Fundamentals of Nursing - Communication

Fundamentals of Nursing - Communication

• Communication is a dynamic process used to gather assessment data, teach, and express caring and comfort. It's an integral part of the helping relationship.
• Communication is any means of exchanging information, ideas, or feelings between two or more people. It's a two-way process involving sending and receiving a message.
• Methods of communication include talking, listening, writing, or reading.
• Communication is a basic component of human relationships in nursing.

Types of Communication

• Intrapersonal (Self-Talk):

  • Internal thoughts of a communicator.
  • Happens within the person, often involving dialogues with the self.
  • Includes daydreams, self-talk, and thinking about a message before, during, or after it is sent.

• Interpersonal:

  • Communication between the nurse and patient.
  • Communication between healthcare professionals (e.g., nurse and physician).
  • Effective communication is crucial among healthcare professionals to prevent errors.
  • Nurses are often trained to communicate descriptively, both verbally and in writing. Physicians are taught to be concise and focused on the issue.
  • Examples of interpersonal communication include nurse-patient interactions, and nurse-physician communication.

• Group:

  • Involves two or more people with shared goals and needs.
  • Group communication helps people achieve goals that would be impossible by individual effort.

Group Dynamics

• Communication between members affects the group's process.
• Each member's communication style influences the dynamics.
• Successful groups maintain unity and cohesion, develop/modify structure, and achieve goals.

Element of Communication Process

• Sender: The person or group initiating the communication.

  • A sender has an idea, feeling or reason to communicate, and encodes that into a transmitted form using specific signs, symbols, or language.

• Encoding: The process of translating the idea or feeling into a form suitable for transmission, through the use of language, tone of voice, or gestures.

• Message: The means by which the sender conveys the idea. This can use any of the receiver's senses (sight, sound, touch).

  • Includes verbal (words) and non-verbal (gestures, expressions) methods.

• Channel: The medium of transmission of the message.

  • Examples include talking face-to-face, phone calls, or written messages.
  • Visual channel involves sight, allowing visual observation and perception.
    -Auditory channel consists of spoken words and other verbal cues.
  • Kinesthetic channel involves physical sensations mediated through touch.

• Receiver: The person or group receiving the message.

  • The receiver of the message decodes the message in relation to their knowledge and experiences, and interprets the message's meaning.

• Response or Feedback: The message returned to the sender, which can be verbal, nonverbal, or both, indicating the reception/understanding of the initial message.

Characteristics of Effective Feedback

• Specific and descriptive, avoids generalities.
• Supportive and non-threatening.
• Given in a timely manner.
• Practical and relevant to the client.
• Clear and unambiguous.
• Direct and honest.

Modes of Communication

• Verbal: Using words and sounds to express oneself.
• Nonverbal: Using gestures, mannerisms, body language, facial expressions, posture, and physical appearance to communicate. This includes avoiding defensive postures also.

Factors Influencing the Communication Process

• Development: Understanding the client's developmental stage is essential for modifying messages.
• Gender: Females and males communicate differently, with girls often seeking confirmation & intimacy, and boys often emphasizing independence.
• Values and Perceptions: Individual values and perceptions influence behavior and how events are interpreted.
• Personal Space: The preferred distance during interactions with others. Different distances (intimate, personal, social, and public) exist among different cultures (15cm, .5-1.2m, 1.2-3.7m, 3.7-4.5m).
• Territoriality: Concept related to the space and belongings an individual considers theirs.
• Roles and Relationships: communication style can vary based on the nature of relationship.
• Environment: Factors such as noise, temperature, ventilation, privacy can affect communication.
• Congruence: The agreement between verbal and nonverbal communication.
• Interpersonal Attitudes: Beliefs, emotions, caring, respect, and acceptance conveyed.
• Boundaries: Limits in which a person interacts with others & time spent.

Therapeutic Communication

• Purposeful communication that creates a beneficial outcome for the client.
• Interaction between the nurse & patient advances their health (physically & emotionally).
• Communication is active and relies on both verbal and nonverbal skills.
• Aims to promote understanding and build constructive relationships. Focused on the client and their goals.

Principles of Therapeutic Communication

• Time and Place: Choosing appropriate times and places for interactions. Considering environment comfort.
• Setting the Stage: Clear purpose and expected duration.
• Accepting the Client: Neutral or non-judgmental approach.

Active Listening

• Reflecting back understanding of what a person says.
• Communicating acceptance of thoughts and emotions.
• Important element of therapeutic communication.

Nurse-Client Communication (as dynamic processes)

• Therapeutic Communication
• Attentive Listening
• Physical Attending

Attentive Listening

• Active listening using all senses to understand both verbal and nonverbal messages.
• Absorbs both content and emotion.
• Shows caring and interest to encourage the client to talk, but without interrupting.
• Crucial to actively listen before responding.

How to be an Active Listener

• Using silent pauses.
• Showing attentiveness.
• Restating what was said.
• Asking clarifying questions.
• Reflecting emotions.
• Summarizing key points.

Physical Attending

• Facing the other person squarely, showing engagement.
• Adopting an open posture.
• Leaning towards the person.
• Maintaining good eye contact.
• Maintaining eye contact that conveys comfort and willingness to communicate.
• Relaxing and using appropriate natural gestures.

Barriers to Therapeutic Communication

• Language: Cultural or communication differences can cause misunderstandings. Seek a common ground.
• Culture: Cultural nuances in communication that extend beyond spoken words.
• Gender: Some differences in verbal communication styles.
• Health Status: Pain or preoccupation can hinder communication.
• Communication Blocks: Issues that negatively influence therapeutic communication, and specific examples of these. These include issues like:
  • Reassuring when not appropriate
  • Agreeing/Approving when not helpful
  • Defending
  • Using "yes/no" questions only
  • Judging
  • Blaming
  • Advising
  • Rejecting
  • Disapproving
  • Probing

Communication among Health Professionals

• Crucial for effective collaboration, especially between nurses and physicians, and between nurses and patients.
• Needed for effective intercommunication and to improve care. Communication between nurses and physicians needs particular emphasis.

Communication Between Nurses and Physicians

• Current lack of formal guidelines can lead to misunderstandings and medication errors.
• Nurses often use narrative and descriptive communication, whereas physicians often focus on needs and problems, potentially leading to omissions of important context.

Critical Thinking in Nursing

• Active, organized, and cognitive process.
• Reviews data, considers explanations, and assesses outcomes before deciding.
• Applying knowledge and skills to new situations, and thinking about situations from different angles.
• An intentional higher level reasoning process.

Components of Critical Thinking

• Mental Operations: Activities like decision-making, planning and evaluation. The purpose is problem-solving and identifying solutions.
• Knowledge: Essential to critical thinking; nurses must build a broad knowledge base.
• Attitudes: Positive and helpful attitudes, like a sense of curiosity and openness to learning more.

Strategies to Promote Critical Thinking

• Identifying goals.
• Determining required knowledge.
• Assessing margin for error.
• Assessing the time available for decision-making.
• Identifying available resources.
• Recognizing factors influencing decision-making (like bias, fatigue).

Critical Thinking Requires

• Cognitive skills.
• Asking questions.
• Staying well-informed.
• Being honest about personal biases.
• Being willing to reconsider and clearly think about issues.

Characteristics of a Critical Thinker

• Understanding the links between ideas.
• Identifying inconsistencies and mistakes in reasoning.
• Solving problems systematically.
• Acknowledging assumptions and biases.
• Openness to different perspectives.
• Eagerness to accept new explanations when valid.

Benefits of Critical Thinking

• Determining the best nursing action.
• Identifying patient needs.
• Enhancing clinical decision-making.
• Finding workable solutions.
• Providing correct answers/solutions by examining all evidence before deciding anything.
• Leading to dependable clinical decisions.
• Using appropriate Nursing Process to guide patient care..
• Implementing Evidence-Based-Practice (EBP).