Interpersonal Communication
COMMUNICATION AND
INTERPERSONAL RELATIONSHIPS
PHI
SESSION 2
LEARNING OUTCOMES
Explore definitions, models, and methods of communication
Discuss how interpersonal relationships and communication link
Highlight barriers to communication and discuss how these may be addressed
COMMUNICATION
Small group discussion
Communication - we are all doing it already, so why study it?
Communication – what does it mean?
WHY ARE GOOD COMMUNICATION SKILLS
IMPORTANT? ONE VIEWPOINT…
‘The power of creative and effective nursing care is strengthened by good communication skills. Patients share their stories, symptoms, and concerns by talking with us.
Both the spoken word and the body language convey information about the patient’s experience.’
‘Your words …show more content…
can do so much: put a patient at ease, set up a productive relationship, and carry out interventions. There is no other skill that is used more in nursing than communication.’ (Sheldon
2004, p. 132)
EFFECTIVE COMMUNICATION IS ALSO KEY WITHIN GOALS FOR NURSES
An essential goal for nursing staff is that their patients experience effective communication (DOH 2010 – Essence of
Care)
‘Nurses are at the heart of the communication process: they assess, record and report on treatment and care…’ (RCN Principles of Nursing Practice)
WHAT IS COMMUNICATION?
‘Communication is one of those human activities that everyone recognises, but few can satisfactorily define’ (Fiske 2011:1)
Communications is:
Talking to one another
TV
Spreading information
Our hair style
/
K
N
I
U
.
M
/
O
C DY E
.
D
C
O
N
B
I
B
/
.B N S
W A LE
W U M MI
W /H /S
/
/
: E S
P
Y
C
T
E
N V
T
E
H CI R L
S /SU TM
D .SH
X
L
B
O
F
D
A
Y
C
I
A
A
L
N
G
E
U
X
A
P
G
R
E
E
S
S
I
O
N
S
…
.
WHAT IS COMMUNICATION IN NURSING?
Many definitions describe communication as a transfer of information between a source and a receiver.
In nursing, communication is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers.
The information may be verbal or nonverbal, written or spoken, personal or impersonal, issue-specific, or even relationshiporiented, to name a few possibilities.
(Sheldon 2004:4)
COMMUNICATION FRAMEWORKS
Frameworks describe how communication takes place
Two main frameworks:
Linear and circular
LINEAR MODEL OF COMMUNICATION
A message is relayed by one or more of the senses
Sender
Message
Idea is encoded
& expressed
verbal or non verbal thoughts
& feelings
& made
Receiver
Idea is decoded, translated sense of
CIRCULAR MODEL OF COMMUNICATION
COMMUNICATION AND INTERPERSONAL RELATIONSHIPS
Interpersonal – refers to a connection between two or more people; the way they behave or feel towards each other
Communication – focuses on the exchanging of information between people
(Bach & Grant 2011)
WHAT ARE INTERPERSONAL SKILLS?
They include:
Counselling skills – listening & talking
Assertiveness skills – working with ‘difficult’ people
Social skills – working with the general public
Facilitation skills – managing groups
(Morrison & Burnard 1998)
INTERPERSONAL RELATIONSHIPS IN NURSING
The relationship between nurse and patient is a key factor in nursing practice
Patient-centred communication is suggested to have a demonstrable effect on patient outcomes (Charlton et al
2008)
Time spent developing therapeutic relationships can be difficult to find, but is time well spent (Bach & Grant 2010)
Key elements include: building a rapport, developing a working partnership and terminating a relationships (Peplau 1952)
SELF AWARENESS
It is suggested that self awareness is the first step in being able to facilitate effective communication and interpersonal relationships Self awareness allows us relate to the experience of others and develop the skill of empathy
(Miller & Nambiar-Greenwood, …show more content…
in
Webb 2011:21)
JOHARI WINDOW
VERBAL COMMUNICATION – WHAT DO THESE TERMS MEAN?
TLA
CO
U
P
S
M Discharge D
NMB
DO
W
BE
N
LO
W
s e Em WATER is S
K
R
WO
‘They stood in a huddle and discussed me just as if I wasn’t there. I couldn’t understand a word they were saying. It was complete gobbledegook to me!’
(Kraszewski & McEwan 2010:41)
VERBAL COMMUNICATION
A focus on the actual words used in communication
Try to choose language that the patient will understand
Accents, dialects, acronyms can effect understanding
PARA-VERBAL COMMUNICATION
Can be described as the attributes that affect the words
Volume – consider maintaining privacy for example
Tone – usually reflects how the sender is feeling
Speed of speech – can emphasise meaning of words.
Also consider ‘companionable silences’
NON-VERBAL COMMUNICATION
… the messages transmitted without using any words a look, a gesture, facial expression, position, or touch
Very powerful – the receiver of the message often pays more attention to this than the words spoken
LISTENING SKILLS
Active listening – listener gives non verbal messages which encourage the patient to share while feeling safe
SOLER – BECOMING A BETTER LISTENER
S – squarely face the person to show you are ready to listen to them O – open your posture, to indicate you are open to their words
(uncross legs and arms)
L – lean forward, to show you are listening
E – eye contact is maintained, to show you are concentrating on what is being said
R – relax, to help the other person feel
comfortable
BARRIERS TO COMMUNICATION
Prejudice & stereotyping are common barriers that affect communication What types of differences do you think might cause barriers in communicating? EXAMPLES ISSUES THAT MAY CAUSE BARRIERS TO COMMUNICATION
Learning difficulties
Sensory loss –e.g. visual or hearing problems
Autism
Physical disability
Stereotypes of older people
Cultural influences
Dementia
Parkinson 's disease
Intoxication
Aggression
OVERCOMING BARRIERS
With hearing loss, sight loss, with people with alzheimers and dementia: Allow time for the client to process and understand information or questions before responding
Use familiar terms and appropriate complexity of sentence structure If giving instructions, tasks need to be broken down into small
‘steps’ if appropriate. These can be more easily understood and followed.
BARRIERS TO EFFECTIVE LISTENING
Physical: environmental e.g. disturbance, lack of time, distractions Psychological: emotions, alertness, differences in social values, prejudices & stereotypes
KEY POINTS FOR EFFECTIVE LISTENING
Don’t interrupt before the client has finished
Never complete a sentence for a client
Listen in a non-evaluative way
Let client set speed and tone
Use SOLER
Be aware of body cues e.g. facial expression
Learn to gate/exclude sounds
Look for central ideas, themes
Seek clarification where needed
ASKING QUESTIONS
Nurse sets and controls the agenda through asking questions
(Webb 2011)
Guidance
Be clear – ask one question at a time
Closed questions – elicit single word answers (do you want to give a limit choice of response?)
Open questions – elicit more complex answers
OPEN QUESTIONS
What What happened when you went to A&E?
Why Why did you go to your GP?
Who Who helps you at home?
Where Where is the pain originating?
When When do you feel like drinking?
How How does the wound affect your mobility?
EXERCISE – PUTTING SKILLS INTO PRACTICE
Work in pairs and try to out into practice the skills discussed – listening, use of verbal, non verbal and paraverbal communication skills
One student to ‘role play’ a patient, second student to use skills as a student nurse, then swap.
EXERCISE – PUTTING SKILLS INTO PRACTICE
Scenarios
1. Mr/Ms Jones is 25 and has just arrived on your ward and has severe abdominal pain. The student needs to ask some initial questions to begin the assessment process as well as familiarising the patient with key information about the ward.
2. Mr/Mrs Kolvos is 73 and has a leg ulcer which you are going with the district nurse to dress. The patient is a bit hard of hearing and seems a little lonely – they want to chat with you, the student nurse.
WRITTEN COMMUNICATION
Information leaflets
Online advice
Discharge instructions
Medicine labels
Signs in health care settings
Care plans
ACTIVITY - WRITING PLAIN ENGLISH
Work in groups of 3 to re-write the instructions in clear, plain
English.
One observer, 2 writers
Tips:
Short sentences
No jargon, lay words
Direct not indirect (e.g. utilise 'you ')
Remember to check it makes sense
Wheezoff paediatric syrup is specially formulated for children.
It is indicated for the relief of cough and its congestive symptoms and for the treatment of hay fever and other allergic conditions affecting the upper respiratory tract.
Contraindications, warnings etc. Hypersensitivity to any of the active constituents. If symptoms persist consult your doctor. Notwinge cream - directions for use
Apply a sufficient quantity of balm to the part affected.
Massage lightly until penetration is complete.
Vitamin B1, also called thiamin, is required for the functioning of the nervous system, digestion and metabolism.
Insufficient vitamin B1 can cause anorexia and fatigue.
REFERENCES
Bach S & A Grant (2011) Communication & Interpersonal Skills in Nursing. 2 ed. Exeter: Learning matters
Charlton C et al (2008) nurse practitioner 's communication styles Journal of the American Academy of Nurse practitioners 20:382-8.
DOH (2010) Essence of Care 2012 London: DOH
Fiske J (2011) Introduction to communication studies 3rd edition London: Routledge
Kraszewski S & McEwan A (2010) Communication skills for adult nurses. Maidenhead: Open University Press
REFERENCES
Mehrabian A. (1972) Nonverbal communication Chicgao: Aldine
Atherton.
Morisson P & Burnard P (1997) Caring and Communication. 2nd ed. London: Macmillan Press
RCN (2012) Principles of Nursing Practice [Accessed online] http://www.rcn.org.uk/development/practice/principles Sheldon, LK (2004)Communication for nurses: talking with patients. New Jersey: SLACK Inc. pp. 4,132.
Webb L Ed. (2011) Nursing: Communications Skills in Practice
Oxford: Oxford University Press
INTERPERSONAL RELATIONSHIPS
PHI
SESSION 2
LEARNING OUTCOMES
Explore definitions, models, and methods of communication
Discuss how interpersonal relationships and communication link
Highlight barriers to communication and discuss how these may be addressed
COMMUNICATION
Small group discussion
Communication - we are all doing it already, so why study it?
Communication – what does it mean?
WHY ARE GOOD COMMUNICATION SKILLS
IMPORTANT? ONE VIEWPOINT…
‘The power of creative and effective nursing care is strengthened by good communication skills. Patients share their stories, symptoms, and concerns by talking with us.
Both the spoken word and the body language convey information about the patient’s experience.’
‘Your words …show more content…
can do so much: put a patient at ease, set up a productive relationship, and carry out interventions. There is no other skill that is used more in nursing than communication.’ (Sheldon
2004, p. 132)
EFFECTIVE COMMUNICATION IS ALSO KEY WITHIN GOALS FOR NURSES
An essential goal for nursing staff is that their patients experience effective communication (DOH 2010 – Essence of
Care)
‘Nurses are at the heart of the communication process: they assess, record and report on treatment and care…’ (RCN Principles of Nursing Practice)
WHAT IS COMMUNICATION?
‘Communication is one of those human activities that everyone recognises, but few can satisfactorily define’ (Fiske 2011:1)
Communications is:
Talking to one another
TV
Spreading information
Our hair style
/
K
N
I
U
.
M
/
O
C DY E
.
D
C
O
N
B
I
B
/
.B N S
W A LE
W U M MI
W /H /S
/
/
: E S
P
Y
C
T
E
N V
T
E
H CI R L
S /SU TM
D .SH
X
L
B
O
F
D
A
Y
C
I
A
A
L
N
G
E
U
X
A
P
G
R
E
E
S
S
I
O
N
S
…
.
WHAT IS COMMUNICATION IN NURSING?
Many definitions describe communication as a transfer of information between a source and a receiver.
In nursing, communication is a sharing of health-related information between a patient and a nurse, with both participants as sources and receivers.
The information may be verbal or nonverbal, written or spoken, personal or impersonal, issue-specific, or even relationshiporiented, to name a few possibilities.
(Sheldon 2004:4)
COMMUNICATION FRAMEWORKS
Frameworks describe how communication takes place
Two main frameworks:
Linear and circular
LINEAR MODEL OF COMMUNICATION
A message is relayed by one or more of the senses
Sender
Message
Idea is encoded
& expressed
verbal or non verbal thoughts
& feelings
& made
Receiver
Idea is decoded, translated sense of
CIRCULAR MODEL OF COMMUNICATION
COMMUNICATION AND INTERPERSONAL RELATIONSHIPS
Interpersonal – refers to a connection between two or more people; the way they behave or feel towards each other
Communication – focuses on the exchanging of information between people
(Bach & Grant 2011)
WHAT ARE INTERPERSONAL SKILLS?
They include:
Counselling skills – listening & talking
Assertiveness skills – working with ‘difficult’ people
Social skills – working with the general public
Facilitation skills – managing groups
(Morrison & Burnard 1998)
INTERPERSONAL RELATIONSHIPS IN NURSING
The relationship between nurse and patient is a key factor in nursing practice
Patient-centred communication is suggested to have a demonstrable effect on patient outcomes (Charlton et al
2008)
Time spent developing therapeutic relationships can be difficult to find, but is time well spent (Bach & Grant 2010)
Key elements include: building a rapport, developing a working partnership and terminating a relationships (Peplau 1952)
SELF AWARENESS
It is suggested that self awareness is the first step in being able to facilitate effective communication and interpersonal relationships Self awareness allows us relate to the experience of others and develop the skill of empathy
(Miller & Nambiar-Greenwood, …show more content…
in
Webb 2011:21)
JOHARI WINDOW
VERBAL COMMUNICATION – WHAT DO THESE TERMS MEAN?
TLA
CO
U
P
S
M Discharge D
NMB
DO
W
BE
N
LO
W
s e Em WATER is S
K
R
WO
‘They stood in a huddle and discussed me just as if I wasn’t there. I couldn’t understand a word they were saying. It was complete gobbledegook to me!’
(Kraszewski & McEwan 2010:41)
VERBAL COMMUNICATION
A focus on the actual words used in communication
Try to choose language that the patient will understand
Accents, dialects, acronyms can effect understanding
PARA-VERBAL COMMUNICATION
Can be described as the attributes that affect the words
Volume – consider maintaining privacy for example
Tone – usually reflects how the sender is feeling
Speed of speech – can emphasise meaning of words.
Also consider ‘companionable silences’
NON-VERBAL COMMUNICATION
… the messages transmitted without using any words a look, a gesture, facial expression, position, or touch
Very powerful – the receiver of the message often pays more attention to this than the words spoken
LISTENING SKILLS
Active listening – listener gives non verbal messages which encourage the patient to share while feeling safe
SOLER – BECOMING A BETTER LISTENER
S – squarely face the person to show you are ready to listen to them O – open your posture, to indicate you are open to their words
(uncross legs and arms)
L – lean forward, to show you are listening
E – eye contact is maintained, to show you are concentrating on what is being said
R – relax, to help the other person feel
comfortable
BARRIERS TO COMMUNICATION
Prejudice & stereotyping are common barriers that affect communication What types of differences do you think might cause barriers in communicating? EXAMPLES ISSUES THAT MAY CAUSE BARRIERS TO COMMUNICATION
Learning difficulties
Sensory loss –e.g. visual or hearing problems
Autism
Physical disability
Stereotypes of older people
Cultural influences
Dementia
Parkinson 's disease
Intoxication
Aggression
OVERCOMING BARRIERS
With hearing loss, sight loss, with people with alzheimers and dementia: Allow time for the client to process and understand information or questions before responding
Use familiar terms and appropriate complexity of sentence structure If giving instructions, tasks need to be broken down into small
‘steps’ if appropriate. These can be more easily understood and followed.
BARRIERS TO EFFECTIVE LISTENING
Physical: environmental e.g. disturbance, lack of time, distractions Psychological: emotions, alertness, differences in social values, prejudices & stereotypes
KEY POINTS FOR EFFECTIVE LISTENING
Don’t interrupt before the client has finished
Never complete a sentence for a client
Listen in a non-evaluative way
Let client set speed and tone
Use SOLER
Be aware of body cues e.g. facial expression
Learn to gate/exclude sounds
Look for central ideas, themes
Seek clarification where needed
ASKING QUESTIONS
Nurse sets and controls the agenda through asking questions
(Webb 2011)
Guidance
Be clear – ask one question at a time
Closed questions – elicit single word answers (do you want to give a limit choice of response?)
Open questions – elicit more complex answers
OPEN QUESTIONS
What What happened when you went to A&E?
Why Why did you go to your GP?
Who Who helps you at home?
Where Where is the pain originating?
When When do you feel like drinking?
How How does the wound affect your mobility?
EXERCISE – PUTTING SKILLS INTO PRACTICE
Work in pairs and try to out into practice the skills discussed – listening, use of verbal, non verbal and paraverbal communication skills
One student to ‘role play’ a patient, second student to use skills as a student nurse, then swap.
EXERCISE – PUTTING SKILLS INTO PRACTICE
Scenarios
1. Mr/Ms Jones is 25 and has just arrived on your ward and has severe abdominal pain. The student needs to ask some initial questions to begin the assessment process as well as familiarising the patient with key information about the ward.
2. Mr/Mrs Kolvos is 73 and has a leg ulcer which you are going with the district nurse to dress. The patient is a bit hard of hearing and seems a little lonely – they want to chat with you, the student nurse.
WRITTEN COMMUNICATION
Information leaflets
Online advice
Discharge instructions
Medicine labels
Signs in health care settings
Care plans
ACTIVITY - WRITING PLAIN ENGLISH
Work in groups of 3 to re-write the instructions in clear, plain
English.
One observer, 2 writers
Tips:
Short sentences
No jargon, lay words
Direct not indirect (e.g. utilise 'you ')
Remember to check it makes sense
Wheezoff paediatric syrup is specially formulated for children.
It is indicated for the relief of cough and its congestive symptoms and for the treatment of hay fever and other allergic conditions affecting the upper respiratory tract.
Contraindications, warnings etc. Hypersensitivity to any of the active constituents. If symptoms persist consult your doctor. Notwinge cream - directions for use
Apply a sufficient quantity of balm to the part affected.
Massage lightly until penetration is complete.
Vitamin B1, also called thiamin, is required for the functioning of the nervous system, digestion and metabolism.
Insufficient vitamin B1 can cause anorexia and fatigue.
REFERENCES
Bach S & A Grant (2011) Communication & Interpersonal Skills in Nursing. 2 ed. Exeter: Learning matters
Charlton C et al (2008) nurse practitioner 's communication styles Journal of the American Academy of Nurse practitioners 20:382-8.
DOH (2010) Essence of Care 2012 London: DOH
Fiske J (2011) Introduction to communication studies 3rd edition London: Routledge
Kraszewski S & McEwan A (2010) Communication skills for adult nurses. Maidenhead: Open University Press
REFERENCES
Mehrabian A. (1972) Nonverbal communication Chicgao: Aldine
Atherton.
Morisson P & Burnard P (1997) Caring and Communication. 2nd ed. London: Macmillan Press
RCN (2012) Principles of Nursing Practice [Accessed online] http://www.rcn.org.uk/development/practice/principles Sheldon, LK (2004)Communication for nurses: talking with patients. New Jersey: SLACK Inc. pp. 4,132.
Webb L Ed. (2011) Nursing: Communications Skills in Practice
Oxford: Oxford University Press