PHYSICAL ASSESSMENT-COMMUNICATION

This section discusses the key points about the communication process and techniques. "A health interview is a structured interaction between you and the patient" The terms governing this interaction should be stated clearly at the start of the interview so that openness and trust are facilitated. Your mutual goal is the patient’s optimal health.

COMMUNICATION

Is “a process by which two or more people exchange ideas, facts, feelings or impressions in ways that each gains a 'common understanding’ of meaning, intent, and use of a message.”

Process of COMMUNICATION

Is “a process by which two or more people exchange ideas, facts, feelings or impressions in ways that each gains a 'common understanding’ of meaning, intent, and use of a message.”

Process of Communication

Sender: The sender (communicator) is the originator of the message.

Sender formulates, encodes and transmits the information which he/she wants to communicate.

The impact of the message will depend on the sender’s communication skill, social status(authority), knowledge, attitude and prestige in the community.

Message: A message is the information/desired behavior in physical form which the communicator transmits to his audience to receive, understand, accept and act upon.

The message may be in the form of words, pictures or signs.

Receiver: Who receives messages from the sender, decoding interprets the meaning and giving feedback.

Response/Feedback: The response is the message that the receiver returns to the sender.

It can be either verbal, non-verbal, or both.

Methods of Communication

Verbal Communication:

 Pace and Intonation.

 Simplicity.

Clarity and Brevity.

Timing and Relevance.

Adaptability.

 Credibility.

 Humor

Nonverbal Communication:

 Personal Appearance.

 Posture and Gait.

 Facial Expression.

Gestures.

Influence of Communication Development.

Gender.

Values and Perception.

Influence of Communication

Personal Space.

Roles and Relationships.

Territoriality.

Influence of Communication

 Environment.

Interpersonal Attitude.

Congruence.

Communication with Health Care Team

4 C’s of Professional Nurse Communication:

Collaboration: seeking and giving info, filtering important info, concise language, preparedness and organization.

Credibility: precise, accurate, assertive, direct, adjusting communication appropriately

Compassion: consideration, caring, respect, positivity, advocacy

Coordination: delegation, organization, teamwork, leadership, mentoring

Therapeutic
 vs.
Non-therapeutic Communication

Therapeutic Communication

Is a process in which the nurse consciously influences a client or helps the client to abettor understanding through verbal or nonverbal communication?

Therapeutic Communication Techniques

• Using silence.
• Providing general leads.
• Being specific and tentative.
• Using open-ended questions.
• Using touch.
• Restating or paraphrasing.
• Seeking clarification.
• Perception checking.
• Therapeutic Communication Techniques
• Offering self.
• Giving information.
• Acknowledging.
• Clarifying time or sequence.
• Presenting reality.
• Focusing.
• Reflecting.
• Summarizing.
• planning

Non-therapeutic communication techniques

“Ten traps of interviewing:

·       Providing false assurance or reassurance:

·       never say, "Everything will be alright"

·       Giving unwanted advice:

·       do not tell the patient what they should do

·       Using authority

·       Using avoidance language: sometimes patients feel uncomfortable using certain verbiage, be able to pick up on it when patients are trying to allude to something

·       Engaging in distancing: the patient may become emotionally removed

·       Using professional jargon

·       Using leading or biased questions: you don't smoke do you?" instead of "do you smoke?"

·       Talking too much

·       Interrupting

·       Using “why” questions-avoid using why, can be part of confrontation -try to ask in different way Nurse-Client Communication

3 C’s:

Confirm feelings and thoughts.

Clarify information.

Collaborate to evaluate healing.

History Taking

 Asking questions of patients to obtain information and aid diagnosis.

Gathering data both objective and subjective for the purpose of generating differential diagnoses, evaluating progress following a specific treatment/procedure and evaluating the change in the patient’s condition or the impact of a specific disease process and guide you to a proper nursing care plan.

Initiating the Session

Preparation:

–        Yourself

–        The environment

Establish rapport:

–        Initial greeting

–         Introductions

–         Seeking consent

–        Respecting the patient

Initiating the Session

Identify the reason for the consultation:

§  Open questions:

–        Always start with an open-ended question and take the time to listen to the patient’s ‘story’.

 “How can I help you?”

 “You said you have pain on movement, can you tell me which movements make your pain worse?”

Initiating the Session

§  Identify the reason for the consultation:

–        Closed questions:

•      Once the patient has completed their narrative to closed questions that clarify and focus on aspects can be used.

o   “Are you still taking the aspirin your GP prescribed?”

o   “Is that an accurate summary of your symptoms?”

Initiating the Session

§   Leading questions:

–        Questions based on your own assumptions that lead the patient to the answer you want to hear. These should not be used at all.

 “You are not allergic to anything are you?”

 “Are your joints painful in cold weather?

pay attention to do the following:

Establishing rapport

 Listening

 Demonstrating empathy

 Facilitating

 Clarifying