Chapter 24Communication

Communication and Nursing PracticeA lifelong learning process for nursesAn essential attribute of professional

nursing practiceBuilds relationships with clients,

families, and multidisciplinary team members

Communication and Interpersonal RelationshipsThe means to establish helping and

healing relationships.The ability to relate to others is

important for interpersonal communication.

Developing communication skills requires both an understanding of the communication process and of one’s own communication experience.

Box 24-1 presents communication throughout the nursing process.

Box 24-2 presents challenging communication situations.

Levels of Communication1. Intrapersonal A. One-to-one interaction

between two people

2. Interpersonal B. Occurs within an individual

3. Transpersonal C. Interaction with an audience

4. Small Group D. Interaction within a person’s spiritual domain

5. Public E. Interactions with a small number of people

Basic Elements of the Communication Process

1. Referent A. One who encodes and one who decodes the message

2. Sender and receiver B. The setting for sender-receiver interactions

3. Message C. Message the receiver returns

4. Channels D. Motivates one to communicate with another

5. Feedback E. Means of conveying and receiving messages

6. Interpersonal variable F. Factors that influence communication

7. Environment G. Content of the message

Forms of CommunicationVerbal

VocabularyDenotative and connotative meaningPacingIntonationClarity and brevityTiming and relevance

Nonverbal CommunicationPersonal appearancePosture and gaitFacial expressionsEye contactGesturesSoundsTerritoriality and personal space

Other Forms of CommunicationSymbolic

The verbal and nonverbal symbolism used by others to convey a meaning

MetacommunicationA broad term that

refers to all factors that influence communication

Professional Nursing RelationshipsNurse-client helping relationshipsNurse-family relationshipsNurse-health team relationshipsNurse-community relationships

Elements of Professional Communication

Appearance, demeanor, and behavior

Courtesy

Use of names Trustworthiness

Autonomy and responsibility

Assertiveness

Therapeutic Communication TechniquesAttentive (active) listening – SOLERSharing Observations, Empathy, Hope,

Humor, FeelingsUsing TouchUsing SilenceProviding InformationClarifying

Therapeutic Communication TechniquesFocusingParaphrasingAsking Relevant Questions - Seeking

validationSummarizingSelf-DisclosureConfrontationSummarizing

Non-Therapeutic Communication TechniquesAsking personal questions Giving personal opinionsChanging the subjectAutomatic responseFalse Re-assuranceSympathyAsking for ExplanationApproval or Disapproval

Non-Therapeutic Communication TechniquesDefensive ResponsesPassive or Aggressive ResponsesArguing

Barriers to communicationAgreeing or disagreeingAsking personal questionChanging the subjectEnvironmentGiving adviceLanguage and culturePassing judgmentPhysical limitationStereotypingTesting

Adapting Communication Techniques for Client with Special NeedsAging population and communication

disability.Cultural DifferenceImpaired communication because requires

special thought and sensitivity.See Box – 24-10: Communicating With Clients

Who Have Special needsSee Sample Communication Analysis.Critical Thinking Exercises – page 359 NCLEX Style Questions – page 359.

Communication Within the Nursing ProcessAssessment

Physical and emotional factorsDevelopmental factorsSociocultural factorsGender

Communication and Nursing ProcessDiagnosis

Many clients experience difficulty with communication Lacking skills in attending, listening,

responding, or self- expression Inability to articulate, inappropriate

verbalization Difficulty forming words Difficulty with comprehension

Communication and Nursing ProcessPlanning:

Goals and outcomes: Specific and measurable

Setting of prioritiesContinuity of care:

Collaboration with other health care providers

Communication and Nursing ProcessImplementation:

Therapeutic communication techniquesNontherapeutic communication

techniquesAdapting communication techniques

Communication and Nursing ProcessEvaluation:

Nurses and clients need to determine whether the plan of care has been successful.

Nursing interventions are evaluated to determine which strategies or interventions were effective.

If expected outcomes are not met, the plan of care needs to be modified.