Communication

Caring

• Considered by many nurses to be essential aspect of nursing.

• Leninger states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. She states that there can be no cure without caring, but that there may be caring without curing.

• Watson describes caring as grounded in a set of universal human values.

• Caring is the anti – thesis of simply using the other person to satisfy one’s needs.

13 Carative Elements1. Humanistic – altruistic value system

– Refers to an individual’s ability to be in touch with reality and to give self in service of others.

2. Faith and Hope– Faith is the person’s adherence to what is good and real, personified

in our Creator. Hope is the propelling motor that keeps one going even through rough ways.

3. Sensitivity to self and others– Ability of the individual to feel and realize one’s needs, weaknesses

and strengths in relation to other’s needs, weaknesses, and strengths.

4. Helping trusting relationship– Anchors his/her beliefs in other’s capacity based on trust and

confidence.

5. Ability to accept positive and negative expression of feelings– The individual is reality based and does not live in fantasies.

6. Personality type– The carer is able to identify whichever personality type suits any

particular situation and devices way to adapt.

7. Interpersonal teaching and learning abilities− The individual is an educator and should be able to impart

knowledge to modify one’s behavior.

8. Solid family background− The solidarity and the harmony within the family relationship that the

background the individual’s grown and development are the capital determinants in making one a caring person.

9. Experience of having been loved and the ability to love− The quality of love the child receives at home and the role model

he/she sees among the significant other around him/her influence to a great extent, is his/her very own way of giving or receiving love.

10. Spiritual life− The more spiritual the person is, the finer is the regard and

relatedness with the other.

13 Carative Elements

11. Sense of humor− Humor relaxes tension and makes one feel at ease

with oneself and others.

12. Relaxed attitude− When one is comfortable, his vision is broader and

accommodates more things in his heart and mind.

13. Open – mindedness− The ability to choose between two sides is an important asset

in learning to prioritize care and devotion.

13 Carative Elements

COMFORTING

Comforting

• Is a complex process that includes discrete, transitory actions such as touching or broad, longer lasting interventions such as listening.

• The desired outcome or product of comforting is comfort. (from Latin word “comfortare” meaning to “strengthen greatly”

Comfort

• implies a renewal, an amplification of power or sense of control, an invigorating influence, a positive mind – set, and a readiness for action.

Different Comfort NeedsKolcaba identifies comfort needs within four

contexts:

1. Physical Comfort

2. Psychospiritual Comfort

3. Social Comfort

4. Environmental Comfort

1. Physical Comfort- relates to the bodily sensations and the physiologic problems associated with the medical diagnosis.

2. Psychospiritual Comfort- relates to the internal awareness of self, including esteem, concept, sexuality, and meaning in one’s life. They can also include the person’s relationship to a higher order or being.

3. Social Comfort- relates to interpersonal, family, and social relationship.

4. Environmental Comfort- relates to the external background of human experience and can include light, noise, ambience, color, temperature, and natural versus synthetic elements. They may also include culturally specific foods and languages.

Intensity (Type) of Comfort

(according to Kolcaba)

1. Relief

2. Ease

3. Transcendence

1. Relief

Relief from discomfort is the experience of having the specific need met. Relief may be incomplete, partial, temporary, lasting only a short time until discomfort arises again.

2. EaseRefers to the state of calm or peaceful contentment. This state of comfort can exist without a prior state of discomforts that are lasting, rather than temporary relief from severe discomforts

3. Transcendence

Refers to the state in which the client rises above problems or pain. This state of comfort differs from the other two states in that the client is invigorated or inspired for extraordinarily performance as the end state, rather than ordinary performance, which is the end state for relief and ease.

COMMUNICATION

Communication

- The process of sharing information or the process of generating and transmitting meanings.

- Foundation of our way of life

- Requirement for a person’s well being

- “communicare”; to impart, share or make common

10 Commandments of Communication

1. Clarify ideas before communicating2. Examine the true purpose of each communication3. Consider the total physical and human setting4. Consult with others when appropriate5. Be mindful of overtones6. Convey only something of value7. Follow up8. Communicate for the future as well as the present9. Support communication with action10. Seek to understand as well as to be understood

General Purpose of Communication

• To gather information

• To validate information

• To share information

• To develop a trusting relationship

Elements of Communication

1. Referent or Stimulus

2. Sender or Encoder

3. Message

4. Channel or medium

5. Receiver or decoder

6. Feedback

Types of Communication

1. Social Communication – usually for enjoyment.

2. Therapeutic communication – nurse – patient relationship/interaction; to improve the patient’s ability to function.

3. Formal Communication – lectures, reports, charting in the patient’s records and public speaking.

Reasons for Ineffective Communication

• The sender may not be able to send the message he thought he had already sent

• The receiver may not hear or receive the message intended

• Verbal and non – verbal messages may conflict• Many words have multiple meaning• The message may be abstract and therefore

confusing• The receiver may not be prepared to hear or

receive another message

THE COMMUNICATION PROCESS

thought encoding transmission reception decoding understanding

FEEDBACK

NOISE

Channels of Communication1. Auditory

1.1 Hearing – receiving an auditory stimulus1.2 Listening – Interpreting what was heard and attaching meanings to them

2. Visual/Use of non – verbal cues2.1 Sight – receiving a visual stimulus2.2 Reading2.3 Observation2.4 Perception – sense of understanding

3. Kinesthetic3.1 Procedural touch3.2 Caring touch

Modes of Communication• Verbal communication – through words, and language,

either spoken or written When Choosing words to say or write, nurses need

to consider:

a. Pace and Intonation

b. Simplicity

c. Clarity and Brevity

d. Timing and Relevance

e. Adaptability

f. Credibility

g. Humor

• Non Verbal Communication – without the use of words.

Facial expression – e.g fear, interest, concern, sadness, dishonesty or honesty, shock, shyness, pleasure, excitement, and frustration

Postures – anxiety, relaxation, negative or positive self – image, confidence, depression, bodily condition, acceptance or interest, rejection or aversion, depression, exhaustion or boredom

Gestures – movement of body parts such as shrugging the shoulders, waving the hand, and tapping the feet

Touch – used cautiously for patients who are: confused (may misinterpret the intent to touch); aggressive (may see the touch as a threat and freak out; suspicious (may think touch is harmful; victims of the abuse (may frighten them)

Physical appearance and artifacts – include client’s environment, grooming or use of clothing and jewelry.

Modes of Communication

Factors Influencing the Communication Process

• Development• Gender• Values and perception• Personal space• Territoriality• Roles and relationship• Environment• Congruence• Interpersonal attitudes

Phases of Communication

• Orientation Phase – tone and guidelines are established.

• Working Phase – interaction is the essence of this phase.

• Termination Phase – occurs when the conclusion of the initial agreement is acknowledged.

Therapeutic Communication Techniques that allows the client to set

the pace

1. Offering Self – nurse is available, physically, and emotionally.

- indicates nurse’s willingness/intent to help.

- nurse’s presence is reassuring; may prompt client to continue.

- indicates nurse’s attention and interest.

- ex. “go on”; head nodding

2. Broad Openings – encourages client to choose topic for discussion– Demonstrates respect for client’s thoughts– Emphasizes importance of client’s needs– Ex. “what do you want to talk about?”

“ Can you tell me more about that?”“How have things been going?”

3. Silence – gives client time to reflect.– Encourages client to express self.– Indicates interest in what client has to say.– Increases nurse’s understanding of client’s message.– Helps to structure and pace the interaction– Conveys respect and acceptance.– Ex. “Sit quietly and observe client’s behavior”

Use appropriate eye contact Employ attending behavior Control own discomfort during quiet periods or

conversation

1. Verbalizing the implied– An attempt to detect the true meaning of verbal

messages.– Ex. Client “How much is the xray going to cost?

Nurse “You’re worried about your medical bills?

2. Making Observations – Nurses calls attention to behavior indicative of

feeling.– Ex. “You seem sad today.”

“You’re limping as if your leg hurts”

Therapeutic Communication Techniques that encourages expression

of feelings

3. Clarifying– Makes the meaning of client’s message clear– Prevents nurse from making assumptions about

client’s message.– Ex. Client: “Whenever I talk to my doctor, I feel

upset.” Nurse: “Tell me what you mean by upset.” Client: “They said I could be discharged tomorrow” Nurse: “Who told you this?”

4. Giving Information– Providing in a simple and direct manner, specific,

factual information the client may or may not request. When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it.

– Ex. “Your surgery is schedules for 11 am tomorrow”

5. Summarizing– Stating the main point of a discussion to

clarify the relevant points discussed. – Ex. “During the past hour we have talked

about…”

“Tomorrow afternoon we may explore this further”

1. Confronting / presenting reality– Nurse’s verbal response to incongruence between

client’s words and actions.– Encourages client to recognize potential areas for

change.– Ex. Client: “I am so angry at her” (stated while

smiling) Nurse: “You say you’re angry, yet you’re smiling”

Client: “I never know which of my symptoms to pay attention to. I think maybe I’m just a hypochondriac” Nurse: “You say you’re not sure which symptoms are important, yet you knew when to come to the clinic for help.”

Therapeutic Communication Techniques that encourages the client to

make some changes

2. Limit setting – Stating expectations for appropriate behavior.– Establishing behavioral parameters.– Ex. Nurse: “It seems that you are feeling unsure of

how to behave right now.” Client: “What do you mean?”

Nurse: “Well, you’re asking me a lot of personal questions. The reason you’re here is because you have some health problems. How can I help you tell me more clearly what brought you here to the clinic?”

1. Open ended comments/questions– Unfinished sentences that prompt client to

continue– Questions that cannot be answered with a

one word answer– Allows client to decide what content is

relevant– Ex. “Tell me about your pain?” instead of

“Are you in pain?”

Therapeutic Communication Techniques that encourage

spontaneity

2. Reflection– Focuses on content of client’s messages and feelings– Repeating client’s last words in order to prompt further

expression – Communicate nurse’s interest– Lets clients know the nurse is actively listening– Ex. Client: “Do you think I should tell the doctor I

stopped taking my medication?” Nurse: “What do you think about that?”

Client: “I probably should. But the medicine makes me so tearful and agitated”

Nurse: “You sound a bit agitated now”

3. Restating– Repeating or paraphrasing client's main idea

– Indicates nurse is listening to the client.

– Encourages further dialogue

– Gives client an opportunity to explain or elaborate

– Ex. Client: “I told the doctor that I had problems with this medicine, but he just didn’t listen to

me!”

Nurse: “Sounds like you’re pretty angry at him”

Client: “I don’t sleep well anymore”

Nurse: “You’re having problems sleeping?”

1. Exploring– Attempts to develop in more detail or specific area

of concern to client.– Identifies patterns of themes– Ex: “Tell me more how you feel when you do

not take your medication.”

2. Recognition– Nurse points out observed cues to the client.– Ex. “I notice that you became embarrass

when..” “I can see that you have some pictures

of the new baby”

Therapeutic Communication Techniques thatfocus on the client by

responding verbal, paraverbal, and non verbal cues

3. Focusing– Questions or statements that help clients develop or expand

an idea.– Directs conversation towards key topics– Ex. “You mentioned that you are having a

problem with…” “You say you feel nauseous a lot”

4. Directing– Comments that elicit specific information from the client– Is used to collect assessment data, not to satisfy nurse’s

curiosity– Ex. Client: “They told me I needed to see a

specialist” Nurse: “What made them say to you?” or “When

were you told this?” or “Where were you when they told you?” or “How do you feel abut seeing another doctor?”

Non Therapeutic Communization Techniques (Communication Blocks)

1. Challenging – giving a response that makes clients prove their statement or point of view. These responses indicate that the nurse is failing to consider the client’s feelings, making the client feel it necessary to defend a position.

Ex. Client: “I felt nauseated after that red pill.”

Nurse: “Surely you don’t think I gave you the wrong pill?”

2. Testing – asking questions that make the client admit to something. These responses permit the client only limited answers and often meet the nurse’s nee rather than the client’s.

Ex. “Who do you think you are?”

3. Reassuring – Comments that indicate to the client that concerns or fears unwarranted.Ex. “Everything will be fine.”

“You will feel better soon.”

4. Agreeing – comments that indicate that the nurse’s views are those of the client.Ex. “I think you are right.”

5. Approving – comments that indicate that the client’s views, actions, needs, or wishes are “good” rather than “bad”.Ex. “That’s good.”

6. Using close ended questions – questions or comments that can be answered by Yes or No.Ex. “Would you like some water?”

“Did you sleep well?”

7. Defending – comment that are aimed at protecting the nurse, someone else, or something from verbal attack.Ex. “Dr. Reyes is a good doctor.”

8. Stereotyping – “Pat” answers or clichés that indicate that the client’s concerns are unimportant or insignificant.Ex. “It will all come out in the wash.”

9. Changing focus – switching to a topic that is more comfortable to discuss.Ex. Client: “I wish I were dead.” Nurse: “Did your wife visit today?”

10. Disapproving – indicating displeasure about comments or behaviors and/or placing a value on them.Ex. “That’s bad.”

11. Judging – comments or actions by the nurse that indicate pleasure or displeasure with what the client says.Ex. “I do not like that”

12. Blaming – accusing the client of misconduct; undermines the client’s needs to be loved and accepted.Ex. “You should know better than to talk like that” “If you had not moved, I would have been able to

complete this venipuncture”

13. Belittling the client’s feelings – indicating to the client that feelings expressed are unwarranted or unimportant.Ex. “Be a big boy and stop crying.”

14. Advising – giving the client opinion or direction about solving a problem.

Ex. “If I were you, I would talk to you husband about this”

15. Rejecting – indicating to the client that certain topics are not open to discussion.

Ex. “Let’s not talk about that right now.”

16. Probing – pressuring the client to discuss something before she is ready.

Ex. “Why do you feel this way?”

“Why did you come to the hospital?”