Chapter 24
Communication
Communication and Nursing
Practice
A lifelong learning process for nurses
Therapeutic communication promotes personal
growth and attainment of patients’ health-related
goals
Key to nurse-patient relationships
Patient safety requires effective communication
Improves patient outcomes and increases
patient satisfaction
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Communication and Interpersonal
Relationships
Communication establishes caring, healing
relationships.
The ability to relate to others is important for
interpersonal communication.
Communication, including posture,
expressions, gestures, words, and attitudes,
has the power to hurt or heal.
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Developing Communication Skills
Critical thinking
Perseverance and creativity
Self-confidence
Humility
Integrity
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Developing Communication Skills
(Cont.)
Thinking is influenced by perception
➢ Five senses
➢ Culture
➢ Education
Perceptual bias
Emotional intelligence
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Levels of Communication
Intrapersonal
Interpersonal
Small group
Public
Electronic
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Elements of the Communication
Process
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Circular Transactional Model
Components
➢ Referent
➢ Sender and receiver
➢ Message
➢ Channels
➢ Feedback
➢ Interpersonal variables
➢ Environment
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Forms of Communication
Verbal communication
➢ Vocabulary
➢ Denotative and connotative meaning
➢ Pacing
➢ Intonation
➢ Clarity and brevity
➢ Timing and relevance
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Forms of Communication (Cont.)
Nonverbal
➢ Personal appearance
➢ Posture and gait
➢ Facial expressions
➢ Eye contact
➢ Gestures
➢ Sounds
➢ Territoriality and personal space
Metacommunication
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Nurse-Patient Relationship
Caring relationships are the foundation of clinical
nursing practice.
Therapeutic relationships promote a
psychological climate that facilitates positive
change and growth.
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Nurse-Patient Relationship (Cont.)
1. Preinteraction phase: occurs before meeting
the patient
2. Orientation phase: when the nurse and the
patient meet and get to know each other
3. Working phase: when the nurse and the
patient work together to solve problems and
accomplish goals
4. Termination phase: occurs at the end of a
relationship
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Motivational Interviewing
A technique that holds promise for encouraging
patients to share their thoughts, beliefs, fears,
and concerns with the aim of changing their
behavior.
The interviewing is delivered in a
nonjudgmental, guided communication
approach.
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Professional Nursing Relationships
(Cont.)
Nurse-family relationships
Nurse-health care team relationships
Nurse-community relationships
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Elements of Professional
Communication
Appearance,
demeanor, and Courtesy
behavior
Use of names Trustworthiness
Autonomy and
Assertiveness
responsibility
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Nursing Process: Assessment
Through the patient’s eyes
➢ Gather information, synthesize, apply critical thinking
Physical and emotional factors
Developmental factors
Environmental factors
Gender
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Nursing Diagnosis
Nursing diagnosis for communication
➢ Many patients experience difficulty with
communication:
• Lacking skills in attending, listening, responding, or self-
expression
• Inability to articulate, inappropriate verbalization
• Difficulty forming words
• Difficulty with comprehension
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Planning
Goals and outcomes
➢ Specific and measurable
Setting of priorities
Teamwork and collaboration
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SKILLS
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Implementation
Therapeutic communication techniques are
specific responses that encourage the
expression of feelings and ideas and convey
acceptance and respect.
➢ Active listening means being attentive to what a
patient is saying both verbally and nonverbally.
➢ Use “SURETY”: Sit facing the patient; observe an
open posture, lean toward the patient, establish and
maintain intermittent eye contact; relax
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Implementation (Cont.)
Therapeutic {Insert Figure 24-2
communication here}
techniques (Cont.)
➢ Sharing observations
➢ Sharing empathy
➢ Sharing hope
➢ Sharing humor
➢ Sharing feelings
➢ Using touch
➢ Using silence
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Implementation (Cont.)
Therapeutic communication techniques (Cont.)
➢ Providing information
➢ Clarifying
➢ Focusing
➢ Paraphrasing
➢ Validation
➢ Asking relevant questions
➢ Summarizing
➢ Self-disclosure
➢ Confrontation
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Implementation (Cont.)
Nontherpeutic communication techniques
➢ Asking personal questions
➢ Giving personal opinions
➢ Changing the subject
➢ Automatic responses
➢ False reassurance
➢ Sympathy
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Implementation (Cont.)
Nontherpeutic communication techniques
(Cont.)
➢ Asking for explanations
➢ Approval or disapproval
➢ Defensive responses
➢ Passive or aggressive responses
➢ Arguing
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Adapting Communication
Techniques
Patients who cannot speak clearly
Cognitive impairment
Hearing impairment
Visual impairment
Unresponsive
Patients who do not speak English (or your
language)
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Evaluation
Through the patient’s eyes
Patient outcomes
➢ Nurses and patients 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.
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THANK YOU.
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