LECTURE NOTES

Fritz Gerald V. Jabonete, MAN, RN

Week 2
Communication Process
LEARNING OUTCOMES • Sender
1. Define communication. – The source-encoder
2. Describe the components of the – A person or group who wishes to
communication process. communicate a message to another
3. Discuss the various aspects that nurses need to • Message
consider when using the different forms of – The message itself
communication. – What is said or actually written
4. Describe factors influencing the communication • Receiver
process. – The decoder
– The listener
5. Compare and contrast therapeutic • Response
communication techniques that facilitate – Feedback
communication and focus on client concerns. – Message that receiver returns to sender
6. Recognize barriers to communication.
7. Describe four phases of the helping
relationship.
8. Discuss characteristics of an effectively
functioning group.
9. Identify types of groups helpful in promoting
health and comfort.
10. Discuss how nurses use communication skills in
each phase of the nursing process.
11. State why effective communication is
imperative among health professionals. Modes of Communication
12. Describe the following disruptive behaviors and
how they affect the health care environment • Verbal
and client safety: incivility, lateral violence, and – Uses spoken or written word
bullying. • Nonverbal
13. Discuss the differences between nurse and – Uses gestures, facial expressions, touch,
physician communication and how to address and other forms
these differences. – Makes up majority of communication
• Electronic
14. Differentiate the major characteristics of - E-mail
assertive and nonassertive communication.
Verbal Communication
• Pace and intonation
• Simplicity; clarity and brevity
• Timing and relevance
• Adaptability
Communication • Credibility
• Critical nursing skill used to gather data, • Humor
teach and persuade, express caring and
comfort Non- Verbal Communication
• Interchange of information, ideas, or feelings • Personal appearance
between two or more people • Posture and gait
• Process: to influence, to obtain information • Facial expression
• Includes verbal and nonverbal methods • Gestures
• Includes self-talk
Electronic Communication

A. E-mail advantages
– Fast, efficient
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN

– Provides record • Offering self

– Can improve communication • Giving information
and continuity of care • Acknowledging
• Seeking clarification
B. E-mail disadvantages • Perception checking, seeking consensual
– Risk to client confidentiality (HIPAA) validation
– Socioeconomics • Offering self
– May not enhance communication with all • Giving information
– Avoid when information is urgent to • Acknowledging
client’s health, highly confidential, or
Barriers to Communication
potentially distressing or confusing (e.g.,
abnormal lab values)
• Need to be recognized when they occur
• Major barriers
Factors Influencing Communication Process – Failure to listen
– Improperly decoding client’s intended
• Development message
• Gender – Placing nurse’s needs above client’s
• Values and perceptions needs
• Personal space • Stereotyping
– Intimate (touching to 1 ½ feet) • Agreeing and disagreeing
– Personal (1 ½ to 4 feet) • Being defensive
– Social (4 to 12 feet) • Challenging
– Public (12 to 15 feet) • Probing
 Territoriality • Testing
• Roles and relationships • Rejecting
• Environment • Changing topics and subjects
• Congruence • Unwarranted reassurance
• Interpersonal attitudes • Passing judgment
– Caring and warmth • Giving common advice
– Respect
– Elderspeak Nurse-Client Relationships
• Boundaries
• Referred to as
Therapeutic Communication – Interpersonal relationship
• Promotes understanding – Therapeutic relationship
• Establishes constructive relationships – Helping relationship
• Attentive listening
– Listening actively Phases of Helping Relationship
• Physical attending • Pre-interaction
– Manner of being present to • Introductory
another • Working (maintaining)
– Five actions • Termination

1. PRE-INTERACTION
Therapeutic Communication Techniques
• Using silence • Obtain information before first face-to-face
• Providing general leads meeting
• Being specific and tentative – Name, address, age, medical history,
• Using open-ended questions and/or social history
• Using touch • Anxious feelings in nurse addressed by
• Restating or paraphrasing identifying specific information to be
• Seeking clarification discussed
• Perception checking, seeking consensual • Positive outcomes can evolve
validation
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN
2. INTRODUCTORY
 Orientation Phase
a. Sets tone for rest of the relationship
 Develop trust and security
 Getting to know each other
 Resistive behaviors may be displayed
a. Inhibit involvement, cooperation, or
change
3. WORKING
 View each other as unique individuals
 Once caring develops, empathy increases
 Exploring and understanding thoughts and
feelings
 Facilitating and taking action
 Helping client explore thoughts, feelings, and
actions
 Helping client plan a program of action to
meet pre-established goals
 Exploring and understanding thoughts and
feelings
a. Empathetic listening and responding
b. Empathy
c. Ability to experience, in the present, a
situation as another person did at some
time in the past
• Exploring and understanding thoughts and
feelings
• Facilitating and taking action
– Client must make decision and take
action
– The responsibility belongs to the client
– Nurse collaborates in these decisions,
provides support, may offer options or
information
4. TERMINATION
• Nurse and client accept feelings of loss
• Client accepts the end of the relationship
without feelings of anxiety or dependence
GROUP COMMUNICATION
• Group – two or more people with shared
needs and goals
• Group dynamics – communication between
any members of a group, affecting the group
process
Types of Healthcare Groups
• Task groups
• Teaching groups
• Self-help groups
• Self-awareness/growth groups
• Therapy groups
• Work-related social support groups
Disruptive Behaviors Affecting Nursing
• Negative impact on work environment
• Cause departures from the nursing
profession
• Interfere with effective communication
• Negatively affect performance and outcomes
• Incivility
• Rudeness, discourtesy, disrespect
• Lateral violence
• Negative physical, verbal, nonverbal, or
emotional behaviors directed at co-workers
at same organizational level
• Bullying
• Offensive, abusive, intimidating, insulting
behavior or abuse of power
• Recipient feels upset, threatened, humiliated,
or vulnerable
Assertive Communication
• Promotes client safety by minimizing
miscommunication with colleagues
• Honest, direct, and appropriate; open to
ideas
• Respects rights of others
• “I” statements, not “you” statements
– “You” statements place blame and put the
listener in a defensive position
– “I” statements encourage discussion
Non- Assertive Communication
• Submissive communication
– Allows one’s own rights to be violated by
others
– Meets the demands and requests of others
without regard to own feelings and needs
– Believes own feelings are not important
– Is insecure and tries to maintain self-
esteem by avoiding conflict
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN

Eg. Developmental screening condition to lessen its

severity, Vision and hearing screening,
vaccination during an epidemic

– Tertiary - focus on restoration and

rehabilitation; goal to return individual to
optimal level of functioning
Eg. Rehabilitation activities for child after a car
crash

C.) HEALTH MAINTENANCE

Learning Outcomes
- referstoactivitiesthatpreserveanindividual’spresentst
1. Differentiate ateofhealthandthatpreventdiseaseorinjuryoccurrenc
a. Health Promotion e.
b. Health Prevention
c. Health Maintenance or Restoration Examples
d. Health Rehabilitation Developmentalscreeningorsurveillancetoidentifyearlyde
viations from normal development, providing
immunizations to prevent illnesses, and teaching about
common childhood safety hazards.
A.) HEALTH PROMOTION
While it is clear that health promotion and health
Health promotion refers to activities that increase well-being maintenance activities are closely linked and often
and enhance wellness or health (Pender, Murdaugh, & overlap, there are some differences.
Parsons, 2006).
Health maintenance focuses on known potential health
These activities lead to actualization of positive health risks and seeks to prevent them or identify them early
potential for all individuals, even those with chronic or acute so that intervention can occur.
conditions.
Examples Health promotion looks at the strengths and goals of
individuals, families, and populations, and seeks to use
 Enhance nutrition at each developmental stage
them to assist in reaching higher levels of wellness. It
 Integrate physical activity into the child’s daily events
involves partnerships with the family as health goals
 Provide adequate housing
are set, and with other health professionals and
 Promote oral health
resources to provide for meeting the
Health promotion is concerned with developing sets of
D.) HEALTH REHABILITATION
strategies that seek to foster conditions that allow
- The process of helping a person who has suffered
populations to be healthy and to make healthy choices
an illness or injury restore lost skills and so regain
(World Health Organization, 2001).
maximum self-sufficiency.
B.) HEALTH PREVENTION
For example, rehabilitation work after a stroke may
help the patient walk and speak clearly again.
• Three levels of prevention
– Primary - focus on health promotion,
Learning Outcomes
protection against specific health problems
Eg. Giving immunizations for illness or injury
1. Discuss the the problem-solving process and
Teaching about car safety seats
use of Concept Maps
– Secondary - focus on early identification
and prompt intervention for health problems
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN

6. Identify three methods of data collection

and give examples of how each is useful.
Problem- Solving Process 7. Compare directive and nondirective
approaches to interviewing.
• Clarify the nature of a problem and suggest
possible solutions 8. Compare closed and open-ended questions,
• One situation contributes to the nurse’s body providing examples and listing advantages
of knowledge for problem solving in similar and disadvantages of each.
situations 9. Describe important aspects of the interview
• Commonly used approaches setting.
– Trial and error 10. Contrast various frameworks used for
– Intuition
nursing assessment.
– Research process

NURSING PROCESS OVERVIEW

• Nursing process – systematic, rational

method
• Five or six phases
– Assessing
– Diagnosing
– Identifying outcomes (sometimes
included)
– Planning
– Implementing
– Evaluating

Characteristics of Nursing Process

• Cyclic and dynamic rather than static
• Client centered
• Problem-solving and systems theory
• Decision making
• Interpersonal and collaborative
• Universal applicability
• Critical thinking skills

ASSESSING
Types of concept maps: A, hierarchical; B, spider; C,
flowchart; D, systems.

ASSESSING

LEARNING OUTCOMES
1. Describe the phases of the nursing process.
2. Identify major characteristics of the nursing
process.
3. Identify the purpose of assessing.
4. Identify the four major activities associated
with the assessing phase.

5. Differentiate objective and subjective data

and primary and secondary data.
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN
• Data (information) gathered systematically
• 4 types of assessment
– Initial nursing assessment
– Problem-focused assessment
– Emergency assessment
– Time-lapsed reassessment
Types of Assessment
• Initial
– Performed within a specified time
period
– Establishes complete database
• Problem-Focused
– Ongoing process integrated with care
– Determines status of a specific problem
 Emergency
– Performed during physiologic or
psychologic crises
– Identifies life-threatening problems
– Identifies new or overlooked problems
• Time-lapsed
– Occurs several months after initial
– Compares current status to baseline
A.) COLLECTING DATA
• Gathering information about client’s health
status
• Must be systematic and continuous
• Includes past history and current problem
• Subjective or objective
• Primary or secondary source
• Establishes database
A. Subjective Data
• Symptoms or covert data
• Apparent only to person affected
• Can be described only by person affected
• Includes sensations, feelings, values, beliefs,
attitudes, and perception of personal health
status and life situations
B. Objective Data
• Signs or overt data
• Detectable by an observer
• Can be measured or tested against an
accepted standard
• Can be seen, heard, felt, or smelled
• Obtained through observation or physical
examination
Sources of Data
• Primary source
– The client
• Secondary sources
– All other sources of data (support
people, records, other health care
professionals, literature)
– Should be validated, if possible
Methods of Data Collection
• Observing
– Gathering data using the senses
– Used to obtain following types of data:
 Skin color (vision)
 Body or breath odors (smell)
 Lung or heart sounds (hearing)
 Skin temperature (touch)
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN

• Interviewing • Seating arrangement

– Interview - planned communication or a – Hospital
conversation with a purpose – Office or clinic
– Used to: – Group
• Distance
 Get or give information
– Comfortable
 Identify problems of mutual concern
• Language
 Evaluate change
– Use easily understood terms
 Teach
– Interpreter or translator
 Provide support
 Provide counseling or therapy
Stages of Interview
a. Directive Approach to Interviewing
• Nurse establishes purpose 1. Opening – establish rapport, orient client
2. Body – client communicates, nurse asks questions
• Nurse controls the interview 3. Closing – nurse ends interview when necessary
• Used to gather and give information when information is collected
time is limited, e.g., in an emergency
2.) ORGANIZING THE DATA
b. Non-Directive Approach to Interviewing Frameworks for Nursing Assessment
• Rapport-building
• Client controls the purpose, subject matter, • Nursing models framework
and pacing – Gordon’s functional health pattern
• Combination of directive and nondirective framework
approaches is usually appropriate during – Orem’s self-care model
information-gathering interview – Roy’s adaptation model

Types of Interview Questions • Wellness models

• Nonnursing models
• Closed questions – Body systems model
– Restrictive – Maslow’s Hierarchy of Needs
 Yes/no – Developmental theories
 Factual
– Less effort and information from client
– “What medications did you take?” 3.) VALIDATING THE DATA
– “Are you having pain now?”
• Assessment complete
• Validation -determining that objective and
• Open-ended questions related subjective data agree
– Specify broad topic to discuss • Clarify vague statements
– Invite longer answers • Double-check extreme data; use references
– Get more information from client as needed
– Useful to change topics and elicit • Determine which data can be overlooked
attitudes • Differentiate between cues and inferences
• Neutral question • Avoid jumping to conclusions
• Leading question

Factors in Interviewing Setting 4.) DOCUMENTING THE ASSESSMENT

• Time • Record client data

– Client free of pain • Record in factual manner; do not state
– Limited interruptions interpretations
• Place • Record subjective data with quotes in client’s
– Private own words
– Comfortable environment
– Limited distractions
LECTURE NOTES
Fritz Gerald V. Jabonete, MAN, RN