?

To promote effective written communication the nurse should:Be aware of the tone that may come across since nonverbal and verbal cues will not be available.Ensure wording is clear and concise to avoid any misunderstandings by the receiver.Take safeguards to protect the client's personal health information.

What behaviors should be suspected with Aggressive Communication?

Uses "you" statements, verbally abusive, controlling, and interruptive

Commonly refers to oral communication. This mode can occur through face-to-face communications and via telephone. The nurse commonly uses verbal communication to exchange information and gather data.

Verbal Communication

What are the four modes of communication?

Verbal, nonverbal, electronic, and written.

What Nursing considerations should be taken when attempting to understand nonverbal communication?

When attempting to understand nonverbal communication, the nurse must take culture, age, language, physical deficits, and developmental levels into account.

What three components modified the first communication model (Shannon-Weaver)?

Wilbur Schramm further modified the Shannon-Weaver model to show three main components: the sender, the receiver, and the message. Schramm's model suggests that communication is an engaged process where the sender and receiver send messages back and forth and receive feedback. Feedback allows the sender and receiver to demonstrate whether the message was properly received. If the receiver does not provide feedback, for whatever reason, then the process is incomplete and communication has not successfully occurred.

Includes electronic communication and can be in the form of a letter, handwritten or typed, or an email or computer-based post. The nurse uses written communication to transmit information to other nurses, other members of the interprofessional team, and clients.

Written Communication

What behaviors should be suspected with Passive-Aggressive Communication?

Acts out in anger in indirect ways, feels powerless, and resentful, sarcastic

What does the "A" in OARS represent?

Affirmations are statements that encourage the client, such as "You did very well with your food diary this week".

Communicators have developed a pattern of expression that is verbally, and sometimes physically, abusive, such as "This is all your fault. I will make you pay." These people tend to blame the receiver using "you" statements. These senders often interrupt other speakers, tend to be controlling, and may become antagonistic or even hostile when they are challenged. They are quick to react and often do not take the time to work through misunderstandings.

Agressive Communication

What developmental and cognitive factors affect communication?

Cognitive, intellectual, or developmental deficits, such as autism spectrum disorder (ASD), can greatly influence a person's ability to effectively communicate, particularly in social situations. Clients who have developmental and cognitive factors influencing their communication abilities may be distracted by an environment that is very noisy or bright, more so than clients without these deficits. Physiological issues and disease processes can also affect cognitive function, such as poorly controlled chronic pain, Parkinson's disease, and multiple sclerosis.

Is the transfer of information. It is always occurring, even if the participants are not directly speaking. Information is shared between the sender and receiver through verbal connection, body language, emotions, and the use of technology or other equipment.

Communication

What behaviors should be suspected with Passive Communication?

Conflict, avoidance, anxious, hesitates to stand up for self

This mode includes email, texting, video conferencing, and social media. This technology can allow health care team members to communicate with each other and their clients more efficiently, but also can lead to privacy violations, mistakes from typographic errors, and distractions. According to the HIPAA Security Rule, any ________ _________ containing PHI must have the following safeguards: each user must have a personalized login that can be monitored, the system must have an automatic logoff function if left unattended, and PHI sent as attachments must be indecipherable if intercepted. The nurse uses electronic communication to transmit information to other nurses, other members of the interprofessional team, and clients.

Electronic Communication

What four components make up the SMCR model?

Ender, message, channel, and receiver. In this model, elements that affect messages are included to illustrate how they aid or hinder effective communication. The sender is the one who starts the message, the message is the topic being transmitted, the channel is the method by which the message is sent, and the receiver is the one to whom the message is being transmitted. This model is a one-way process and does not include any feedback or cyclical processes like many other communication models.

What situational and environmental factors affect communication?

Environmental factors, such as excessive noise, extreme temperatures, poor or too bright lighting, and other elements that can make those trying to communicate uncomfortable, can hinder the connection between nurse and client and act as a distraction. Outside interferences, such as the use of social media or texting during communication sessions, are detrimental to effectively sharing a desired message. In addition, situational issues that cause strong emotions, such as fatigue, anxiety, and fear, can hinder effective exchange.

Why is feedback important concept for nurse communication?

Feedback is an important concept when evaluating nurse-client communication. If a nurse is providing information to a client and the client does not verbally state an understanding or provide some form of positive nonverbal cue, the nurse does not know if the message was understood and does not know how to proceed to achieve effective communication.

What is an example of how the first communication model was used?

For example, a nurse (sender) is using a translation application (encoder) via a computer (channel) to speak to a home health client (receiver) who has questions about a piece of equipment, but the mobile device (decoder) the client is using has poor reception (noise) and they cannot understand the translated instructions provided.

What is an example of how the ABX communication model is implemented?

For instance, a facility has installed a new computer-based order transcription system to help reduce transcription errors in verbal prescriptions. In the past, the nurse took verbal prescriptions from the provider and entered them, but now the nurse (A) explains that the provider (B) must manually enter the prescription using the new software (X). X, the ordering transcription system, is the topic that affects communication and the relationship between the nurse and provider.

What behaviors should be suspected with Assertive Communication?

Honest and clear communication, advocates for self, uses "I" statements

What three components make up the ABX model?

In the ABX model, there are three components: sender, receiver, and topic. n health care, this model can easily be used in nurse-client communications and interprofessional exchanges.

What are examples of communication barriers?

Language differences, cultural diversities, speech or hearing impairments, developmental or cognitive disorders, medication effects, effects of recreational drugs, emotional distress, and environmental factors can all be communication barriers

Is a form of therapeutic communication that allows the nurse and client to develop plans to promote the client's health by using several techniques, known by the mnemonic OARS.

Motivational Interviewing

Is body language. Actions such as eye contact, facial gestures, posture, and overall appearance send messages to the receiver in addition to what the sender is saying. The nurse uses nonverbal communication to transmit messages to others and when assessing clients.

Nonverbal Communication

What does the "O" in OARS represent?

Open-ended questions allow the client to disclose more information. Strategies such as asking the client "Tell me more about..." rather than "Why did you..." tend to be perceived as less judgmental.

What four phases affect a nurse-client relationship?

Orientation, identification, exploitation, and resolution/ termination. The orientation phase is the initial phase in which the client reaches out to the nurse or other health care provider for help. Identification occurs when the two establish a mutually respectful relationship. Exploitation is the active phase of the relationship where the nurse educates the client to change the situation or behavior. In the final phase, resolution or termination, the client has had the issue resolved and the relationship between the nurse and client is terminated until the next event. Throughout this interaction, the nurse acts as a guide to help the client receive the needed care.

Communication style has developed a pattern to avoid conflict, expressing feelings or opinions, or standing up for themselves when boundaries are crossed. These people are often anxious and fearful in regards to how their messages will be perceived and will say nothing or respond to an assertive or aggressive style by agreeing. Some novice nurses may demonstrate this communication type when faced with confronting a provider or authority figure due to lack of confidence.

Passive Communication

What physiological factors affect communication?

Physiological factors such as hearing or vision loss can prevent effective communication as well, especially if the client is not open with this information. If the nurse determines the client has a physical deficit, strategies should be implemented to assist, such as moving a client with hearing impairment to a quieter area or reading to a client with impaired vision.

How should the nurse promote effective verbal communication?

Speak clearly and with a volume and pitch that the receiver can hear and understand. Ensure that the receiver understands what was said. Decrease distraction, such as turning down the volume on the television. Face the receiver when speaking to them.

How should the nurse display emotional communication?

Speaking to a client from an empathetic frame of mind will often help build trust and a positive rapport. This is especially true in health care when many nurse-client interactions involve difficult conversations that may be hindered by the client's fear or anxiety.

What Nursing considerations should be taken when determining cognitive and developmental factors affecting communication?

The nurse working with these clients can enhance communication by giving short, directive instructions that are clear and free from slang, medical terminology, or abstract imagery.

What cultural and demographic factors affect communication?

A client's language, religion, sexual orientation, age, and gender can all affect the way communication occurs. The nurse's cultural competency or biases influence this communication as well. Sexual orientation may influence communication among health care providers and clients. Some clients may fear disclosing this information, especially transgender clients, who research states tend to receive less support due to health care providers' lack of education about lesbian, gay, bisexual, transgender, and queer (LGBTQ) topics.

Communicators are viewed as most effective because they communicate clearly and honestly. They advocate for their opinions, rights, and needs without violating the rights of others. ________ communication is fundamental for good communication, mental health, and healthy relationships. These people are confident in their message and assert their rights if boundaries are crossed, but are also fair and receptive.

Assertive Communication

Why are effective communication skills important?

Effective communication skills are extremely important for the professional nurse, as miscommunication between team members is often cited as a key issue in client safety. Unclear messages and other forms of miscommunication among members of the health care team contribute to many medical errors. Nurses are required to share complex messages with a variety of people with various cultural and educational backgrounds and, at times, these messages are emotional by their very nature. Because of this, it is essential for nurses to understand the communication process and the factors involved that can distort sent and received messages. The nurse also needs to be aware of signs that the client is not understanding the message the nurse is sending.

Refers to the speaker's emotional state when conveying a message. This emotional state can be transferred to the receivers and will affect how the message is accepted.

Emotional Communication

What are the five levels of communication?

Emotional, Energetic, Auditory, Physical, and Verbal

Refers to how the person projects themselves.

Energetic Communication

How should nurses display energetic communication?

For nurses, maintaining a caring and compassionate attitude and demonstrating empathy when communicating with clients and their families will help their message be received in a more positive light.

What components should be considered when assessing a therapeutic relationship?

Maintaining meaningful relationships, be a good listener, approach all problems with a caring attitude and healing environment, be open-minded and respect the needs of others in order to maintain human dignity, treating oneself and others with compassion and kindness, be in the moment and respect the world and those around you, and strengthen your spiritual beliefs.

Communicators appear passive only on the surface. Often, the individual is acting out anger in a subtle, indirect, or secretive way. This behavior stems from feelings of powerlessness and resentment. These senders will use sarcasm or other witty responses. Unlike aggressive communicators, these persons rarely interrupt others, but then feel ostracized from groups when they do not feel heard.

Passive-Agressive Communication

What does the "S" in OARS represent?

Summarizing seeks to ensure understanding by paraphrasing what the client said, such as "Your mother also had diabetes".

How should the nurse promote effective electronic communication?

To promote effective electronic communication the nurse should:Encrypt health data to protect the client's private health information. Use a personalized login to access computers and other electronic devices. Ensure computers have an automatic logoff function if left unattended.

What are the types of communication styles?

passive, aggressive, assertive

What is an example of how the SMCR communication model is implemented?

An example of how this model is used in health care is the client instructional video. For instance, a facility (S) sends clients scheduled for joint surgery (R) an informational video (C) regarding what to expect before, during, and after the procedure (M). The client receives the message from the sender but has no means to ask questions or continue the communication process at that specific time.

Is what the receiver hears when the sender speaks a message. ________ ________ includes the speed and tone of voice that the receiver perceives.

Auditory Communication

What are some factors that affect Communication?

Many factors can influence communication, affecting the sender, receiver, or both. Cognitive, intellectual, or developmental deficits, such as dementia, Down syndrome, and autism spectrum disorder (ASD), are examples. Physical deficits, such as hearing loss; cultural differences; language barriers; and environmental factors like a noisy emergency department can influence one's ability to effectively communicate a message.

What does the "R" in OARS represent?

Reflective listening restates what the client said, encouraging clarification of feelings, such as "So you are worried that you will get diabetes like your mother".

Many health care providers are encouraged to receive additional training in _________ _______ to better communicate with clients and each other. Discussing topics with clients using an empathetic tone rather than an impatient or critical one often reduces stress and encourages honesty in disclosures.

Therapeutic Communication

How can effective interprofessional communication be displayed?

There are four core competencies for interprofessional collaborative practice, plus many subcompetencies. The four core competencies are to work with each other respectfully, to work together utilizing each other's knowledge to care for clients and promote health, to communicate effectively as a team to promote clients' health, and to use effective dynamics and values within the team to develop and use client-centered care and health promotion policies.