Week 3-4 Levels of Communication PDF

BSN509 THERAPEUTIC COMMUNICATION Semester 1, 2023-2024 Week 3 & Week 4 Levels and forms of Communication Therapeutic communication Revised on Jan 19, 2023 1 Learning Outcomes By the end of the ses...

BSN509 THERAPEUTIC COMMUNICATION Semester 1, 2023-2024 Week 3 & Week 4 Levels and forms of Communication Therapeutic communication Revised on Jan 19, 2023 1 Learning Outcomes By the end of the session, the student will be able to… 1- Describe the five levels of communication and it’s importance in nursing 2- Discuss the two different forms of Communication. 3- Recognize the different aspects of verbal and nonverbal communication skills. 4- Identify the meaning of therapeutic and non-therapeutic communications. 5- Explain the key aspects of therapeutic communication. POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 2 Levels of Communication POTTER & PERRY, (2017). FUNDAMENTALS OF NURSING (9TH ED.). P. 318 3  Forms of communication 1- Verbal communication It uses words (spoken OR written). 2. Non verbal communication Includes the five senses and everything that does not involve the spoken or written words. Potter & Perry, (2017). Fundamentals of Nursing (9th ed.). P. 320  Aspects of Verbal Communication Vocabulary Denotative and Connotative Meanings Pacing Intonation Clarity and Brevity Timing an Relevance POTTER & PERRY, (2017). FUNDAMENTALS OF NURSING (9TH ED.). 5  Aspects of verbal communication: 1-Vocabulary: It is important for the senders and receivers to translate one another’s word and phrases. * Vocabulary may vary with age, profession, and culture. Examples: - Children have limited vocabulary than adults. Children may use special words to describe bodily function. - Teenage have often unique ways to communicate. - Medical jargon sounds like a foreign language to patient unfamiliar with health care settings. (ICU, V/S) Aspects of Verbal Communication 2-Denotative and Connotative Meanings : Individuals who use a common language share the denotative meaning. The connotative meaning is the interpretation of a word’s meaning influenced by thoughts, feelings, or ideas people have about the word. Aspects of verbal communication 3- Pacing (speed): How rapid is the speaking act, will affect the conversation and its effectiveness. Speak slowly and pronounce clearly. 4- Intonation: Tone of voice affect the message’s meaning. Simple statement express anger, concern and enthusiasm. Be aware of voice tone to avoid sending unintended massages. Aspects of verbal communication 5- Clarity and brevity: Effective communication is simple, brief, an direct. Use short sentences and words that express an idea simply and directly. 6- Timing and relevance: even though the message is clear, poor timing prevents it from being effective.(e.g., do not begin routine teaching when patient is in severe pain)  Forms of communication Nonverbal communication Is unconsciously motivated and more accurately indicates a person’s intended meaning that the spoken words. It is more congruent with feelings. Usually the person doesn’t have control on it. Aspects of Nonverbal communication: * Personal appearance * Posture and gait * Facial expression * Eye contact * Gestures (signs and signals) * Sounds * Personal space and touch Aspects of Nonverbal communication 1- Personal appearance: include physical characteristics, facial expression, and manner of dress and grooming. Give impression about professionalism and caring. 2-Posture and Gait: are forms of self expression. The way people sit, stand, and move reflect attitude, emotions, self concept, and health status. Leaning forward coveys attention, quick gait & erect posture indicate confidence. Shuffling gait indicates depression and fatigue. Aspects of Nonverbal communication 3- Facial expressions: most expressive part. convey emotions such as surprise, fear, anger, happiness, and sadness. Avoid showing shock or distressing reactions. 4- Eye contact: Maintaining eye contact during conversation shows respect and willingness to listen. Lack of eye contact may indicate anxiety and discomfort. Aspects of Nonverbal communication 5- Gestures: they alone or with other cues carry specific meanings. A finger pointed toward a person communicates several meaning, when accompanied with frown and stern (harsh) voice becomes a threat. Gesture emphasize and clarify the spoken words. Joy Frustratio n 6- Sounds: sighs, moans, groans communicate feelings and thoughts. Moaning, screaming, shouting may indicate joyful, pleasure or sorrowful (sadness).. POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 13 Aspects of Nonverbal communication 7- Personal space: is invisible + individual, People maintain varying distances between each other depending on their culture and nature of their of relation. - When personal space become threatened, communication will be less effective. - Nurse need to convey confidence, gentleness, respect of privacy. POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 14 Therapeutic Communication 15  What is Therapeutic Communication? It is a technique we use to encourage the expression of feelings and ideas, and convey acceptance and respect (Pottery & Perry, 2017, p. 327) This form of communication used in health settings to support, educate and empower patient. It is a process in which the nurse consciously influences a client or helps the client to have a better understanding through verbal or nonverbal communication. ***Help patient both physically and emotionally. It will stop when patient does not need more help. ***Goals set by both nurse and patient. Based on professional relationship RILEY, B (2017). COMMUNICATION IN NURSING), 8TH ED. 16  How does the therapeutic relationship differ from social relationships, like friendships? A Therapeutic Relationship is: Time limited. A one-way relationship with the nurse “being there” for the patient. For the sake of the patient’s well being. Established to meet the need of the patient, not the nurse. (STEIN-PARBURY, 2009, P. 5) 17 Human Connection “Nursing care that is offered without a human connection is impoverished. It lacks a caring connection.” “Human connections in the form of the nurse- patient relationship is vital to nursing.” (Stein-Parbury, 2009, p. 3) How do we as nurses make the human connection? In the helpful ways we interact with the patient:- “For example: listening without judging and responding with understanding to create a therapeutic relationship based on acceptance and respect.” (Stein-Parbury, 2009, p. 4) STEIN-PARBURY, (2009) 18 Key Aspects of Therapeutic Communication - Active Listening – most important - Sharing Hope - Paraphrasing and clarifying - Sharing Humour - Sharing Observations - Sharing Feelings - Display Warmth - Using touch - Genuineness, - Using silence - Respect - Providing information - Sharing Empathy - Self-Disclosure - Confrontation RILEY, B (2017). COMMUNICATION IN NURSING), 8TH ED. 19 Active listening How to do it? Focus your attention on what the person is saying, repeat it in your mind, and then reflect on what it might be like to be in the person’s situations Ask questions to clarify “don’t assume” You need to be fully present and attentive In the moment on purpose without judging (mindful listening) Sit facing the client, open posture, lean toward the client, eye contact, and relax. By doing this you convey respect for patient feelings and build trust 20 RILEY, B (2017;2020). COMMUNICATION IN NURSING), 8-9TH ED. Paraphrasing and clarifying Restating another’s message more briefly using one’s own words. It consists of repeating in fewer words, the essential ideas of the client. For example the client says “I can’t focus. My mind keeps wandering.” The student nurse says,” You’re having difficulty concentrating?” To check whether understanding is accurate, the nurse restates an unclear or ambiguous message to clarify the sender’s meaning. “I’m not sure I understand what you mean by ‘sicker than usual’? Nurse asks to clarifyPOTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 21 Sharing Observations By commenting on how the client looks, sounds, or acts. Helps the client communicate without the need for extensive questioning, focusing, or clarification. This reflect good understanding of the patient’s condition. And might lead to the discovery of a new symptom Examples of sharing observation: “ You look tired…” “ You seem different today..” “ I see you haven’t eating anything.” 22 RILEY, B (2017). COMMUNICATION IN NURSING), 9TH ED.  Display Warmth Showing warmth to others means conveying that you like to be with them and you accept them as they are. Displaying warmth making others feel accepted and important. The opposite – cold behavior – conveys disapproval or disinterest Warmth can be conveyed verbally. The volume of voice is related to warmth. Softer tones convey warmth more than loud, aggressive tones. Warmth expressed predominantly by non-verbal communication, makes the client feel relaxed, welcomed and unjudged. RILEY, B (2017). COMMUNICATION IN NURSING), 9TH ED. 23 Acceptance and Respect Acceptance and respect of the clients as individuals with values and beliefs of their own is an attitude enhances communication, that lets clients know they can be themselves and they will still receive quality care, even though they have different values and beliefs than the nurse. Actions you can take to show respect: Look at your client and offer him attention. Maintain eye contact and smile if appropriate Determine how the other person likes to be addressed. Introduce yourself and also address the client by name (preceded by Mr. or Mrs.) 24 24  Genuineness How? To be genuine is to be honest, showing real thoughts and feelings, and be yourself. It means being truthful and not attempting to answer a question when the answer is not known. What could influence you of obtaining genuineness? oSelf-confidence oPerception of others oEnvironment 25 25  Sharing Empathy Empathy is the ability to understand and accept another person’s reality, to accurately perceive feelings, and to communicate this understanding to the other. To express empathy, the nurse reflects understanding of the importance of what has been communicated by the other person on a feeling level. Example: The nurse said to angry client (who has low mobility after stroke): “ It must be very frustrating to know what you want, and not be able to do it”. You feel with him 26 POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). Sharing Hope Nurses recognize that hope is essential for healing and learn to communicate a sense of possibility. Appropriate encouragement and positive feedback are important in fostering hope and self confidence. The nurse can give hope by commenting on the positive aspects of the other person’s behavior, performance, or response. Example: “ I believe you will find way to face your situation , because I have seen your courage (bravery) and creativity in the past”. 27 POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.).  Sharing Humor Humor “is any intervention that promotes health and wellness by stimulating a playful expression or appreciation of life’s situation. Humor serves both social and psychological functions. Examples (coping with social conflict, relieving tension, coping with death). Nurses report that humor in health care shows that you care, shows you your clients’ personalities with their defenses down,, makes us equal, because we all laugh at the same time. The goal of humor is to bring hope and joy to the situation and to enhance the client well- being and the therapeutic relationship. The nurse should not take the client’s anger or frustration personally. Sharing emotion makes nurses seem more human and can bring people closer Humor strategies: try gentle banter (joke), let humor take the lead, look for the positive, be creative, use toys and props. 28 POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.).  Sharing Feelings Emotions are subjective feelings that result from one’s thought and perceptions. If feelings are not expressed, stress and illness can worsen. Nurses can help clients express emotions by making observations, acknowledging feelings, and encouraging communication. 29 POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). Using Touch Touch conveys many messages (affection, emotional support, encouragement, and personal attention). In older persons , touch increase sense of safety, self-confidence and decrease anxiety. (Glesson & Timmons, 2004). POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 30  Using Silence Silence plays a major part in effective listening To be silent and not interrupt patients is a sign of respect and interest. Silent moments are useful because they allow patients and nurse time to collect their thoughts and reflect on what has been expressed. Silence prompt people to think and talk. Silence allows nurse to pay particular attention to nonverbal messages. Silence is therapeutic during time of sadness or grief. He only needs to ventilate. 31 POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). Providing Information Telling persons what they need, or want to know, to make decisions, experience less anxiety, and feel safe and secure. It is an important goal in health teaching. Clients have a right to know about their health status and what is happening in their environment. POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 32 Self Disclosure What are you suppose to do? Show your feelings and thoughts. Share your personal experiences, be specific and focus only on relevant information How this helps your patient? shows patients that their experiences are not unique. It indicates closeness of the nurse-client relationship. It does not mean sharing or burden the client with your personal problems. POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 33 Confrontation (facing) Help the person become aware of inconsistencies in feeling, behaviors, and beliefs. Used only after establishing trust with patients. Should be done gently, and with sensitivity. Example: “you say that you’ve already decided what to do, yet you’re still talking a lot about your options”. POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 34  Non-Therapeutic Communication “Blocks” communication of feelings and ideas: * Asking personal questions, * Giving personal opinions, * Changing the subject, * False reassurance, POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 35 Thank you POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 36 Video links https://www.youtube.com/watch?v=W54yhhZ9DOQ https://www.youtube.com/watch?v=TZI6zhWfULc POTTER & PERRY, (2013). FUNDAMENTALS OF NURSING (8TH ED.). 37 References Riley, J.B. (2017). Communication in Nursing (8th ed.). Missouri: Mosby Elsevier Potter, P.A. & Perry, A.G. (2017). Fundamental of Nursing.9th ed.USA: Mosby Elsevier Stein-Parbury, J. (2010). Patient and Person: Interpersonal skills in nursing 4th ed. : NSW Australia: Church hill Livingstone. 38