Nursing: Communication & Interpersonal skills

Communication

• Defined as the exchange of information between individuals, groups, or organizations.
• Essential for nursing, leading to effective patient care and positive health outcomes.
• Effective communication fosters interprofessional collaboration, ensures ethical and legal responsibilities are met, earns public trust, and contributes to positive patient outcomes.
• Ineffective communication can result in poor patient outcomes, increased adverse incidents, and decreased professional credibility.

Communication and Interpersonal Relationships

• Therapeutic interpersonal relationships, based on caring, mutual respect, and dignity, are at the core of nursing care.
• Communication is the means to establish helping-healing relationships.
• Behavior always communicates a message, and all communication influences behavior.
• Relational practice involves listening, questioning, empathy, mutuality, reciprocity, and self-observation/reflection.
• Being relational means taking initiative in establishing and maintaining relationships and being authentic and responsive.
• Relational communication involves the nurse's active intention to connect with people where they are.
• Authenticity fosters public trust.
• Mutuality is required for effective interpersonal communication, and being in sync indicates partnership and equality.
• Nurses use questioning beyond the surface to facilitate relational practice in complex health situations.
• Even amid patient silence, nurses communicate with compassion, willingness, and preparedness to face uncertainty.
• Relational capacities that expand the capacity to communicate includes collaboration, commitment, compassion, competence, leadership, orienting, and scrutinizing.
• Therapeutic communication happens in a healing environment between a nurse and patient.
• Attitudes and emotions are easily transmitted.
• Intention and behaviors influence human energy.
• Nurses have an ethical responsibility to pay attention to their communication with patients.

Developing Communication Skills

• Perception is acquired through the 5 senses and involves organizing/interpreting sensory information for understanding.
• Perceptual biases are human tendencies that interfere with accurately perceiving and interpreting messages.
• People assume that others think, feel, act, and react as they would in similar situations.
• Seeking contextual knowledge is key to providing context-based and relevant care.
• Reflexivity means being aware of your communication patterns and responses, and the responses you evoke in others.

Levels of Communication

• Intrapersonal communication is self-talk or inner thought, fostering self-awareness and positive self-concepts.
• Interpersonal communication is one-on-one interaction, common in nursing.
• Transpersonal communication occurs within a person's spiritual domain.
• Spiritual inquiry allows nurses to connect with patients to explore what is meaningful.
• Small group communication involves interaction with a few people.
• Public communication involves interaction with an audience.
• Communication is an active process between a sender and receiver.
• Referent motivates communication.
• The sender encodes and delivers the message.
• The receiver gets and decodes the message.
• Messages are verbal/nonverbal/symbolic expressions of thought or feelings.
• Channels convey messages through visual, auditory, and tactile senses.
• Feedback is the message returned by the receiver.
• Environment influences communication; noise, temperature, and privacy should meet patient needs.

Forms of Communication

• Verbal communication involves spoken or written words; vocabulary, pacing, denotative and connotative meaning, clarity, brevity, timing, and relevance are critical.
• Nonverbal communication uses the 5 senses and includes appearance, posture, gait, facial expressions, gestures, sounds, and personal space.
• Facial expressions convey emotions.
• Eye contact allows close observation.
• Gestures clarify spoken words.
• Sounds communicate feelings/thoughts.
• Personal space involves defending one's space.
• Symbolic communication uses verbal and nonverbal symbolism in art, music, and dance.
• Metacommunication includes factors that influence how a message is perceived.

Professional Nursing Relationships

• In nurse-patient helping relationships, the nurse helps a patient with unique healthcare needs.
• Such relationships are therapeutic and nonjudgmental.
• These relationships progress through preinteraction, orientation, working, and termination phases.
• Nurses also form relationships with families and communities.
• Interprofessional Collaborative practice (ICP) relationships with colleagues focus on accomplishing work/goals.

Elements of Professional Communication

• Professional appearance, demeanor, and behavior establish trustworthiness and competence.
• Professional behavior communicates warmth, friendliness, confidence, knowledge, skill, and competence.
• Courtesy involves greeting/saying goodbye, knocking, and using polite terms.
• Self introduction, including the use of names, is crucial.
• Terms of endearment are inappropriate.
• Trustworthiness involves following through on commitments.
• Autonomy/responsibility involves self-direction and advocacy.
• Assertiveness means acting in one's interests without infringing on others' rights.

Communication Within The Nursing Process

• Assessment: Assess a patient's ability to communicate based on physical, emotional, developmental, and sociocultural factors.
• Nursing Diagnosis:
• People may lack skills in attending, listening, responding, and self-expression.
• Impaired verbal communication is a primary nursing diagnostic label for those with limited verbal ability.
• Planning: Create a care plan to improve communication.
• Nurse availability is crucial.
• Collaborate with speech therapists.
• Implementation: Carry out the care plan.
• Evaluation: Determine if the care plan was successful.

Therapeutic Communication Techniques

• Active listening.
• Sharing observations.
• Sharing empathy/hope/humor/feelings.
• Using touch.
• Using silence.
• Providing information.
• Clarifying/focusing/paraphrasing.
• Asking relevant questions.

Non-Therapeutic Communication Techniques

• Asking personal questions.
• Giving personal opinions.
• Changing the subject.
• Using automatic responses/clichés.
• False reassurance.
• Expressing sympathy.
• Asking "why" questions.
• Expressing approval or disapproval.
• Using defensive responses.
• Arguing.
• Passive aggression.

Self-Concept

• A person's mental image of themself.
• It's a subjective mix of conscious and unconscious thoughts, attitudes, and perceptions about one's identity.
• Self-esteem is subjective feelings of self-acceptance/respect.
• Self-concept includes social, emotional, physical, and academic domains, and affects how people adapt to health challenges.
• Nurses care for patients with health problems that can threaten self-concept and self-esteem.
• Nurses assess patients to determine if they have a healthy self-concept and develop strategies to meet patients' needs.
• People are born with a self-concept.
• Self-concept is closely related to perceptions of health.
• Self-concept also is affected by illness, hospitalization, and surgery.
• Individuals may regress during stressful events.
• Self-concept is always changing and is based on multiple factors, i.e sense of competency, reactions from others, relationships, coping ability, ethnicity, gender etc

Identity

• The internal sense of individuality, wholeness, and consistency.
• Influenced by age, gender, sexuality, social class, ethnicity, and culture.
• Race and ethnicity influence identity formation.
• Associating with a religious community provides identity experiences.

Body Image

• The perception of our bodies, including size, appearance, and functioning.
• Feelings include femininity, masculinity, youthfulness, sexuality, health, and vitality which are not always consistent with structure/appearance.
• Most individuals feel some body dissatisfaction.
• Disturbances can be exaggerated when health status changes.
• Body image is affected by cognitive growth, physical development, and normal transitions (puberty/menopause).
• Cultural and societal attitudes/values influence body image.

Role Performance

• How people see their ability to carry out significant social roles.
• Approved behaviors are learned through reinforcement-extinction, inhibition, substitution, imitation, and identification.

Stressors Affecting Self-Concept

• Identity stressors: Developmental markers like puberty, menopause, child-bearing, and retirement can affect identity.
• Identity is vulnerable during adolescence due to physical/emotional/mental changes.
• Retirement can mean loss of achievement and social connection.
• Identity confusion happens when a person can't maintain a clear sense of personal identity.
• Body image stressors: Perception of change and importance placed on body image affect the significance of loss of function or change in appearance.
• Amputations and scars are physical stressors.
• Role performance stressors: Role changes occur throughout life.
• Role conflict happens when a person has two or more inconsistent roles.
• The sick role involves expectations about how a sick person should behave.
• Role ambiguity involves unclear expectations.
• Role strain is stress from incompatible expectations.
• Role overload involves unmanageable responsibilities.
• Individuals with high self-esteem cope with stress better than those with low self-esteem.

The Family Effect on the Development of Self

• A basic sense of self comes from caregivers.
• Bowlby's attachment theory suggests that attachment influences a child's expectations about themself.
• Consistent/warm parents promote positive self-esteem, but harsh/inconsistent parents may foster negative self-concepts.

The Nurse Effect on the Patients Self-Concept

• Verbal/nonverbal reactions matter.
• Nurses secure in their own identities reinforce patients' identities.
• Nurses can influence body image positively.
• Recognize personal reactions, acknowledge them, and focus on the patient.

Self-Concept and the Nursing Process

• Assessment:
• Focus on identity/body image/role performance/self-esteem.
• Observe behaviors and note coping patterns.
• Ask specific questions and use knowledge of developmental stages to determine areas that are important.
• Nursing Diagnosis:
• Identify actual/potential problem areas.
• Examples: disturbed body image, caregiver role strain, disturbed personal identity, ineffective role performance, chronic/situational low self-esteem, risk for situational low self-esteem, readiness for enhanced self-concept.
• Planning:
• The care plan integrates all that the nurse knows and includes critical thinking elements.
• Goals are individualized, realistic, and measurable.
• Implementation:
• Nursing interventions promote a healthy self-concept and help the patient achieve goals.
• Evaluation:
• Expected outcomes may include nonverbal behaviors, statements of self-acceptance, and acceptance of change in appearance/function.
• Interventions involve increasing self-awareness, encouraging self-exploration, aiding in self-evaluation, helping formulate goals, and assisting the patient to achieve those goals.

Spirituality in Health and Healthcare

• Spirituality is personal and unique, influenced by sociocultural meanings and relationships.
• Nurses must be aware of their own spirituality.
• Religion is organized beliefs and worship that expresses spirituality.
• Faith is a relationship with God or a higher power that gives purpose and meaning.
• Canadian nursing practice has a rich spiritual heritage.
• Canada has religious/spiritual diversity.
• Spirituality can have beneficial health outcomes.
• Spiritual resources may help recovery during illness.
• Faith communities can provide social support, connectedness, and healing practices.
• Spirituality is a lifelong journey.
• Spiritual concerns can vary by life events/illnesses/clinical contexts.
• Spiritual practices may include worship, prayer, meditation, sacraments, singing, and reading religious texts.
• Nurses need spiritual care competencies.
• Critical thinking includes understanding the patient's perspective.
• One competency is knowing when to refer to a spiritual care provider.
• A spiritual assessment should try to understand rather than assess.
• Assessment tools should be flexible.
• Open communication and trust are needed.
• Ethical care includes respecting boundaries and knowing when to refer patients.
• Certain religions have dietary restrictions or healthcare beliefs that affect nursing practice.
• Spiritual care expresses self; how nurses are with patients is important.
• Spiritual practices may help with physical and psychological symptoms.
• Spiritual practices can be effective forms of self-care for nurses.
• Spiritual care cannot be evaluated like other nursing practices, but nurses should focus on presence and alleviating suffering.