Effective communication is the key to providing quality nursing care to our patients”
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Define therapeutic communication
Identify key features of therapeutic communication
Understand verbal communication principles
Explore forms of non-verbal communication
Understand the importance of active listening skills in nursing
Identify the barriers to listening
It is the purposeful use of communication to build and maintain helping relationships with patients, families and significant others.
Its techniques encourage the patient to express feelings and thoughts in a safe, nonjudgmental manner.
Assessment, diagnosis, planning, implementation and evaluation of a patients care depend on therapeutic communication between the nurse, patient, family, significant others and the multidisciplinary team (MDT).
To establish effective therapeutic communication trust, rapport, empathy, respect, privacy, confidentiality and boundaries should pre vail.
therapeutic communication occurs within the nursing context.
Provides exchange of health related information.
Requires knowledge and attitudes pertinent to nursing.
It is patient centred and goal directed.
It is responsive without being overly accommodating.
It is assertive without being domineering.
Trust – confidence in and reliance upon the health professional to provide quality service that is always in the best interests of the person seeking assistance. Trust is critical in the nurse-client relationship because the client is in a vulnerable position. Initially, trust in a relationship is fragile, so its especially important that a nurse keep promises to a client. If trust is breached, it becomes
difficult to re-establish
Rapport – A connection between two people based on trust and awareness that they have a common goal.
Empathy – the direct, clear and accurate understanding and expression of the emotions of an individual.
Respect – Unconditional positive regard for self and others regardless of weaknesses or failure, position or status, beliefs and values, and marital possessions or socioeconomic level. It assumes all human beings have innate worth and value. Respect is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal
attributes and the nature of the health problem.
Privacy – someones right to keep their personal matters and relationships secret.
Confidentiality – Keeping information within a particular context; involves keeping information private.
Boundaries – A boundary is a limit, or a behavioral line which cannot be crossed.
Warning signs of unhealthy boundaries could be:
You share personal problems or aspects of your intimate life with patients.
You keep secrets with patients.
You become defensive when someone questions your interaction with.
You have received gifts from a patient.
You speak to the patient about your own professional needs or inability.
You speak poorly of co-workers or the hospital to patients.
You talk to patients/families about things that are out of your scope of practice.
You give certain patients extra time or attention.
You give patients personal contact information or money.
You fail to set limits with a patient.
You spend duty time with patients.
You feel that you understand the patients problems better than other members of the healthcare team.
Susan is a 38-year old woman coming into the outpatient surgery centre for a breast biopsy. She sits in the waiting room with her husband and is obviously nervous – starting unblinking at the wall, taping her feet, and writing a tissue in her hand. The perioperative nurse approaches Susan to introduce herself and bring her into the operation suite to prepare for surgery.Nurse: “Mrs R., I am Laurie Snow, and I will be the nurse working with you today. What do you like to be called?”
Pt: “Hello, Call me Sue; thats what everyone else calls me. This is my husband, Andrew.”
Nurse: (she shakes hands with the patient and her husband.) “it is nice to meet both of you, Sue. I would like to explain whats going to happen today, get a little more information from you, and answer any questions that you may have about the surgery.”
Pt: “Oh, thank you. I am so scared. I dont know how I am going to get through this.”
Nurse: “Its common to feel nervous about surgery. My goal is to help you through today. I will explain everything as we go along and answer any questions you and Andrew may have.”
Pt: “I am glad that you will be there. May my husband come with me?”
Nurse: “of course.”
What is the role of the nurse?
Identified herself by name.
Established her credentials and her role.
Greeted the patient by her preferred name.
Addressed both the patient and her husband by their preferred names.
Reflected and normalised the patients anxiety by explaining her role.
Acknowledged that the patient might have questions and she was there to help.
Demonstrate genuineness, empathy and positive regard towards the patient.
Focus on the patients thoughts, feelings and experiences.
Identify and explore the patients needs and problems.
Help to develop the patients strengths and new coping skills.
Assist the patient to develop a sense of independence and self-reliance.
What is the role of the patient?
Explore ones thoughts, feelings and experiences;
Identify and explore the ones needs and problems;
Take steps to draw on ones strengths and to develop ones coping skills; and
Take steps to develop a sense of independence and self-reliance
Privacy and confidentiality
Document key verbal communication
(Hally, 2009, p. 141)
Verbal communication in nursing practice
All verbal communication in nursing practice should be courteous and polite. It should convey care and respect for the patient, and be accompanied by appropriate non-verbal communication.
Be specific and correct.
Avoid subjective comments or personal opinions that reflect negatively on other people – patients or colleagues.
Do not avoid verbal communication.
Avoid omissions (do not leave out important information)
If care is omitted, state why.
Avoid repetition and do not routinely report normal data or information recorded on standard documents
Repeat only unusual or significant data in handover.
Report deterioration in the patients condition, clinical emergencies, abnormal findings or errors immediately.
Privacy and confidentiality
Nurses must ensure that all verbal communication about patients remains private and confidential, according to the laws governing privacy and confidentiality of health information.
Document key verbal communication
All verbal reports (e.g., advising a doctor that the patient has chest pain) and referrals (e.g., to a social worker) should be documented.
Care should be taken to ensure that verbal interactions are culturally sensitive.
“I will check your cannula regularly for any signs of phlebitis”.
“Can you provide a midstream urine?”
“I need to know when you have passed flatus post operatively. We are concerned about a paralytic ileus”
“I am just checking your oxygen sat for adequate tissue perfusion”
“You are little hypotensive. Dont stand up in a hurry. I am worried thParalysis of the intestine
A partial or complete non-mechanical blockage of the small and/or large intestine
Tissue perfusion is the amount of blood that a tissue is receiving from the circulation.
Oxygen saturation is a term referring to the concentration of oxygen in the blood.
Fainting – vasodepressor response, caused by a drop in blood pressure (to as low as 80/20) without much change in heart rate. This phenomenon occurs due to vasodilation, probably as a result of withdrawal of sympathetic nervous system tone.
at you will have a vaso vagal”