M5-7

• Nursing

  An art and science
• The nurse in charge identifies a patient's responses to actual or potential health problems during the assessing step of the nursing process
• When two nursing diagnoses appear closely related

  1. Examine the related to factors

  2. Analyze the secondary to factors

  3. Review the defining characteristics
• The nurse performs an admission assessment primarily to identify important data
• Communication and nursing practice is a lifelong learning process for nurses
• Therapeutic communication


  • Promotes personal growth and attainment of patients' health-related goals
  • Key to nurse-patient relationships
  • Improves patient outcomes and increases patient satisfaction
• The Joint Commission recognized the need to promote effective communication for patient- and family-centered care, cultural competence, and improved patient safety
• Perception


  Influenced by five senses, culture, education, and perceptual bias
• Emotional intelligence (EI)


  An assessment and communication technique that allows nurses to better understand and perceive the emotions of themselves and others
• Communication throughout the nursing process

  1. Assessment

  2. Nursing Diagnosis

  3. Planning

  4. Implementation

  5. Evaluation
• Intrapersonal communication


  A powerful form of communication that nurses use for self-talk, developing self-awareness and positive self-esteem
• Interpersonal communication

  One-on-one interaction between a nurse and another person, often face-to-face, at the heart of nursing practice
• Small-group communication


  Interaction that occurs when a small number of people meet, usually goal-directed and requires understanding of group dynamics
• Public communication


  Interaction with an audience, such as speaking to groups of consumers about health-related topics, presenting scholarly work to colleagues, or leading classroom discussions
• Electronic communication


  Use of technology to create ongoing relationships with patients and health care team, such as secure messaging via patient portals
• Elements of the communication process

  • Referent
  • Sender and receiver
  • Message
  • Channels
  • Context or environment
  • Feedback
  • Interpersonal variables
• Circular transactional model

  Includes referent, sender and receiver, message, channels, context, feedback, and interpersonal variables. Each person is both a speaker and listener, simultaneously sending and receiving messages.
• Complementary role relationships


  One person holds an elevated position over the other
• Symmetrical relationships

  More equal
• Components of the circular transactional model

  • Referent
  • Sender
  • Receiver
  • Message
  • Communication channels
  • Feedback
  • Interpersonal variables
  • Environment
• Forms of communication

  • Verbal communication
  • Nonverbal communication
  • Metacommunication
• Verbal communication


  Uses spoken or written words, with consideration of vocabulary, denotative and connotative meaning, pacing, intonation, clarity and brevity, timing and relevance
• Nonverbal communication


  • Personal appearance
  • Posture and gait
  • Facial expressions
  • Eye contact
  • Gestures
  • Sounds
  • Territoriality and personal space
• Metacommunication


  Refers to all factors that influence communication, awareness of which helps people better understand what is communicated
• Zones of personal space

  • Intimate zone (0-8 inches)
  • Personal zone (1.5-4 feet)
  • Social zone (4-12 feet)
  • Public zone (12+ feet)
• Nonverbal communication


  • Avoiding showing shock, disgust, dismay, or other distressing reactions in a patient's presence
• Eye contact


  • Maintaining eye contact during conversation shows respect and willingness to listen
• Gestures


  • Emphasize, punctuate, and clarify the spoken word
• Sounds


  • Sighs, moans, groans, or sobs also communicate feelings and thoughts. Combined with other nonverbal communication, sounds help to send clear messages
• Territoriality and personal space


  The needs to gain, maintain, and defend one's right to space. Territory is important because it provides people with a sense of identity, security, and control
• Metacommunication

  A broad term that refers to all factors that influence communication. Awareness of influencing factors helps people better understand what is communicated
• Zones of Personal Space


  • Intimate Zone (0 – 8 inches)
  • Personal Zone (18 inches – 4 feet)
  • Public Zone (12 feet and more)
• Special Zones of Touch

  • Social Zone (Permission Not Needed)
  • Consent Zone (Permission Needed)
  • Vulnerable Zone (Special Care Needed)
  • Intimate Zone (Permission & Great Sensitivity Needed)
• Professional Nursing Relationships

  A nurse's application of knowledge, understanding of human behavior and communication, and commitment to ethical behavior create professional relationships. Having a philosophy based on caring and respect for others helps you be more successful in establishing relationships of this nature
• Nurse-Patient Caring Relationship

  1. Pre-interaction Phase

  2. Orientation Phase

  3. Working Phase

  4. Termination Phase
• Motivational Interviewing


  A technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior. The interviewing is delivered in a nonjudgmental, guided communication approach
• Nurse-Family Relationships


  Many nursing situations, especially those in community and home care settings, require you to form caring relationships with entire families. The same principles that guide one-on-one helping relationships also apply when the patient is a family unit, although communication within families requires additional understanding of the complexities of family dynamics, needs, and relationships
• Nurse–Health Care Team Relationships

  Use of a common language such as the SBAR technique for communicating critical information improves perception of communication and information about patients between health care providers. Lateral violence or workplace bullying between colleagues sometimes occurs and includes behaviors such as withholding information, backbiting, making snide remarks or put downs, and nonverbal expressions of disapproval such as raising eyebrows or making faces
• Nurse-Community Relationships


  Many nurses form relationships with community groups by participating in local organizations, volunteering for community service, or becoming politically active. As a nurse, learn to establish relationships with your community to be an effective change agent
• Elements of Professional Communication

  • Appearance, demeanor, and behavior
  • Courtesy
  • Use of names
  • Trustworthiness
  • Assertiveness