PNC121

Caring and Communication

Kozier Chapter 22
REVIEW: FROM WEEK 1

Nursing Practice Concepts:

 Competency
 Connectedness
 Health and Healing
 Critical Thinking
 Professionalism
PRACTICE STANDARDS

Nursing Practice Standards:

 Accountability
 Continuing Competence
 Ethics
 Knowledge
 Knowledge Application
 Leadership
 Relationships
• Therapeutic Nurse-Client Relationship
• Professional Relationship
LEARNING OUTCOMES

1. Describe how a nurse demonstrates caring practice

2. What is communication?
3. Explain the communication process (sender, message, receiver and
response).
4. Explain and practice modes of communication including non-verbal, verbal
and electronic.
5. Identify what the nurse needs to consider when choosing words to ‘say’ or
‘write’.
6. Explain the factors influencing the communication process.
7. Describe therapeutic communication, attentive listening and physical attending
(providing presence).
8. Discuss and provide examples of therapeutic communication techniques and
barriers to communication.
9. Demonstrate the ability to provide and accept feedback
10. Demonstrate communication techniques that are used in the practice setting

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CARING IN PRACTICE

 Involves connection, mutual recognition, and involvement between

the nurse and the client
 Engagement and connection between the nurse and the client and
between the community
 Caring includes assistive, supportive, and facilitative acts
 Caring is an essential aspect of nursing
 Focus of nursing discipline defined as the study of caring in the
human health experience
 Caring responses are as varied as clients’ needs, environmental
resources, and nurses’ imaginations.
 Perceive caring increases client’s sense of dignity and self-worth,
and feelings of connectedness
 Common caring patterns: knowing the client, nursing presence,
empowering the client, compassion, and competence

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SIX C’S OF CARING

1. Compassion
2. Competence
3. Confidence
4. Conscience
5. Commitment
6. Comportment

How do these six C’s impact Nursing Care?

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CARING OUTCOMES

 Self-actualization
 Individual growth
 Human dignity
 Relieve distress 

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THEORIES ON CARING

 Each theory develops different aspects of caring,

describing how caring is unique in nursing.
Nursing theorists focus on caring:
• Leininger
• Swanson
• Watson
• Benner
• Roach

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TYPES OF KNOWLEDGE

 Scientific competence
• Empirical knowing
 Therapeutic use of self
• Personal knowing
 Moral/ethical awareness
• Ethical knowing
 Creative action
• Aesthetic knowing

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WHY IS COMMUNICATION IMPORTANT?

Understanding our patients

http://www.youtube.com/watch?v=Nipj7PwCjTc&NR
=1

Seeing the people we care for

See Me, Nurse

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Communication has various meanings, depending on the context in which it is
used. To some, it is the interchange of information between two or more
people; it is the exchange of ideas or thoughts, a transmission of feelings,
or a more personal and social interaction between two or more people. This
kind of communication uses such methods as talking and listening or
writing and reading; however, painting, dancing, storytelling, and body
gestures are also means of communication.

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COMMUNICATION

Nurses who communicate effectively are better able to:

• Collect assessment data
• Initiative interventions
• Evaluate outcomes on interventions
• Initiate change that promotes health and patient
safety

Examples of nursing communication

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COMMUNICATION PROCESS

 Sender
• Encoding
 Message
 Receiver
• Decoding
 Response or feedback

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COMMUNICATION PROCESS

Gender Gender
Emotions Emotions
Perception Perception
Sociocultural roles Sociocultural roles
Relationships Relationships
Education and developmental level Education and developmental level

Interpersonal variables within

the sender & receiver influence communication
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FACTORS INFLUENCING THE COMMUNICATION PROCESS

 Development
 Gender
 Values and perceptions
 Personal space
• Intimate (touching to 1.5 feet)
• Personal (1.5 to 4 feet)
• Social (4 to 12 feet)
• Public (12 to 15 feet)
 Territoriality
 Roles and relationships
 Environment
 Congruence
 Interpersonal attitudes
 Boundaries

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ZONES OF PERSONAL SPACE

Think of an
example of each
as it applies to
you as a nurse

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ZONES OF TOUCH

 Social zone (permission not needed)

• Hand, arms and shoulders back
 Consent zone (permission needed)
• Mouth, wrists and feet
 Vulnerable zone (special care needed)
• Face, neck and front of body
 Intimate zone (greater sensitivity needed)
• Genitalia, rectum

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MODES OF COMMUNICATION

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VERBAL COMMUNICATION

 Spoken or written word

 Is a code that conveys specific meaning as words are combined
 Words vary among individuals according to culture, socioeconomic
background, age, and education
 When choosing words to say or write nurses need to consider:
• Pace and intonation
• Simplicity
• Clarity and brevity
• Timing and relevance
• Adaptability
• Credibility
• Use of humour

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NONVERBAL COMMUNICATION

 Is message transmission through body language without using

words
 The nurse needs to consider the following nonverbal behaviours:
• Personal appearance
• Posture and gait
• Facial expressions
• Eye contact
• Gestures
• Body movements
• Affect
• Tone of voice
• Sounds
• Territoriality and personal space

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ELECTRONIC COMMUNICATION

Has evolved with technology. Most common is email.

Advantages of E-mail
• Fast & efficient
• Legible
• Record of date & time
Disadvantages of E-Mail
• Risk to client confidentiality
• The health care agency needs to have an e-mail encryption system to
ensure security
Use of e-mail should be avoided in the following situations:
• When the information is urgent and the client’s health care is in jeopardy
if not read immediately
• Information is highly confidential e.g., human immunodeficiency virus
(HIV) status, mental health, chemical dependency
• Lab results showing abnormality
• If the information is confusing and could prompt many questions by the
client

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THERAPEUTIC COMMUNICATION

 Promotes understanding
 Helps to establish a constructive relationship between
the nurse and the client
 Goal-directed
 Important to understand how the client views, feelings
and thoughts expressed
 Attentive listening and physical attending

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ATTENTIVE LISTENING

 Listening actively by using all the senses

 Paying attention to verbal and nonverbal
 Absorbing both the message content and the feeling the
person is conveying
 An attitude of caring and interest, thereby encouraging
the client to talk

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PHYSICAL ATTENDING

The following actions of physical attending convey a “posture of

involvement’ and specifically focus on comforting a client.

1. Face the other person squarely

2. Adopt an open posture
3. Lean toward the person
4. Maintain good eye contact
5. Try to be relatively relaxed

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THERAPEUTIC COMMUNICATION TECHNIQUES

• Using silence • Offering the self

• Providing general leads • Giving information
• Being specific and tentative • Acknowledging
• Using open-ended questions • Clarifying time or sequence
• Using touch • Presenting reality
• Restating or paraphrasing • Focusing
• Seeking clarification • Reflecting
• Checking perception or • Summarizing and planning
seeking consensual
validation

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THERAPEUTIC COMMUNICATION BARRIERS

• Stereotyping • Rejecting
• Agreeing and disagreeing • Changing topics and
subjects
• Being defensive
• Unwarranted reassurance
• Challenging
• Passing judgment
• Probing
• Giving common advice
• Testing

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PHASES OF A THERAPEUTIC RELATIONSHIP

1. Reviews pertinent assessment data and knowledge

2. Considers potential areas of concern
3. Develops plans for interaction

1. Sets the tone for the rest of the relationship

2. Closely observe each other and form judgments about
the other’s behaviour
3. Goal of the nurse: to get to know the client and develop
trust and security within the nurse–client relationship

Stage 1: Exploring and understanding thoughts and

feelings

Stage 2: Facilitating and taking actions

1. Nurse and client accept feelings of loss

2. Summarizing or reviewing the process can produce a
sense of accomplishment.
3. Termination discussions need to start in advance of the
termination interview to allow time for the client to adjust
to independence.

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TALK WITH ME

https://youtu.be/17aXKS3wCIc

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POST-TEST 1

The interpersonal communication process is

situated in the context that includes which of the
following components?
1. Social, historical, physical, psychological, and
cultural
2. Physical and psychological
3. Cultural and historical
4. Environmental

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POST-TEST 2

A young woman is crying on a chair beside her

bed. As her nurse, which of the following is your
most caring response?
1. “You look sad. Why are you crying?”
2. “Are you in pain?”
3. “Tell me more about how you are feeling.”
4. “Do you want to go home?”

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POST-TEST 3

You are a nurse in a fast-paced medical unit. A patient

approaches you and asks where his nurse is. Knowing that
she is on break, which of the following is your most caring
response?
1. “I am not sure, but she will be back soon to assist you.”
2. “She is having coffee. She has had a very busy
morning.”
3. “She is having coffee. Is there anything that I may assist
you with?”
4. “She is having coffee and I am very busy. Can you wait
until she comes back?”

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POST-TEST 4

A health-care team on an acute geriatric unit meets on a

weekly basis to review clients’ progress. The nurse
observes that one team member consistently dominates
the discussion. Which of the following actions is most
appropriate for the nurse to take?
1. Continue observing and note any changes in behaviour.
2. Discuss these observations with the group.
3. Speak to group members individually to validate these
observations.
4. Speak with the individual privately regarding these
observations.

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