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COMMUNICATION
Module D
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
Communication (cont.)
Levels of Communication– Intrapersonal– Interpersonal– Public
Forms Of Communication
Verbal– Vocabulary– Denotative meaning– Connotative meaning– Pacing– Intonation– Clarity & Brevity– Timing & Relevance
Forms of Communication (cont.)
Non-verbal– *adds cues & meaning to verbal
communication– Personal appearance– Posture & gait– Facial expression– Eye contact– Gestures– Territoriality & Space
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.
Zones of Personal Space
Intimate (0-18 in) Personal (18-4ft) Social (4- 12 ft) Public (12 ft or greater)
Zones of Touch
Social ( permission not needed) Consent (permission needed) Vulnerable (special care needed) Intimate (great sensitivity needed)
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.
Building and Maintaining Nurse-Client Helping Relationships Pre-interaction Phase Orientation Phase Working Phase Termination Phase
Pre-interaction Phase
Before meeting client Review data available ( diagnosis, medical
history Assign appropriate room Anticipate concerns or needs
Orientation Phase
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
Working Phase
Encourage and help the client express feelings
Encourage and help client set goals Take action to meet the goals set the client
Termination Phase
Remind client that termination is near Evaluate goal achievement Help to achieve a smooth transition to other
caregivers
Techniques for improved therapeutic communication Professionalism Courtesy Confidentiality Availabilty Trust Empathy Sympathy
Acceptance Respect Silence Hope Encouragement Socializing Gender/Cultural
sensitivity
Barriers to Effective Communication Inattentive listening Medical vocabulary Giving personal
opinions Being defensiveness Showing disapproval
Cultural differences
Be aware of language barriersSensory impairments
WHAT CAN WE DO TO OVERCOME THESE BARRIERS?
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.
Documentation:
Financial record of care. Used for clinical research Used for professional development
What do we chart?
Assessment Vital signs Any change in pt
condition If verbal order taken Procedure done PRN medication Intake & output
What is in “The Chart”? 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!!!
“The Chart” cont
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)_
More…
Discharge summary- Summary of the pt’s
condition upon D/C, meds, prognosis, F/U care, teaching needs, etc.
Types and Categories of Information Flowsheets Graphics Sheets Computerized charting Charting by exception SOAP Narrative Careplans
POMR PIE Focus charting Critical pathways DRGS-for
reimbursement Kardex
Reporting and Documenting
REPORTING – Change of Shift Report Types Purpose Information to include Information to omit
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
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?
Professional Communication
Courtesy Use of names Privacy Confidentiality Trustworthiness Autonomy Responsibility Assertiveness