Communicating with Communicating with patients and familiespatients and families

A Communication Model

CommunicationCommunication

► Communication is the very heart of the Communication is the very heart of the nurse-patient relationshipnurse-patient relationship

Nurses often must communicate with patients Nurses often must communicate with patients and families when they are stressed and dealing and families when they are stressed and dealing with intensely difficult situations- with intensely difficult situations- not an easy jobnot an easy job

Failure to communicate effectively can Failure to communicate effectively can jeopardize the nurse’s credibility with the patient jeopardize the nurse’s credibility with the patient and familyand family

Doctors vs. nursesDoctors vs. nurses

► Patients expect doctors to speak in fancy medical Patients expect doctors to speak in fancy medical terminology…terminology…

► Patients expect that nurses will speak so that they Patients expect that nurses will speak so that they can understand what is being saidcan understand what is being said

► Patients expect that doctors may be aloof and Patients expect that doctors may be aloof and distant…distant…

► Patients expect that nurses will demonstrate caring Patients expect that nurses will demonstrate caring and empathy in their demeanorand empathy in their demeanor

Communication consists of a sender, Communication consists of a sender, a message, a receiver, and feedback.a message, a receiver, and feedback.

Methods of CommunicationMethods of Communication

►Verbal - Speaking, Listening, Verbal - Speaking, Listening, Writing, Reading.Writing, Reading.

►Nonverbal - Gestures, Facial Nonverbal - Gestures, Facial Expressions, Posture and Gait, Expressions, Posture and Gait, Tone of Voice, Touch, Eye Contact, Tone of Voice, Touch, Eye Contact, Body Position, Physical Body Position, Physical Appearance.Appearance.

Influences on CommunicationInfluences on Communication

►AgeAge

►EducationEducation

►EmotionsEmotions

►CultureCulture

►LanguageLanguage

►AttentionAttention

►SurroundingsSurroundings

Factors Influence Factors Influence Communication ProcessCommunication Process

►Development & genderDevelopment & gender►Sociocultural characteristicsSociocultural characteristics►Values and perceptionValues and perception►Personal space and territorialityPersonal space and territoriality►Roles and relationshipsRoles and relationships►EnvironmentEnvironment►CongruenceCongruence►AttitudesAttitudes

DevelopmentDevelopment

►Language and communication skills Language and communication skills develop through stagesdevelop through stages

►Communication techniques for Communication techniques for childrenchildren PlayPlay Draw, paint, sculptDraw, paint, sculpt Storytelling, word gamesStorytelling, word games Read books; watch movies, videosRead books; watch movies, videos WriteWrite

GenderGender

► Females and males communicate differently from Females and males communicate differently from early ageearly age

► Boys Boys establish independence, negotiate status establish independence, negotiate status► Girls Girls seek confirmation, intimacy seek confirmation, intimacy

Communication Channels

Intrapersonal Communication

A Nurse Communicating with Client on theInterpersonal Level

Team Conference

Impressions are everythingImpressions are everything

It doesn’t matter to familiesIt doesn’t matter to families

that the nursing staff may have that the nursing staff may have performed the most advanced performed the most advanced lifesaving techniques for the lifesaving techniques for the

patient…patient…

if the nursing staff comes across if the nursing staff comes across

as cold and distant, as cold and distant,

the patient and family will not feel the patient and family will not feel cared for.cared for.

Non-verbal communicationNon-verbal communication

► Don’t underestimate the power of non-verbal Don’t underestimate the power of non-verbal communication!communication!

► Watch for nonverbal cues that don’t match what Watch for nonverbal cues that don’t match what

the person is saying-the person is saying-

Patient says “I’m fine” but is holding on to the Patient says “I’m fine” but is holding on to the side rails with a death grip and rocking in side rails with a death grip and rocking in painpain

Nurse says “I’m here to help you” while Nurse says “I’m here to help you” while rolling her eyes and scowlingrolling her eyes and scowling

TouchTouch

► Be very careful when using touch to communicateBe very careful when using touch to communicate

► Touching a patient who has neuropathy can be very Touching a patient who has neuropathy can be very painful, especially hands and feetpainful, especially hands and feet

► Certain cultures forbid men and women to touch, Certain cultures forbid men and women to touch, while other cultures frown upon shaking handswhile other cultures frown upon shaking hands

► Warn patients before you touch them, and describe Warn patients before you touch them, and describe what to expect- “this will feel tight around your arm”what to expect- “this will feel tight around your arm”

► Also be careful with gestures- what is acceptable to Also be careful with gestures- what is acceptable to one culture may be offensive to anotherone culture may be offensive to another

Be honestBe honest

► Don’t lie to patients- if what you are going to do will Don’t lie to patients- if what you are going to do will hurt, say so!hurt, say so!

Patients (especially kids) Patients (especially kids) reallyreally resent hearing resent hearing phrases like “it’s just a little poke” before a shot- phrases like “it’s just a little poke” before a shot- it’s going to hurt and they know it. it’s going to hurt and they know it.

When the nurse does this, the patient loses trust When the nurse does this, the patient loses trust in the nurse and then disregards everything else in the nurse and then disregards everything else that the nurse has to say.that the nurse has to say.

Giving news over the phoneGiving news over the phone

► Sometimes nurses have to inform family members Sometimes nurses have to inform family members that someone has been injured or has diedthat someone has been injured or has died

► Make sure that you have the correct person on the Make sure that you have the correct person on the other end of the line!other end of the line!

► Introduce yourself and keep the conversation simple Introduce yourself and keep the conversation simple while conveying your messagewhile conveying your message

► Try to keep the conversation short- extensive Try to keep the conversation short- extensive explanations can usually wait until the family comes explanations can usually wait until the family comes to the hospitalto the hospital

► If the family asks if the patient has died, be honest If the family asks if the patient has died, be honest but wait to give details in personbut wait to give details in person

Putting a good face on…Putting a good face on…

► Shortly after I started working on an oncology unit Shortly after I started working on an oncology unit at a metro Detroit hospital, a very good friend was at a metro Detroit hospital, a very good friend was diagnosed with a very malignant brain cancer.diagnosed with a very malignant brain cancer.

► My husband and I saw him over the weekend, and My husband and I saw him over the weekend, and found out that he would probably die in the next found out that he would probably die in the next year or two.year or two.

► When I went to work on Monday, I had to care for a When I went to work on Monday, I had to care for a patient with cancer that had spread to her brain- patient with cancer that had spread to her brain- she was having seizures and could no longer talk. she was having seizures and could no longer talk. Seeing her, I could only imagine that my friend Seeing her, I could only imagine that my friend would soon be in the same state.would soon be in the same state.

Putting a good face on…Putting a good face on…

► Even though I was in turmoil over my friend’s Even though I was in turmoil over my friend’s cancer diagnosis, I still had to be a professional, cancer diagnosis, I still had to be a professional, caring nurse for my patient and her family.caring nurse for my patient and her family.

► Yes, it was terribly difficultYes, it was terribly difficult!!

► I knew that it would be painful to continue working I knew that it would be painful to continue working on the oncology unit after that, so I soon on the oncology unit after that, so I soon transferred to a supervisory position instead in the transferred to a supervisory position instead in the hospital. hospital.

► My friend died 2 years later.My friend died 2 years later.

Putting a good face on…Putting a good face on…

► No matter how you may be feeling inside, you No matter how you may be feeling inside, you alwaysalways must put forth a professional, caring must put forth a professional, caring demeanor for patients and their familiesdemeanor for patients and their families

► You will sometimes see horrible-looking wounds or You will sometimes see horrible-looking wounds or experience nasty smells when working with experience nasty smells when working with patients- you absolutely patients- you absolutely cannotcannot let the patient know let the patient know how you really feel about it.how you really feel about it.

► Sometimes nurses have to put on Oscar-winning Sometimes nurses have to put on Oscar-winning performances to hide negative feelings- but it’s part performances to hide negative feelings- but it’s part of being a professional, respectful, and empathetic of being a professional, respectful, and empathetic caregivercaregiver

As you get started…As you get started…

► Listen.Listen. You may hear someone talking, but are You may hear someone talking, but are you listening? Too often nurses don’t listen to you listening? Too often nurses don’t listen to what a patient or family member is saying, but what a patient or family member is saying, but instead are busy forming a response.instead are busy forming a response.

► Maintain eye contact.Maintain eye contact. When you are listening, When you are listening, be sure to observe body gestures for signs of be sure to observe body gestures for signs of contradiction to what he or she is saying verbally.contradiction to what he or she is saying verbally.

► Speak with the family members as well as Speak with the family members as well as

the patient.the patient. Try to encourage family interaction Try to encourage family interaction and questions, especially if a family member is and questions, especially if a family member is the primary caregiver for the patient.the primary caregiver for the patient.

As you get started…As you get started…

► Don't be judgmentalDon't be judgmental.. Listen attentively but don’t Listen attentively but don’t show excessive emotion to what the patient or family show excessive emotion to what the patient or family members is saying. Don't ever say that the person's members is saying. Don't ever say that the person's idea is silly. idea is silly. Respond gently instead-Respond gently instead- suggest that suggest that there may be another way to address the issue and there may be another way to address the issue and the new approach may work better.the new approach may work better.

► Listen carefullyListen carefully.. You can learn much from a You can learn much from a patient who is willing to share how he or she patient who is willing to share how he or she addresses and copes with chronic illness or difficult addresses and copes with chronic illness or difficult situations. Listening can be a tremendous situations. Listening can be a tremendous educational experience, especially when starting a educational experience, especially when starting a nursing career.nursing career.

As you get started…As you get started…

► Speak clearly.Speak clearly. This will also help you speak more This will also help you speak more slowly, making it easier for patients and families to slowly, making it easier for patients and families to understand you. understand you.

► Skip the medical terminologySkip the medical terminology. This only . This only confuses patients and families. Use terms that are confuses patients and families. Use terms that are easy to understand.easy to understand.

► Allow periodic moments of silence.Allow periodic moments of silence. Silence Silence provides an opportunity for the patients and provides an opportunity for the patients and families to mull over information that formulate families to mull over information that formulate new questions for the nursenew questions for the nurse

► Respect cultural differencesRespect cultural differences. Use caution with . Use caution with touch and humor.touch and humor.

Getting down to a patient’s level can Getting down to a patient’s level can help improve communications on a help improve communications on a

pediatric call.pediatric call.

An open An open stancestance

A closed stance

Interpersonal Zones

Eye ContactEye Contact

► Use eye contact as much as Use eye contact as much as possible.possible.

► Remember to remove sunglasses Remember to remove sunglasses while working with patients.while working with patients.

Use an appropriate compassionate Use an appropriate compassionate touch to show your concern and touch to show your concern and

support.support.