Communication

This is about nursing admissions, transfers, & Discharges.   Information comes from Davis Advantage for Fundamental Nursing Care by Marti Burton and David Smith

Transcript

Copy Transcript Copied

Choehns 0:01

Welcome back to Nursing Together, the podcast created for nursing students who are learning not only what to do, but how to think, communicate, and care like a professional nurse. I'm Michele Hohen, your host, and today we are going to be talking about one of the most important skills you will develop throughout your nursing career. And here's the interesting part. You don't need a medical chart. You don't need a stethoscope. You don't even need a fancy piece of technology. Actually, you don't even need a hospital. The skill that I am talking about is something that you already use every single day. Communication. Now, you might think, "I know how to communicate." And you're right. You've been communicating your entire life. But communicating as a nurse is different. As a nurse, your words, your tone of voice, your facial expressions, your posture, your listening skills, your documentation, and even your silence can affect a patient's safety and the nurse-to-patient relationship. Communication is the foundation of the nurse-patient relationship. It also allows healthcare information to be transferred accurately, supports proper documentation, and allows members of the healthcare team to work together effectively. And when communication breaks down, patient safety can be affected. So today, we're going to slow down and really think about what effective nursing communication looks like. Let's start with a simple concept. Communication is not simply talking. Communication is an exchange. Think about someone giving you a gift. You give the gift and the other person receives it. Communication kind of works similar. You send a message, the other person receives it, interprets it, processes it, and responds. And that response is important because it tells you whether your message was accurately understood. The goal is something called shared meaning. Shared meaning means that the message was communicated and understood as you intended. Here's a simple example. Imagine you are walking into your patient's room and say, "Your medication is due." The patient looks at you and says, "Okay." Did you communicate accordingly? Technically, yes. But did you share meaningful conversation? Maybe. Maybe the patient understood exactly what you meant, or maybe the patient thinks you are telling them that they need to take their medication later. Or maybe they didn't understand what medication you were talking about at all. That's why nurses need to communicate clearly and then make sure the patient understands. There are two major types of communication, verbal communication and non-verbal communication. Verbal communication involves words we use, whether spoken or written. But communication is much more than words. Non-verbal communication includes some important aspects: your facial expression, posture, body position, gestures, touch, eye contact, and behavior, and really, your general appearance. And here's something important for all nursing students to understand. Your verbal and non-verbal communication should agree. Imagine that your patient says, "I'm really scared about this procedure." And your response is, "There's nothing to worry about." But while you're saying that, you're looking down at your computer, your arms are crossed, and you've already gone halfway out the door. What message did the patient actually receive? Probably not reassurance. Your word says one thing, but your behavior said something else. That is why effective communication requires nurses to pay attention to both. Let's talk about personal space. Technically, the term for space is proxemics. There are different zones of personal space, ranging from intimacy to public space. But nursing is unique. Think about how often you have to actually enter the patient's personal space. You may need to perform a physical assessment, give a bath, change a dressing, insert a catheter, assist with toileting, or reposition someone in the bed. These are very personal activities. So what should you do? You probably guessed it already. Communicate. Tell the patient exactly what you are doing and why you're doing it. For example, "I'm gonna move closer to you, so I can assess your lungs." That's a simple explanation. It acknowledges what you are doing and that you're gonna enter the patient's personal space. Remember that culture can also influence comfort with touch and personal space. Never assume that every patient has the same preference that you do. Ask, observe, and respect Body positioning is another important aspect. Imagine sitting in a chair while someone is standing directly over you with their arms crossed. How does that make you feel? Maybe intimidated, maybe uncomfortable. As a nurse, try hard to communicate at eye level whenever possible. Lean slightly forward, maintain an open posture, show the patient that you're present. Your body should communicate, "I am here. I am listening. You matter." Your choice of words actually matter as well. As a nurse, you communicate clearly and avoid unnecessary medical jargon when talking with patients. Instead of saying, "You're experiencing dyspnea," you might just say, "You're having trouble breathing." Instead of saying, we need to monitor your urinary output," you might explain, "We need to keep track of how much urine you are producing." Your language should be appropriate for the patient's age, developmental s- level, education, culture, and the level of understanding. If a patient does not understand you, the problem isn't solved by simply repeating the same complicated explanation louder. You need to change your approach. When language differences exist, use appropriate interpreters according to your facility policies. Do not rely on family members to interpret important medical health information simply because they happen to speak the same language and are there. Now let's talk about one of the most powerful nursing skills, and that's active listening. Active listening means you are doing more than just hearing the words. You're paying attention to the entire message. You're listening to what the patient has to say. You're watching what the patient doesn't say. You're observing facial expressions, postures, movement, and tone. You are also putting aside distractions and allowing the patient to finish the message before you decide what they mean. Let's imagine your patient is telling you, "I am tired of all of these treatments. They don't seem to be doing anything." A nurse who is actively listening might say, Well, you need to keep taking your treatments." That's not very therapeutic. An active listener might say, "It sounds like you are becoming discouraged about your treatments." Now the patient has the opportunity to say, yes, I just don't know if all of this is working." You have opened up the door for the patient to communicate, and that's what therapeutic communication is all about. As a nurse, you're going to communicate with patients, families, nurses, providers, nursing assistants, supervisors, and many, many other people. And sometimes you're gonna have a difficult conversation, and there are three communication styles you need to understand: passive, aggressive, and assertive. A passive communicator may avoid confrontation. They may have difficulty expressing their needs. They may be afraid to speak up. An aggressive communicator puts their own needs ahead of every other person and may communicate through anger, hostility, humiliation, and intimidation Then we have assertive communication. Assertive communication means you stand up for yourself while respecting the rights of others. You're direct, you're honest, you're respectful, and you are clear. For nurses, assertive communication is particularly important because patient safety sometimes depends on your willingness to speak up. Imagine you notice something about your patient that concerns you. You shouldn't just ignore it because you're afraid someone will be annoyed. You also shouldn't approach your coworkers aggressively. Instead, communicate assertively. One strategy for assertive communication is the DESC method. D stands for describe the behavior. Focus on what you've observed rather than attacking the person. E, explain the impact. Explain why the behavior matters. S, state the desired outcome. Tell the person what you need to happen, and C, consequences when appropriate. Let's create a nursing example. Imagine that you are working with someone who repeatedly interrupts you while you're giving an important information You might wanna just say, "When I'm giving a report, I'm interrupted before I'm finished. Important patient information may be missed. I need to be able to complete the report before we discuss questions." Notice you didn't say, "You're always rude." You described the behavior. You explained the impact. You stated what you needed. That is assertive communication. Assertive does not mean rude. Assertive means respectful and clear. Now let's move into another important concept in nursing, and that is therapeutic communication. Therapeutic communication is patient-centered. Its purpose is to help patients express their thoughts, feelings, concerns, and needs. It is not about making the conversation about you. It is about helping the patient. And there are communication barriers that can interfere with therapeutic communications. For example, false reassurance, "Don't worry, everything will be fine." Giving advice, "If I were you, I would..." Belittling the feeling, "There are other patients who have it worse." Expressing disapproval, "I would never make that decision." Or unnecessarily probing questions. Instead, try response that allow the patient to explore their feelings. For example, "Tell me a little bit more why you're feeling that way. What concerns you most right now? How has this experience been for you?" These types of response encourage communication rather than shutting it down Imagine you are working on a very busy unit. A patient suddenly develops a change in condition. The room is busy, the family is frightened, other staff members are moving quickly, and you need to contact the provider. This is not a time to ramble. This is a time to have focused communication A tool that you might wanna use is a longer version of an SBAR. It's called an ISBAR. Let's break it down. I is for introduction, who you are, where you are calling from, and who the patient is. S is the situation, what's happening right now. B is the background, what is important information that led up to this situation. A is assessment What you are seeing right now and what that assessment means in this situation. R is for recommendation your recommendation, what you think needs to happen or what you are asking the provider for. And then finally, read back. If the provider gives you an order, read back and verify that you heard it correctly. This is especially important when receiving telephone or verbal orders. Let's say you are calling a provider about a patients whose condition has changed. You might begin with, "Dr. Smith, this is Michelle, LPN. I am calling from the medical surgical unit about Mr. Jones." That is your introduction. Then, "Mr. Jones has developed shortness of breath," your situation. Then provide the relevant background. Then your assessment, then your recommendation. And if the provider gives you an order, read it back. Communication during stressful situations should be clear, concise, organized, and controlled. Your goal isn't to sound panicked. Your goal is to communicate the information the other person needs to make a safe decision Another frequent type of communication is the shift report. I want you to remember this. A shift report isn't simply a conversation between two nurses. It is a patient safety activity. The off-going nurse needs to communicate important information to the nurse assuming responsibility for the patient. Your report should include current and accurate information, changes in condition, changes in orders, the plan of care, and the important anticipated changes. Be thorough, but don't become distracted by unnecessary information. One of the easiest mistakes students make during this report is a social conversation. Remember, report is about the patient and protect the confidentiality. Patient information is not to be discussed in hallways, cafeterias, elevators, or any other areas that may be ov-overheard. HIPAA and patient privacy still applies during report. When possible, bedside report can provide opportunities for clarification and allow for the oncoming nurse to see the patient and equipped directly. But always be careful about what type of information is discussed in front of the patient and others. Patient safety depends on it As an LPN, you are a part of a team. You'll communicate upwards with your supervisor, with your peers, providers, and depending on your role and facility, you may also provide direct or supervision to assistant personnel. Communication when directed to others needs to remain respectful. Think about the four important areas. Job instructions, what needs to be done. Job rationale, why does this task matter? Policies and procedures, what should be completed according to the facility's expectations, and feedback, how well the task was completed. Good nurses don't simply tell people what to do. They communicate expectations clearly and respectfully, and they model professional behavior. Nursing communication just doesn't stop by leaving the patient's bedside. Your written communication is equally important. You may need to document an electronic health record, or you write a progress note, or contribute to the care plan. Remember this acronym, KISS. Keep it short and simple. Write clearly. Be specific. Be concise. Use appropriate terminology. Avoid unnecessary words, and always proofread. So don't just write something that forces another nurse to guess what you meant There are difference between task-centered and patient-centered. Task-centered nursing focuses heavily on completing something on a list, vital signs, bath, medicines, documentation. Patient-centered communication keeps the individual at the center of care. And here's something important. You don't necessarily need hours with your patients to build a positive relationship. It's the quality of communication that matters. You can make a difference in a short interaction. Instead of entering the room, completing the task, and leaving, make eye contact. Ask how the patient is doing, listen to the answer, explain what you are doing, That may take less than a minute, but that minute can change the patient's experience. Another important communication is a patient interview. The interview is a planned communication with purpose. It has three basic parts: opening, body, closing. During the opening, you introduce yourself, explain the purpose, and establish a rapport. During the body, you gather the information. During the closing, the patient has the opportunity to ask questions, explain what is gonna be happening next, and thanking them for their participation Open-ended questions encourage patient explanation Technology is an important part of modern nursing. You will spend time documenting in the electronic record, but don't let the computer become the person you're talking to. If you're asking the patient the question while staring at the screen the entire time, what message does that send? It might make the patient feel ignored. Position the computer so you can be looking at the patient while asking the questions, making sure that you are making eye contact, listening, and then documenting. The computer is the tool. The patient is the person. Another responsibility is assessing whether the patient understands health information. This is called health literacy. Your patient needs to be able to obtain, process, and understand the basic health information they are participating in. Don't assume that the patient's nodding their head that they understand. Ask them to explain the information that you just gave them, and try to avoid unnecessary medical terminology. A patient who asks questions is giving you an opportunity to improve their understanding. Every person doesn't communicate the same way. Some patients have hearing impairments, some visual, language. Some might n-not be able to speak at all, and patients may be unconscious. Your responsibility is to adapt. For a patient with hearing impairment, face the patient, get their attention before speaking. Reduce background noises and speak clearly. Don't shout, don't mumble, and don't pretend you understand something when you didn't. Ask for clarification For patients with visual impairment, identify yourself when in the room. Speak naturally, introduce other people who are in the room, tell the patient that you're leaving, and don't talk about the patient as though they are not present. For patients with speaking impairment, give them time. Don't rush them. Use a communication board, writing, pictures, or other appropriate devices when needed. Don't assume that difficultly speaking means difficultly understanding. Work with the patient's abilities. And what if the patient cannot speak? Communication is especially important. Make sure the patient has a reliable way to call for help. How they can communicate, maybe they can write something down, nod, blink, press your hand, maybe use a communication board. Whatever works, make sure the nurse understands what that looks like. Let's finish with one of the most important reminders in this area. Just because a patient cannot respond doesn't mean you should stop communicating. A sedated or unconscious patient may still hear and respond emotionally to your verbal communication. So explain what you are doing. Talk to the patient. Use simple, respectful language. Instead of silence, turn to the patient and say, "Mr. Smith, I'm going to help you turn on your left side now." Instead of performing it without explanation, tell the patient what you are doing. And never discuss other patients while caring for an unconscious or sedated patient Let's go ahead and bring this all together. Communication isn't a separate nursing skill that you pull out when you need it. Communication is woven into everything that you do. You communicate when you enter the room, give medications, during assessments, during reports, with providers and coworkers, with family. You communicate without saying a word with your facial expressions. So as you move listen before you respond. Be clear and respectful. Protect confidentiality. Use therapeutic communication. Speak up when the patient is at risk. Use structured communication such as your SBAR when appropriate. Document clearly. And most importantly, remember every patient is a person before they are a diagnosis, a room number, or a task on your assignment sheet. That is the power of nursing. Thank you again for joining me for another episode of Nursing Together. Until next time, keep learning, keep listening, keep asking questions. And remember, great nursing care begins with caring for a person, and sometimes the most powerful intervention you have is simply knowing how to communicate.