The Art of Communication in Nursing

1. The Art of Communication in Nursing Cathy Groggel Nursing 450

2. Objectives: • To understand the basic components and forms of communication. • To understand the importance of effective communication in the healthcare environment. • Discuss what approaches and techniques are useful for nurses in communicating with their patients and families. • Understand the barriers in communication and how improvements can be made in nursing.

3. Communication The Who? What? Where? When? Why? • How?

4. Communication “Effective communication is the creation of meaning in communication in which patients and healthcare providers exchange information so that patients are able to actively participate in their care.” Boykins, 2014, p. 40

5. Root Cause Analysis MeasurementMaterials Method Patient Satisfaction Written Verbal NDNQI Content Non-Verbal Training/Skills Medical Jargon Manner Time Brochures Emotions Safety Reports Cue-Cards Feelings Errors Interpreters Task Approach Medication Respect/Dignity Noise Nurse EMR Lighting Physician Email Home Unlicensed Personnel Telephone Hospital Patient Texting Privacy Family Members Social Media Readiness Age Web Distractions Socio-economic Status Environment Manpower Machine Communication Breakdowns

6. “Between 1995 and 2005, ineffective communication and breakdowns in working together was the root cause of 66% of healthcare errors (Hughes, 2008).” Sherwood & Zomorodi, 2014, p. 17

7. “…suggest that an estimated ‘70-80% of healthcare errors are caused by human factors associated with poor team communication and understanding.’” Bleakley& Marshall, 2013, p. 128

8. “The nurse should be able to build communication and leadership skills in practice settings, to function effectively within nursing and other interprofessional teams, to foster open communication, to demonstrate mutual respect, and to engage in shared decision making to achieve quality care.” Boykins, 2014, p. 42

9. SMR Communication • It’s the Right thing to do! • The Joint Commission includes Patient-Centered communication as a Standard for Hospitals. • ANA Standards of Professional Nursing Practice. • Quality and Safety Education for Nursing (QSEN). • AACN Assessment Implementation Collaboration Environmental Health

10. “The nurse caring for the acutely and critically ill patient uses skilled communication to collaborate withthe team of patient, family, and healthcare providers in providing patient care in a safe, healing, humane,and caring environment.” AACN, p.16

11. Basic Components of Communication “Human communication is a two-person process in which both individuals influence and are influenced by each other.” Kearney-Nunnery, 2008, p. 124

12. SMRC Model by David Berlo in 1960 • Source/Encoder • Message • Channel • Receiver

13. Kearney-Nunnery, 2008, p. 125 Source-Message-Channel-Receiver Model

14. Health Communications Model Types of Relationships Kearney-Nunnery, 2008, p. 125 Professional/Professional Professional/Client Professional/Significant other Client/Significant other

15. Health Communications Model Transaction Types Verbal Non-verbal Contexts Setting One on one Group Kearney-Nunnery, 2008, p. 127

16. Forms of Communication • Metacommunication • Verbal • Vocabulary • Meaning • Intonation • Pacing • Clarity/Timing

17. “Nurses should also demonstrate credibility, which is defined as a sense of trustworthiness, sincerity, reliability, and integrity. The nurse must be dependable and believable.” Kearney-Nunnery, 2008, p.129

18. Non-Verbal Communication • Body Language • Cultural differences • Personal space • Gestures • Eye contact • Touch • Use of space • Appearance Kearney-Nunnery, 2008, p. 130-132

19. Approaches in Communication • Involvement of Patient • Patient-centeredness • Sensitivity in Providing Information and Explanations • Quality • Readiness • Task Approach • Manner of Approach • Rapport • Tone • Pleasant

20. “The words people say are important, but the way they are said is important too. When we talk to someone, we choose the words to use and modify the way they are used on the basis of an unconscious appraisal of that person.” Draper, 2014, p. 276

21. Communication Techniques • Tools • Question types • Active listening • Interest • Attention • Restatement/Reflection • Questioning • Open-ended • Close-ended • Circular • Goal oriented • Understanding • Elaboration • Alternatives • Non-Verbal • Silence

22. Distractions • Nurse • Sensory • Knowledge Level • Deficits • Interpretation • Language • Cultural • Literacy level Communication Barriers

23. Training • Inadequate Nurse Training • Poor planning • Emotions • Regulate • Time Communication Barriers Yoder-Wise, 2014, p. 350-351

24. “...pitfalls in communication comprise actions, behaviors, and words that create distrust, are dishonoring, and decrease the feelings of self-worth in the receiver and can lead to poor outcomes for patients.” Yoder-Wise, 2014, p. 351 Communication Pitfalls

25. Improving Communication • Speak-Up • https://www.youtube.com/watch?v=rOlCMLbOm6c

26. Improving Communication • Share stories • Near-misses • Simulated learning • Change Behavior • Classes • Scripting • Emotions • Be accountable

27. Improving Communication • Use Standard Methods of Communication • Bedside Handovers • SBAR • Read-Backs • Briefings/Huddles • Huddles • Interdisciplinary Rounds • Nurse Liaison • Research in Nursing

28. Types of Communication • Face to face

29. Types of Communication Written

30. Types of Communication Email

31. Types of Communication Electronic Health/Medical Records

32. Types of Communication Telephone

33. Types of Communication Text Messaging

34. Types of Communication Social Media

35. Future Communications Nursing Impact Improving patient outcomes Enhancing patient connection Improving efficiencies Decreasing costs Strengthen communication Informed decision making Standardizing report Engaging patients

36. References American Association of Critical-Care Nurses. (n.d.). Standards. In American Association of Critical-Care Nurses. Retrieved June 22, 2014, from http://www.aacn.org/WD/Practice/Content/standards.content?menu=Practicetww.aacn.org/WD/Practice/Contenstadards.content?menu=Practice American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.) Silver Spring, MD: Nursebooks.org. Bleakley, A., & Marshall, R. (2013). Can the science of communication inform the art of the medical humanities?. Medical Education, 47(2), 126-133. doi:10.1111/medu.12056 Boykins, D. (2014). Core Communication Competencies in Patient-Centered Care. ABNF Journal, 25(2), 40-45. Davies, N. (2014). Empathic nursing: going the extra mile. Practice Nursing, 25(4), 198-202. Draper, P. (2014). Words, words, words: conversation as a tool to promote wellbeing. Nursing & Residential Care, 16(5), 275-277. Kearney-Nunnery, R. (2008). Advancing your career: Concepts of professional nursing (4th ed.). Philadelphia, PA: F. A. Davis Company.

37. References • Leef, B. L., & Hallas, D. (2013). The Sensitivity Training Clown Workshop: Enhancing Therapeutic Communication Skills in Nursing Students. Nursing Education Perspectives, 34(4), 260-264. • McGilton, K., Boscart, V., Fox, M., Sidani, S., Rochon, E., & Sorin-Peters, R. (2009). A systematic review of the effectiveness of communication interventions for health care providers caring for patients in residential care settings. Worldviews On Evidence-Based Nursing, 6(3), 149-159. doi:10.1111/j.1741-6787.2009.00155.x • O'Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T., & Webb, G., & McColl, G. (2013, October). What counts as effective communication in nursing? Evidence from a nurse educators' view and clinicians' feedback on nurse interactions with simulated patients. Journal of Advanced Nursing, 70(6), 1344-1356. • Sherwood, G., & Zomorodi, M. (2014). A New Mindset for Quality and Safety: The QSEN Competencies Redefine • Nurses' Roles in Practice. Nephrology Nursing Journal, 41(1), 15-72. • Spruce, L. (2014). Back to Basics: Speak Up. AORN Journal, 99(3), 407-415. doi:10.1016/j.aorn.2013.10.020 • Tremayne, P. (2014). Using humour to enhance the nurse-patient relationship. Nursing Standard, 28(30), 37-40. • Yoder-Wise, P. S. (2014). Leading and managing in nursing: Revised reprint (5th ed.). St. Louis, • MO: Elsevier Inc.