Chapter 20: Communicator

Incivility is rude, intimidating, and undesirable behavior directed at another person

Horizontal- nurse to nursing student Lateral violence- administrator to staff nurse * affects mostly new nurses

Characteristics of effective and Ineffective groups: Group identity Cohesiveness Patterns of interaction Decision making

Responsibility Leadership Power

message

speech, interview, conversation, chart, gesture, memorandum, or nursing note. - can be verbal/nonverbal

channel

the medium the sender has selected to send the message i.e- Auditiory: spoken words, and cues Visual: sight, observations, and perception Kinesthetic: touch

Forms of communications: *Verbal (language): using words both the spoken and written word. -oral reports -writing care plans -public speaking

*Nonverbal (body language) -Facial expressions, touch, eye contact -Posture, gait, gestures -General physical appearance -Mode of dress and grooming -Sounds, silence -Electronic communication -crying, moaning, gasping, and sighing are oral but nonverbal forms of communication.

when possible sit when communicating with a patient. Do not cross your arms of legs because that body language conveys a message of being closed to the patients comments. -be alert and relaxed and take sufficient time to communicate with the patient. -keep the conversation natural and avoid sounding over eager

- maintain eye contact with the patient, without starring, in a face-to-face pose -think before responding -do not pretend listen -listen for themes in the patients comments -all interviews should begin with an explanation of the purpose of the interview

orientation phase- tone and guidelines for the relationship are established -you and the patient meet and learn to identify each other by name -roles are clarified -agreement or contract about the relationship is established

- patient is provided with an orientation to the health care facility, its services, admission routines, and any pertinent information the patient requires to decrease anxiety -interviewing the patient

Developing conversation skills: -Control the tone of your voice. -Be knowledgeable about the topic of conversation. -Be flexible. -Be clear and concise. -Avoid words that might have different interpretations.

-Be truthful. -Keep an open mind. -Take advantage of available opportunities.

Agressive behavior: Involves asserting one's rights in a negative manner that violates the rights of others. -Can be verbal or physical. -Communication is marked by tension and anger, inhibiting the formation of good relationships and collaboration.

-Characteristics include using an angry tone of voice, making accusations, and demonstrating belligerence and intolerance. -Focus is usually "winning at all costs."

Goals of the orientation phase: -Establish tone and guidelines for the relationship. -Identify each other by name.

-Clarify roles of both people. -Establish an agreement about the relationship. -Provide the patient with orientation to the health care system.

The helping relationship: -Does not occur spontaneously -Characterized by an unequal sharing of information -Built on the patient's needs -The nurse is the helper, and the patient is the person being helped.

-Communication is the means used to establish rapport and helping-trust relationships.

Goals of Termination Phase: -Examine goals of helping relationship for attainment. -Make suggestions for future efforts, if necessary. Encourage patient to express emotions about the termination.

-If appropriate, help the patient establish a helping relationship with another nurse. -Assist the patient transferring from one agency to another or from one unit in an agency to another.

Interviewing techniques: -Open-ended questions or comments -Closed questions or comments -Validating questions or comments -Clarifying questions or comments

-Reflective questions or comments -Sequencing questions or comments -Directing questions or comments

Characteristics of the assertive self-presentation: -Confident; open body posture -Use of clear, concise "I" statements -Ability to share effectively one's thoughts, feelings, and emotions -Working to capacity with or without supervision

-Remaining calm under supervision -Asking for help when necessary -Giving and accepting compliments -Admitting mistakes and taking responsibility for them

Four levels of communication: Intrapersonal- Self-talk; communication within a person Interpersonal- Occurs between two or more people with a goal to exchange messages

-Small-group: nurse interacts with two or more people -staff meetings, conferences, teaching sessions, support groups -Organizational communication: people and groups within a organization communicate to achieve established goals. -Group dynamics: how individual group members relate to one another during the process of working toward group goals

Listening skills: -Sit when communicating with a patient. -Be alert and relaxed and take your time. -Keep the conversation as natural as possible. -Maintain eye contact if appropriate. -Use appropriate facial expressions and body gestures.

-Think before responding to the patient. -Do not pretend to listen. -Listen for themes in the patient's comments. -Use silence, therapeutic touch, and humor appropriately.

Source (encoder)

-a person or group who initiates or begins the communication process

Assertive behavior- ability to stand up for oneself and others using open, honest and direct communication. -focus is on the issue not the person -expressing feelings and beliefs in a non-defensive manner

-confident, open body posture, eye contact, use of clear concise "I" statements -ability to share one's thoughts, feelings, and emotions

SBAR- S-situation B-background A-Assessment R-recommendation

-consistent method for hand off communication that is clear, structured and easy to use -all hopitals do this when communicating with other health care providers

touch- -form of nonverbal communication -viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger frustration, aggression, excitement.

-most highly developed sense at birth -older people long for touch, especially when isolated from loved ones. -therapeutic touch involves clearing congested areas of energy in the body and redirecting this energy

Communication process (Berlo)

-source (encoder) -message -channel -receiver (decoder)

Empathy -empathetic nurse is sensitive to the patients feelings and problems, but remains objective enough to help the patient work to attain positive outcomes.

-sympathy shifts the emphasis from the patient to the nurse as the nurse shares feelings and personal concerns and projects them onto the patient

Which activity generally occurs during the orientation phase of the helping relationship? A. An agreement or contract about the relationship is established. B. The nurse provides any assistance needed to achieve patient goals. C. The nurse provides patient counseling and teaching. D. The patient and nurse examine the goals of the helping relationship for indications of attainment.

A. An agreement or contract about the relationship is established. Rationale: In the orientation phase a contract is made defining the goals of the relationship, frequency, location, length of contacts, and duration of the relationship. The nurse provides assistance needed to achieve patient goals, counseling, and teaching in the working phase. The patient and nurse examine the goals of the helping relationship for indications of attainment in the terminations phase.

A nurse reassuring oneself of being prepared to speak in front of a peer group is using which of the following types of communication? A. Intrapersonal B. Interpersonal C. Group D. Organizational

Answer: A. Intrapersonal Rationale:Intrapersonal communication is self-talk that happens within the individual. Interpersonal communication occurs between two or more people to exchange messages. Group communication includes small-group and organizational group communication.

Touch is a personal behavior that means the same thing to all persons. A. True B. False

B. False Rationale: Touch is a personal behavior that means different things to different people.

Electronic communication: Social media: -Both the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) have issued guidelines for RNs regarding use of social media.

E-mail and text messages: -The risk for violating patient privacy and confidentiality exists any time a message is sent electronically. -Health care agencies usually have security measures in place to safeguard e-mail and text communications.

sequencing question/comment -places events in chronological order or to investigate a possible cause-and-effect relationship between events.

Ive been taking my blood pressure medicine and have been feeling tired and don't have energy. Nurse- Your tiredness began after you started taking your medicine?

reflective question/comment- repeating what the person has said or describing the persons feelings. This encourages patients to elaborate on their thoughts and feelings.

Ive been upset about my blood pressure and have to take these pills. nurse- You've been upset...

Factors influencing communication: Developmental level Gender Sociocultural differences- how close we get to someone. Roles and responsibilities

Space and territoriality- personal space Physical, mental, and emotional state Values- interpret experiences differently Environment

Five parts of communication process (Berlo)

Stimulus or referent Sender or source of message (encoder) Message itself Medium or channel of communication Receiver (decoder)

Blocks to communication: Failure to perceive the patient as a human being Failure to listen Non-therapeutic comments and questions Using clichés Giving false assurance Using gossip and rumors Using disruptive interpersonal behavior

Using closed questions Using questions containing the words "why" and "how" Using questions that probe for information Using leading questions Using comments that give advice Using judgmental comments Changing the subject

working phase- -longest phase of the helping relationship -nurse works together with the patient to meet the patients physical and psychosocial needs. -interaction with the patient is the basis of the working phase

i.e nurse or caregiver helping with personal hygiene.

anywhere from 18 inches to 4 feet might be optimal distance to sit from a patient during intake interview

levels of privacy: mouth, feet, face, neck, front of body and genitalia

Communication

process of exchanging information and generating and transmitting meanings between two or more people. -ability to communicate is basic to human functioning and well-being.

receiver (decoder)

translates and interprets the message sent and received. -person makes a decision about the proper response