Transpersonal – Interaction within a person’s

NCM 122: Fundamentals of Nursing Practice

spiritual domain
THERAPEUTIC COMMUNICATION Small Group – Interactions with a small
number of people
Diagnosis Public – Interaction with an audience
Intervention

COMMUNICATION AND NURSING PRACTICE

You are invited to attend the weekly unit patient care
A lifelong learning process for nurses conference. The staff discusses patient care issues.
Therapeutic communication promotes This type of communication is:
personal growth and attainment of patient’s
health-related goals. a. Public
Key to nurse-patient relationships b. Intrapersonal
Patient safety requires effective c. Transpersonal
communication d. Small Group
Improves patient outcomes and increases
patient satisfaction CIRCULAR TRANSACTIONAL MODEL

Referent
COMMUNICATION AND INTERPERSONAL
Sender and Receiver
RELATIONSHIPS
Message
Communication establishes caring, healing Channels
relationships Feedback
The ability to relate to others is important for Interpersonal Variables
interpersonal communication. Environment
Communication, including posture,
expressions, gestures, words, and attitudes
has the power to hurt or heal.
Referent – Motivates one to communicate with
DEVELOPING COMMUNICATION SKILLS another
Sender and Receiver – One who encodes
Critical thinking and one who decodes the message
Perseverance and Creativity Message – Content of the message
Self-Confidence Channels – Means of conveying and receiving
Humility messages
Integrity Feedback – The setting for sender-receiver
interactions
THINKING IS INFLUENCED BY PERCEPTION Interpersonal Variables -Message the
receiver returns
Five Senses
Environment – Factors that influence
Culture
communication
Education
Perceptual Bias
VERBAL COMMUNICATION
Emotional Intelligence
Vocabulary
LEVELS OF COMMUNICATION Denotative and Connotative Meaning
Pacing
Intrapersonal
Intonation
Interpersonal
Clarity and Brevity
Small Group
Timing and Relevance
Public
Electronic
NONVERBAL COMMUNICATION

Personal Appearance
Posture and Gait
Intrapersonal - Occurs within an individual Facial Expressions
Interpersonal – One-to-one interaction Gestures
between two people Sounds
Territorial and Personal Space
 METACOMMUNICATION
NURSING ACTIONS WITHIN THE ZONES OF
PERSONAL SPACE
INTIMATE ZONE (0 -18 INCHES)
Holding a crying infant
Performing physical assessment
Bathing, grooming, dressing, feeding, and
toileting a patient
Changing a patient’s dressing
PERSONAL ZONE (18 INCHES TO 4 FEET)
Sitting at patient’s bedside
Taking patient’s nursing history
Teaching an individual patient
Exchanging hand-off communication at
change of shift
SOCIAL ZONE (4-12 FEET)
Making rounds with a health care provider
Sitting at the head of a conference table
Teaching a class for patients with diabetes
Conducting a family group support
PUBLIC ZONE (12 FEET AND MORE)
Speaking at a community forum
Testifying at a legislative hearing
Lecturing to a class of students
NURSING ACTIONS WITHIN THE ZONES OF
TOUCH
SOCIAL ZONE (PERMISSION NOT NEEDED)
Hands
Arms
Shoulders
Back
CONSENT ZONE (PERMISSION NEEDED)
Mouth
Wrists
Feet
VULNERABLE ZONE (SPECIAL CARE
NEEDED)
Face
Neck
Front of Body
INTIMATE ZONE (GREAT SENSITIVITY
NEEDED)
Genitalia
Rectum
NURSE-PATIENT RELATIONSHIP
Caring relationships are the foundation of
clinical nursing practice.
Therapeutic relationships promote a
psychological climate that facilitates positive
change and growth.
Pre – interaction Phase: Occurs before
meeting the patient.
Orientation Phase: When the nurse and the
patient meet and get to know each other.
Working Phase: When the nurse and the
patient work together to solve problems and
accomplish goals.
Termination Phase: Occurs at the end of a
relationship.
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.
PROFESSIONAL NURSING RELATIONSHIPS
Nurse-Family Relationships
Nurse-Health Care Team Relationships
Nurse-Community Relationships
CASE STUDY
Roberto Ruiz is a 44-year-old man of Puerto
Rican descent, suffering from HIV / AIDS. He
was near death and in hospice, but his
condition has improved and he is now home.
Suzanne is a 54-year-old nurse dedicated to
hospice and committed to maximizing quality
of life in end-of-life care.
Helping relationships serve as the foundation of clinical CASE STUDY
nursing practice. Contracts for a therapeutic helping
relationship are formed during the: As Suzanne works with Roberto, she develops
a helping relationship. Suzanne knows that
a. Orientation Stage posing questions for the patient’s reflection
b. Working Stage helps her assess his needs and support his
c. Termination Stage self-care strategies.
d. Pre - interaction Stage
NURSING PROCESS: ASSESSMENT
ELEMENTS OF PROFESSIONAL
COMMUNICATION Through the Patient’s Eye
o Gather information, synthesize, apply
Appearance, Demeanor, and Behavior critical thinking
Use of Names Physical and Emotional Factors
Autonomy and Responsibility Developmental Factors
Courtesy Sociocultural Factors
Trustworthiness Gender
Assertiveness
 CASE STUDY IMPLEMENTATION

Suzanne learns that Roberto wants to travel to Therapeutic communication techniques are
New York to see his extended family. specific responses that encourage the
Even though Roberto is in poor health and the expression of feelings and ideas and convey
trip will be difficult, Suzanne expresses her acceptance and respect.
understanding of the importance of the trip. Active listening means being attentive to what
She understands how important extended a patient is saying both verbally and
family is in the Puerto Rican culture. nonverbally.
Use “SOLER”:
NURSING DIAGNOSIS o Sit facing the patient
o Observe an open posture
Many patients experience difficulty with
o Lean toward the patient
communication:
o Establish and maintain intermittent eye
Lacking skills in attending, listening, contact
responding, or self-expression o Relax
Inability to articulate, inappropriate
verbalization IMPLEMENTATION
Difficulty forming words Sharing Observations
Difficulty with comprehension Sharing Empathy
Sharing Hope
PLANNING Sharing Humor
Goals and Outcomes Sharing Feelings
Using Touch
Specific and Measurable Using Silence
Setting of Priorities Providing Information
Teamwork and Collaboration Clarifying
Focusing
CASE STUDY Paraphrasing
Validation
During her visit, Roberto tells Suzanne, “I Asking Relevant Questions
really want to go visit my uncles in New York, Summarizing
but I’m not sure I’m up for the trip”. Self-Disclosure
Suzanne is understanding. “It sounds like you Confrontation
miss your family. Let’s talk about your options
for maintaining contact”.
As they talk, Suzanne helps Roberto to identify
two methods of communicating with his family
in New York.
 NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
Asking Personal Questions
Giving Personal Opinions
Changing the Subject
Automatic Responses
False Reassurance
Sympathy
Asking for Explanations
Approval or Disapproval
Defensive Responses
Passive or Aggressive Response
Arguing
BARRIERS OF COMMUNICATION AND
METHODS OF OVERCOMING THE BARRIERS
PHYSIOLOGICAL BARRIERS
DESCRIPTION
Poor retention due to memory problems
Lack of attention
Discomfort due to illness
Poor sensory perception
Hearing problems
Poor listening skills
Information overload
Gender physiological differences
METHODS TO OVERCOME THE BARRIERS
OF COMMUNICATION
Sender and recipient must keep in mind each
other’s retention and memory abilities.
Sender and recipient must have each other’s
complete attention
Before initiating communication, the sender
and the recipient must ensure each other’s
comfort.
Intactness of sensory perception between the
sender and the recipient must be considered.
Limitations of hearing ability must be kept in
mind
In addition to hearing, the sender and the
recipient must ensure active listening between
each other.
Information overload must be avoided
Gender differences must be kept in mind
ENVIRONMENTAL BARRIERS
DESCRIPTION
Loud background noise
Poor lighting
Uncomfortable setting
Unhygienic surroundings and bad odor
Very hot or cold room
Distance

METHODS TO OVERCOME THE BARRIERS
OF COMMUNICATION
Background noise must be kept at lowest
possible level
Good lighting must be ensured to facilitate
nonverbal communication.
Comfortable seating arrangement must be
provided for effective communication.
Hygienic and odor-free environment must be
ensured.
 PSYCHOLOGICAL BARRIERS
DESCRIPTION
Misperception and misunderstanding
Distrust and unhappy emotions
Emotional disturbance such as anger,
jealousy, and suspicion
Prejudice, resentment, and antagonism
Psychotic or neurotic illness
Worry and emotional disturbance
Fear, anxiety, and confused thinking
METHODS TO OVERCOME THE BARRIERS
OF COMMUNICATION
Communication must be carried out in a happy
and trustworthy manner.
 The sender and the recipient must refrain from
negative emotions such as anger, jealousy,
and suspicion.
The sender and the recipient must avoid
feelings of prejudice, resentment, and
antagonism.
The sender and the recipient must be free
from fear, anxiety, and confused thinking.
SOCIAL BARRIERS
DESCRIPTION
Diffidence in social norms, values, and
behavior
Social taboos
Different social strata
METHODS TO OVERCOME THE BARRIERS
OF COMMUNICATION
Diffidence in social norms, values, and
behavior must be given due consideration.
Social beliefs of the sender and the recipient
must be kept in mind while communicating.
CULTURAL BARRIERS
DESCRIPTION
Ethnic, religious, and cultural differences
Cultural traditions, values, and behavior
METHODS TO OVERCOME THE BARRIERS
OF COMMUNICATION
Cultural difference must be given due
consideration.
Cultural traditions, values, and behavior must
be kept in mind.
OTHER BARRIERS
I. SEMANTIC BARRIERS
Language barriers
Language jargons
Faulty language translations
Individual differences in expression and
perception
Past experiences of an individual
Failure to listen
II. ORGANIZATIONAL BARRIERS
Organizational policy, rules, and regulations
Technical failure
Time pressure
Complexity of organizational structure due to
hierarchy
Size of the organization
III. COMMUNICATION PROCESS – RELATED
BARRIERS
Unclear and conflicting messages
Stereotypical approach
Inappropriate channels
Lack of or poor feedback
ADAPTING COMMUNICATION TECHNIQUES
Patients who cannot speak clearly
Cognitive impairment
Hearing impairment
Visual impairment
Unresponsive
Patients who do not speak English (or your
language)
COMMUNICATING WITH PATIENTS WHO
HAVE SPECIAL NEEDS
PATIENTS WHO ARE HEARING IMPAIRED
Ensure the patient has access to working
hearing aids and glasses.
Reduce environmental noise and distractions.
Speak at a normal volume and avoid shouting.
Rephrase instead of repeat if misunderstood.
Punctuate speech with facial expression and
gestures.
Provide a sign language interpreter if needed.
PATIENTS WHO ARE VISUALLY IMPAIRED
Ensure that patient has access to glasses –
corrective lenses and / or magnifying lenses.
Reduce environmental noise and distractions.
Speak at a normal volume and avoid shouting.
Rephrase instead of repeat if misunderstood.
Punctuate speech with facial expression and
gestures.
Provide a sign language interpreter if needed.
PATIENTS WHO ARE VISUALLY IMPAIRED
Ensure that patient has access to glasses –
corrective lenses and / or magnifying lenses.
Communicate verbally before touching the
patient.
Orient the patient to sounds in the
environment.
Ensure that lighting is adequate for patient to
see the speaker.
Identify yourself when entering the room and
notify the patient when leaving the room.
Modify written handouts to accommodate
degree of visual impairment.
Offer audiotapes for instructional information.
 PATIENTS WHO ARE COGNITIVELY
IMPAIRED
Reduce environmental distractions while
conversing.
Prioritize communication over other tasks.
Get patient’s attention before speaking.
Use simple sentences and avoid long
explanations.
Avoid shifting from subject to subject.
Ask one question at a time.
Allow time for patient to respond.
Include family and friends in conversations
when appropriate.
PATIENTS WHO ARE UNRESPONSIVE
Call patient by name during interactions.
Communicate both verbally and by touch.
Speak to patient as though he or she could
hear.
Explain all procedures and sensations.
Provide orientation to person, place, and time
as needed.
PATIENTS WHO ARE MUTE, UNABLE TO
SPEAK, OR CANNOT SPEAK CLEARLY
Answer nurse call system in person.
Listen attentively, be patient, and do not
interrupt or finish patient’s sentences.
Ask simple questions that require “yes” or “no”
answers.
While admitting a patient during the initial interview, a
Allow time for understanding and responses
family member tells you, “My mom really means that
Use visual cues (e.g.., words, pictures, and
she does not understand her medical diagnosis”. The
objects) when possible.
communication form used by the family member is:
Allow only one person to speak at a time.
Use normal volume and do not shout or speak
too loudly.
Let patient know if you do not understand.
Use communication aids as needed:
o Pad and felt-tipped pen or Magic Slate
o Flash cards
o Communication boards with words,
letters, or pictures denoting basic
needs
o Computer toy “speak and spell” type
for children
o Call bells or alarms
o Sign language
o Use of eye blinks or movement of
fingers for simple responses “yes” or
“no”.
Be attentive and responsive to restless
physical movements.
PATIENTS WHO DO NOT SPEAK ENGLISH
Speak to patient in a normal tone of voice
(shouting may be interpreted as anger).
Establish a method for patient to signal desire
to communicate (nurse call system or bell).
Avoid using family members, especially
children, as interpreters.
Provide professional interpreter / translator as
needed:
o Use a person familiar with patient’s
culture and with health care if
possible.
o Allow plenty of time for interpreter to
transmit messages.
o Communicate directly to patient and
family rather than to interpreter.
o Ask one question at a time
o Avoid making comments to interpreter
about the patient or family (they may
understand some English).
Develop a communication board, pictures, or
cards using words translated into English for
patient to make basic requests (e.g.., pain
medication, water, and elimination).
Have a dictionary (e.g.., English / Spanish)
available if patient can read.
Provide written materials in English and in
patient’s primary language.
a. Focusing
b. Clarifying
c. Summarizing
d. Paraphrasing
EVALUATION
Through the patient’s eyes
Patient outcomes
o Nurses and patients need to
determine whether the plan of care
has been successful.
o Nursing interventions are evaluated to
determine which strategies or
interventions were effective.
o If expected outcomes are not met, the
plan of care needs to be modified.