COMMUNICATION

1. COMMUNICATION Module D

2. Communication • Definition • Consists of five elements • Encoder, or sender • Message • Sensory channel • Decoder • The feedback, or return • This indicates the degree of understanding of the message

3. Communication (cont.) • Levels of Communication • Intrapersonal • Interpersonal • Public

4. Forms Of Communication • Verbal • Vocabulary • Denotative meaning • Connotative meaning • Pacing • Intonation • Clarity & Brevity • Timing & Relevance

5. Forms of Communication (cont.) • Non-verbal • *adds cues & meaning to verbal communication • Personal appearance • Posture & gait • Facial expression • Eye contact • Gestures • Territoriality & Space

6. Forms of Communication • Therapeutic- Communication that is beneficial in developing a nurse-client helping relationship (Ex. Active listening- SOLER, empathy, humor, touch) • Non-Therapeutic- Communication that is not beneficial or helpful to people involved Ex. Personal questions, personal opinions, changing the subject.

7. Zones of Personal Space • Intimate (0-18 in) • Personal (18-4ft) • Social (4- 12 ft) • Public (12 ft or greater)

8. Zones of Touch • Social ( permission not needed) • Consent (permission needed) • Vulnerable (special care needed) • Intimate (great sensitivity needed)

9. The Nurse-Client Helping Relationship • The Nurse-Client Helping Relationship • Helping relationships are created through the nurse’s: • Application of scientific knowledge • Understanding of human behavior and communication • Commitment to caring • *Therapeutic communication doesn’t happen. You have to work at it.

10. Building and Maintaining Nurse-Client Helping Relationships • Pre-interaction Phase • Orientation Phase • Working Phase • Termination Phase

11. Pre-interaction Phase • Before meeting client • Review data available ( diagnosis, medical history • Assign appropriate room • Anticipate concerns or needs

12. Introduce yourself Set a positive tone with a warm empathetic manner Assess client health status Prioritize needs and goals of your client Clarify client’s and your roles Let the client know when to expect the relationship to end Orientation Phase

13. Working Phase • Encourage and help the client express feelings • Encourage and help client set goals • Take action to meet the goals set the client

14. Termination Phase • Remind client that termination is near • Evaluate goal achievement • Help to achieve a smooth transition to other caregivers

15. Professionalism Courtesy Confidentiality Availabilty Trust Empathy Sympathy Acceptance Respect Silence Hope Encouragement Socializing Gender/Cultural sensitivity Techniques for improved therapeutic communication

16. Inattentive listening Medical vocabulary Giving personal opinions Being defensiveness Showing disapproval Cultural differences Barriers to Effective Communication • Be aware of language barriers • Sensory impairments

17. WHAT CAN WE DO TO OVERCOME THESE BARRIERS?

18. Documentation- What is it and why do we do it?????? • Documentation is defined as anything written or printed within a client record. • A record is a permanent legal written document. • NOT CHARTED NOT DONE!!!!!!!!! • Documentation provides written record of the care given to the patient.

19. Documentation: • Financial record of care. • Used for clinical research • Used for professional development

20. Assessment Vital signs Any change in pt condition If verbal order taken Procedure done PRN medication Intake & output What do we chart?

21. Admission sheet- demographic data, in case of emergency, etc.. Physician’s order sheet- record of MD orders( meds, Tx,etc.) Nurses admission assessment- Nsg summary of Hx & Physical Graphic/ Flowsheet- VS, Daily wts, I/O Med Hx & Exam- Initial exam and hx taken by MD RN notes- record of RN assessments, treatments, etc. What we did!!! What is in “The Chart”?

22. Med Record- MAR Tells Who, What, When, and Where!! Client education record- Documentation of teaching done, response, if reinforcement needed, how it was done. Physician’s progress notes- Updated record of how the pt is doing,response to tx, and any changes. Healthcare discipline records- all areas of healthcare have a place to chart their specifics (resp, PT)_ “The Chart” cont

23. Discharge summary- Summary of the pt’s condition upon D/C, meds, prognosis, F/U care, teaching needs, etc. More…

24. Flowsheets Graphics Sheets Computerized charting Charting by exception SOAP Narrative Careplans POMR PIE Focus charting Critical pathways DRGS-for reimbursement Kardex Types and Categories of Information

25. Reporting and Documenting • REPORTING – Change of Shift Report • Types • Purpose • Information to include • Information to omit

26. REPORTING – Transfer Report • Name, age, primary physician, medical dx • Summary of medical progress up to time of transfer. • Current health status (physical & psycho-social) • Current nsg. Dx or problems & care plans • Any critical assessments or interventions • Need for any special equipment

27. Telephone Orders and Reports • Complete info given to MD • Verbal or telephone order- given to RN by MD and written by RN that takes order. Note as TO or VO. Repeat order back to MD After receiving it. MD must sign w/in 24hrs or by hosp policy • TO should be used only when necessary not for convenience. WHY?

28. Professional Communication • Courtesy • Use of names • Privacy • Confidentiality • Trustworthiness • Autonomy • Responsibility • Assertiveness