Chapter 20 Communicating & Therapeutic Relationships
TheoreticalKnowledge knowing why
The Joint Commission National Patient Safety Goal 2,
effective 2015, aims to improve patient safety by improving
communication among caregivers.
The Joint Commission states that patients have the right to
have a language interpreter. This is an essential component of
quality care and patient safety
Quality and Safety Education for Nurses (QSEN). To provide
for patient safety, nurses need to effectively communicate their
concerns about hazards and errors to patients, families, and the
healthcare team.
WHAT IS COMMUNICATION?
Communication is a dynamic, reciprocal process of sending and
receiving messages using words, sounds, expressions, body
movements, written symbols, and behaviors.
Communication Occurs on Many Levels
Communication is not just an exchange of words between two
individuals. It occurs in inner dialogue, between people, and among
groups.
Intrapersonal Communication is conscious internal dialogue,
sometimes known as self-talk.
Interpersonal Communication occurs between two or more
people.
Group Communication is interaction occurring between more than
two people.
Public Speaking is a unique form of group communication.
Generally, the speaker addresses a group with varying degrees of
interaction.
,Communication Is a Process
Process refers to the act of sending, receiving, interpreting, and
reacting to a message. The five elements of the communication
process.
The sender (source or encoder) uses verbal and nonverbal
methods to deliver a message (content) to another person.
Encoding refers to the process of selecting the words, gestures,
tone of voice, signs, and symbols used to transmit the message. For
example, as a beginning nursing student, you might feel anxious
about caring for Mr. Barker (Meet Your Patient). To communicate
your concerns to your instructor, you might say directly, “It makes
me nervous to be assigned to him.” Or you might avoid eye contact
and tell your instructor, “I’m going to need some help today.” Both
styles communicate your anxiety, but they are encoded differently.
The message is the verbal and nonverbal information the sender
communicates. It might be content of a conversation, a speech, a
gesture, a letter, and so forth. Effective messages are complete,
clear, concise, organized, timely, and expressed in a manner that
the receiver can understand.
The channel is the method in which the message is conveyed. Face-
to-face communication is a commonly used channel. Nurses
frequently use touch as a nonverbal way to communicate caring
and concern. Other channels include written pamphlets, audiovisual
aids, recordings, telephone and text messages, and the Internet.
The receiver is the observer, listener, and interpreter of the
message. The receiver interprets, (decodes/convert) by relating
the message to past experiences to determine the sender’s
meaning. The receiver uses visual, auditory, and tactile senses to
decode the message. If the sender’s intended meaning matches
what the receiver thinks it means, then the message was effective.
Messages are sometimes misinterpreted, especially when the
receiver is not physically or emotionally ready to receive the
message.
, For example, if you approached your instructor to discuss your
concerns about your patient when she was assisting with an
emergency, she might be unable to receive your message.
Feedback may be verbal, nonverbal, or both. Once the receiver
has received and interpreted the message, he may be stimulated to
respond by providing feedback to the sender.
Verbal Communication
Verbal communication is the use of spoken and written words to
send a message. The following factors affect how a message is
received:
Denotative and Connotative Meaning
Denotation is the literal (dictionary) meaning of a word.
Connotation is the implied or emotional meaning of the word.
Consider the following examples:
A mother says to her infant, “Don’t cry, Baby.”
A 40-year-old man says to his nurse, “Would you rub my back,
Baby?”
A 10-year-old boy says to another boy, “You’re a baby!”
As you can see, words are often value laden or biased. KEY
POINT: Use terms that provide clear, objective data and are
not open for misinterpretation.
Pacing
The pace and rhythm of the delivery can alter the receiver’s
interpretation of the message. Must have the right pace, not too slow
and not too fast.
Intonation
“Tone of voice,” or intonation, reflects the feeling behind the words.
Clarity and Brevity
A conversation that is clear and brief holds the interest of all parties
and effectively conveys the intended messages.
Clarity—requires (1) that you select words that convey the
intended meaning and (2) that you make sure your spoken words
and the nonverbal language send the same message.
TheoreticalKnowledge knowing why
The Joint Commission National Patient Safety Goal 2,
effective 2015, aims to improve patient safety by improving
communication among caregivers.
The Joint Commission states that patients have the right to
have a language interpreter. This is an essential component of
quality care and patient safety
Quality and Safety Education for Nurses (QSEN). To provide
for patient safety, nurses need to effectively communicate their
concerns about hazards and errors to patients, families, and the
healthcare team.
WHAT IS COMMUNICATION?
Communication is a dynamic, reciprocal process of sending and
receiving messages using words, sounds, expressions, body
movements, written symbols, and behaviors.
Communication Occurs on Many Levels
Communication is not just an exchange of words between two
individuals. It occurs in inner dialogue, between people, and among
groups.
Intrapersonal Communication is conscious internal dialogue,
sometimes known as self-talk.
Interpersonal Communication occurs between two or more
people.
Group Communication is interaction occurring between more than
two people.
Public Speaking is a unique form of group communication.
Generally, the speaker addresses a group with varying degrees of
interaction.
,Communication Is a Process
Process refers to the act of sending, receiving, interpreting, and
reacting to a message. The five elements of the communication
process.
The sender (source or encoder) uses verbal and nonverbal
methods to deliver a message (content) to another person.
Encoding refers to the process of selecting the words, gestures,
tone of voice, signs, and symbols used to transmit the message. For
example, as a beginning nursing student, you might feel anxious
about caring for Mr. Barker (Meet Your Patient). To communicate
your concerns to your instructor, you might say directly, “It makes
me nervous to be assigned to him.” Or you might avoid eye contact
and tell your instructor, “I’m going to need some help today.” Both
styles communicate your anxiety, but they are encoded differently.
The message is the verbal and nonverbal information the sender
communicates. It might be content of a conversation, a speech, a
gesture, a letter, and so forth. Effective messages are complete,
clear, concise, organized, timely, and expressed in a manner that
the receiver can understand.
The channel is the method in which the message is conveyed. Face-
to-face communication is a commonly used channel. Nurses
frequently use touch as a nonverbal way to communicate caring
and concern. Other channels include written pamphlets, audiovisual
aids, recordings, telephone and text messages, and the Internet.
The receiver is the observer, listener, and interpreter of the
message. The receiver interprets, (decodes/convert) by relating
the message to past experiences to determine the sender’s
meaning. The receiver uses visual, auditory, and tactile senses to
decode the message. If the sender’s intended meaning matches
what the receiver thinks it means, then the message was effective.
Messages are sometimes misinterpreted, especially when the
receiver is not physically or emotionally ready to receive the
message.
, For example, if you approached your instructor to discuss your
concerns about your patient when she was assisting with an
emergency, she might be unable to receive your message.
Feedback may be verbal, nonverbal, or both. Once the receiver
has received and interpreted the message, he may be stimulated to
respond by providing feedback to the sender.
Verbal Communication
Verbal communication is the use of spoken and written words to
send a message. The following factors affect how a message is
received:
Denotative and Connotative Meaning
Denotation is the literal (dictionary) meaning of a word.
Connotation is the implied or emotional meaning of the word.
Consider the following examples:
A mother says to her infant, “Don’t cry, Baby.”
A 40-year-old man says to his nurse, “Would you rub my back,
Baby?”
A 10-year-old boy says to another boy, “You’re a baby!”
As you can see, words are often value laden or biased. KEY
POINT: Use terms that provide clear, objective data and are
not open for misinterpretation.
Pacing
The pace and rhythm of the delivery can alter the receiver’s
interpretation of the message. Must have the right pace, not too slow
and not too fast.
Intonation
“Tone of voice,” or intonation, reflects the feeling behind the words.
Clarity and Brevity
A conversation that is clear and brief holds the interest of all parties
and effectively conveys the intended messages.
Clarity—requires (1) that you select words that convey the
intended meaning and (2) that you make sure your spoken words
and the nonverbal language send the same message.
