Chapter 8: Communication

Assess

Gather info both verbal and nonverbal Should determine before if assistive devices are necessary to understand conversation Identify prefer language and secure interpreter Written word is used to obtain data and reading records or charts before meeting patient Spoken word is used to receive and give reports to health personnel Effective communication skills and observation Data collected verbally and nonverbal are documented

Gossip and Rumor

Grapevine Damage reputation

Interview techniques

Purpose is to obtain accurate and thorough information Major tool to collect data during assessment All interviews should begin with explanation of purpose Interview itself is therapeutic interaction and essential for orientation phase of helping phase

ISBAR-R and QSEN institute

Quality and Safety Education for Nurses- identifies quality and safety competencies for nursing with goal for preparing nurses with knowledge, skills, and attitudes necessary to improve quality and safety Provides teaching strategies and resources to assist nurses educators to meet QSEN goals ISBARR I- identify self and patient and R for readback at close of communication Can help reduce anxiety and increase confidence

Verbal communication

Exchange of information using words, including spoken and written Depends on language or prescribed way of using words so people can share information effectively A person's use of written and spoken language forms reveals aspects of intellectual development, educational level, and geographic origin Nurses must consider if English is a second language Nurses must develop their own language skills to assist in reciprocal response Use verbal communication when providing care, interactions, giving oral reports, developing care plans, and evaluation

Message

Actual communication from source Channel or communication- medium the sender has selected to send message Message can be sent to receiver through: Auditory, Visual and kinesthetics or touch The receiver must translate and interpret message sent and receive To be an effective communicator, the nurse needs to be considerate of receiver and select a message that appeals to patient's interests and that requires minimal effort and time to decode

Silence

Allows gathering of thought and process at their own pace Reflect on what is shared and observe patient without having to concentrate on spoken words The patient might be comfortable and content in the nurse-patient relationship. Continuous talking is unnecessary. The patient might be trying to demonstrate stoicism and the ability to cope without help. The patient might be exploring inner thoughts or feelings, and a conversation would disrupt this. In effect, the patient is really saying, "I need some time to think." The patient might be fearful and use silence as an escape from a threat. The patient might be angry and use silence to display this emotion. The patient's culture may require longer pauses between verbal communication. Fear of silence can lead to too much talking on nurse

Clarifying question

Allows nurses to gain understanding of comment Can prevent possible misconception that could lead to inappropriate nursing diagnosis Overuses of clarifying question can lead to not listening or lack of knowledge

Social media

Allows users to create, share, and participate in virtual communication Allows sharing of ideas, professional connections, access education offerings, receive support, and investigate evidence based practices Nurses must adhere to Health Insurance Portability and Accountability to protect patient confidentiality and privacy and be aware of policies about social media Inappropriate disclosure can be unintentional Once information is deleted is still available as it is still considered breach of confidentiality

Assertive vs Aggressive Behavior

Assertive- stand up for oneself and others using open, honest and direct communication Focus on issue not person Differ from avoidance and acquiescent behaviors Assertive behavior is expressing feelings and beliefs in nondefensive manner without judging or blaming others Characteristics of assertive behavior include confidence, open body posture, eye contact, use of clear and concise and ability to share effectively thoughts and emotions Ability to remain calm under supervision, freedom to ask help when needed, give and accept compliments, honesty in admitting mistakes and taking responsibility Aggressive behavior- asserting one's right in negative manner that violates right of others Verbal or physical Communication marked by tension and anger and inhibits the formation of good relationships Accusations, demonstrating belligerence and intolerance Enhance self esteem and provide superiority through destructive comments at others

Patient from different cultures

Assess your personal beliefs surrounding people from different cultures. Review your personal beliefs and past experiences. Set aside any values, biases, ideas, and attitudes that are judgmental and may negatively affect care. Assess communication variables from a cultural perspective. Determine the ethnic identity of the patient, including generation in the United States. Use the patient as a source of information when possible. Assess cultural factors that may affect your relationship with the patient and respond appropriately. Plan care based on the communicated needs and cultural background. Learn as much as possible about the patient's cultural customs and beliefs. Encourage the patient to reveal cultural interpretation of health, illness, and health care. Be sensitive to the uniqueness of the patient. Identify sources of discrepancy between the patient's and your own concepts of health and illness. Communicate at the patient's personal level of functioning. Evaluate effectiveness of nursing actions and modify nursing care plan when necessary. Modify communication approaches to meet cultural needs. Be attentive to signs of fear, anxiety, and confusion in the patient. Respond in a reassuring manner in keeping with the patient's cultural orientation. Be aware that in some cultural groups, discussion concerning the patient with others may be offensive and may impede the nursing process. Understand that respect for the patient and communicated needs is central to the therapeutic relationship. Communicate respect by using a kind and attentive approach. Learn how listening is communicated in the patient's culture. Use appropriate active listening techniques. Adopt an attitude of flexibility, respect, and interest to help bridge barriers imposed by culture. Communicate in a nonthreatening manner. Conduct the interview in an unhurried manner. Follow acceptable social and cultural amenities. Ask general questions during the information-gathering stage. Be patient with a respondent who gives information that may seem unrelated to the patient's health problem. Develop a trusting relationship by listening carefully, allowing time, and giving the patient your full attention. Use validating techniques in communication. Be alert for feedback that the patient does not understand. Do not assume meaning is interpreted without distortion. Be considerate of reluctance to talk when the subject involves sexual matters. Be aware that in some cultures, sexual matters are not discussed freely with members of the opposite sex. Adopt special approaches when the patient speaks a different language. Use a caring tone of voice and facial expression to help alleviate the patient's fears. Speak slowly and distinctly, but not loudly. Use gestures, pictures, and play acting to help the patient understand. Repeat the message in different ways if necessary. Be alert to words the patient seems to understand and use them frequently. Keep messages simple and repeat them frequently. Avoid using medical terms and abbreviations that the patient may not understand. Use an appropriate language dictionary. Use interpreters to improve communication. Ask the interpreter to translate the message, not just the individual words. Obtain feedback to confirm understanding. Use an interpreter who is culturally sensitive.

Diagnosis

Assessment can lead to development of multiple diagnosis or one related to alteration in communication Impaired ability to communicate can contribute to development of other nursing diagnoses NANDA- Communication

Nontherapeutic comments

Cliches- stereotyped, trite or pat answer Offer false assurance Patients tend to interpret them as lack of real interest Makes sweeping generalization that does not apply to person Tends to cut off communication and make people feel insignificant Questions that can be answered simply with yes or no to cut off discussion even when the person might wish to continue Posing a question to which the patient can say no when that answer could indicate a problem Questions containing how and why can intimidate patient Questions that probe for information might cut off communication Patients who are made to feel as though they are receiving third degree stop talking and avoid further conversation Let patient take initiative allows to delve more deeply at a time when patient is ready Leading questions tend to produce answers that might please nurse but unlikely to encourage the patient to respond without feeling intimidated Examples-You aren't going to smoke that cigarette, are you? Nurse: You have been well cared for by your nurses, haven't you? Giving advice often implies that the nurse knows what is best for patients and denies them the right to make decisions and having feelings Tends to increase the patient's dependence on caregivers Advice have a rightful place when requested and when person gives advice has expert knowledge that patient does not Judgmental comments- impose the nurses standards on patients Patient feels safe when allowing to express feelings without judgment

Disruptive interpersonal behavior and communication

Communication between health care workers become ineffective and negative Develop report systems, use mediators if needed and document all efforts to address unacceptable behaviors

Values

Communication is influenced by how people view themselves, others, and purpose of human interaction Teaching is an important aspect of nursing and values empowering patients will communicate

Termination phase

Conclusion of initial agreement is acknowledged Happen at change of shift time, when discharged, nurse take vacation Examine goals of helping relationships indicate attainment of evidence of progress Emotions associated Explain concern of transfers and ease worries through introducing personnel

Feedback

Confirmation of message that the receiver has understood the intended message Noise-Factor that distort quality of message and can interfere with communication Communication is reciprocal process in which both sender and receiver of messages participate Messages can be influenced by person's previous knowledge, past, feelings, or sociocultural level

Document communciation

Continual assessment of needs and conditions requires accurate documentation Significant info must be passed on to other through nursing process and care plans

Therapeutic skills

Conversations or verbal communication is social interactions Control the tone of your voice so that you are conveying exactly what you mean to say and not a hidden message. Your tone should indicate interest rather than boredom, patience rather than anger, acceptance rather than hostility, and so forth. Be knowledgeable about the topic of conversation and have accurate information. When possible, be familiar with the subject of conversation before discussing it with the patient. If the topic is unfamiliar to you (e.g., the availability of community resources for family caregivers of patients with special needs), admit that to the patient and family and direct them to other resources. Convey confidence and honesty to the patient. Be flexible. You might want to discuss a certain subject but learn that the patient wishes to discuss something else. It is better to follow the patient's lead whenever possible; in due time, you can return to the subject. For example, you arrive at the patient's bedside to administer a medication, but the patient begins to talk about diet issues. It is better to take a little time to talk about the patient's interest than to insist on talking about only the procedure at hand, as long as there is enough time for the conversation. Be clear and concise, and make statements as simple as possible. Patients are often anxious and fail to understand the message unless the patient understands the language used. Stay on one subject at a time. This helps prevent confusion. Avoid words that might have different interpretations. The study of the meaning of words is called semantics. Even when two people speak the same language, some words—such as love, hate, freedom, and health—might have different meanings to different people. Be truthful. A patient who is given false information will soon distrust the nurse. If you're not sure about something, admit you don't know and seek an answer rather than make a comment that may be an error. Keep an open mind. An attitude of "I know better than the patient" is quickly discerned by the patient. Patients can make valuable contributions to their own health care. Take advantage of available opportunities. During most caregiving situations, you can facilitate conversation that makes even the most routine task meaningful. For instance, when giving a bed bath to a patient, ask about the patient's employment. This would allow the patient to verbalize any positive or negative feelings about the job and being temporarily absent from it, reducing the anxiety that often occurs with the loss of work. It is often comforting to know that someone understands and cares.

Good communication

Enables nurses to know their patients and meet care Communication is building block of relationships between nurses, patients, and health members

Factors that promote effective communication within helping relationship

Dispositional traits Warmth and friendliness- initiate helping relationship depends on ability to begin orientation phase successfully Pleasant greeting and smile Convey acceptance and interest in concern Openness and respect Develop sensitivity to challenges Attention to variables that influence process of communication, sex, developmental level Empathy- objective understanding to see person's situation, identify how they feel, putting yourself in another circumstance and imagine how they feel Sympathy- expression of sorrow for situation with compassion and kindness Shifts emphasis on patient to nurse as sharing feelings and personal concerns and projects them onto patients Empathic nurse is sensitive to feelings and problems but remain objective enough to help attain positive outcome Honesty and trust- Trust nurse that everything within their level of expertise to secure resources and meet needs Caring- Task centered or relation centered Expert nurse know how to communicate genuine care the minute they step in by how they look and touch the patient Competence- skilled in basic and meet needs based on care needs through their technical, cognitive, interpersonal, and ethical and legal skills Take responsibility to evaluate strength and weakness of self to give optimal care

False assurance

Easier and more pleasant to deal with positive outcomes than negative outcomes Give patient impression the nurse is not interested in the problems Cliches to give false assurance Communication might imped when providing patient and family with false assurance

Characteristics of effective and ineffective groups

Group identity Members value and "own" the aims of the group; aims are clearly articulated. Group's aims are not of major importance to members. Cohesiveness Members generally trust and like one another and are loyal to the group; high commitment; high degree of cooperation. Members often feel alienated from the group and from one another; low commitment; members tend to work better alone than with the group. Patterns of interaction Honest, direct communication flows freely; members support, praise, and critique one another. Communication is sparing; little self-disclosure; self-serving roles (i.e., dominator, blocker, or aggressor) may be unchecked. Decision making Problems are identified, appropriate method of decision making is used (i.e., individual, minority, majority, consensus, or unanimous); decision is implemented and followed through; group commitment to decision is high. Problems are allowed to build without resolution; little responsibility is shown for problem solving; group commitment to decision is low. Responsibility Members feel strong sense of responsibility for group outcomes. Little responsibility for group felt by group members. Leadership Effective style of leadership meets desired aims. Ineffective leadership styles are used. Power Sources of power are recognized and used appropriately; needs or interests of those with little power are considered. Power is used and abused to "fix" immediate problems; little attention to needs of powerless.

Hand off TST

Hand off communication targeted solutions tool which examines hand off communication problems and identifies causes for failure and barriers to improvement Provides validated solution to improve hand off communication targeted to specific causes of inadequate hand off at individual organization

Environment

Happens best in environment easy to exchange info Most conducive to communicate is calm and nonthreatening Goal- minimize distraction and ensure privacy

Listening skills

Hearing and interpret what other says Requires attention and concentration to sort out, evaluate, and validate clues to better understand the true meaning of what is said When possible, sit when communicating with a patient. Do not cross your arms or legs because that body language conveys a message of being closed to the patient's comments. Be alert and relaxed and take sufficient time so that the patient feels at ease during the conversation. Keep the conversation as natural as possible, and avoid sounding overly eager. If culturally appropriate, maintain eye contact with the patient, without staring, in a face-to-face pose. This technique conveys interest in the conversation and willingness to listen. Indicate that you are paying attention to what the patient is saying by using appropriate facial expressions and body gestures. Be attentive to both your own and the patient's verbal and nonverbal communication. Think before responding to the patient. Responding impulsively tends to disrupt communication and listening. Do not pretend to listen. Most patients are sensitive to an attitude of feigned attention or to boredom and apathy. Listen for themes in the patient's comments. What are the repeated themes in the person's speech and behavior? What topics does the patient tend to avoid? What subjects tend to make the patient shift the conversation to other subjects? What inconsistencies and gaps appear in the patient's conversations?

Electronic communication

Provides ways to communicate and collaborate with health care providers Disadvantage- protect privacy, confidentiality, prevent unintended consequences

General Physical appearance and Dressing Sounds

Illness can cause alteration in appearance Observe changes to detect illness or evaluate effectiveness of care Dress can indicate health or emotion Sounds- Be interpret to describe pain nonverbally or express happiness Silence- Indicate understanding when conversing with someone else

Incivility and Bullying

Incivility is rude, disruptive, and intimidating and undesirable behavior Failing to act when action is warranted- refuse to assist coworker or share important info about patient's care Considered precursor to bullying behavior or lateral violence and others as form of bullying Horizontal violence- anger and aggressive behavior between nurses or nurse to nurse hostility All psychological and social harassments- bullying Covert bullying occurs withholding information from colleague, gossip widespread, using nonverbal communication such as eye rolling and other body language and social isolation Overt bullying includes accusing a nurse of errors made by someone else (scapegoat) or humiliate person in front of others Physical and emotional toll those employed in toxic work environment can be significant Report physical consequence including frequent headaches, sleep disturbance, GI symptoms, and decreased energy Psychological manifestations- increase level of stress, anxiety, fear, frustration, and loss of self esteem

Characteristics of helping relationship

It is dynamic. Both the person providing the assistance and the person being helped are active participants to the extent each is able. It is purposeful and time limited. This means there are specific goals that are intended to be met within a certain period. Although both parties in the helping relationship have responsibilities, the person providing the assistance is professionally accountable for the outcomes of the relationship and the means used to attain them. Helping persons should present their helping abilities as honestly as possible and not promise to provide more assistance than they can offer. Goal-determined cooperatively and defined in terms of patient's needs Common goals increase independence for patient, improve health and well being Select nursing interventions will help person move towards goal Goals changes so do interventions implements in attaining goals

Sociocultural difference

Lifestyle, language, behavior patterns, traditions learned and passed from generation First step of cultural competence requires becoming aware of own personal cultural beliefs and identify prejudices or attitudes that could affect interactions and barrier to communication Understand patient's cultures to help understand nonverbal cues and deliver accurate care Health care system is culture with own customs, values, and language Patients with limited proficiency in English have difficulty understanding medical instructions and understanding test results and diagnoses Remain aware of cultural variations and terminology Terms can alienate and inhibit communication

Working phase

Longest phase of helping relationship Nurses work together with patient to meet physical and psychosocial needs Interaction is essence of phase Occur at time are purposeful to ensure achievement in goal or objectives and mutually agreed upon Nursing as caregivers, teachers, and counselors- motivate patient to learn and implement health- promotion activities, express feelings of health problems, and any concerns Interpersonal skills are used the most Satisfaction gives people integrity while promoting an atmosphere characterized by minimal fear, distrust, and tension

Humor

Maintain perspective in work and encourage patient Accept failures and absurdities of everyday practice Laughter release physical and psychological energy and reduce stress, anxiety, worry, and frustration Be aware of cultures who perceive or use humor in presence of illness

Biological sex

Men and women have different communication styles and different interpretations to same observation Girls- seek confirmation, minimize differences and establish intimacy Boys- independence and negotiate status Ensure receiving message trying to communicate

Direct question

Necessary to obtain more information about topic brought up earlier in interview or to introduce a new aspect of current topics Nurses can gain additional information to consider in assessing the patient's health status and educational needs Example Nurse: You mentioned your dad earlier. Did he develop complications related to high blood pressure? Patient: Yes. Nurse: What sort of complications? Patient: Kidney failure. He was on dialysis for years before getting a transplant. Nurse: Are you afraid this might happen to you?

Orientation phase

Nurse and patient during data gathering of nursing process Can be initiated during other times during nurse patient relationship Tones and guidelines are establish Identify each other The patient will call the nurse by name. The patient will accurately describe the roles of the participants in the relationship. The patient and nurse will establish an agreement about: Goals of the relationship Location, frequency, and length of the contacts Duration of the relationship The roles of both people in the relationship are clarified. An agreement or contract about the relationship is established. The agreement is usually a simple verbal exchange related to goals and the means of achieving them or occasionally a written document, especially if the relationship extends over a long period of time. The 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. This orientation should be identified as one of the goals in the nurse-patient helping relationship. Exhibit openness and interest in concerns of patient paves way for developing trust and communicating care and respect

Helping relationship

Nurse patient relationship People who provide and receive assistance in meeting needs The helping relationship does not occur spontaneously, as do most social relationships. It occurs for a specific purpose with a specific person. The helping relationship is characterized by an unequal sharing of information. The patient shares information related to personal health problems, whereas the nurse shares information in terms of a professional role. In a friendship, information sharing is more likely to be similar in quantity and type. The helping relationship is built on the patient's needs, not on those of the helping person. In a friendship, needs of both participants are generally considered. A friendship might grow out of a helping relationship, but this is separate from the purposeful, time-limited interaction described as a helping relationship. Professional relationships Attitude can impact relationship and breach professionalism undermining nursing image

Blocks to communication

Nurses aware of own their feelings and response are better to communicate and response to others Nurses focus on whole patient and not merely diagnosis Patient reports that feeling as an object than human Patients might not be able to speak freely to nurse Signals indicate readiness to talk are subtle Do not miss opportunities for communication by approaching patients with closed mind or focus on own needs rather than patient's needs Nurses who lack confidence in own ability to meet the challenges a patient can become defensive in response to patient's comments

Roles and responsibilities

Occupation gives nurse a supposition about person's abilities, interest and economic status Be careful not to ignore uncomplaining patient who never ask for anything because power differences in health care- patient relationships can make communication intimidating

Hands off communication: SBAR

Occurs between nurses and other departments, nurse to nurse reports, or nurse to physicians Miscommunication between health care providers during hand off communication, nurse shift change or interdepartmental transfers presents risk for adverse effects Joint commission and institute for healthcare improvement recommended SBAR Situation, Background, Assessment and Recommendations Enhance clarity and efficiency of communication between health care team members Used to meet specific situations related to shift reports, conversations with physicians and other health providers, and transferring patients

Phases of helping relationship

Orientation, Work Phase, and Termination Phase Continuous and reciprocal Nurse initiates helping relationship and works with patient and family through termination

Change subject

Patient might be at point of readiness to discuss something and will feel frustrated when put off Nurse could feel uncomfortable and change topic

Patient communication (Special needs)

Patients Who are Visually Impaired Acknowledge your presence in the patient's room. Identify yourself by name. Remember that the visually impaired patient will be unable to pick up most nonverbal cues during communication. Speak in a normal tone of voice. Explain the reason for touching the patient before doing so. Indicate to the patient when the conversation has ended and when you are leaving the room. Keep a call light or bell within easy reach of the patient. Orient the patient to the sounds in the environment and to the arrangement of the room and its furnishings. Be sure the patient's eyeglasses are clean and intact or that contacts are in place. Patients Who are Hearing Impaired Orient the patient to your presence before initiating conversation. This may be done by gently touching the patient or moving so that you can be seen. Talk directly to the patient while facing him or her. If the patient is able to lip read, use simple sentences and speak in a quiet, natural manner and pace. Be aware of nonverbal communication. Do not chew gum or cover your mouth when talking with the patient. Demonstrate or pantomime ideas you wish to express, as appropriate. Use sign language or finger spelling, as appropriate. Write any ideas that you cannot convey to the patient in another manner. Be sure that hearing aids are clean, functioning, and inserted properly. Patients With a Physical Barrier (Laryngectomy or Endotracheal Tube) Select one or more simple means of communication that the patient is physically able to use. Options include eye blinks or hand squeezes to communicate yes or no; writing pads or magic slates; communication boards with words, letters, or pictures; flash cards; sign language. Be sure that everyone communicating with the patient—family, friends, and caregivers—understands and is able to use the communication devices selected. Demonstrate patience with the time needed to communicate effectively, and reinforce the patient's efforts. Ensure that the patient has an effective means of signaling need for assistance, such as a call bell or alarm. Patients Who are Cognitively Impaired Establish and maintain eye contact with the patient to hold attention. Communicate important information in a quiet environment where there is little to distract the patient's attention. Keep communication simple and concrete. Break down instructions into simple tasks and avoid lengthy explanations. Do not use pronouns or abstract terms. Use pictures or drawings when appropriate. Whenever possible, avoid open-ended questions. Ask "Would you like to wear the brown pants or the gray pants?" instead of "What would you like to wear?" Be patient and give the patient time to respond. If the patient does not respond after 2 minutes, repeat what you said. If there is still no response, take a break before continuing the conversation so that neither you nor the patient becomes frustrated. Patients Who are Unconscious Be careful of what is said in the patient's presence. Hearing is believed to be the last sense lost; therefore, the unconscious patient is often likely to hear even though there is no apparent response. Assume that the patient can hear you. Talk in a normal tone of voice about things you would ordinarily discuss. Speak with the patient before touching. Remember that touch can be an effective means of communication with the unconscious patient. Keep environment noises at as low a level as possible. This helps the patient focus on the communication. Patients Who Do Not Speak English Use an interpreter whenever possible. Use a dictionary that translates words from one language to another so that you can speak at least some words in the patient's language. Speak in simple sentences and in a normal tone of voice. Demonstrate or pantomime ideas you wish to convey, as appropriate. Be aware of nonverbal communication. Remember that many nonverbal communication cues are universal.

Physical, mental, and emotional

People are physically comfortable and mentally and emotionally free to engage in interactions influence communications Cognitive impaired patients- special communication

Posture Gait Gesture

Person hold their body Healthy- good alignment Depression- slouch Posture can provide clues for pain, limitations and indicate health overall Gaits can associate with illness or convey emotion Gesture- carry numerous messages Thumbs up, kicking when angry Use when two people speaking in different language attempts to communicate

Sequencing question

Place events in chronological order or investigate a possible cause and effect relationship between events When events lead to a problem are placed in sequence

Outcome identification and Planning

Planning steps requires communication among patients and other health members Oral and written communication needed to inform others and set objectives and goals Implement- Nurse assumes multiple roles when implementing Verbal and nonverbal communication enhance basic caregiving measures and used to teach, counsel, and support patients Nurse communicate plans and patient speaks inability or ability to carry out objectives

Touch

Powerful means of communication Connects people, provides affirmation, reassurances, and stimulation, decrease loneliness, and increase self esteem, share warmth, intimacy, and emotional support Communicate anger and invade personal space and privacy Weigh benefits of touch against detrimental Anxiety of discomfort- patient does not understand tactile gestures Touch- developed at birth Tactile experiences of infants and young children to be essential for normal development of self and awareness of others Older people long for touch especially when isolated from love ones Require touch while implementing care Physical closeness Study therapeutic touch

Communication

Process of exchanging information and generating and transmitting meanings between multiple people Assists in psychosocial needs of love, belonging, and self esteem Involves the source or encoders, message, channel, and receiver (decoder)

Closed question

Provides receivers with limited choices of possible responses and might be answered by yes or no Used to gather questions specific from patient and allow nurses and patients to focus on particular area Often barrier to effective communication

Rapport builders

Rapport- mutual trust experience by people in satisfactory relationship Specific objectives- have a purpose for interaction provides guidance to achieve encounter with patient Discuss assessment or illness Comfortable environment Promote interactions Proper lighting, moderate temp, atmosphere that is relaxed and unhurried Privacy Draw curtain Home visits Confidentiality- indicate whom the info can be shared with Right to specify who has such access Patient vs task focus Focus on patient and needs not activity nurse is engaging in Nurse observation Validate objective and subjective data It helps increase the awareness of a patient's nonverbal messages. It is the primary source of information when a patient is unwilling or unable to communicate verbally. It demonstrates caring and interest in the patient. (Patients often recognize when a nurse is unobservant and, rightly or wrongly, commonly conclude that the nurse does not care about them.) Optimal pacing- Consider pace of conversation Let patient know the beginning of interaction is limited time so no rush and prevent lack of interest

Developmental level

Rate of language development correlates with patient's neurologic competence and cognitive development Helpful to understand language development process and stags of intellectual and psychosocial development Knowing how each age group perceives health, illness , and body function can guide interactions Communicate differently with each age Adolescents- abstract thinkers Adults- Past positive or negative health related experiences Older adults- assess hearing or visual deficits

Evaluate

Rely on verbal and nonverbal cues from patient to verify patient objectives or goals is achieved Communication through positive and negative messages between nurse and patient can facilitate revision of care plan

Reflective question

Repeating what patient said or describe how they feel Encourages patients to elaborate on thoughts and feelings

Response to disruptive behaviors

Response assertively and address issue with those involves Speak to person privately and address remarks Document any bullying and speak to manager if continued Education must be provided for all staff regarding respectful, professional behavior, and communication. All staff members must be held accountable for their behavior and use of communication techniques. Zero-tolerance policies must be implemented regarding disruptive behaviors, and protection must be provided for those who report these behaviors and communication. Those in leadership positions must attend training regarding professional standards of behavior and communication techniques and function as a positive role model. Surveillance and reporting systems must be available to identify unprofessional behaviors and communication. Emphasis must be placed on the importance of documenting bullying behaviors and disruptive communication. Response include reacting professionally in moment, document and report, welcome new nurses, use conflict management strategies when responding to bullying and insisted the disruptive behavior and communication

Email and text messages

Risk for violating confidentiality can happen Concise and avoid text abbreviations Any emails sent to patient must be duplicated and part of medical record

Intrapersonal communicaiton

Self talk Affects nurses behavior and enhance or detract from positive interactions Positive words

Validating question

Serves to validate what nurses believe they observed or heard Overusing validating can lead to thinking that the nurse is not listening

Group communication

Small groups and Organizational group communication Small group Communication- Nurse interact with multiple people Members must communicate to achieve goal Staff meetings, patient care conferences, teaching sessions, and support groups Organizational communication- People and groups within organization communicate to achieve goal Council meeting to review unit policies, or nurses working with interdisciplinary groups on strategic planning or quality assurance Group dynamics- Determine effectiveness of groups How individuals relate to one another during process of working towards group goals All members use interpersonal strengths and ideas to establish goal To function at high level depends on each member's sensitivity group members dominate or thwarts group process

Impaired verbal communication

Specific communication for older adults for those who have speech, language, and hearing disorders Avoid elderspeaking- speaking patterns and words mimicking baby talk Ageism Cause of hearing loss include chronic ear infections, heredity, birth defects, health issues at home, certain drugs, head injury, bacterial infection, exposure to loud noise, aging, and tumors Causes of speech and language disorders are related to hearing loss, cerebral palsy, other nerve and muscle disorders, severe head injury, stroke (brain attack), viral disease, mental retardation, certain drugs, physical impairment- cleft lip, vocal abuse

Concern of communications CUS

Structured communication techniques can help members communicate effectively and accurately Recommended for use to assist in effective communication related to patient safety Concerned, Uncomfortable and Unsafe When in unsafe situation and need to effectively communicate concern to providers

Touch Eye Contact Facial expression

Tactile sense Touch is viewed as most effective ways to express comfort, love, affection, security, feelings Communication begins with eyes Glance- attention getting method Many cultures- consider respect and willingness to listen and keep communication Absence- anxiety or avoidance of communication In some cultures like Asians and Natives- rude and invasion of privacy Eyes used to express emotion- anger, scared Facial messages can convey feelings or emotion Some show some mask the feelings Nurses need to control their own expressions

Nonverbal communication

Transmission of information without words Body language If verbal and nonverbal communication conflict- nonverbal is the best Working with different cultural backgrounds should understand cultural variations to avoid misunderstandings

Interpersonal communication

Two or more people with goals exchange message Ability to communicate effectively at this level can influence sharing, problem solving, goal attainment, team building, and effectiveness in critical nursing roles (teacher, manager, caregiver)

Space and territoriality

Urge to maintain an exclusive right to certain space is territoriality Proxemics- distance zones between people during communication Each person has a sense of how much personal or private space is needed when distance between people is optimal Intimate zone: interaction between parents and children or people who desire close personal contact Personal zone: distance when interacting with close friends Social zone: space when interacting with acquaintances such as in a work or social setting Public zone: communication when speaking to an audience or small groups Understand personal and distancing characteristics can enhance communication Some communication can be dictate through culture and some are idiosyncratic 18 in to 4 ft is optimal for interviews Best to take cues when patient is uncomfortable Develop habit of seeking permission before touching areas within private zone Areas like mouth, feet, neck, face, front of body and genitalia

Open ended or comments

Use open ended to allow wide range of possible response Allows to express patients and specific enough to prevent digressing from issue at hand Encourages free verbalization Prevents patients from giving simple yes or no that can limit the response