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www.BrainKart.com CHAPTER 5 CHAPTER 5 Communication and Nurse-Patient Relationship Page 1 of 61
www.BrainKart.com ❑ Define communication. ❑ Explain the process and elements of communication. ❑ Enlist the types and modes of communication ❑ Explain the factors influencing ❑ communication. ❑ Describe the methods and barriers of effective communication. ❑ Understand the concept of professional communication. ❑ Explain phases of nurse- patient relationship ❑ Exhibit skills in communicating effectively with patient, families, and team members. Learning Objectives Page 2 of 61
www.BrainKart.com ❑ Communication. Elements, process and levels of communication. Types, modes and principles of communication. Factors influencing communication. Therapeutic communication. Methods and barrier of effective communication/therapeutic communication techniques. Professional communication. Phases of nurse-patient relationship. Effectively communicating with the patient, families, and team members CHAPTER CHAPTER OUTLINE OUTLINE Page 3 of 61
www.BrainKart.com MEANING OF COMMUNICATION Definiton : Concept: Communication is defined as a process of generating, exchanging, understanding and transmitting the information between two individuals. Communication is the base of community because through communication only the individuals are able to understand each other appropriately Page 4 of 61
www.BrainKart.com ELEMENTS & PROCESS OF COMMUNICATION Page 5 of 61
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www.BrainKart.com LEVELS OF COMMUNICATION Page 7 of 61
www.BrainKart.com LEVELS OF COMMUNICATION Intrapersonal Communication : also known as self-talk. Like we decide what to wear. Similarly, nurses also do intrapersonal communication through which they enhance and focus toward positive interaction. Interpersonal Communication: includes the communication between two or more individuals and always have goal to exchange messages. Page 8 of 61
www.BrainKart.com Group communication Interpersonal Communication Organizational communication Public communication Mass Communication Page 9 of 61
www.BrainKart.com CLASSIFICATION CLASSIFICATION OF COMMUNICATION OF COMMUNICATION According to The Channel According to The Channel of of Communication Communication Page 10 of 61
www.BrainKart.com 1. VERBAL COMMUNICATION Is the traditional way of communication and language is the channel of communication. Language can be used in the form of oral or written form. Page 11 of 61
www.BrainKart.com 1. VERBAL COMMUNICATION- Types Written communication Refers to the communication which involves use of words through letter or memo/report etc. Oral communication: Refers to the communication that involves the use of Spoken words and done by word of mouth. Page 12 of 61
www.BrainKart.com Advantages & Advantages & Disadvantages Disadvantages Oral And Written Communication Page 13 of 61
www.BrainKart.com 2. NON-VERBAL COMMUNICATION It is the type of communication that involves wordless conversation, also referred as body language. Page 14 of 61
www.BrainKart.com 2. NON-VERBAL COMMUNICATION - Types Page 15 of 61
www.BrainKart.com 3. ELECTRONIC COMMUNICATION SOCIAL MEDIA: popular methods of sharing information is social media liked what’s app, twitter, Facebook, etc. Even official information is being exchanged on these platforms. But nurses must be aware about the privacy and confidentiality of information and adhere to the policies of the governing body. EMAIL AND TEXTS: Are effective ways of communication within an organization. Emails and texts should always be specific and concise, while drafting the message make sure the professional code of conduct should be maintained Page 16 of 61
www.BrainKart.com CLASSIFICATION CLASSIFICATION OF COMMUNICATION OF COMMUNICATION According to The According to The Style and Purpose Style and Purpose of of Communication Communication Page 17 of 61
www.BrainKart.com 1. FORMAL COMMUNICATION - Types • It is the one that flows through the official channels normally used within the organizational setup Page 18 of 61
www.BrainKart.com Vertical Vertical Communication Communication • Flows upwards or downwards through formal channels. • Upward communication flow of communication from a subordinate to superior. • Downward communication flows from a superior to a subordinate. Page 19 of 61
www.BrainKart.com Horizontal Horizontal Communication Communication • It is a lateral communication takes place among people having equal authority. Page 20 of 61
www.BrainKart.com 2. INFORMAL COMMUNICATION • It takes place without following the formal channels of communication is said to be informal communication like talking to friends. Page 21 of 61
www.BrainKart.com CLASSIFICATION CLASSIFICATION OF COMMUNICATION OF COMMUNICATION Based on Flow of Information Based on Flow of Information TWO-WAY COMMUNICATION: involves equal participation of sender and receiver also. Communication is active and democratic. Like discussion and brainstorming session where teacher and students freely expresses their facts and opinion on said topic. ONE-WAY COMMUNICATION: information is passed from one side to another only like in lecture – teacher only teaches and student learns Page 22 of 61
www.BrainKart.com Appropriateness: Suitable to the situation. Clarity: Communication should always be clear no ambiguity should rise with message conveyed. PRINCIPLES OF COMMUNICATION Channel of communication: It should be chosen carefully so that the clarity is maintained in the communication Feedback: It should always be sought to prevent ambiguity or doubts in the information shared or conveyed. Page 23 of 61
www.BrainKart.com Attitude of nurse: Attitude sets the mood of nurse-client relationship, like when working with positive attitude the nurse will approach the patient in unhurried manner, avoiding abrupt responses, making patient feel valued and respected. Cultural background: Nurse should be aware about the different sociocultural beliefs and practices. FACTORS INFLUENCING COMMUNICATION Gender: Men and women communicate differently and their perception and interpretation of information may also differ. Status/Role: Patient’s role in society or occupation can affect the nurse-patient relations. Page 24 of 61
www.BrainKart.com Environment/Space/Territory: Suitable area or environment helps. Collecting patient history in waiting area can cause patient to be uncomfortable because it is a public space. FACTORS INFLUENCING COMMUNICATION Physical, Mental and Emotional state: Should be assessed if found suitable then only communication can be effective Values - personal values of nurse and patient may differ and may lead to disruption in communication. Developmental stage: According to age the understanding and perception changes, with this intellectual and psychological development occurs. So communication shall be as per age. Page 25 of 61
www.BrainKart.com “It is interpersonal interaction between nurse and the patient for a specific purpose or where nurse focuses on patient’s unmet needs and aims to collect information to promote health”. THERAPEUTIC COMMUNICATION “Therapeutic communication is defined as the face-to-face process of interacting that focuses on advancing the physical and emotional well-being of a patient”. Page 26 of 61
www.BrainKart.com GOALS OF THERAPEUTIC COMMUNICATION GOALS OF THERAPEUTIC COMMUNICATION Page 27 of 61
www.BrainKart.com Methods of effective communication/ Therapeutic Communication Techniques Confirming/ Clarification Paraphrasing Sharing feelings Focusing Sharing Information Broad ended questions Humor providing leads Hope Offering self Empathy Reflecting Therapeutic Communication Techniques Active Listening Summarizing Page 28 of 61
www.BrainKart.com TECHNIQUES OF THERAPEUTIC TECHNIQUES OF THERAPEUTIC COMMUNICATION COMMUNICATION Page 29 of 61
www.BrainKart.com TECHNIQUES OF THERAPEUTIC COMMUNICATION TECHNIQUES OF THERAPEUTIC COMMUNICATION Page 30 of 61
www.BrainKart.com TECHNIQUES OF THERAPEUTIC COMMUNICATION TECHNIQUES OF THERAPEUTIC COMMUNICATION Page 31 of 61
www.BrainKart.com BARRIERS TO EFFECTIVE COMMUNICATION /NONTHERAPEUTIC COMMUNICATION TECHNIQUES Communication is the base of nurse-patient relationship; however, it can be disrupted very easily due to the following barriers”. Page 32 of 61
www.BrainKart.com BARRIERS TO EFFECTIVE COMMUNICATION Asking Personal Questions - questions that are not relevant to the situation is not appropriate. Or the questions asked to satisfy personal curiosity is also not professional. Giving personal opinion While communicating about nurse may come across the situation where patient may share situation where decision making is needed. Then nurse should refrain from giving any opinion or decision because it may divert or hinder the response of the patient. Changing the topic – While in conversation nurse should not change the topic or the subject, this indicates that nurse is either uncomfortable or not interested in the conversation. This impedes the communication and causes barrier Cliché / automatic responses – for example, “everybody is afraid of needles” or “administration is always money minded not employee supporter”. This kind of stereotype or automated answers can cause barrier in the communication and therapeutic communication because these replies reflect poor nursing judgement. False reassurance – or false hope can be can be another barriers in communication. As the nurse tells a terminally ill patient’s relative that “everything will be fine”, later the patient deteriorates. This false reassurance or hope will cause mistrust and lead to the barrier.. Page 33 of 61
www.BrainKart.com BARRIERS TO EFFECTIVE COMMUNICATION Sympathy - Expressing sympathy focuses on nurse’s feeling not on the patient. For example, “I am extremely sorry for your amputation”. This shows that nurse is feeling sorry and sympathize with patient. In this situation, patient stops expressing thoughts and wont share feelings. Moreover, for nurse, sympathy clouds ability of clear thinking Physical/ mental discomfort – Any pain anxiety or discomfort leads to barrier in communication, as discussed in factors influencing communication. Nurse should make sure of the comfort Approval/Disapproval– As mentioned in the factors, patient may bring up situation where nurse may have to express her opinion or give judgement. In this case, nurse must not impose their personal attitude value or belief or being judgemental. . Agreeing or disagreeing sends a message to the patient that information shared is right or wrong. Jargon – Use of medical terminology or technical terms may lead to confusion in patient’s mind and leading to lack of trust on nurse. Moreover, jargon will lead to inability to understand what nurse is saying Page 34 of 61
www.BrainKart.com BARRIERS TO EFFECTIVE COMMUNICATION Arguing – nurse must not argue with client, if a patient argues then nurse need to refrain from it and understand the situation and calm the patient. Challenging or arguing may leads to the defensive communication and revealing of incomplete true information Gossip and Rumour – discussing patients details with other health team members for non professional motive is unethical and should be avoided Giving Advice - Similarly like opinion nurse should refrain from giving advice as it this may cause defensive conversation or hiding of information which disrupts communication Time Constraints – is one of the key barrier because each nurse has multipole patients due to which the expectation of patient may not be met due to time constraints, and leading to disruption of nurse patient relationship. Page 35 of 61
www.BrainKart.com PNEUMONIC – BARRIERS IN COMMUNICATION “J has opinion on personal topic and automatically reassures - physical Sympathy, Arguing, gossiping, advising with time” I. J - jargon II. Opinion –Giving Personal Opinion III. Personal – Asking Personal Questions PNEUMONIC – BARRIERS IN COMMUNICATION IV. Topic – Changing the Topic V. And – Approval/Disapproval Of information VI. Automatically - Cliché/Automatic Response VII.Reassures – false Reassurance VIII. Physical – Physical/Mental Discomfort IX. Sympathy - Sympathy X. Arguing- Arguing with Patient XI. Gossiping - Gossip and Rumour XII. Advising -giving Advise XIII. Time – Time Constraint Page 36 of 61
www.BrainKart.com • Professional communication refers to oral/written, visual or digital form of communication in workplace. • Professional communication is important in nursing too, because it helps in developing rapport with patient and have trust among health team members and between nurse and patient. Professional communication aids in achieving productivity and objectives PROFESSIONAL COMMUNIICATION Page 37 of 61
www.BrainKart.com PROFESSIONAL COMMUNICATION The distance between two individuals has different zone of communication. Page 38 of 61
www.BrainKart.com PROFESSIONAL COMMUNICATION Intimate Zone: close contact : interaction between parents and children or partners or mother and child, who desire close contact. Personal Zone : distance maintained between close friends Social Zone: distance maintained while interacting with acquaintances like with colleagues. Public Zone: distance maintained while communicating in meetings or public speaking reality”. Page 39 of 61
www.BrainKart.com PRINCIPLES OF PROFESSIONAL COMMUNICATION • it involves whole process of encoding, message sending , channel of communication and influence of environment then receiving or the message and decoding then reflecting the feedback by the receiver. All these activities and events is a process which allows interaction between two individuals. Communication is process Communication is not linear but circular •This is because receiver when decodes the message provides the feedback through which sender evaluates if the message has been perceived in the manner it was intended. Communication is complex •as the message once received has a feedback as well as the response to it, like a message is received and accordingly the reply is given and actions are taken. If in case the message is not clear the sender provides further clarification based on the feedback Communication is irreversible •Interaction once made cannot be reverted, for example the sender sends a message to receiver then the message cannot be undone, this is why it is irreversible. •the communication is dependent on personality because a positive person would communicate in positive manner whereas personality who is dominating will have commanding communication. Therefore it is said that communication involves personality. Communication involves personality Page 40 of 61
www.BrainKart.com “The nurse-patient relationship is result of series of interaction between the nurse and the patient over a period of time with the nurse focusing on needs and problems of patient and his family while using the scientific knowledge and scientific skills of nursing profession”. —Joyce Travelbee NURSE- PATIENT RELATIONSHIP Page 41 of 61
www.BrainKart.com Purposes of Nurse- Patient Relationship Page 42 of 61
www.BrainKart.com Altruism: A professional nurse should be passionate about her services to the patients, family or to community at large. •• Ethics and Responsibility: Nurse should practice in a professional manner where her behavior, decisions, activities should reflect professional ethics and accountability. Elements of Nurse-Patient Relationship Communication Skills: Nurse should be skilful while communicating with the patients and should have adequate knowledge of verbal as well as nonverbal communication. Page 43 of 61
www.BrainKart.com Genuineness: Nurse should be sincere and honest in therapeutic relation. She must have clear and concrete in communications with patient. Respect: It is an unconditional positive regard to the patients and her behavior towards client should not depend on the patient’s behavior. There are different ways to promote respect and positive regard to the patient Elements of Nurse-Patient Relationship Empathy: It is the ability of a nurse to accurately understand the person’s current feelings and their meanings, and to communicate this understanding to the patient. Page 44 of 61
www.BrainKart.com Concreteness: Nurse must communicate information in a clear language using specific terms, according to the patient’s level of understanding. Confrontation: It is a process of helping the client become aware of inconsistencies in his or her feelings, attitudes, beliefs, and behaviors. Effective confrontation is only possible with high levels of empathy and respect toward patient. Immediacy: Immediacy involves sensitivity to the patient’s feelings and a willingness to deal with these feelings rather than ignore them. (Focus on here and now). Elements of Nurse-Patient Relationship Nurse self-disclosure: Nurse intentionally reveals personal experiences about the self to the patient for the purpose of emphasizing both the similarities and the differences of experiences . Page 45 of 61
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www.BrainKart.com PHASES OF NURSE-PATIENT RELATIONSHIP Page 47 of 61
www.BrainKart.com PRE-ORIENATION PHASE In this phase nurse does a preliminary work that is becoming aware of her own personal feelings, fears and worries, planning how to approach and interact with patient and learning about the disease condition patient reports with. This self-preparation would allow nurse to approach patient with unbiased and unprejudiced manner. Page 48 of 61
