Nursing Management of Clients with Stressors
that Affect Communication
NUR101 Fall 2008
Lecture #2
K. Burger MSEd, MSN, RN, CNE
Elements of Communication
Source (encoder)
Message
Channel
Receiver (decoder)
Feedback
Nurses Role
Therapeutic PHASES of HELPING
communication RELATIONSHIP
Helping relationship
between nurse and Orientation
patient Working
Utilizes interviewing
Termination
techniques to gather
information
(assessing)
Factors that Influence Communication
Developmental Space
Stage Physical
Gender Mental
Sociocultural Emotional
Role/Occupation State
Effective Communication
Friendliness, openness, respect
Empathy, trust, caring,
competence
Purpose, privacy,
confidentiality, comfortable
environment, personal space
Verbal Communication
Transmitting
a message using the
spoken or written word
Nurses speaking to patients/
nurses/doctors or writing progress
notes/ nursing care plans
Nonverbal Communication
Transmission Gait
without using Physical
words
appearance
Body language
Dressing/grooming
Touch
Sounds
Eye contact
Facial Silence
expressions
Posture
Techniques Facilitating
Communication
Conversational Listening skills
skills Alert/relaxed
Tone of voice Indicate
Knowledgeable attentiveness
Confidence Think before you
Flexible speak
Clear/Concise Listen for themes
Honesty/Authenticity
Avoid semantics
Facilitating Communication
Silence Humor
Touch Assertive
Eye contact Utilize
Watch your opportunities
body language Use of supportive
statements
Displaying empathy
Blockers to Communication
Not perceiving pt. Inappropriate
as a human comments
Not listening Clichés
Changing the Asking yes/no
subject questions
False Giving advice
reassurance Probing questions
Being judgmental
Interviewing Techniques
Used by nurses to obtain information
about pt.
Useful in the helping relationship
FIRST STEP = attentive listening!!!
ALSO NEED: privacy, comfortable environment
Open ended questions
“What brings you to the clinic today?”
Closed questions/comments – yes/no
Validating questions/comments
“Tell me whether my understanding of what you said
is correct…..”
Interviewing Techniques
Clarifying
questions/comments
Reflective (re-stating)
questions/comments
Paraphrasing
Direct questions
Sequencing
Re-focusing
AN EXAMPLE
During your shift in the ICU you have been
assigned to care for a man injured in a
motor vehicle accident in which he has
been charged with DWI.
The driver of the other car was killed.
The patient says to you:
“I feel so terrible about what has happened”
SUPPORTIVE STATEMENT
“I CAN IMAGINE HOW YOU FEEL”
“THIS MUST BE VERY DIFFICULT FOR
YOU”
CLARIFYING
“ARE YOU FEELING BAD ABOUT HAVING
BEEN DRINKING AND DRIVING?”
“ARE YOU FEELING BAD ABOUT HAVING
KILLED SOMEONE?”
“ARE YOU FEELING TERRIBLE ABOUT
YOUR INJURIES?”
“ARE YOU FEELING TERRIBLE ABOUT THE
FACT THAT YOU ARE GOING TO BE
ARRESTED AND GO TO JAIL?”
CONVEYING EMPATHY
USING CONGRUENT NON-VERBAL
COMMUNICATION TECHNIQUES:
TOUCH
EYE CONTACT
SILENCE
ALONG WITH:
SUPPORTIVE STATEMENTS
???????
NURSE REPLIES:
“YOU FEEL TERRIBLE?”
REFLECTION
(RESTATING)
??????
NURSE REPLIES:
“WELL, YOU SHOULDN’T HAVE BEEN
DRINKING WHILE DRIVING”
BEING
JUDGMENTAL
??????
NURSE REPLIES:
“DON’T WORRY, I’M SURE
EVERYTHING WILL BE ALRIGHT”
FALSE
REASSURANCE
Impaired Communication
Hearing impaired
Visually impaired
Language barriers
Physical barriers
Cognitively impaired
Unconscious