Communication and Nurse Patient
Relationship (NPR)
Communication:
·
Latin
word “Communicare”= Share.
·
Definition:
Giving or Exchanging of information through verbal or written means.
·
A
process that requires interpretation, sensitivity. Imagination and active
participation (Jenner, 1997).
·
A
process of exchanging cognitive material such as facts, information, ideas,
understanding, thoughts or motivational and emotional ideas such as attitudes,
reactive, loyalties, values from one person to another.
What happens during the communication
process?
·
Nurse
and patient work together to solve problems centered on the patient’s health
care needs.
·
Patient
feels cared for and understood.
·
Family
and significant others are included in the care.
·
Health
teaching is conducted.
·
Health
promotion and prevention care are delivered.
Levels of communication:
1.
Intrapersonal:
·
Within
the individual.
·
Self
talk or an internal dialogue occurs constantly and consciously.
2.
Interpersonal:
·
Interaction
between two or in a small group.
·
Often
face to face.
3.
Public:
·
Interaction
with large group of people.
·
E.g.
Lecture, group health education.
Levels as suggested by Powel:
1.
Cliche conversation:
·
Level
with least sharing of feelings.
·
Nurse
use this during the beginning of interaction.

2.
Reporting facts: Does not involve very much about the
persons involved in interaction.
3.
Sharing personal ideas and judgments: Sharing of self is taking place.
E.g.: Patient gives opinion regarding treatment.
4.
Sharing feelings: Individual tells another person his
beliefs and reactions.
5.
Peak communication: Sense of oneness.
Element of communication/ (Process of communication):
·
Referent: The stimulus that motivates a person
to communicate with another. It may be an object, experience, emotion, idea or
act.
·
Sender (Encoder):
o
Initiates
the interpersonal communication.
o
Sender
puts the stimulus into a form that can be transmitted and assumes the
responsibility for the accuracy of the content.
·
Message:
o
The
information that is sent or expressed by the sender.
o
Effective
message is clear and organized and is expressed in a manner familiar to the
person receiving it.
·
Channel:
o
Means
of conveying message such as through visual auditory and tactile sense.
o
E.g.:
facial expression, spoken word.
·
Receiver (Decode): The person whom the message is sent.
·
Feedback:
o
The
receiver returns the message to the sender.
o
This
helps to reveal whether the meaning of the message is received correctly or not
Purposes of communication:
·
Exchange
of information/ feelings
·
Eliciting
a response 

·
Influence
others, obtain information
·
Initiate
change
·
Develop
trustful relationship.
Methods of effective
communication:
·
Attention
skills
·
Rapport
building skills
·
Empathy
skills
Modes (Types) of communication:
Verbal communication:
·
Conscious
·
Use
of words
Considerations in verbal communication:
·
Pace
and intonation
·
Simplicity
(use of common words)
·
Clarity
(saying precisely) and brevity (using fewest essential words)
·
Timing
and relevance
·
Adaptability
(Altering words per behavioral cues from the client)
·
Credibility
(worthiness of belief, trustworthiness and reliability). Credibility can be
fostered by being honest, consistent and
dependable.

·
Humor
(positive & powerful tool in communication, but use with care).
Nonverbal
communication:
Considerations:
·
Personal
appearance:
§ Physical characteristics
§ Facial expression
§ Manner of dress and grooming
·
Posture
and gait:
§ The way people sit, stand and move
reflects attitudes, emotions, self-concept and health status.
·
Facial
expression:
§ Conveys emotions such as surprise,
fear, anger and happiness.

·
Maintaining
eye contact during conversation: shows respect and willingness to listen and if
not maintained indicates anxiety, discomfort and lack of confidence.
·
Gestures
·
Emphasize,
punctuate and clarify spoken word.
Factors influencing the communication process:
· Developmental level.
· Gender
· Value (the way people value
themselves, one another and the purpose of human interaction)
· Personal space (distance people
prefer in an interaction).
· Territoriality (concept about space
and the things individual considers as belonging to self)
· Roles and relationships
· Environment
· Congruence (verbal and nonverbal aspects
of the message match)
· Interpersonal attitudes (caring &
warmth, respect, acceptance)
Therapeutic
communication:
Therapeutic communication promotes understanding and care
help establish constructive relationship between the nurse and the client
Nonverbal
therapeutic techniques:
1.
Listening attentively:
·
S
- Sit facing the client
·
O
- Open posture
·
L
- Lean towards the patient
·
E
- Eye contact
·
R
– Relax
2.
Maintaining silence: A pause in communication that
permits the nurse and patient time to think about what has taken place.
3.
Touch
4.
Conveying
acceptance
Verbal therapeutic techniques:
1.
Using open ended questions: Asking broad questions that lead or
invite the client to explore thoughts or feelings.
E.g.: "What brought you to the hospital?"
i.
Tell
me about

ii.
"How
are things going for you at this point?"
2. Restating:
Actively listening for the client's basic message and then repeating those
thoughts or feelings in similar words.
E.g.: I
couldn't manage to eat any dinner last night.
i.
Nurse:
You had difficulty eating yesterday.
3. Reflecting:
Directing ideas, feelings, questions or content back to clients to enable them
to explore their own ideas and feelings about a situation.
E.g.: What can I do'?
i.
Nurse:
What do you think would be helpful?
4. Clarifying:
Helping the client clarify an event, situation or happening.
E.g.: I
vomited this morning.
i.
Nurse:
Was that after breakfast?
5. Focusing:
Helping the client expand on and develop a topic of importance.
E.g.: Can you
highlight on that issue?
6. Offering information: Providing in a simple and direct manner, specific information to the
client.
E.g.: Your surgery is scheduled
for 9 am tomorrow

7. Summarizing: Stating the main points of a discussion to clarify the
relevant points discussed.
E.g.: During the past half an hour
we have talked about.
Barriers to
communication:
·
Failure
to listen
·
Offering
false reassurance
·
Giving
common advice
·
Asking
why
·
Changing
the subject inappropriately
·
Being
defensive
Other Barriers:
·
Physical:
Hearing impairment, speech defect, any other specific illness. Emotional:
Feeling of anxiety, fear, sadness, disinterest and inattention.
·
Social:
Status, power, prestige
·
Language:
Wrongly expressed messages, use of difficult words, level of language.
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