Communication and Nurse Patient Relationship (NPR)

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.