Chapter 8: Learning to Communicate ProfessionallyNurse-Patient Communication Focused on the patients needs and problems Builds trusts, develops a therapeutic relationship, provides support, comfort, growth, change, and patient educationCategories of Communication Written reports Telephone crisis hotlines Email: dont send unless it is therapeutic Must comply with HIPAA to protect health info Speech and behavior: body language and tone must match Verbal and nonverbal must match Behaviors that show one message and verbal speech that shows another will be confusing Dynamics of Therapeutic Communication Communication is influenced by: Individuals personal experiences, gender, culture, values, and beliefs Purpose of the interaction Physical and emotional context of the interactionThemes Content themes: examines underlying messages about a patients perceptions of self and problems Mood themes: related to affect and feelings conveyed while discussing the issues and concerns Incongruent mood theme: when the affect does not match the content Interaction themes: examines relationships to others Themes reflect in patients thoughts, engender feelings, and produce behaviorsEnvironmental Considerations Privacy Furniture Temperature Noise level Boundaries Proxemics: the way people perceive and use environmental, social, and personal space during interactionsPhysical Considerations Sensory limitations (hearing loss) Development disabilities, problems comprehending and remembering Speech impediments Pain interfering with ability to think clearly and concentrate Kinesic Considerations Culturally based body language Facial expression Eye movement Gestures Eye contact Mannerisms Might be incongruent with words Therapeutic CommunicationSocial Equal disclosure Spontaneous Meets personal needs of both Confidentiality might or might not be observed Listener might not be objectiveTherapeutic Patient-centered and planned Directed by professional Meets patients needs Guides the patient to explore personal issues and painful feelings Listener is objective Information may be shared with the health teamTherapeutic Use of Self Verbal and nonverbal Silence and therapeutic listening Being actively alert Using eye contact Concentrating Being patient Displaying openness Offering empathy and support Asking question Organizing, synthesizing, and interpreting info Validating and clarifying info Responding verbally and nonverbally Summarizing Giving feedback Sensitivity: recognizing important cues and prioritizing them Objectivity: remaining open to many aspects of the patient and their problems Patients must feel respected, values, and accepted Use touch with caution; might violate personal space or be misinterpretedTechniques Offering self: showing interest and concern Active listening: paying close attention to verbal and nonverbal communication, patterns of thinking, feelings, and behavior Silence: allowing the patient to think and say more Questioning: using open-ended questions Empathy: recognizing patients feelings General leads Restating Verbalizing the implied Clarification Making observations Presenting reality: offering a view of what is real and what isnt without arguing Encouraging description of perceptions Voicing doubtInterferences with Communication Nurses fears, feelings, lack of knowledge, insecurity, or ineffective responsesIneffective Responses and Behaviors Not fully listening; not paying attention Looking too busy; ignoring the patient Seeming uncomfortable with silence; fidgeting Being opinionated; arguing with the patient Avoiding sensitive topics; changing topics Being superficial or using clichs Having closed posture; avoiding eye contact Making false promises or reassurances Giving advice or talking too much Laughing or smiling inappropriately Showing disapproval or being judgmental Minimizing problems Being defensive; avoiding patient Making sarcastic remarks Lying; being insincere