Communication Process

Exchanges information with the receiver

Sender

Communication Process

Receives the information from the sender

Receiver

Communication Process

Product of the communication

Message

Communication Process

Interpretation of the message by the receiver

Perceived

What is the best technique to make sure you are understanding the pt?

Validation

What is the best was to make sure the pt is understanding the nurse?

Through feedback

What is important to do when charting what the pt said?

Put it in "quotes"

What are the 2 primary channels of communication?

Verbal and non-verbal

It is important to use proper ____ and ____ when charting so the doctor can accurately define s/s.

Grammar

Medical Vocabulary

How has telephone communication prevented hospitalization of a person?

Crisis and suicide hotline

Use of telephone communication can reduce ____, which is the constant addmission and discharge of a pt in the mental health system.

How is this done? (3 ways)

Recidivism

1. Case management for “high risk patients” (avoid escalation)

2. Facilitating discharge planning (determining referrals)

3. Increasing adherence to follow-up appointments & treatment (reminders for appointments scheduled months in advance)

What is the most important thing to remember when using email communication?

Be cautious of your tone

What are some reasons that doctors tend to not like using electronic communication?

1. Security and privacy issue (HIPPA/hacking)

2. Legal and ethical concerns (changing meds without seeing pt)

3. Guidelines and standards

4. Managing the volume of e-mails (overuse by pt)

Why are satellite clinics better than long distant clinics?

Can see the pt non-verbals

What important to remember about electronic medical records?

Must take care in not reducing patient data to “checks in a box”

____ and ____ of speech affects message

Rate

Emphasis

____  ____ can enhance or change the meaning of speech.

Body language

What is important to chart about a pt verbal and non-verbal comunication?

That they are congruent

What is "elder speak"?

Speaking loudly to an elderly pt based on stereotype that all elderly pt can’t hear well (avoid)

What is important to integrate into a pt plan of care and assessment?

(different for every person)

Cultural preferences

Themes of pt Communication

Goes beyond the words pt uses and underlying messages about their perceptions of themselves and their problems overtime

Content Themes

Themes of pt Communication

Affect and feelings conveyed while pt discusses their issues and concerns (shame, guilt, anger, sadness, and fear)

Mood Themes

Themes in pt Communication

Ways pt relate to family friends, other pt, and staff (dependent, manipulation)

Interaction Themes

Name things that can facilitate or impede therapeutic communication that are enviromental.

Noise level, privacy, types of furniture, space, and temperature

What are proxemics?

The way in which people perceive and use environmental, social, and personal space during interactions

What is the best length for personal space?

(used in one-on-one)

18 inches - 4 feet

What is important to do when communicating with a pt with a sensory limitation such as hearing loss?

(2 things)

1. Speak face-to-face with pt for lip reading

2. Put hearing aids in

What is important to do when communicating with a pt with a developmental disability such as the inability to comprehend or remember?

(3 things)

1. Use simple sentences with a single idea

2. Use a slow speech rate and don't overload

3. Repeat sentences as needed

What is important to do when communicating with a pt with a speech impediment or with a pt that you cannot understand?

(3 things)

1. Ask for repetition and clarification (don't use excessively, it increases frustration)

2. Use validation

3. Have the pt write their answers

What's important to remember about communicating with a pt that is in physical pain?

May interfere with thinking clearly and concentrating and may affects the sense of priority regarding problems to be addressed

What's important to remember when communicating with a pt that has a physical deformity, particularly a facial deformity?

Pt watches you facial expression and where your eyes are focused. Don't focus on the area or make negative facial expressions.

What are kinesics?

Study of body movements (gestures, mannerisms, facial expression, eye movement)

What is the major influence on different kinesics?

Culture

What might prolonged eye contact indicate?

Pt disengaging or ignoring communication

What might a pt project by crossing their arms?

(2 things)

1. Pt is becoming defensive

2. Pt is cold

If a pt verbal and non-verbal messages are not congruent, what should the nurse do? What is the best way to do this?

Explore the reason

Through validation

What are some differences between social communication and therapeutic communication?

1. Therapeutic is focused on the pt

2. Therapeutic must only be shared with the treatment team (confidentiality)

3. Therapeutic the nurse cannot keep secrets

4. Therapeutic relies on the pt to communicate and be honest

5. Therapeutic nurse must remain objective and not give advice

What are the 2 most crucial things to get a pt to open up to the nurse?

1. Use silence

2. Be an active listener

What is objectivity and what does it require from the nurse?

The process of remaining open to aspects of the patients, their problems, and potential solutions.

Requires the nurse to be self aware to avoid countertransference

What is empathy and what is important to know about it?

The ability to recognize and understand pt feelings and POV objectively

Never implies that the RN can fully experience pt feelings

What should a nurse do before touching a pt?

Ask for permission

What are the 3 influences on pt preference of being touched?

1. Culture

2. Past experience

3. Mental illness type

What is important for a nurse to know that might fear hurting a pt feelings during communication?

Pt do not fall apart or act out because of a nurse’s single mistake

How can a nurse make their mistake into a therapeutic encounter?

The nurse can role model the proper way to admit and apologize for an error

If a nurse makes an error, what is the most important thing to do to remain the integrity of the relationship?

Give a sincere apology

What is the number one thing a nurse can do to eliminate insecurity and fear?

Have proper knowledge

What should a nurse do if a pt confronts the nurses anxiety that is being portrayed?

Be truthful and say, “I am afraid I might say something that might upset you”

Definition

Responding to what is happening between the nurse and the pt in the here and now.

Immediacy

Facilitative Communication Skills

Repeating the pt verbal or non-verbal message for the pt benefit. Give the pt the opportunity to hear and think about what they said.

Reflecting Context

Facilitative Communication Skills

Verbalizing what seems to be implied about feelings in the pt comment

Reflecting Feelings

Facilitative Communication Skills

Helping the pt by supplying additional data. "Group therapy will be held on Tuesday evening from 6:30 - 8:30."

Imparting Information

Facilitative Communication Skills

An attempt to understand the basic nature of the pt statement. "You say you're feeling anxious now. What's that like for you?" "I'm confused about ... Could you go over that again please?"

Clarifying

Facilitative Communication Skills

The nurse assimilates and restates what she heard the pt communicate. "In other words, you're fed up with being treated like a child."

Paraphrasing

Facilitative Communication Skills

Nurse share how they perceive and the the pt.  "Let me know if this is how you see it too." "..., is that correct?"

Validating

When is the only time that a nurse should use close ended questions?

When dealing with a confused pt

Facilitative Communication Skills

A very direct way of speaking with the pt.

Questioning

Facilitative Communication Skills

An attempt to create order or evolve guidlines.

"Let's put your goals in a list based on priority."

Structuring

Facilitative Communication Skills

Calls attention to certain kinds of statement and relationships. Nurse may point out inconsistencies.

Pinpointing

Facilitative Communication Skills

The nurse responds to the pt in a way that ties 2 events, experiences, feelings, or persons. "You felt depressed after the birth of your children."

Linking

Facilitative Communication Skills

Helps other become aware of how their behavior affects us and how we perceive their actions.

Giving feedback

Facilitative Communication Skills

A deliberate inivation to another to examine some aspect of personal behavior in which there is a discrepancy between what the pt say and what they do.

Confronting

Facilitative Communication Skills

A way of highlighting the main ideas that have been discussed. "The last time we were together, you were concerned about..."

Summarizing

Communication Blocks

"Don't worry. You'll do just fine."

False Reassurance

Communication Blocks

"You better change your attitude or you will blow it."

Preaching

Communication Blocks

Well, the interview is probably more important than waitressing. Take the night off, go home, practice typing, get a good night's cleep, and do your best."

Advising

(giving advice)

Communication Blocks

"Your problem is poor self confidence. If you don't believe you'll do ok, then you probably won't."

Diagnosing

Communication Blocks

"It's only an interview. A hundred years from now, no one will ever know how many words you typed per minute."

Minimizing

Communication Blocks

"How much practice have you done? Have you tried timing yourself? Have you read any books about interviewing? Have you looked up any information about the company?"

Cross-examining

Communication Blocks

"Where do you waitress?"

Avoidance

Communication Blocks

You'd better brush up on your typing if you ever expect to do anything other than waitress."

Warning