Rachel Natividad, RN, MSN, NP
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Rachel Natividad, RN, MSN, NP. Have you ever been nailed by nasty remarks from a hostile friend, family member, or stranger? Ever been bashed by comments and criticisms from colleagues? How did you react? Did you gracefully defuse the situation?. Communication. Communication defined….

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Rachel natividad rn msn np

Rachel Natividad, RN, MSN, NP


Communication

Have you ever been nailed by nasty remarks from a hostile friend, family member, or stranger?

Ever been bashed by comments and criticisms from colleagues?

How did you react?

Did you gracefully defuse the situation?

Communication


Communication defined

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)


Rachel natividad rn msn np

  • Describe a situation in which you did not communicate effectively and the result.

  • What could you have done differently?


Effective communication in nursing

Effective Communication in Nursing

Increases patient satisfaction and health outcomes

Decreases risk of complaints and litigation

Increases level of job satisfaction


Elements of communication

Elements of Communication

  • Sender

  • Message

  • Receiver

  • Feedback

  • Meaning (sender/receiver)


Rachel natividad rn msn np

Language is inherently ambiguous…

Communication can be confusing!!!

Ambiguous Picture


Communication patterns

Communication Patterns

  • Verbal

  • Tone

  • Nonverbal

    • Facial expressions

    • Gestures

    • Eye contact

    • Body language

Verbal

7%

Tone

38%

Nonverbal 55%


Face talks

Face talks…


Communication in nursing

Communication in Nursing

  • Nurse-client relationship - Therapeutic Relationship-

  • Client-centered


Case study the first encounter

Case Study: The First Encounter


Phases of therapeutic relationship

Phases of Therapeutic Relationship

  • Introductory phase - initiation or orientation phase

  • Working phase– facilitating the relationship

  • Termination phase– relationship comes to an end


Case study resolution the first encounter

Case Study Resolution: The First Encounter

  • Attempt to identify the source of hostility

  • Allow client to verbalize feelings, fears, concerns

  • Offer explanations and explain the purpose of the procedures/medications.


Case study resolution the first encounter1

Case Study Resolution: The First Encounter

Acceptable responses:

  • “You sound upset this morning.”

  • “Mrs. T, it is difficult to be a patient. You haven’t had much time to yourself.”

  • “When would you like me to bring your medicine?”


Listen

Listen…

A poem by….

Anonymous


Blocks to therapeutic communication

Changing the subject

False reassurance

Giving advice

Incongruence

Assumptions

Invalidation

Overloading

Social Response

Underloading

Value judgements

Blocks to Therapeutic Communication

SDM


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

Therapeutic Communication Techniques


Case study cultural diversity 2

Case Study: Cultural Diversity (2)


Cultural diversity

Cultural Diversity

  • Slang terms and colloquialisms

  • Stress of illness – different meanings in various cultures

  • Eye contact, touch personal space – meanings vary among cultures


Let s communicate transculturally

Assess language needs

Approach patient slowly and greet her/him respectfully

Do not raise your voice to be heard

Allow sufficient time and a quiet setting

Pay attention to nonverbals

Try to mirror pt’s style of communicating

Provide written material in patient’s language if available

Let’s Communicate Transculturally!


Are you culturally competent

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 client’s language


Case study resolution cultural diversity

Case Study Resolution: Cultural Diversity

  • Recognize impact of the client’s culture to communication style, health care and practices/beliefs

  • Consider cultural roots when continuing with the plan of care


Anxiety and communication

Anxiety and Communication

  • How can stress/anxiety affect your communication with your clients?

  • How can stress affect client’s communication with you?

  • What techniques do you use to decrease your stress routinely? During exams?


Rachel natividad rn msn np

Mild

Moderate

Severe

Passive

Assertive

Aggressive

Levels of Anxiety

Communication Styles


A confrontation with ms madd

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. K’s 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)


Help the anxious client

Be alert to s/s of anxiety

Assist pt to verbalize feelings and concerns and try to ID source of anxiety

Be understanding of pt’s feelings

Avoid becoming tense or defensive

Speak slowly and briefly, avoid empty phrases that does not help the situation

Offer explanations of info if pt has misconceptions about the situation

Assess the patient’s support system

ID previously useful coping mechanisms

Help the anxious client


Rachel natividad rn msn np

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!


References

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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