This Session Will: Discipline of Nursing Discipline of Nursing

Discipline of Nursing
School of Population Health and Clinical Practice
This session will

Describe communication and various levels of communication Emphasise the need for effective communication skills in nursing Discuss the fundamentals of therapeutic communication
Communication and psychosocial care 1A

Session 1 Introduction to concepts in communication Therapeutic communication
Copyright 2006 The University of Adelaide
Communication defined
the capacity to convey thoughts, feelings and attitudes through spoken, written and nonverbal means in order to exchange ideas and construct human meaning.
Psychosocial defined
Psychosocial theories describe development of personality, thinking and behaviour. Psychosocial care is directed toward promoting psychological ease and relief of distress (Stein- Parbury, 2005,p177)
Crisp and Taylor 2005 p419
Communication levels
Intrapersonal Interpersonal
Nurse / patient interaction
Intrapersonal
Self talk powerful source of motivation and negativity Can be used in a therapeutic way Use for yourself Use for your patient However does not subsume truth and honesty Who is Leyton talking too?
Transpersonal Small group Public
Interpersonal
Face to face communication Often the most significant expression of the nurse / patient relationship. meaning resides in persons and not in words Nursing is delivered across race, religion, values, opinions and experiences What is your interpretation of the following ?
Transpersonal communication
Communication across a spiritual connection Prayer, respect and valuing diversity Do not dismiss your own spiritual standpoint whatever that may be you need to appreciate your own spiritual dimension (not having a spiritual dimension is itself a standpoint) to begin transpersonal communication.
Small group communication

Establish group norms for the course. What rules / agendas do you think we should have to guide communication within the group? These will be recorded and posted on MyUni.
Public
Nursing has a number of opportunities for public speaking Lecturing Conferences In service education sessions School visits
Skilled communicators ..
Those that can assert their own ideas while responding positively to others Nurses require both traits in a blended way Assertiveness is needed to communicate with other health professionals, not allow compromises to patient care (advocacy) Responsiveness is needed to develop empathy What blend of communication skills do you have? (DB posting)
Communication vignette
Patient A is required to attend x-ray which has been requested by the medical staff on the appropriate documentation. As the RN you agree that the student nurse may attend and you ask the student nurse to inform the family of the x-ray appointment. The physio will need to finish their appointment with Pt A quicker than expected as x-ray have a busy schedule and dont know when you will get in to see them again and you need to tell the EN to hold Pt As lunch in case the kitchen staff take it away..
patient
students
allied health
kitchen Registered nurse colleagues
documentation
enrolled nurse
administration
medical staff
relatives
The message ..
Effective communication in the hospital setting often requires consideration of all the people who may be influenced by a simple intervention for example an x-ray. The RN is often the hub around which the wheel of communication turns.
Basic elements of the communication process
Referent
What stimulates a conversation? This may be a sight Sound Schedule Perception Emotions Objects
Sender and receiver

As the name suggests the sender and receiver of communication are communicating back and forth Sender Receiver
Can you send a verbal message without sending a nonverbal message?
Messages
The content of the communication Open to interpretation so essential to have
Clear direct expression Looking for non verbal clues is very important Needs to be contextual
Channels
The use of visual, tactile and auditory senses to convey a message Communication does not often exist without multiple channels of delivery
please change that setting from SIMV 600 x 16 Ps 20 P5 to PC20 P5 FiO2 to 0.8 Nursing and health are jargon laden topics
Copyright 2006 The University of Adelaide Copyright 2006 The University of Adelaide
Feedback
Feedback is necessary to ensure the message has been understood or least received What are examples of feedback you use in daily conversation? When next talking to friends / relatives make a mental note of the feedback mechanisms they use. How well do you recognise the cues of people you know well against those you dont know so well?
Interpersonal variables
Everyone interprets something within their own sphere of experience and perception. In nursing the following issues may influence the perception of a message. Pain Anxiety Body image Medications Emotions
Environment
Often underrated as an element of the communication process. Noise and clinical settings are familiar to nurses - not relatives. Should nurses be able to laugh when working in the intensive care unit?
Barriers to communication
What barriers to communication have you experienced today?
Non verbal communication

Includes Facial expressions Personal appearance Posture Eye contact Gestures Sounds
Therapeutic communication
Communication between nurse and patient is at a professional level with a therapeutic goal. Communication is often best in a relationship that has trust The nurse is responsible for setting the direction of the communication. However the patients needs determine the content of the communication Therapeutic communications may be ..intense, difficult and uncomfortable. They should not be avoided.
Therapeutic communication
Narrative interaction Can you tell me about when the pain started? What other strategies can you employ to initiate a conversation?
For discussion:
Professional communication Professional appearance Courtesy Use of names Privacy and confidentiality Trustworthiness Autonomy and responsibility
NOTE : Establishing an opportunity for therapeutic communication is not the same as breaching the nurse-patient relationship . The nmbsa has clear guidelines on the definition of therapeutic relationships and professional boundaries refer nbsa hyperlink in MyUni
Personal space
What is your zone of personal space?
Communication within the nursing process

Part 2 Therapeutic communication
What is your patients personal space? How do you move into a patients personal space? How do you interact with a patient and their significant others (often used as a term for family, partners etc)
Assessment and communication

Consideration of the following issues when communicating Physical and emotional factors Developmental factors Sociocultural factors Gender
Physical and emotional

Patients may not be able to communicate due to Visual or hearing disturbances Airway or exercise tolerance limitations Any form of oral surgery / injury Stroke Alzheimer's Depression Sedated patients Medications
Developmental factors
Consider the differences in communicating with
Infants
Physical contact Parents in eye contact Soft tone
- Children
Avoid sudden, rushed conversation Use parents as sounding board Give reasons Drawing or play
Toddlers and preschoolers

Eye level Avoid analogies Appropriate facial expressions Transition objects dolls, puppets
Adolescents
Listen, listen Avoid judging or criticising Respect levels of privacy
Sociocultural factors
What impact does culture have on nuances of communication? Eye contact yes or no? Japan USA Canada Greece Vietnam
Gender
Do you agree ? Men communicate to achieve goals, compete for attention and power
Women communicate to build relationships, enjoy discussing feelings and personal issues What is stereotyping?
Therapeutic communication techniques

Facilitative Active listening Expressing empathy Hope Humour Touch Silence Paraphrasing Authoritative Giving information Focusing Self disclosure Confronting Encouraging Instructing
Active listening
Attentive, focussed on the patient Maintain eye contact * Body language oriented towards person Being there
Non-therapeutic communication techniques

Personal questions Personal opinions Changing the subject Automatic responses Sympathy (versus empathy) Defensive responses Arguing
Class discussion
How will you talk to the following patients
6 year old girl with tonsillitis 78 year old German man admitted for prostate surgery Aggressive 22 year old male admitted to emergency with substance abuse 49 year old woman admitted for bilateral mastectomy Confused 80 year old woman with history of dementia and wandering
A most powerful communication tool is

Using the factors above what strategies can you employ to improve your communication strategies. You will need to identify at least one difficult / awkward communication issue when you commence clinical placement Patience !
To effectively communicate, we must realize that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others.
Anthony Robbins

This Session Will: Discipline of Nursing Discipline of Nursing

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Discipline of Nursing

School of Population Health and Clinical Practice

This session will

Communication and psychosocial care 1A

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Crisp and Taylor 2005 p419

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Transpersonal Small group Public

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Small group communication

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

kitchen Registered nurse colleagues

Basic elements of the communication process

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Sender and receiver

Can you send a verbal message without sending a nonverbal message?

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Non verbal communication

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Communication within the nursing process

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Assessment and communication

Physical and emotional

Copyright 2006 The University of Adelaide

Toddlers and preschoolers

Copyright 2006 The University of Adelaide

Therapeutic communication techniques

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Non-therapeutic communication techniques

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

A most powerful communication tool is

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

Copyright 2006 The University of Adelaide

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