The receiver must acknowledge that the message has been received and comprehended for communication to be complete. Anxiety, fear, and pain are often expressed by nonverbal cues.
Nonverbal communication is often referred to as body language. Sometimes a person’s nonverbal communication is incongruent, or in agreement with, the verbal communication. Can you give an example of a situation in which verbal communication and nonverbal communication are incongruent? Nurses can learn a lot about patients by observing nonverbal behavior because anxiety, fear, and pain are often expressed by nonverbal cues.
These factors can affect the communication process. Can you think of others not on this list?
Every culture has norms for appropriate communication. Can you provide an example? Other cultural aspects of communication include tone of voice and the amount of gesturing used.
How might one’s occupation or level of education influence communication? How might a nurse communicate differently than a person with no medical training?
Emotions and mood have a huge effect on the way messages are sent or interpreted. How might a nurse project body language that suggests he has an open, accepting attitude toward a patient? Can you demonstrate this to the class?
Nurses who are active listeners are demonstrating an interest in the patient and are building a trusting relationship. Active listeners do not interrupt the speaker. What are some nonverbal cues that indicate that a nurse is an active listener? (leaning forward, focusing on the patient’s face, nodding slightly, and maintaining an open body posture)
Nonverbal messages must be interpreted in the context of the speaker’s, not the listener’s, culture. When verbal and nonverbal messages are not congruent, the listener should probe the speaker further to determine the real meaning.
The response received from the question should verify whether the original message sent was interpreted correctly.
What does the effective communicator do when the focus of communication has wandered?
If it is comfortable for the patient to display feelings only in the context of telling a story about a related topic, allow enough time for full development of the topic so that the feelings can be adequately expressed
The techniques of therapeutic communication should be used judiciously and in a varied manner so that the interaction does not feel stilted or uncomfortable. Silence gives the patient time to think and respond. Open-ended questions allow the patient to elaborate on a subject and create an inviting atmosphere. Restating the message encourages the patient to continue to provide information on the topic. Therapeutic touch can signify support for the person; however, in some cultures it is not appropriate. Clarifying helps verify that the message is heard, especially when the conversation has rambled.
Providing general leads like, “Tell me more about that,” can get the interaction under way. Encouraging elaboration can elicit more information from the patient. Stating information concisely and allowing time for questions is important to the patient. Looking at alternatives while refraining from giving advice can help patients make their own decisions. Summarizing what has occurred during the interaction can provide closure to the discussion.
What are some examples of behaviors that block effective communication? Changing the subject deprives the patient of the chance to discuss concerns. Giving false assurance can lead to false hope and destroy trust in the nurse. Making defensive comments makes patients feel that they cannot express their concerns. Using clich é s negates the patient’s individual situation and sounds flippant. Giving advice makes the nurse sound controlling and diminishes the patient’s responsibility for his or her own health. Inattentive listening sends the message that the patient is not that important.
Why is an interview more directed than a therapeutic communication interaction? (because it has a planned and definite purpose) An admission interview usually starts with closed questions that call for specific and definite answers, and then moves on to open-ended questions to determine a patient’s concerns. The nurse-patient relationship is defined by specific boundaries. The nurse is in a helper role rather than a social role. Empathy is important. A nurse should maintain a focus on the patient’s feelings and acknowledge them, but not say, “I know how you feel.”
If the patient has hearing aids, make sure that they are used and turned on before communicating. A person with a hearing aid still might not hear very well, so these techniques should help promote comprehension.
Elderly individuals vary greatly in their ability to communicate. Older adults may have hearing, sensory, visual, or motor impairments. Eliminate outside distractions. Also, don’t rush through the communication because this may cause confusion. What other communication strategies might you use when communicating with the elderly?
Language, thought processes, and cognitive abilities are still developing in children. Young children are responsive to nonverbal messages. Do not make sudden movements. With infants, keep the mother in view. With toddlers and preschoolers, focus on the child’s needs and concerns. With school-age children, give simple explanations and demonstrate how equipment works. Listen to the child’s concerns. With adolescents, use active listening, avoid interrupting, and show acceptance. Be honest and tell the child what to expect.
Do not show impatience with a patient’s inability to speak English. Follow the patient’s lead in terms of eye contact.
Communication with the health care team is crucial to ensure continuity of care for the patient. Many different formats are used to give a shift report. Refer to Box 8-2 for information included in an end-of-shift report.
The nurse should follow these steps when calling a physician regarding a change in a patient’s condition or any situation in which new orders are anticipated. If an order is given by the physician, note it in the chart and read it back to the physician to ensure that it is correct. The student nurse should have an instructor or another registered nurse standing by to take the new orders from the physician because students cannot legally take telephone orders.
You must communicate well in order to assign tasks and delegate (authorize another person to do something) to others effectively.
Nurses who work in home care often have both a professional role and a social role with their patients and families.
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