Communication in Nursing

" A person cannot not communicate"

1. Purpose

1) To establish nurse-patient relationship

2) To be effective in expressing interest/concern for patient/family

3) To provide health care information

2. Essential skills

1) Personal insight

2) Sensitivity

3) Knowledge of communication strategies

3. Definition

“ complex process of sending and receiving verbal and non-verbal messages. Allows for exchange of information, feelings, needs, and preferences”

Source/sender and receiver encode and decode message in a cyclic pattern.

4. Goal

Shared Meaning Mutual understanding of the meaning of the message Feedback/response indicates if the meaning of the message was communicated as intended:

5. Levels of communication

1) Social: safe

2) Structured: interviewing, teaching

3) Therapeutic: patient focused, purposeful, time limited Nurse comes to know the patient as a unique individual. Patient comes to trust nurse Context set for nurse to provide care and to help patient identify, resolve, or adapt to health problems

6. Types of Communication

1) Verbal :

conscious use of spoken or written word Choice of words can reflect age, education, developmental level, culture Feelings can be expressed through tone, pace, etc. Characteristics: simple, brief, clear, well timed, relevant, adaptable, credible

2) Non-verbal :

a. use of gestures, expressions, behaviors (body language)

b. 85% of communication

c. Less conscious than verbal

d. Requires systematic observation and valid interpretation

e. Nurse must be aware of personal style

f. How we communicate non-verbally:

physical appearance, posture/gait, facial expressions, gestures, touch (tactile defensiveness)

7. Relationship between verbal and non-verbal communication

Congruency: are verbal and non-verbal messages consistent?

Nurse states observations and validates with patient

Nurse to crying patient: "You seem upset today."

Patient: "I'm fine thanks."

8. Factors that affect communication

Nurse needs to assess and consider when communicating with patient:

“culture, developmental level, physical & psychological barriers, personal space (proxemics), territoriality, roles and relationships, environment, attitudes and values, level of self esteem”

9. Communication Strategies:

1) Active Listening is most critical strategy

2) Strategies that encourage Conversation and Elaboration:

broad opening statements, general leads, reflecting, open-ended and directing questions

3) Strategies that help patient express thoughts and feelings:

stating observations, acknowledging feelings, reflecting, using silence

4) Strategies that insure mutual understanding:

clarifying, validating, verbalizing implied thoughts and feelings, focusing, using closed questions and summary statements

10. Blocks/Barriers to Communication:

Behaviors or comments of the nurse that have a negative effect:

1) Not Listening is most harmful behavior!

reassuring cliches, giving advice, expressing approval/disapproval, requesting an explanation (asking why?), defending, belittling feelings, stereotyped comments, changing the subject

2) Reporting and Documenting

v Reporting: oral, written, or computer account of patient status; between members of health care team. Report should be clear, concise, and comprehensive.

v Documenting: patient record/chart provides written documentation of patient’s status and treatment

v Purpose: continuity of care, legal documentation, research, statistics, education, audits

3) Patient Privacy: Related terms

v Confidential Information: is specific to patients, their diagnosis and treatment.

v Privacy: refers to the patient’s right to control access to confidential information.

v Confidentiality: refers to the professional responsibility to protect patient privacy.

v Need to Know: who has access to what information.

4) Protection of Patient Privacy

Health Insurance Portability and Accountability Act (HIPAA)

Federal guidelines: effective April, 2003

1. Prohibit disclosure for reasons unrelated to health services.

2. Set civil and criminal penalties for violators.

3. Give patients the right to inspect and copy their records.

4. Require providers to notify patients of privacy policies.

11. Legal Concerns :

Record/chart is a legal document; may be admissable in court

If it’s not documented, it didn’t happen!

1) What to document: If it’s not documented, it didn’t happen!

assessment, plan of care, nursing interventions (care, teaching, safety measures), outcome of care, change in status, health care team communication, how the nurse left the patient

2) How to document:

- Use ink

- Write legibly

- Spell correctly

- Use standard abbreviations

- Date, time, chronological order

- Errors and blanks

- Signature and title

3) Characteristics of documentation:

brief, concise, comprehensive, factual, descriptive, objective, relevant/appropriate, legally prudent

4) Types of documentation: Based on how record is organized