FUNMENTALS OF NURSING LECTURE

SCHEDULE: 11-3 PM, MONDAY

PROFESSORE: REMY GARCIA

COMMUNICATING
(COMMUNICATION IN NURSING)

-Process and Modes

-Therapeutic Communication Techniques
-Helping Relationships
-Communication and the Nursing Process

PREPARED BY:
Airish Saddi
 Communications is a process in which people affect one another through
exchange of information, ideas, and feelings. It is a lifelong learning process. It is the key
to the nurse-patient relationship and the ability to deliver patient-centered care. Nurses
make the the intimate journey with patients and their families from the miracle of birth to
the mystery of death.

ELEMENTS OF THE COMMUNICATION PROCESS

Circular transactional model of communication

Referant. Motivates one person to communicate with another. In a health care setting;
sights, sounds, sensations, perceptions, and ideas are examples of cues that initiate the
communication process.

Sender and Receiver. The sender is the person who encodes and deliver a message, and
the receiver is the person who receives and decodes the message.

Message. Content of the communication. It contains the verbal and nonverbal

expressions of thoughts and feelings.

Channels. The means of sending and receiving messages through visual, auditory, and
tactile senses.

Feedback. The message the sender receives from the receiver. It indicates whether the
receiver understood the meaning of the sender’s message.

Interpersonal Variables. The factors within both the sender and the receiver that
influence communications. Perception provides a uniquely personal view of reality
formed by an individual's culture, expectations, and experience

Environment. The setting for sender-interaction. An effective communication setting

provides participants with physical and emotional comfort and safety.
 MODES AND FORMS OF COMMUNICATIONS

i. Verbal Communications
ii. Non-verbal Communications

Verbal Communication. Use spoken and written words. Conveys specific meaning
through a combination of words.

Most important aspect of verbal communication are as follows:

1. Vocabulary
 The sender and the receiver should be able to translate each other’s word and
phrases.
 When a nurse cares for a client who speaks another dialect or language, an
interpreter may be necessary

2. Denotative and Connotative Meaning

 A single word can have several meaning (e.g. “Karon” for cebuanos means now, for
Ilonggos it means later)

3. Pacing
 Conversation is more successful at an appropriate speed or space
 Nurse should speak slowly enough to clearly enunciate

4. Intonation
 Tone of voice; dramatically affects the meaning of a message.

5. Clarity and Brevity

 Clarity is achieved by speaking slowly, enunciating clearly, and using examples to
make explanations easier to understand.
 Brevity is achieved by using short sentences and words that express an idea simply
and directly.

6. Timing and Relevance

 Even though a message is clear, poor timing can prevent it from being effective.
 The best time for interaction is when the client expresses an interest in
communication.

Non-verbal Communication. Includes the five senses and everything that does not
involve the spoken or written word.

The different aspects of non-verbal communication are as follows[

1. Personal appearance. This includes physical characteristic, facial expression, and
manner of dressing and grooming.
2. Posture and Gait. Patterns of walking are forms of self-expressions.
3. Facial Expressions. The face is the most expressive part of the body. Facial
expressions convey emotions such as surprise, fear, anger, happiness, and sadness.
4. Eye Contact. People signals readiness to communicate through eye contact.
Maintaining eye contact during conversation shows respect and willingness to listen.
5. Gesture. Gesture emphasize, punctuate, and clarify spoken word. Gestures alone carry
specific meanings, or they create messages with other communications cues.
6. Sounds. Sounds such as sighs, moans, groans, or also sobs also communicate feelings
and thoughts.
7. Territoriality and Personal Space. Territoriality is the need to gain, maintain, and
defend one’s right to space. Territory is important because it provides people with a sense
of privacy, identity, security, and control
 THERAPEUTIC COMMUNIVATION TECHNIQUES
-Specific responses that encourage the expression of feelings and ideas and
convey acceptance and respect. Still and comfort with using the techniques increase with
consistent practice.

1. Active Listening. Being attentive to what a patient says both verbally and non-
verbally.
2. Sharing Observation. Nurses make observation by commenting on how the other
person looks, sounds, or acts. Stating observation often helps a patient communicate
without the need for extensive questioning, focusing, or clarifications.
3. Sharing Empathy. The ability to understand and accept another person’s reality,
accurately perceive feelings, and communicate this understanding to the other.
4. Sharing Hope. Appropriate encouragement and positive feedback are important in
fostering hope and self-confidence and for helping people achieve their potential and
reach their goal.
5. Sharing Humor. Humor is an important but often underused resource in nursing
interaction. It is a coping strategy that can reduce anxiety and promote positive feelings.
6. Sharing Feelings. Nurses encourage patients to express their emotions and concerns,
creating a safe space for open and honest communication.
7. Using Touch. Touch is the most potent and personal forms of communication. It
express concern or caring to establish a feeling of connection and promote healing.
8. Using Silence. Silence prompts some people to talk. It allows patient to think and gain
insight.
9. Providing Information. Tells other people what to know so they are able to make
decisions, experience less anxiety, and feel safe and secure.
10. Clarifying. To check whether one understands a message accurately, restate an uclear
or ambiguous, message to clarify the sender’s meaning.
11. Focusing. Involves centering a conversation on key concept of a message.
12. Paraphrasing. Restating another’s message more briefly using one’s own word.
13. Validation. Used by nurses to recognize and acknowledge a patient’s thoughts,
feelings, and needs. Patients and families know they are being heard and taken seriously
when the caregiver addresses their issues.
14. Asking relevant Question. Focusing on questions that are crucial for understanding a
patient’s condition. Needs, and concerns to ensure effective and patient-centered care.
15. Summarizing. Concise review of key aspects of an interaction.
16. Self-Disclosure. Subjectively true personal experience about the self that
intentionally revealed to another person.
17. Confrontation. Nurse helps the other patient become aware of inconsistencies in his
feelings, attitudes, beliefs, and behaviour to improve it’s self-awareness.

Non-therapeutic Communication Techniques

-Certain communication techniques hinder or damages professional relationships
causing the recipients to activate defenses to avoid being hurt or negatively affected.

1. Asking Personal Question. Asking personal questions that are not relevant to a
situation simply to satisfy one’s curiosity is not appropriate professional communications.
2. Giving Personal opinions. It takes decision making away from the other person. It
inhibits spontaneity, stalls problem solving, and creates doubts.
3. Changing the Subject. Changing the subject when another person id trying to
communicate his story is rude and shows a lack of empathy.
4. Automatic Responses. Stereotypes are general beliefs held about people. Making
stereotyped comments about others reflect poor nursing judgement and threatens nurse-
patient or team relationship.
5. False Reassurance. Offering reassurance not supported by facts or based in relaity
does more harm than good.
6. Sympathy. Sympathy is a subjective look at another person’s world the presents a
clear perspective of the issue confronting that person. Sympathy is a compassionate
response to another’s situation, but it’s not as therapeutic as empathy.
7. Asking for Explanations. Regardless of a patient’s perception of a nurse’s motivation
asking “why” questions cases resentment, insecurity, and mistrust.
8. Approval or Disapproval. Agreeing and disagreeing sends the subtle message that
you have the right to make value judgement about the patient’s decision.
9. Defensive Responses. Where a nurse reacts to a client’s concerns or criticism with a
protective or dismissive attitude, hindering open and honest communication.
10. Passive and Aggressive Responses. Passive responses serve to avoid conflict or
sidestep issues. Aggressive responses provokes confrontation at the other person’s
expense.
11. Arguing. Arguing against perceptions denies that they are real and valid. A skillful
nurse gives information or presents reality in a way that avoids argument.
12. Giving Literal Responses. Don’t give that patient an opportunity to verbalize inner
feelings and thoughts.

HELPING RELATIONSHIPS
 Communication is a basic component of human relationship and nurse-patient
relationship.
 Effective nurse-patient relationship is a helping relationship which is growth-
facilitating, and provides, support, comfort, and hope.

Phases of the Helping Relationship

1. Preinteractoin Phase. Before meeting a Patient.
2. Orientation Phase. When the nurse and the patient meet and get to know each other.
3. Working Phase. When the nurse ad the patient work together to solve problems and
accomplish goals.
4. Termination Phase. During the ending of the relationship

COMMUNICATION THROUGHOUT THE NURSING PROCESS

-The nursing care process provides a clinical decision-making approach fro nurses
to develop an individualized plan of care. It guides care for patients who need special
assistance with communications.

A. Assessment
 Verbal interviewing and history taking
 Visual and intuitive observation of nonverbal behavior
 Written medical records, diagnostic tests, and literature review
Discussions:
 Physical and Emotional Factors
 Developmental Factors
 Sosiocultural Factors
 Gender

B. Nursing Diagnosis. The primary nursing diagnostic label used to describe a patient
with limited or no ability communicate verbally is “Impaired Verbal Communication”.

C. Planning. It is especially important to involve the patient and the family in decisions
about the plan of care to determine whether suggested methods are acceptable.
 Goals and Outcomes
 Setting Priorities
 Teamwork and Collaboration
D. Implementation. The nurse uses communication techniques that are appropriate for a
patients individual needs.

E. Evaluation. Initially, the nurse may evaluate the effectiveness of her communication
by videotaping practice sessions with peers or by making process recordings (written
records of the nurse’s verbal and nonverbal interactions with patients).