This presentation covers basic communication skills. It is designed for the adult learner.

1. By Ronald Speener

2. Areas
Written Listening & Speaking
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3. Table of Content
What is
Communication
Professional
Writing Skills
Effective
Listening
Effective
Questioning
Scenarios Resources
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4. Objectives
• Understand the two requirements of effective
communication
• Describe the communication paradigm
• Explain the elements of professional written
communication
• Discuss the needs for good listening skills for nurses
• List key listening skills
• Develop good questioning strategies
• Demonstrate good listening and questioning strategies
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5. What is communication?
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6. Communication
• Communication is the
conveying of
information.
•How is communication
done?
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7. Exercise What is in the bag? 1
Gestures only
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8. Communication Paradigm
Talking Listening
Writing Reading
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9. Exercise What is in the bag? 2
Limited vocabulary
a)Big
b)Small
c)Black
d)White
e)One
f) Two
g)Many
h)Round
i) Square
j) Not
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10. Four Areas of Communication
As a College
Student
As a
Professional
As a Citizen
As a
friend/family
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11. Considerations When
Communicating
Purpose
Audience
Meaning Structure
Formality
Grammar Vocabulary
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12. Purpose and Audience
Purpose
•What is the goal of the
communication?
•The purpose will
influence all other
considerations
Audience
• Who is going to the
message?
• What is his or her
language skills?
• What is his or her
vocabulary level?
• What is his or her
general knowledge?
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13. Meaning and Structure
Meaning
• Looks at what is being
said
• Determines why it needs
to be said
• Asks if what is being said
is what is meant
• Drives the structure,
formality, vocabulary and
grammar
Structure
• How the information is put
together
• The layout of the
communication
• E-mail
• Documentation
• Research paper
• Conversation
• Meeting
• Teaching
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14. Formality
• Formality is how casual the writing is
• This is determined by the purpose and
the audience
• It is a matter of degree not yes or no.
Formal Informal
Buttock Rump Behind Caboose Ass
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15. Vocabulary
•It is through words that
ideas are expressed
•The more words one
has the better able to
express one’s ideas
•Not everyone has the
same vocabulary
Grammar
• The basic rules of
language
• Used to understand
vocabulary
• All languages have
grammar, including
computer languages
• A brigant was bending
toward the wind.
• Man the dog big the bit.
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16. Exercise Acceptable or Unacceptable
1. Samantha is a well groomed African
American woman.
2. Charles stinks from poor personal hygiene
because he is fat and cannot reach all
body areas.
3. Zanem, an effeminate male, cried when
given the flu shot.
4. Quill because she is heavily tattooed
requires extra caution with blood draws.
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17. Professional Writing
Skills
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18. Exercise Bad Medical Writing—Why?
“The greater pain
caused by larger-sized
tubes was the result of
increased pain during
the insertion of the tube
and pain while the tube
was in situ, with no pain
difference during tube
removal ”
•Is this clear writing.
•When is the pain?
•“Greater pain was
experienced with a
larger tube during
insertion, while in situ
and during removal.”
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19. Why Writing Matters
• Better Patient Care
• Clear Communication
• Expanded Career
Opportunities
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20. Audience
To Doctors
To Co-Workers
• Supervisors
• Peers
• Subordinates
Patients To Family
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21. Professional Writing
Expectations
Types
• Emails
• Reports
• Physician orders
• Charting/Documentation
• Shift Summaries
• Care plans
• Case studies
Quality
• Full sentences
• Solid grammar
• Clear organization
• Formal style
• Be Precise
• Be Objective
• Remember the reader
• Accurate information
• Accurate use of medical terms
• Accurate spelling
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22. Emails
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23. Definition
Email is the electronic
transmission of
messages through a
computer network
Not everything is
appropriate for emails
HIPPA requirements
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24. Basics of Good Communication
• Know your audience
• Write to that audience
• Emphasize clarity over
cleverness
• Emphasis content over
expansiveness
• Use standard fonts
• Keep bolds, underlines,
and italics to a minimum
• If using a priority system,
be honest.
• Avoid backgrounds or
stationary that detract
from the message
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25. Signature Block
• Sender’s information
• Include
• Name
• Job title
• email address
• Company, Department
• Separate from text by
two or three lines
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26. Before Sending
• Check spelling
• Check grammar
• Check for clarity
• Check Addressee's name
• Don’t send emails when
angry
• Remember telephones
still exist – Is email the
best way to respond?
• HIPPA and emails
• If patient initiates the
email
• If patient prior consents
to email
• If information emailed is
included in the consent
• Patient should be
advised about the risks in
emails
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27. Email and Security
• Emails and email
attachments are a
primary entry method for
computer viruses
• Viruses can spread
extremely fast
• Computer crime is the
growth sector of
organized crime
• Be skeptical
• Open an email from an
unknown sender with
caution
• Never open email
attachments from an
unknown sender
• Never give out
passwords, social
security numbers, bank
account numbers, etc.
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28. Email Security Terms
• Virus – A type of software that run
without your knowledge, replicates
itself and spreads to other
computers
• Trojan Horse– A type of virus that is
intended to do harm to the computer.
It is usually hidden inside something
attractive, such as a cartoon
• Worm – a type of virus that spreads by Email
• Zombie—Unauthorized use of a
computer by others for their personal
reasons
• Bot—A web site that automatically
transfers the user to another
undesired website
• Spam—Mass mailings to know email
users
• Phish—Requests for personal
information from what appears to be
a trusted organization; e.g. personal
bank
• Ransomware-is a type of malicious
software that threatens to publish
the victim's data or perpetually block
access to it unless a ransom is paid
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29. Security Measures
• Have a good anti-virus program
• Use a firewall
• Have good spyware and adware
filters
 Update regularly
• Have a good spam filter
• Update programs frequently and
quickly
• Do not open emails with multiple
forwards
• Be cautious in downloading free or
shareware programs
• Be cautious in opening emails from
unknown senders
• Be wary of attachments
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30. Exercise Bad Medical Email—Why?
From: Mabel Lean, RN
To: Cmesoon@Hotmail.com
RE: Lab results
Dear Ms. Didledump,
Since your son is covered under your insurance. I
am notifying you about the lab results for him after
he went to the college health center.
He tested positive for gonorrhea and is being
treated.
I suggest you have a discussion with your son
about his sexual behavior.
Thanks
Nurse Lean
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HIPPA violation

31. Exercise Bad Medical Email—Why?
From: doctorawesome@aol.com
To: orthorules@hotmail.com
Hey
THIS IS JOE FROM THE ER. GOT A PT
FOR U!! HAHA I KNO U ORTHO DOCS
LOVE A BROKE BONE, AND THIS ONE
HAS 2 LOL! TIB/FIB FRACS. 60 yo named
Ned Carson, fall dwn stairs
Later
Joe DR. JOE ACULA ER PHYSICIAN
“A flower cannot blossom without sunshine, and
man cannot live without love.” —Max Muller
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• Too informal for the
workplace
• All caps
• Acronyms

32. Listening Skills
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33. Listening helps clients
• Feel cared about and
accepted
• Feel significant and
respected
• Feel heard and understood
• Feel connected with other
people
• Feel less isolated and
alone
• Establish a sense of trust
with helper(s)
• Make sense of their
current situations and/or
past experiences ask for
help
• Give feedback about their
care express emotions and
release tensions
• Participate in their care
planning
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34. Listening involves
• Providing time for the person to tell his/her story
offering a quiet and private space,
• free from distractions to listen to the person listening
• with the purpose of understanding the person’s
message giving full attention
• by focusing on what the person is saying tuning out
external distractions, such as background noises
tuning out internal distractions, such as thoughts
about what to say next.
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35. Listening to non-verbal
communication
• Eye contact such as staring,
avoiding eye contact
• Facial expressions such as
frowning, smiling, clenching or
‘biting’ lips, raising eyebrows
• Voice, such as tone, volume,
accent, inflection, pauses
• Body movement, such as
posture, gestures, fidgeting
• Physiological responses, such as
perspiring, breathing rapidly,
blushing
• Appearance, such as dress.
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36. Five Listening Skills
• Building rapport
Attending Behavior
• Open questions
• What, Why, HowQuestioning
• Identifying mixed messages
Confrontation
• Finding broader aspects and possible solutions
Focusing
• Deeper meaning or thoughts
Reflection
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37. Attending Behavior
Building rapport
•Be at eye level
•Use person’s name
•Smile
•Encourage talking
about self and
concerns
Skills that demonstrate listening
• Reflecting
• Acknowledging
• Summarizing
• Empathizing
• Making educated
guesses
• Paraphrasing
• Checking
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38. Exercise Attending Behavior
• You are meeting for
the first time Louisa
Gomez, a 24 year old
woman who has just
given birth to twin boys
• How would you
approach her?
•Identify self
•Identify reason for
meeting Louisa
•Ask how she is feeling
•Discuss the babies
•Answer questions
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39. Questioning Skills
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40. Questioning
Building understanding
• Ask open ended questions
• Why
• What
• Where
• Ask closed questions
• Yes/no
• Ask for clarifications
• Restate answers for
accuracy
Bad Questioning
•Do not bombard
•Do not ask multiple
questions
•Do not make questions
as statements
•Understand cultural
differences
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41. Skills that assist with information
giving
• Checking what information the person knows already.
• Giving small amounts of information at a time, using clear terms and avoiding
jargon.
• Avoiding detail unless it is requested – do not assume people want to know.
• Checking understanding using an open question. For example: ‘I’ve gone
through some difficult information, what sense have you made of it?’
• Pausing and waiting for a response to what you have said before moving on.
• Checking, with sensitivity, the effect of the information you have given on the
patient or caregiver.
• For example: ‘There has been a lot of information to take in today, how are you
feeling?’
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42. Exercise Questioning
• Gabriel Popowloski, age 57, is ready for
discharge after coronary bypass.
• What questions might you ask?
• How does he feel?
• Does he have transportation?
• post-operative home care
• Do you have a list of post-operative
resources to home
• Home health
• Therapy
• Do you understand your medications
• Do you understand your wound care
• Do you understand your critical issues he
should seek immediate help
• How much you and the hospital appreciate
by his trust in them
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43. Confrontation
Helping bring awareness to the patient over something they do not
accept or are overlooking
• Thoughts and feelings
• Thoughts and actions
• Feelings and actions or
• A combination of
thoughts, feelings and
actions
• Good confrontation is
gentle
• Acknowledge feelings
• Reduces defensiveness
• Pay attention to non-
verbal cues
• Offer alternative views
and options
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44. Focusing
Keeping the conversation flowing in a certain direction
•Helping understand condition and treatment
•Helping understand why
•Helping see a broader picture
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45. Skills that assist in keeping the
focus on the patient
• Looking and listening for cues.
• Asking open questions.
• For example: ‘How are you?’
• Asking open directive questions.
• For example: ‘How are you since I
last saw you?’
• Asking open questions about
feelings.
• Exploring cues.
• For example: ‘You said you are
not with it, can you tell me more
about that?’
• Using pauses and silence.
• Using minimal prompts.
• Screening.
• For example: asking the question
‘Is there something else?’ before
continuing with the discussion.
• Clarifying.
• For example: asking the question
‘You said you are not with it, from
what you say, it sounds like it is
hard to concentrate?’
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46. Scenario Focusing
• Heather Broadsande, age 16, is pregnant and is worried about her future: school, friends,
church, and keeping the baby.
• She is having a difficult time focusing on the prenatal care.
• What do you do?
a) Validate her worries
b) Help her put priorities to these worries
a) Baby’s health
b) Mother’s health
c) Go over each care issue
d) Have her repeat the care issue
e) Explain why it is important
f) Have her repeat the importance
g) Be patient and redirect
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47. Influencing
Changing the way a person thinks or reacts
•Everyone experiences and reacts to things
differently
•Helps redirect thinking toward condition
•Reframe
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48. Giving Information
Giving Information
• Provide data or facts
relevant to the patient’s
needs.
• Ensure that the patient
is receptive to the
information.
• Be direct, clear,
specific, concise and
concrete.
• Break the information
into units that the
patient can utilize.
After giving
information
• Check that the
patient has attended
to the data and facts
provided.
• Have the patient
repeat back.
• Evaluate for
distortions and use
other interviewing
skills to correct them.
Use information
giving
• To provide
instructions or
directions.
• To present
feedback.
• To provide
alternative
perspectives.
• To direct patients
to other resources.
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49. Scenario Influencing
• Matt Shorenstein, age 45, is a noncompliant diabetic.
• This is his third hospital stay this year for complications
from his diabetes.
• How do you influence him to be compliant?
a) Try to discover why he is noncompliant
b) Factually state the risks of his noncompliance
c) Have him restate the risk
d) Ask if he is willing to live with the risk
e) Tell him he is an adult and it is his choice
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50. Giving Bad Information
• Establish an appropriate setting.
• Check the patient's perception of the situation prompting
the news regarding the illness or test results.
• Determine the amount of information known or how much
information is desired.
• Know the medical facts and their implication before
initiating the conversation.
• Explore the emotions raised during the interview.
• Respond with empathy.
• Establish a strategy for support
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51. Scenario Bad News
• Hudsen Rivera, 18, was in a serious car accident and
lost his left leg. He has a football scholarship.
• What do you say?
a) Ask what he remembers about the accident
b) State the results clearly
c) Allow time to process
d) Be prepared to answer unanswerable questions
e) Be patient
f) Offer professional resources
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52. SOLAR Position
• S—sitting facing the client
squarely, at an angle
• O—open adopting an open
posture, arms and legs
uncrossed
• L—leaning (at times)
towards the person
• E—eye contact, without
staring
• R—relaxed posture
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53. Barriers to Effective
Communication
Patient
• Environment – noise, lack of privacy,
no control over who is present or not
present (staff or relatives).
• Fear and anxiety – related to being
judged, being weak, or breaking
down and crying.
• Other barriers – difficulty explaining
feelings (no emotional language to
explain feelings), being strong for
someone else, or communication
cues being blocked by healthcare
professionals.
Healthcare professional barriers
• Environment – high workload, lack of time,
lack of support, staff conflict, lack of
privacy or lack of referral pathway.
• Fear and anxiety – related to making the
patient more distressed by talking and/or
asking difficult questions.
• Other barriers – not having the skills or
strategies to cope with difficult reactions,
questions and/or emotions. Thinking ‘it is
not my role’, and ‘the patient is bound to
be upset’.
(Wilkinson 1991, Booth et al 1996, Heaven and Maguire 1998, Maguire 1999)
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54. Role Play
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55. Role Play
Your task is to document the
cause of injury
•Hugh Grant
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56. Role Play
Your task is to obtain a social
history.
•Clarence Stelton.
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57. Role Play
Your task is to find out why she is
upset
•Marybeth Creamsworth
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58. Summary
• Effective communication is essential to quality
patient care
• Nurse need to effectively communicate in writing
• Nurses need to listen carefully and ask critical
questions
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59. Resources
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60. Resources 1
• Australian Institute of Professional Counsellors. (2017). Five
Counselling Microskills. Retrieved July 13, 2017, from
http://www.aipc.net.au/articles/five-counselling-microskills/
• Bramhall, E. (2014, September 1). Effective communication skills in
nursing practice. Retrieved from
http://journals.rcni.com/doi/pdfplus/10.7748/ns.29.14.53.e9355
• Case Tompkins, J., Tompkins, E., & Angeli, E. (2017). Purdue OWL
Writing as a professional nurse. Retrieved July 12, 2017, from
https://owl.english.purdue.edu/owl/owlprint/922/
• Counselling Academy. (2010). Counselling micro skills. Retrieved from
https://www.aipc.net.au/student_bonuses/Counselling%20Micro%20Skil
ls.pdf
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61. Resource 2
• Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing
practice. Mater Sociomed, 26(1), 85-87. doi:10.5455/msm.2014.26.65-
67
• Mikanowicz, C., & Gmeiner, A. (2017). Communication strategies.
Retrieved from https://www.nursece.com/courses/48
• Morrissey, J. (2011). Core communication skills in mental health
nursing. In Communication skills for mental health nurses (pp. 1-16).
Retrieved from
https://www.colleaga.org/sites/default/files/attachments/core%20commu
nication%20skills.pdf
• Rosenzweig, M. Q. (2012). Breaking bad news. The Nurse
Practitioner, 37(2), 1-4. doi:10.1097/01.npr.0000408626.24599.9e
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62. Resource 3
• Sacramento State College. (n.d.). Helpful guide for writing In nursing. Retrieved July 12,
2017, from http://online.annamaria.edu/rn-bsn/resource/why-nurses-need-good-writing-
skills
• Stanford School of Medicine. (2017). Palliative care: Examples of common clinical
situations that are emotionally charged:. Retrieved from
https://palliative.stanford.edu/communication-breaking-bad-news/examples-of-common-
clinical-situations-that-are-emotionally-charged/
• Taylor, D. B. (2013). Writing skills for nursing and midwifery students. Retrieved from
https://books.google.com/books?hl=en&lr=&id=ACkA3W5y4SEC&oi=fnd&pg=PP1&dq=W
riting+Skills+for+Nursing+and+Midwifery+Students&ots=SUx5NaFxYM&sig=zlVsvQgel3xi
Ro82Tub2q6JibZI#v=onepage&q=Writing%20Skills%20for%20Nursing%20and%20Midwi
fery%20Students&f=false
• Vertino, K. A. (2014). Effective interpersonal communication: A practical guide to improve
your life. Online Journal of Issues in Nursing, 18. doi:10.3912/OJIN.Vol19No03Man01
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