Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 1

Communication - written communication is appropriate for

- interchange of information between two long explanation that needs to be
or more people preserved
- exchange of ideas and thoughts - the nonverbal channel of touch of touch
- uses method such as talking or listening is often highly effective appropriate
or writing and reading forms of touch can communicate caring
- any means of exchanging information or
feelings between two or more people\ C. Receiver
- basic component of human relationships - the one who decodes the message
including nursing (decoder) who must perceive what the
sender intended (interpretation)
Communication process - the listener who must listen observe and
Elements of communication process: attend
Face to face communication involves - to decode means to relate the message
1. sender received and to sort out the meaning of
the message
2. message
- if the meaning of the decoded message
3. receiver
matches, he intent of the sender, the
4. response or feedback
communication is effective
A. Sender
- ineffective communication occurs when
- a person or group who wishes to convey
the message sent is misinterpreted by
message to another
the receiver
- source encoder
- the person or group sending the
D. Response
message must have an idea or reason
- the message that the receiver returns to
for communicating (source) or put the
the sender
idea or feeling into a form that can be
- also called feedback
transmitted (encode the message and
feelings) - can either be verbal or nonverbal or both

✓ Encoding - involves the

selection of signs Modes of communication
and symbols (codes) to transmit the 1.Verbal Communication
message. - Utilizes spoken or written words
- Nurses need to consider the following
B. Message when choosing words to say or write:
- what is actually said or written, the body Place and Intonation - the manner of
of language that accompanies the words speech will modify the feeling and impact
and how the message is transmitted
of the message; intonation can express
- the medium (method to receive) used to
enthusiasm, sadness, anger and
convey the message is the channel; can
amusement; pace may indicate interest,
target any of the receiver’s senses;
anxiety, boredom or fear
important channel to be appropriate for
Simplicity - includes the use of commonly
the message, and it should help make
understood words, brevity, and
the intent of the message clearer.
completeness; complex technical terms
- talking face to face may be more
effective become natural to nurses but laypersons
- recording messages or communicating often misunderstood these terms
by radio or television may be more Clarity and Brevity - the message is
appropriate for larger audience direct and simple will be more
effective; clarity is saying precisely what is
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 2

meant and brevity is using few words, Physical Appearance- how a person
meaning message that is simple and clear. dresses is often indicator of how
Timing and relevance - nurses needs to person feels. Someone who is tired or ill
be aware of both relevance and timing may not have the energy or desire to
when communicating with clients. No maintain their normal grooming. The nurse
matter how clearly or simply words are
must Validate and observe nonverbal data
stated or written, the timing needs to be
appropriate to ensure that words are by asking the client
heard. The message needs to relate to the Posture and Gait - the way people talk
persons interest and concerns and carry themselves are often
Adaptability - spoken messages need to reliable indicators of self-concept, current
be altered in accordance with behavioral mood and health. The nurse must clarify
cues from the client; this adjustment is the meaning of the observed behavior to
referred to as adaptability. have a correct interpretation
✓ if the patient is sad do not smile, be Facial Expression - no part of the body is

sensitive as expressive as the face. Feelings of

Credibility - worthiness of belief, surprise, fear, anger, disgust, happiness

trustworthiness and reliability. May be the and sadness can be conveyed by facial
most important criteria of effective expression.
communication. Nurse must be consistent
- Gestures - hand and body gestures may
dependable and honest. Nurse needs to
be knowledgeable about what is being emphasize and clarify the spoken word, or
discussed and have accurate information, they may occur without word to indicate a
nurses should convey confidence and particular feeling or to give a sign
certainty in what they are saying while
being able to acknowledge their
limitations. 3. Electronic Communication - Emails
Humor - the use of humor can be positive
and powerful tool in the nurse client Factors affecting Communication
relationship, but it must be used with care. Process
Can be used to help client adjust to 1. Development
difficult and painful situations. The physical - language, psychosocial and intellectual
act of laughter can be both an emotional development moves through the stages
and physical release reducing tension by across the life span.
providing a different perspective and - knowledge of a client’s developmental
promoting sense of well-being. stage will allow the nurse modify the
✓ if the patient is in pain it may not be message
effective 2. Gender
- females and males communicate
2.Nonverbal Communication differently
- sometimes called the body language - girls tend to use language to seek
confirmation, minimize differences
- it includes gestures, body movement, use
of touch, and physical appearance, 3. Values and Perception
including adornment - standards that influences behavior and
- observing and interpreting he client’s perception are the personal view of an
nonverbal behaviors is an essential skill for event
nurses to develop - because each person has a unique
- To observe nonverbal behavior efficiently personality, traits, values and life
requires a systematic assessment experiences, each will perceive and
interpret message and experiences
differently
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 3

- it is important for the nurse to be aware for communicating with several people at
of a client’s values and to validate or the same time or within a short time.
correct perceptions to avoid creation Examples occur when nurses make
barriers in the nurse client relationship rounds or wave a greeting to someone.
Social distance is important in
4. Personal Space- the distance people accomplishing the business of the day.
prefer in interaction with others However, it is frequently misused.
Proxemics - the study of distance D. Public distance - 12 feet and
between people in their interaction beyond
Communication alters in accordance with - requires loud, clear vocalizations with
four distances, each with close and far care full enunciation. Although the faces
phase and forms of people are seen at public
A. Intimate distance communication - distance, individuality is lost. Instead, the
0 to 1 1/2 feet perception is of the group of people or
- characterized by body contact, the community.
heightened sensations of body heat and
smell, and vocalizations that are low. 5. Territoriality - concept of the space things
Vision is intense, is restricted to a small that an individual considers as belonging
body part, and may be distorted. Nurses to the self.
frequently use intimate distance. Example: Clients in the hospital often
Examples include cuddling a baby, consider their territory bounded by the
touching a client who is blind, positioning curtains around the bed unit or by the walls
clients, observing an incision, and of the private room.
restraining a toddler for an injection.
B. Personal distance - 1 1/2 to 4 feet 6. Roles and relationships - the roles and
relationships between the sender and the
- less overwhelming than intimate
receiver affect the communication process.
distance. Voice tones are moderate, and
Roles such as nursing student and
body heat and smell are noticed less.
instructor, client and physician, or parent
Physical contact such as a handshake or
and child affect the content and responses
touching a shoulder is possible. More of
in the communication process.
the person is perceived at a personal
distance, so that nonverbal behaviors
such as body stance or full facial 7. Environment - people usually
expressions are seen with less distortion. communicate in a comfortable
Much communication between nurses environment
and clients occurs at this distance. - temperature extremes, excessive noise,
and a poorly ventilated environment can all
Examples occur when nurses are sitting
interfere with communication.
with a client, giving medications, or
establishing an intravenous infusion.
8. Congruence - in congruent
C. Social Distance - 4 - 12 feet
communication, the verbal and nonverbal
- is characterized by a clear visual
aspects of the message match
perception of the whole person. Body
- clients more readily trust the nurse when
heat and odor are imperceptible, eye
they perceive the nurse communication as
contact is increased, and vocalizations
congruent
are loud enough to be overheard by
- congruence between verbal and nonverbal
others. Communication is therefore more
expressions easily seen by the nurse and
formal and is limited to seeing and
the client.
hearing. The person may feel protected
and out of reach for touch or personal
9. Interpersonal Attitudes
sharing of thoughts or feelings. Social
- attitudes are communicated convincingly
distance allows more activity and
and rapidly to others.
movement back and forth. It is expedient
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 4

- attitudes such as caring, warmth, respect being of the group. Example:

and acceptance facilitate communication; active listener, harmonizer
lack of interest, condescension, coldness supporter
inhibit communication. ➢ Self-serving Role - which
advance the needs of
Levels of Communication individual members at the
Intrapersonal Communication groups expense. Example:
- communication that happens among the attention seeker, dominator,
individual blocker
- must be positive
Barriers to Communication
Interpersonal Communication - nurses need to recognize barriers or non-
- occurs between two or more people with a therapeutic responses to effective
goal to exchange message communication
- the ability to communicate effectively in this Major barriers to communication are:
level may influence your sharing, problem • Failure to listen.
solving, goal attainment and other critical • Improperly decoding the client’s
nursing roles. intended message.
• Placing the nurse’s needs above the
Group Communication client’s needs.
- includes small group and organizational 1. Closed Questions
group communication - questions that can be answered by yes
- to determine effectiveness, one studies or no, communication is usually ended
group dynamics and there is no other avenue for the
1. Small Group Communication communication or conversation to follow.
a) Interaction with two or more Instead use why or how questions so
individuals that the client will be able to expound
b) Members must communicate to what he or she is saying.
achieve goal Example: Is the pain gone? Did you
c) The more people in the group, the sleep well?
more complex it becomes
Example: Staff Meeting, Conferences, 2. Clichés
Teaching Sessions or support groups - are overused trite phrases that are
2. Organizational Communication almost meaningless. Impersonal and
a) Occurs when individuals and often used when an individual is at loss
groups within an organization for anything better to say. Used without
communicate to achieve thinking of the impact on the other
established goals person and often seem disrespectful of
Example: Nurses practice council the client's individual circumstances
meeting, nurses working with Example: Hang in there, tomorrow is
interdisciplinary groups. another day. It could be worse.
3. Group Dynamics
3. Rejecting
a) Can be described most simply as
how individual group members - refusing to discuss certain topics with the
relate to one another during the client.
process of working - these responses often make clients feel
b) Categories: that the nurse is rejecting not only the
➢ Task oriented Role – focusing communication but the client themselves
on the work to be done. Example:
Example: information giver, ➢ "I don't want to discuss that. Let's talk
clarifier, coordinator about .... "
➢ Group-building or Maintenance ➢ “I can't talk now. I'm on my way for
Role – focuses on the well- coffee break”
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 5

➢ “let's discuss other areas of Interest to have sexual relation with

you rather than the two problems you another women?"
keep mentioning." Nurse: "I see that you're 36
and that you like gardening.
4. Being Defensive
This sunshine is good for my
- attempting to protect a person or roses for I have a rose
health care services from negative garden."
comments 7. Agreeing or Disagreeing
- this prevent the client from expressing - Imply that the client is either right or
true concerns; is if the nurse is saying wrong and that the nurse is in a
“You have no right to complain." position to judge this
- the response protects the nurse from - the responses deter clients from
admitting weaknesses in the health thinking through their position and
care services and personnel may cause a client to become
weaknesses defensive
Example: Example:
➢ Client: "Those night nurses ➢ Client: ''I don't think Dr. Broad
must just sit around and talk all Is a very good doctor. He
night. They didn't answer my doesn't seem interested in his
light for over an hour patient."
Nurse: "I'll have you know we Nurse: ''Dr. Broad Is head of·
literally run around on nights. the department of Surgery and
you’re not the only client, you is an excellent surgeon. ''
know” 8. Stereotyping
5. Giving Advices - offering generalized or oversimplified /
- Involves offering personal rather than beliefs about groups of people that are
professional opinion based on experiences too limited to be
- the client's responsibility for making valid
decision is diminished; no autonomy - these responses categorize clients
from patient and negate their uniqueness as
- some clients may end up feeling individuals
unable to make their own choices and Example:
may become more dependent on the ➢ "Two-year-olds are brats.
nurse ➢ "Women are complainers."
Example: ➢ "Men don't cry."
➢ Client: ''Should I move from my 9. Judgmental Responses
home to a nursing home?" - giving opinions, approving or
Nurse: ''If I were you, I'd go to disapproving responses, moralizing, or
a nursing home, where you'll implying own values
get your meals cooked for you - these responses imply that the client
6. Changing the Subject must t think as the nurse thinks,
- An abrupt change of subject by the fostering client
nurse generally indicates to the client Example:
that the nurse is uncomfortable or ➢ "That's good (bad)."
anxious about the topic under ➢ ''You shouldn't do that'
discussion. ➢ ''That's not good enough.''
- It is often used to avoid listening to a 10. False Reassurance
client’s fear, distress, or problems and - often used in an effort to cheer up the
is interpreted by the client as a lack of client regardless of the facts, giving
interest false hope about the outcome of the
Example: situation
➢ Client: "I'm separated from my - can be traumatic to a desperately ill
wife. Do you think I should client who may be desperate to
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 6

believe assurances even if they are - Being empathetic, genuine, caring

not founded in reality and unconditionally accepting of
Example: the person
➢ "Don't worry, I'm sure - Understanding the client's
everything will be fine.'' perception.
- Exploring the client's thoughts and
Therapeutic Communication
feelings Developing problem-
- To carry out the role effectively, solving skills
the nurse -must become aware of - Promoting the client's evaluation
the way in which she is interacting solutions
with patients
1. Using Silence
- Note: Every communication from
the nurse to the patient can be - utilizing absence of verbal
evaluated as having therapeutic or communication. This encourages the
non-therapeutic value client to verbalize
- Promotes understanding and - this gives time to organize thoughts
helps establish a constructive and reflect on the topic
relationship between the nurse - client’s nonverbal behavior may
and the client indicate mood, feelings,
- Client and Goal -directed thoughtfulness or any variety of
- Attentive listening behaviors
- Focusing on the client's needs and
2. Accepting
not the nurses needs
- giving indication of reception
Therapeutic Communication
- may indicate that you are following
Techniques
what the client is saying and does not
- Therapeutic communication indicate agreement
techniques are responses that Example:
facilitate interaction and enhance ➢ nodding, “I follow what you have
communication between client and said”
nurse
3. Giving Recognition
- Nontherapeutic communication
techniques are responses that cut - acknowledging, indicating awareness
off communication and make it - greeting by client’s name may show
more difficult for the interaction to that you recognize them as a person,
continue as an individual
- Techniques are tools -not ends in Example:
themselves ➢ “Good Morning Mrs. S”
- They are only as therapeutic as
the person who uses them 4. Offering Self
Purpose: - making oneself available
➢ To offer the nurse a greater - Sometimes clients are unable to
variety of therapeutic verbalize or make themselves
responses; understood or the client may not be
➢ To limit the use of non- ready to talk.
therapeutic responses Example:
➢ To help her gain awareness of ➢ "I'll sit with you awhile."
what is happening as she/he ➢ I'll stay here with you."
interacts with the patient
➢ "I'm interested in what you're
Goals of Therapeutic Communication thinking."

- Establishing rapport
- Identifying issues of concern
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 7

5. Giving Broad Openings 8. Making Observations

- allowing the client to take the initiative - verbalizing what ls ·perceived

In Introducing the topic - making an observation gives the client
- broad openings make explicit the idea the opportunity to agree or disagree
that the client has the lead In the with the nurse's observation.
Interaction. - client may be showing signs of anxiety
- Gives a patient the opportunity to of which he or she is unaware or the
begin to express him/herself client may have begun to hallucinate
Example: or the nurse may be uncertain what
➢ “Is there something you'd like the client is thinking or feeling.
to talk about?” Example:
➢ What are you ta/king about'?" ➢ "You appear tense ... "
➢ "Where would you like to ➢ “Are you uncomfortable when
begin?" you?"

6. Offering General Leads 9. Encouraging Comparison

- giving encouragement to continue. - Asking that similarities and differences

- indicate the nurse is listening and be noted
following what the client is saying - Comparing Ideas or experiences or
without taking away the initiative for the relationship brings out many recurrent
interaction. themes
- It encourages the client to continue If Example:
he or she is hesitant or uncomfortable ➢ ''Was this something like ... ''
about the topic. ➢ ''Have you had similar
- indicates that the nurse understood experiences?''
what the patient has said, and the
10. Restating
nurse wishes to proceed with e
conversation - repeating the main idea expressed
Example: - this restatement lets the client know
➢ "And then?" that the idea was communicated
➢ "Tell me about it." effectively.
Example:
7. Placing the event in time or
➢ Client: ''I can't sleep. I stay
sequence
awake all night.''
- clarifying the rel8tlonshlp of events in Nurse: ''You have difficulty
time sleeping."
- helps both the nurse, and the client to Client: ''I'm really so upset.'
see them in perspective Nurse: "You're really mad and
- The client may gain insight into cause- Upset?”
and effect behavior and consequences, 11. Reflecting
or likewise help the client 'to see that - directing questions, feelings, or Ideas
perhaps some things are not related to back to the client
each other. - Reflection encourages the client to
- The nurse may gain information about recognize and accept his or her own
recurrent patterns or themes in the feelings
client's behavior or relationships Example:
Example: ➢ Client: "Do you think I should
➢ "What seemed to lead up to tell the doctor?"
...?” Nurse: "Do you think you
➢ "Was this before or after. ?" should?"
➢ ''When did this happen?" ➢ Client: "My brother spends all
my money and then has the
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 8

nerve to ask for more" said?''

Nurse: This causes you to feel ➢ “Have I heard you correctly?''
angry." 16. Presenting Reality
12. Focusing - offering or consideration that which Is
- concentrating on a single point. real
- The client can be encouraged to - not by way of arguing with the client or
concentrate his or her energies on a belittling the client's own experience but
single point and max avoid being rather by calmly expressing the nurse's
overwhelmed by a multitude of factors or own perceptions or the facts of the
problems situation.
Example: Example:
➢ This point seems worth looking ➢ ''I see no one else in the room."
at more closely” ➢ ''That sound was a car
➢ “Of all the concerns you've backfiring."
mentioned, which is most ➢ ''Your mother Is. not here; I'm a
troublesome?'' nurse.''
13. Exploring
17. Voicing Doubt
- delving further into a subject or idea
- When clients tend to deal with topics in - expressing uncertainty about the
a superficial manner, exploring can help reality of the client’s perceptions.
them examine the issue more fully. - permits the client to become aware
- Any problem or concern can be better that others do not necessarily perceive
understood if explored in depth. events in the same way or draw the
Example: same conclusions as the client does
➢ ''Tell me more about that." - client will be encouraged to re-
➢ ''Would you like to describe it consider or re-evaluate what has
more fully?” occurred
➢ ''What kind of work?'' Example:
14. Giving Information ➢ "Isn't that unusual?"
- making available the facts the client ''Really?"
needs.
- Informing the client of facts increases 18. Seeking Consensual Validation
his or her knowledge about a topic or - searching for mutual understanding for
lets the client know what to expect. accord the meaning of the word
Example: - it Is Important to avoid slang or
➢ "My name is .. " popular words or phrases that are
➢ ''Visiting hours are” more easily misunderstood.
➢ "My purpose in being here is.. " - Example:
➢ "I'm taking you to ..” ➢ "Tell me whether my
15. Seeking information understanding of it agrees with
- seeking to make clear that which Is not yours”
meaningful or that which Is vague. “Are you using this word to
- Clarification should be sought convey the idea that ..?"
throughout interactions with clients.
- helps the client articulate thoughts, 19. Verbalizing the Implied
feelings and ideas more clearly
- voicing what the client has hinted at or
- can help the nurse avoid making
suggested
assumptions that understanding has
- Putting into words what has been
occurred when It has not
implied or said indirectly tends to
Example:
make the discussion less obscure
➢ “I’m not sure that I follow.''
- The nurse should take care to express
➢ ''What would you. say Is the
only what is fairly obvious; otherwise
main point of what you Just
the nurse may be jumping to
Basic Concepts of Nursing Notes by Lovely Jovellanos BSN 1-4 9

conclusions or interpreting the client’s Identify problems in living with other,

communication grow emotionally, and improve the
Example: ability to form satisfactory
➢ Client: "I can't talk to you or relationships.
anyone. It is a waste of time.” - The nurse offers to do things with the
Nurse: "Is it your feeling that no client, rather than doing things for the
one understands? client
➢ Client: "My wife pushes me Example:
around just like my mother and ➢ "Perhaps you and I can discuss
sister did." and discover what produces
Nurse: "Is it your impression your anxiety:
that women are domineering?” ➢ “Let’s go to your room and I’ll
help You find what you’re
20. Encouraging Expression
looking for."
- asking the client to appraise the
23. Summarizing
quality of his or her experience
- The client is asked to consider people - organizing and summing up that which
and events in the light of his or her has gone before
own values. - seeks to bring out the important points
- The client is encouraged to make his of the discussion and to increase the
or her own appraisal rather than awareness and understanding or both
accepting the opinions of others. participants
Example: - It allows both the nurse and client to
➢ "What are your feelings in depart with the same Ideas In mind and
regard to ... ?" “Does this provides the sense of closure at the
contribute to your discomfort?'' completion of each discussion
Example:
21. Attempting to Translate into “Have I got this straight?"
Feelings
"You've said that ... "
- Seeking to verbalize feelings that are "During the past hour you and I have
only expressed indirectly. discussed ... "
- Often what the client says, when
taken literally seems meaningless or LIFESPAN CONSIDERATIONS
far removed from reality AND SAMPLE PROCESSES
- To understand, the nurse must
concentrate on what the client might
be feeling in order to express him or
herself in this manner.
Example:
➢ Client: "I'm dead."
Nurse: "Are you suggesting that
you feel lifeless?”
➢ Client: "I'm way out in the
ocean."
➢ Nurse: "You seem to feel lonely
or deserted."

22. Suggesting Collaboration

- offering to share, to strive, to work

together with the client for his ·or her
benefit.
- The nurse seeks to offer the client a
relationship in which the client can