communication

Assessment

Assessment is the nurse's conclusion about the patient's condition based on the situation and background information. When the nurse is unsure what the problem is, he or she should try to identify the related body system and how serious the issue is. An example of the information provided as the assessment component of SBAR is: I believe her abdominal pain is a result of constipation and does not indicate any further health problems.

Background

Background information gives context to the patient's situation. This is important because context can provide clues to the reasons behind a patient's pain or condition. Background information can include a variety of details like: • When the patient was admitted • What the patient's diagnosis is • What the patient was doing when the problem started • Diet and activity prior to the issue • Any previous health conditions that could have contributed An example of the information provided as the background component of SBAR is: She reported that the pain occurred gradually and has become constant. Last night she went out to eat at a restaurant she described as "greasy" and has not yet had a bowel movement.

Body Language

Body language is a very important part of communication. The same words can convey completely different messages depending on the accompanying body language that is used. Nurses need to use body language that supports the meaning and tone they are trying to express. For example, a nurse should be careful not to repeatedly look at his or her watch. This gives off the message that the nurse would rather be somewhere else and does not care about the patient. Instead, nurses should take the time to sit down with the patient to show them they are going to stay as long as the patient needs them to. Leaning forward, maintaining eye contact, nodding, and smiling also send positive messages to the patient. Additionally, body language plays a role in how the patient perceives the nurse's credibility and experience. Nurses should present themselves well by using good posture and confident facial expressions. A nurse who appears shy, confused, or scared will not instill confidence in the patient, which can increase fear and anxiety.

Nurses can use speed and tone in order to convey messages differently. For example, speaking quickly in a high pitch can convey anxiety. Nurses need to choose the pace and tone of their words carefully in order to convey the appropriate feel of their message. Patients who seem afraid or worried might be able to calm down more easily if the nurse speaking to them uses a slow, quiet voice. Additionally, nurses need to be careful not to speak too quickly as this can cause patients to miss information or become confused.

Clarity and simplicity are especially important when nurses communicate with patients. It is important to avoid technical medical language since patients typically will not understand it. Nurses should use simple, common words and short sentences, especially when explaining medical conditions and procedures. Careful enunciation is also an important aspect of clarity.

SBAR

Communication between nurses and physicians plays an important role in patient health and treatment. Poor communication can impair collaboration and lead to medical errors. Nurses are typically taught to communicate in a descriptive, narrative manner while physicians are encouraged to keep medical conversations short and to the point. These differences in communication styles were found to lead to communication issues among nurses and doctors. In response, a procedure for communication called SBAR was created to improve the effectiveness of communication among health care professionals.

Communication Skills

Communication is the process of sending and receiving information between two people. Even before you could talk, you were communicating with others. Babies are able to communicate by smiling, crying, sucking, yawning, and by giving other cues from their body language. Effective communication consists of three basic skills: 1. Speaking 2. Listening 3. Body Language

The purpose of SBAR is to provide guidelines for effective communication. Medical conversations should remain brief and focused on relevant details. This way health care professionals can quickly communicate as much information as possible.

In order to keep communication efficient, nurses should be prepared to share the information included in the SBAR procedure before talking to physicians. Nurses should also be prepared to answer any follow up questions the doctor may have. This often requires up to date information about the patient's health status, treatments and procedures, and test results.

Listening

It is also important for nurses to be good listeners. Patients are more likely to trust and open up to a nurse who shows they are interested in their well being by listening to them carefully. Nurses need to listen to the patient's questions and concerns. This way, they can ease patient fears and use their input when planning. Patients are more likely and willing to follow their care plan if they are involved in the process. Nurses can show they are listening by using appropriate body language such as eye contact and nodding and by responding verbally to what the patient is saying. They can also encourage good listening from their patients. Nurses do this by asking questions and having the patient rephrase things they are being told. These actions allow nurses to ensure the patient is listening and gauge how much of the information they understand.

Special needs can arise from a variety of factors such as the patient's condition, native language, or cultural norms. Patients who have conditions that affect their mental capacity or ability to communicate may require adaptations or careful timing. Patients who speak a foreign language may benefit from the presence of a translator. Cultural considerations also need to be taken into account. For example, a patient may be more comfortable communicating with a nurse of a certain gender.

Nurses also need to adhere to the limits set by their licenses. A nurse is able to read a patient his or her results, but is not licensed to interpret those results for the patient. Even if the patient asks, the nurse cannot interpret what the information means. Additionally, nurses need to be careful about communication with the patient's family and friends. The health information privacy act (referred to as HIPAA) puts patients in control over how much medical information is shared with others. Patients can decide to share all, some, or no medical information with family and friends. Nurses need to privately and specifically discuss with the patient what he or she would like to share with others and what information should remain confidential. Communicating with the patient's family is very similar to communicating with the patient. Nurses need to be attentive to both verbal and nonverbal expressions. They should express interest and concern while displaying confidence and trustworthiness. Language should be direct, clear, and simple. Medical terminology should be avoided. Just like it is during patient communication, repetition is especially important when telling family or friends serious or grave information.

Nurses also need to be sensitive to the patient's needs. Important information should be given to a patient when he or she is in the proper frame of mind to receive them whenever possible. Nurses should encourage patients to express concerns and ask questions. They also need to look for nonverbal clues to the patient's reaction and feelings.

Nurses need to communicate in a credible way. Credibility is built as the nurse is consistent, reliable, and honest. Nurses also need to be knowledgeable about the information they are discussing with the patient so they can answer questions and explain details clearly. Additionally, confidence is important. Patients will not respond well to a nurse who either verbally or nonverbally demonstrates that they are not sure what they are doing.

Situation

Nurses should begin by describing the situation. This information includes details such as the patient's name and relevant characteristics, signs and symptoms, and changes in health status. As is the case with each portion of SBAR communication, the situational information should be kept brief. Details are limited to relevant, useful information. These details are generally offered as a short list rather than a narrative. An example of the information provided as the situation component of SBAR is: Laura Wright, age 24, was admitted half an hour ago with complaints of abdominal pain.

Humor needs to be used very carefully, especially when a patient is under a lot of stress. Laughter can help relieve tension, but it can also confuse or frustrate a patient who is not receptive to humor at the moment. It is important that the nurse does not use humor in a way that conveys a lack of concern for the patient's feelings.

Repetition can also play a very important role as nurses communicate with patients. Patients who are feeling stressed and anxious may need to have important information repeated several times before they can fully process and understand its meaning, particularly if the information is serious or life threatening.

Nurses are encouraged to use SBAR when conducting medical conversations about a wide range of topics such as when a patient's condition or treatment changes, is transferred between facilities, or needs an appointment with a specialist. SBAR can also be used during shift change reports between nurses.

The communication guidelines known as SBAR were created to improve communication between nurses and physicians. This procedure is highly encouraged as it keeps medical conversations brief and to the point. SBAR improves collaboration among health professionals and reduces the occurrence of medical errors that result from miscommunication.

Recommendation

The last step is for nurses to offer a recommendation for patient treatment or request appropriate actions from the doctor. For example, a nurse may recommend that the physician transfer the patient to another department, prescribe medication, or personally perform a needed procedure. An example of the information provided as the recommendation component of SBAR is: I would recommend that she increase her fluid intake and take a mild laxative over the next 48 hours or until she is able to move her bowels. Do you agree?

Other Considerations

There are other considerations nurses need to keep in mind when communicating with patients including: • Any special needs • Licensing limitations • Speaking to family and support members

Think of a time when you could tell a friend was upset, not because of what he or she said, but because of his or her body language. While someone may not verbally admit to how they are feeling, their demeanor and actions often provide insight about their emotions.

These actions are often very subtle, and you may not even realize you are doing them. Therefore, it is important to become aware of your body language to make sure that your body says the same thing as your words.

Communicating With Patients

When nurses communicate with patients, it is important for them to be mindful of the three basic skills of communication: • Speaking • Listening • Body Language

Speaking

When speaking, nurses need to pay attention to the following: • Speed and tone • Clarity and simplicity • Sensitivity • Credibility • Humor • Repetition • Questions

Clarifying

asking the other person questions so you more fully understand what is being said.

Empathizing

feeling what the other person feels. If the speaker is sad, empathizing is feeling sad for them while you listen. It is also important that you don't interrupt the speaker or pass judgment while you listen.

Encouraging

giving signals that you are involved in the conversation and interested. You can provide encouragement by nodding your head, quietly saying "Uh-huh," and maintaining eye contact.

Body language

non-verbal communication, is what you communicate to others by your actions. Body language includes any gestures you make, facial expressions, and other behaviors.

Active listening

paying attention to what someone is saying and feeling. Characteristics of active listening include: • Reflective listening • Clarifying • Encouraging • Empathizing

Reflective listening

rephrasing or summarizing what you heard in order to make sure you understand what the person intended.

Speaking skills

the ability to express what you mean clearly and effectively. This not only includes being able to articulate what you mean with words but also the delivery of those words. The volume, tone, and pitch of your words can change their meaning For example, saying the word "no" in a soft voice can be perceived as if you don't mean it. Whereas saying, "No," in an assertive tone makes it clear that you truly mean it. Therefore, it is not just what you say but how you say it. Speaking skills also include saying what you really mean. It is your responsibility to say what you are feeling or what you want. You should not assume that other people can read your mind or know your needs.

Listening skills

the ability to hear, interpret, and retain what is being said. The act of hearing is not the same thing as listening. If your mom asks you for help while you are watching TV, you may hear her request but forget it moments later if you are not truly listening. Listening skills use the technique of active listening.

SBAR stands for:

• Situation • Background • Assessment • Recommendation

Strong communication skills involve:

• Speaking • Listening • Body language It is important to develop awareness and skills in each of these areas in order to be a clear and effective communicator