Chapter 20

Communicator

Copyright 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Five Parts of the Communication Process

Communication- the method of conveying information
and clarity
Stimulus or referent
the need to communicate
Sender or source of message (encoder)
The one who begins communication
Message itself
Medium or channel of communication
The method of interaction: auditory, visual, touch
Receiver (decoder)
The recipient of the communication
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Forms of Communication
Verbal (language)
Nonverbal (body language)
Facial expressions, touch, eye contact
Posture, gait, gestures
General physical appearance
Mode of dress and grooming
Sounds, silence
Electronic communication

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Electronic Communication
Social media
Both the American Nurses Association (ANA) and the
National Council of State Boards of Nursing (NCSBN)
have issued guidelines for RNs regarding use of social
media.
E-mail and text messages
The risk for violating patient privacy and confidentiality
exists any time a message is sent electronically.
Health care agencies usually have security measures in
place to safeguard e-mail and text communications.

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Four Levels of Communication

Intrapersonal
Self-talk; communication within a person
Interpersonal
Occurs between two or more people with a goal to
exchange messages
Group
Small-group
Organizational communication
Group dynamics

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Characteristics of Effective and Ineffective

Groups
Responsibility

Group identity
purpose and goals of
the group

accountability of
individuals
Leadership

Cohesiveness
cooperation and
commitment
Patterns of interaction
how communication
takes place

successful or
unsuccessful
Power
used appropriately or
inappropriately

Decision making
identification and
resolution of issues
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Factors Influencing Communication

Developmental level
Intellectual,
psychosocial

Space and territoriality

Personal space
Location of the interaction
Physical, mental, and
emotional state

Gender
Interpersonal
interaction styles
Sociocultural differences
Language and cultural
barriers
Roles and responsibilities
Misreading or making
assumptions

Comfort and cognitive

level
Values
Personal significance of
the information
Environment
Where and how the
communication takes
place

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Using Hand-Off Communication: SBAR

Technique

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The Helping Relationship

Characteristics
Dynamic
Purposeful and time limited
Person providing assistance is professionally
accountable for the outcomes and the means used to
attain them
Goals
Depend on the individual needs of the patient

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The Helping Relationship

Does not occur spontaneously

Characterized by an unequal sharing of information
Built on the patients needs
The nurse is the helper, and the patient is the person
being helped.
Communication is the means used to establish rapport
and helpingtrust relationships.

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Phases of the Helping Relationship: Goals

of the Orientation Phase
Establish tone and guidelines for the relationship.
Identify each other by name.
Clarify roles of both people.
Establish an agreement about the relationship.
Provide the patient with orientation to the health care
system.

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Phases of the Helping Relationship: Goals

of the Working Phase
Work together to meet the patients needs.
Provide whatever assistance is needed to achieve each
goal.
Provide teaching and counseling.

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Phases of the Helping Relationship: Goals

of the Termination Phase
Examine goals of helping relationship for attainment.
Make suggestions for future efforts, if necessary.
Encourage patient to express emotions about the
termination.
If appropriate, help the patient establish a helping
relationship with another nurse.
Assist the patient transferring from one agency to
another or from one unit in an agency to another.

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Factors that Promote Effective

Communication: Dispositional Traits
Warmth and friendliness
Openness and respect
Empathy
Honesty, authenticity, trust
Caring
Competence

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Factors that Promote Effective

Communication: Rapport Builders
Specific objectives
Comfortable environment
Privacy
Confidentiality
Patient vs. task focus
Utilization of nursing observations
Optimal pacing

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Developing Conversation Skills

Control the tone of your voice.

Be knowledgeable about the topic of conversation.
Be flexible.
Be clear and concise.
Avoid words that might have different interpretations.
Be truthful.
Keep an open mind.
Take advantage of available opportunities.

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Developing Listening Skills

Sit when communicating with a patient.

Be alert and relaxed and take your time.
Keep the conversation as natural as possible.
Maintain eye contact if appropriate.
Use appropriate facial expressions and body gestures.
Think before responding to the patient.
Do not pretend to listen.
Listen for themes in the patients comments.
Use silence, therapeutic touch, and humor appropriately.

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Interviewing Techniques
Open-ended questions or
comments
Tell me more about.
Closed questions or
comments
Specific short answer
Validating questions or
comments
To confirm the
patients information
Clarifying questions or
comments

Reflective questions or
comments
Repeat the patients
statements
Sequencing questions or
comments
Describing the order
of events
Directing questions or
comments
Transition to new or
previous information

Let me be clear
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Characteristics of the Assertive Nurses

Self-Presentation
Confident; open body posture
Use of clear, concise I statements
Ability to share effectively ones thoughts, feelings, and
emotions
Working to capacity with or without supervision
Remaining calm under supervision
Asking for help when necessary
Giving and accepting compliments
Admitting mistakes and taking responsibility for them

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Aggressive Behavior

Involves asserting ones rights in a negative manner that

violates the rights of others.
Can be verbal or physical.
Communication is marked by tension and anger,
inhibiting the formation of good relationships and
collaboration.
Characteristics include using an angry tone of voice,
making accusations, and demonstrating belligerence and
intolerance.
Focus is usually winning at all costs.

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Blocks to Communication
Failure to perceive the patient as a human being
Failure to listen
Nontherapeutic comments and questions:
Using clichs
Using closed questions
Using questions containing the words why and
how
Using questions that probe for information
Using leading questions
Using comments that give advice
Using judgmental comments
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Blocks to Communication (cont.)

Changing the subject

Giving false assurance
Using gossip and rumors
Using disruptive interpersonal behavior

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Disruptive Interpersonal Behavior

Incivility
Bullying
Horizontal violence- single or repetative
Nurse bullying
Negative communication between nurse and
physician
Organizational response to disruptive behaviors

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