Psychiatric-Mental Health Nursing
Chapter 6 Communication
What is communication?
- A personal, interactive system; a series of ever-changing, ongoing transactions in the environment.
What is therapeutic communication?
- A meaningful relationship between the patient and professional helper. The patient-centered approach is influenced and directed by the professional.
What are the theories that influence nursings approach to therapeutic communication?
- Therapeutic communication involves the patient and professional.
- Feedback Loop involves a response-stimulus interchange.
- Internalization involves patterned learning and behavior from influences of gender, culture and developmental needs.
- Transactional Analysis I involves using the functions of the ego as a way of relating and communicating.
Describe communication patterns.
- Patterns of communication include parent, child or adult patterns (the different ego states).
- Adult patterns are most effective because they do not communicate rebellion (child pattern) or judgement (parent pattern).
Describe dysfunctional communication.
- There are several patterns.
- Crossed dysfunctional communication is a message addressed to a specific ego state but not received in that state.
- Double messages in a double message the exchange seems to be adult to adult but the subtle relevant message may be coming from another ego state.
Facts on Communication.
- Even if a person tried they could never not communicate lack of eye contact or not speaking communicates something.
- Communication is a personal, interactive system a series of ever-changing, ongoing transactions in the environment it is how we develop a sense of identity and being.
Communication involves what three essential steps?
- The transmission of information (sending and receiving messages).
- The meaning of the transmission.
- And the behavioral effects of the transmission.
What communication model does nursing use?
- A model of communication compatible with the nursing process is an adaptation of the Wenburg and Wilmot process model of communication.
- This is useful for nursing because it emphasizes behavioral aspects and internal and external influences on communication.
What are the components of the communication process (or model)?
- A sender or encoder person sending the message - can be verbal or nonverbal.
- A
receiver - or decoder gets the message.
- A message
unit of information received.
- Message variables
verbal and nonverbal communication.
- Verbal - is written and spoken structural defects, malfunctioning due to disease, auditory and verbal impairments, sensory deprivation, overload or learning disabilities may affect or decrease accurate communication. Examples: A schizophrenic person, a stutterer, a mentally retarded or autistic person.
- Voice pitch, voice quality (harsh, weak or strained), voice amplification (soft or loud), words, grammar and understanding are included in assessment.
- Nonverbal - is gestures, facial expressions and dress and represents 65% of the communication. Examples of nonverbal behavior include: crying, screaming, laughing, moaning, giggling and sighing, facial expression, body posture, gait, tone of voice and gestures.
- Space and territory are forms of nonverbal communication as well. Personal space is the space preferred for interactions. Territory refers to implied space such as a patients room or a specific seating arrangement.
- Intrusion or violation of these areas can distract or distort communication.
- Noise
sound interference can impair accurate transmission.
- Communication skills
include being able to observe, listen, clarify and validate by both sender and receiver.
- Setting
where communication takes place.
- Media
refers to sensory channels that carry the message hearing, sight, touch, taste and smell. Example: You get the message a patient needs pain medication you hear (hearing)complaints of pain, you see (sight) tears in their eyes, they grasp (touch) your arm in pain.
- Feedback
involves the continuous interpretation of response of the sender and receiver as messages are simultaneously encoded and decoded.
- Environment
are the internal and external influences affecting the communication process. External examples: room temperature, smells and lighting. Internal examples: feeling cold, tired or experiencing pain.
Interpersonal Communication
- Is the most direct and pertinent form of communication because through this transaction needs are met.
- The main focus of interaction occurs at the interpersonal and group levels.
- There are three basic interpersonal styles of communicating:
- Nonassertive or passive letting others control behavior
- Aggressive threatening, blaming and hostile
- Assertive openly expressive, spontaneous, yet considerate of others.
Important elements in therapeutic communication
- Empathy which is a communication skill and behavior.
- Attending being with the patient both in physical and psychological presence.
- Observing
- Listening
Congruence between verbal and nonverbal communication
- There are two levels to every message content and feeling when content and feeling do not match this is termed incongruent. Example: A patient with a sad facial expression and tear filled eyes, tells you he is fine. Or a husband says he is supportive of his wifes therapy but will be too busy to attend family sessions with her.
Barriers to therapeutic communication
- Lack of planning by the nurse.
- Poor data collection.
- Inappropriate Nursing Diagnosis and Outcome criteria.
- Lack of regard or respect for the patient.
- These are just examples review page 67 Table 6-2 and 6-3 for more examples.
Nontherapeutic communication techniques
- Interrupting
- Approving
- Moralizing
- Social responding
- Belittling
- Changing the subject
Therapeutic communication interventions
- Listening
- Observation
- Self-disclosure
- Cultural Sensitivity
- Communication Techniques:
See pages 69 72 for examples.
Additional space was provided to write examples.
