NUR 139 MODULE C

SBAR Communication

• Situation
• Background
• Assessment
• Recommendation

Three Channels of Communication

• Auditory
• Visual 
• Kinesthetic
• nurses use all channels of communication to communicate with their patient and typically receive feedback on their communication
• "noise"(not just obvious sound) can be distracting and inhibit communication in certain situations  
  • monitors
  • TV/other audio
  • family members
  • patient's experience in regards to their Maslow needs at the time
• Verbal VS Nonverbal 
  • Verbal: any spoken or written words
  • Nonverbal: any other type of communication

Factors that Influence Communication

• developmental differences
• gender
• socio-cultural differences
• roles
• space (intimate, personal, social, public)
• physical, mental, and emotional state
• values
• environment

Defining the Communication Process

• process of exchanging information and generating, transmitting information between     two or more people
• the communication process is based on a need
• the sender of a message is also known as the encoder
• the message is the actual communication product from the source which may include verbal communication but also can be nonverbal cues
• ADPIE requires the nurse to communicate effectively

Therapeutic Communication Techniques

• Conversation Skills: ex. tone, speed of voice, patient control of conversation, being clear/concise 
• Active Listening: ex. seated at level of patient, maintain eye contact if applicable, open posture
• Silence (to allow for processing of information at times)
• Touch (in a therapeutic manor)
• Humor (when appropriate for the situation/patient)
• Interviewing Techniques: open ended questions, closed ended questions, validating questions, clarifying questions, reflective questions, sequencing questions, directing questions

Examples of Blocks to Therapeutic Communication

• not using a variety of question types to gain information
• failure to perceive that the patient as a human being
• nontherapeutic comments/questions 
  • cliches
  • yes or no  questions
  • questions with the words why or how
  • leading questions
  • comments that give personal advise
  • judgmental comments
• changing the subject
• giving false assurance
• gossiping and rumors
• disruptive interpersonal behavior and communication
• Nurses should avoid using "elder speak" when communicating with older adults 
  • can include speaking patterns and words mimicking "baby talk"
  • imply that the older adult is not competent

Examples of Patients who have Special Needs

• hearing impaired patient 
  • get in their line of vision
  • talk directly to your patient
  • can use nonverbal cues or other resources to convey questions
  • use of written messages if applicable
• visually impaired patient 
  • remember that they will not be able to pick up on nonverbal cues
• cognitively impaired patient 
  • may need to keep  statements simple
  • short ended questions but still give choices to promote autonomy when you can
• unconscious patient 
  • still communicate  directly and clearly
  • keep conversations that pertain to the patient only

Phases of the Nurse Patient Relationship

1. Orientation Phase 
   • the patient will  call the nurse by name
   • describe the roles of the relationship
   • establish goals of the relationship
   • describe location, frequency, and length of the contacts
   • duration of the relationship
2. Working Phase 
   • the patient will actively participate in the relationship
   • work towards achieving mutually acceptable goals
   • the patient will express feelings and concerns to the nurse
3. Termination Phase 
   • the patient will participate in identifying the goals accomplished or the progress made towards the goals
   • the patient will verbalize feelings about the termination of the relationship

Therapeutic Nurse Patient Relationship

• AKA the "helping relationship"
• foundation of clinical practice
• respectful
• patient focused 
• time limited
• honest and trusting
• promotes patient autonomy