NCM 103 FUNDAMENTALS OF NURSING PRACTICE  Takes place within a social context and includes

MAE CHRISTE LIMBARING-ELEGADO, MAN, RN all the symbols and cues used to give and
NCM103 Fundamentals in Nursing Practice receive meaning.
2nd Semester, SY 2022-2023
SMALL GROUP COMMUNICATION
ART OF COMMUNICATION IN NURSING  Interaction that occurs when a small number of
persons meet.
Learning Outcomes:  Usually, goal directed and requires an
At the end of the learning activity, the students will be understanding of group dynamics.
able to:
 Describe the use and importance of PUBLIC COMMUNICATION
communication process in nursing.  Interaction with an audience
 Identify levels of communication.  Requires special adaptations in eye contact,
 Describe qualities, behaviors, communication gestures, voice inflection, and use of media
techniques and barriers that affect professional materials to communicate messages effectively.
communication.
ELECTRONIC COMMUNICATION
 Discuss effective communication techniques for
clients at various developmental levels.  Use of technology to create ongoing
relationships with patients and their health care
team.
 Electronic portal
WHAT IS COMMUNICATION?
ELEMENTS OF THE COMMUNICATION PROCESS
 Process of exchanging information and the
process of generating and transmitting CIRCULAR TRANSACTIONAL COMMUNICATION MODEL
meanings between 2 or more individuals. Elements:
 Life-long learning process  Referent
 Essential part of patient-centered nursing care.  Sender
 Essential to patient safety & high-quality patient  Receiver
care.  Message
 Channels
 Context or environment
COMMUNICATION  Feedback
 Interpersonal variables
Effective communication is reciprocal interaction (two-
way process) based on trust and aimed at identifying REFERENT
client needs and developing mutual goals.  motivates one person to communicate with
another
 TRUST is the foundation of a positive nurse- o Sights,
client relationship. o Sound
o Odors
LEVELS OF COMMUNICATION o Time schedules
INTRAPERSONAL COMMUNICATION o Messages
 Self-talk, self-verbalization, inner thought o Objects
 Provides a mental rehearsal for difficult tasks or o Emotions
situations so individuals deal with them more o Sensations
effectively and with increased confidence. o Perceptions
 Self-awareness, positive self-esteem, o Ideas
appropriate self-expression
SENDER AND RECEIVER
INTERPERSONAL COMMUNICATION  Sender is the person who encodes and delivers
 One-on-one interaction between a nurse and the message
another person that often occurs face to face.  Receiver is the person who receives and
decodes the message.
  Transactional communication involves the role
of the sender and receiver switching back and
forth between nurse and patient.
MESSAGE
 Content of the communication.
 Verbal, nonverbal expressions of thoughts and
feelings
FEEDBACK
 Message the receiver returns or the message a
receiver receives from the sender
 Indicates whether the receiver understood the
meaning of the sender’s message.
INTERPERSONAL VARIABLES
 Factors within both the sender and receiver
that influence communication
o Perception
o Educational Level
o Values and beliefs
o Sociocultural background
o Emotions
o Gender
o Physical health status
o Roles and relationships
ENVIRONMENT
 Setting for sender-receiver interaction
 For effective communication the environment
needs to meet participant needs for physical
and emotional comfort and safety.
FORMS OF COMMUNICATION
VERBAL COMMUNICATION
 Uses spoken or written words
NONVERBAL COMMUNICATION
 Includes the five senses and everything that
does not involve the spoken or written word
 General Physical Appearance
 (Facial expression, mode of
dressing and grooming)
 Posture and Gait
 Touch
 Eye Contact
 Gestures
 Sounds
 Territoriality & Personal Space
 Silence
 Non-verbal communication is a more accurate
expression of a person’s thoughts and feelings
than verbal communication.
 When assessing nonverbal behaviors, consider
cultural influences.
CHARACTERISTICS OF COMMUNICATION
SIMPLICITY
 Use of commonly understood words, brevity
and completeness.
CLARITY
 Involves saying exactly what is meant.
TIMING AND RELEVANCE
 Require choice of appropriate time and
consideration of the client’s interests and
concerns.
ADAPTABILITY
 Involves adjustment on what the nurse says and
how it is said depending on the moods and
behavior of the client.
CREDIBILITY
 Means worthiness of belief. To become
credible, the nurse requires adequate
knowledge about the topic being discussed.
ZONES OF PERSONAL SPACE AND TOUCH
ZONES OF PERSONAL SPACE
INTIMATE ZONE (0 to 18 inches)
 Holding a crying infant
 Performing physical assessment
 Bathing, grooming, dressing, feeding, and
toileting a client.
 Changing a client’s dressing
PERSONAL ZONE (18 inches to 4 feet)
 Sitting at a client’s bedside
 Taking the client’s nursing history
 Teaching an individual client
 Exchanging information at change of shift
SOCIAL ZONE (4 to 12 feet)
 Making rounds with a physician Sitting at the
head of a conference table
 Teaching a class for clients with diabetes
 Conducting a family support group

PUBLIC ZONE (12 feet and greater)
 Speaking at a community forum
 Testifying at a legislative hearing
 Lecturing to a class of students
ZONES OF TOUCH
SOCIAL ZONE (permission not needed)
 Ex. Hands, arms, shoulders, back
CONSENT ZONE (permission needed)
 Ex. Mouth, wrists, feet
VULNERABLE ZONE (special care needed)
 Ex. Face, neck, front of body
INTIMATE ZONE (great sensitivity needed)
 Ex. Genitalia, rectum
PROFESSIONAL NURSING RELATIONSHIPS
NURSE – PATIENT CARING RELATIONSHIPS
 Exists among people who provide and receive
assistance in meeting human needs.
 Does not occur spontaneously.
 Occurs for a specific purpose with a
specific person
 Characterized by an unequal sharing of
information
 Built as the patient’s needs, not on
those of the helping person
 Social conversation
 Therapeutic relationship
 Narrative interaction
Motivational interviewing – technique that
holds promise for encouraging patients to share
their thoughts, beliefs, fears and concerns with
the aim of changing their behavior
PHASES OF HELPING RELATIONSHIPS
1. PRE-INTERACTION PHASE
 Before meeting the client
2. INTRODUCTORY PHASE/ORIENTATION PHASE/
PRE-HELPING PHASE
 Nurse and client meet and get to know
each other
3. WORKING PHASE
 Nurse and client work together to solve
problems and achieve goals
4. TERMINATION PHASE
 At the end of the relationship
THERAPEUTIC COMMUNICATION
 Fundamental component in all phases of the
nursing process, and for establishing effective
nurse – client relationship.
 Effective nurse-client relationship is a helping
relationship which is growth-facilitating and
provides support, comfort and hope.
CHARACTERISTICS OF AN EFFECTIVE
NURSE-CLIENT RELATIONSHIP
 Intellectual and emotional bond between the
nurse and the patient must be focused on the
patient.
 Respects the client as an individual – his ability
to participate in his care, ethnic and cultural
factors, family relationships and values
 Respects client’s confidentiality.
 Focuses on the client’s well-being.
 Based on mutual trust, respect and acceptance.
NURSE – FAMILY RELATIONSHIPS
 There are situations that a nurse is required to
form helping relationships with entire families.
NURSE – HEALTH CARE TEAM RELATIONSHIPS
 When patients move from one nursing unit to
another or from one provider to another, there
is a risk for miscommunication.
 Accurate communication is essential to prevent
errors.
 SBAR (Situation, Background, Assessment,
Recommendations) - a communication tool that
is standardized among health care providers.
NURSE – COMMUNITY RELATIONSHIPS
 Establish relationships with the community to
be an effective change agent
Channels of communication: neighborhood
newsletters, health fairs, public bulletin boards,
newspapers, radio, television, and electronic
information sites
ELEMENTS OF A PROFESSIONAL COMMUNICATION
 Courtesy
 Use of Names
 Trustworthiness
 Autonomy and Responsibility
 Assertiveness

BLOCKS TO COMMUNICATION
1. Failure to perceive the client as a human being
2. Failure to listen
3. Inappropriate comments and questions
4. Gossip and Rumor
GUIDELINES FOR NURSING CARE
RELATING TO CLIENTS FROM DIFFERENT CULTURE
1. Assess your personal beliefs surrounding
persons from different cultures.
2. Assess communication variables from a cultural
perspective.
3. Plan care based on the communicated needs
and cultural background.
4. Modify communication approaches to meet
cultural needs.
5. Understand that respect for the client and
communicated needs is central to the
therapeutic relationship.
6. Communicate in a non-threatening manner.
7. Use validating techniques in communication.
8. Be considerate of reluctance to talk when the
subject involves sexual matters.
9. Adopt special approaches when the client
speaks a different language.
10. Use interpreters to improve communication.
THERAPEUTIC COMMUNICATION TECHNIQUE
COMMUNICATION TECHNIQUES
 Specific responses that encourage the
expression of feelings and ideas and convey
acceptance and respect.
ACTIVE LISTENING
 means being attentive to what the client is
saying both verbally and nonverbally.
 Several Non- Verbal Skills
 S - SIT
 O - OBSERVE
 L - LEAN
 E - ESTABLISH
 R – RELAX
SHARING OBSERVATIONS
 Nurses make observations by commenting on
how the other person looks, sounds, or acts.
SHARING EMPATHY
 Empathy is the ability to understand and accept
another person’s reality, accurately perceive
feelings, and communicate this understanding
to the other.
SHARING HOPE
 Hope is essential for healing
 One should learn to communicate a “sense of
possibility” to others
SHARING HUMOR
 Humor is a coping strategy that adds
perspective and helps a nurse and patient
adjust to stress
 “Any intervention that promotes health and
wellness by stimulating a playful discovery,
expression or appreciation of the absurdity or
incongruity of life’s situations.”
SHARING FEELINGS
 Nurses help patients express emotions by
making observations, acknowledging feelings,
encouraging communication, giving permission
to express “negative” feelings, and modeling
healthy emotional self-expression.
USING TOUCH
 Physical touch played a central role in healing.
 It conveys many messages such as affection,
emotional support, encouragement,
tenderness, and personal attention.
USING SILENCE
 Allow time for a nurse and patient to observe
one another, sort out feelings, think about how
to say things, and consider what has been
communicated.
 Silence prompts some people to talk.
 It allows a patient to think and gain insight.
PROVIDING INFORMATION
 This will tell other people what they need or
want to know so they are able to make
decisions, experience less anxiety, and feel safe
and secure.
CLARIFYING
 To check whether understanding is accurate,
restate an unclear or ambiguous message to
clarify the sender’s meaning.
FOCUSING
 Useful technique if conversation is vague, or
rambling, or when patients begin to repeat
themselves.

PARAPHRASING
 Restating another’s message more briefly using
one’s own words.
 Sending feedback that lets a patient know that
he or she is actively involved in the search for
understanding.
ASKING RELEVANT QUESTION
 To seek information needed for decision making
 Use open-ended questions
 Use focused question when more specific
information is needed in an area
SUMMARIZING
 Concise review of key aspects of an interaction
 It brings a sense of satisfaction and closure to
an individual conversation.
SELF – DISCLOSURE
 Self-disclosures are subjectively true personal
experiences about the self that are intentionally
revealed to another person.
 Indicates closeness of the nurse-patient
relationship and involves a particular kind of
respect for the patient.
CONFRONTATION
 One can help the other person become more
aware of inconsistencies in his or her feelings,
attitudes, beliefs, and behaviors.
NON-THERAPEUTIC COMMUNICATION TECHNIQUE
1. Asking Personal Questions
o Asking personal questions that are not
relevant to the situation simply to
satisfy your curiosity is not appropriate
professional communication.
o nosy, invasive, and unnecessary
2. Giving Personal Opinions
o It could take away decision making from
the other person.
o It inhibits spontaneity, stalls problem
solving, and creates doubt.
3. Changing the Subject
o It is rude and shows a lack of empathy.
o It tends to block communication, and
the sender then withholds important
messages or fails to openly express
feelings.
4. Automatic Responses
o Stereotyping is generalized beliefs held
about people. Making stereotyped
remarks about others reflects poor
nursing judgment and threatens nurse -
patient or team relationships.
o Parroting - repeating what the other
person has said word for word
5. False Reassurance
o It discourages open communication.
o Offering reassurance not supported by
facts or based in reality does more
harm than good.
6. Sympathy
o It is a concern, sorrow, or pity felt for a
patient.
o Taking patient’s problem as if they were
his or her own.
7. Asking for Explanations
o Patients frequently interpret “why”
questions as accusations or think the
nurse knows the reason and is simply
testing them.
o “why” questions cause resentment,
insecurity, and mistrust
8. Approval or Disapproval
o Judgmental responses often contain
terms such as should, ought, good, bad,
right, or wrong.
o Agreeing or disagreeing sends the
subtle message that you have the right
to make value judgments about patient
decisions.
o Approving implies that the behavior
being praised is the only acceptable
one.
o Disapproval implies that the patient
needs to meet your expectations or
standards.
9. Defensive Responses
 o Becoming defensive in the face of
criticism implies that the other person
has no right to an opinion.
10. Passive or Aggressive Responses
o Passive responses serve to avoid
conflict or sidestep issues.
o Aggressive responses provoke
confrontation at the other person’s
expense.
11. Arguing
o Challenging or arguing against
perceptions denies that they are real
and valid to the other person.
o It implies that the other person is lying,
misinformed, or uneducated.
COMMUNICATING IN SPECIAL CIRCUMSTANCES
1. Clients who are visually impaired
o Check for use of glasses or contact
lenses.
o Identify yourself when you enter room
and notify patient when you leave
room.
o Speak in a normal tone of voice.
o Do not rely on gestures or nonverbal
communication.
o Use indirect lighting, avoiding glare.
o Use at least 14-point print.
2. Clients who are hearing impaired
o Check for hearing aids and glasses.
o Reduce environmental noise.
o Get patient’s attention before speaking.
o Face patient with mouth visible.
o Do not chew gum.
o Speak at normal volume—do not shout.
o Rephrase rather than repeat if
misunderstood.
o Provide a sign language interpreter if
indicated.
3. Clients with a physical barrier
4. Clients who are cognitively impaired
o Use simple sentences and avoid long
explanations.
o Ask one question at a time.
o Allow time for patient to respond.
o Be an attentive listener.
o Include family and friends in
conversations, especially in subjects
known to patient.
5. An unconscious client / Clients who are
unresponsive
o Call patient by name during
interactions.
o Communicate both verbally and by
touch.
o Speak to patient as though he or she
can hear.
o Explain all procedures and sensations.
o Provide orientation to person, place,
and time.
o Avoid talking about patient to others in
his or her presence.
6. Clients who speak a foreign language
o Speak to patient in normal tone of
voice.
o Establish method for patient to ask for
assistance (call light or bell).
o Provide an interpreter as needed.
o Avoid using family members, especially
children, as interpreters.
o Use communication board, pictures, or
cards.
o Translate words from native language
into English list for patient to make
basic requests.
o Have dictionary (e.g., English/Spanish)
available if patient can read.