communication in Nursing course 2021.pptx

HELPFUL FOR NURSING STUDENTS

1. Communication Presented by, Anjitha C Lecturer KMCT CON

2. communication

3. INTRODUCTION The communication skill is regarded as a basic component of human relationships. Effective communication is essential for the establishment of a nurse-client relationship. The quality of care you can provide is, in many ways, dependent on the quality of communication that exists between you and your patient. Through your direct contact, the patient must perceive your intentions of support and your positive expectations. You must accurately assess the patient’s physical and emotional symptoms. Communication has only taken place if the message being sent was accurately received. The term communication has various meanings, depending on the context in which it used.

4. DEFINITIONS Communication is the interchange of information between two or more people: In other words, the exchange of ideas or thoughts. “Communication is a process by which information is exchanged between individual through a common system of symbols, signs, behaviour” -Webster’s New Collegiate Dictionary

5. “Communication is shared understanding of shared purposes”. - Millet “Communication is the process of sharing information using a set of common rules”. – Peter G Northouse (1992)

6. MAIN PURPOSES OF COMMUNICATION: To send information To obtain information To interpret To respond appropriately and clearly to a message To interchange the information. To influence others.

7. SUPPORTIVE PURPOSES: * To correct the information a person has about himself and others. * To provide the satisfaction or pleasure of expressing oneself.

8. PUPURPOSES OF COMMUNICATION IN NURSING To collect assessment data. To initiate intervention. To evaluate outcome of intervention. To initiate change which helps in promoting health. To make measures for preventing legal problems associated with nursing practice. To develop mutual understanding among health team members. To analyze factors affecting the health team.

9. LEVELS OF COMMUNICATION Nurses uses different levels of communication in their professional role. The nurses’ communication skills need to include techniques that reflect competence in each level.

10. 1. Intrapersonal communication Intrapersonal communication is a powerful form of communication occurs within an individual. This level of communication is also called self-talk, self-verbalization and inner thought. People’s thought strongly influence perceptions, feelings, behaviour, and self-concept, and you need to be aware of your own thinking. Nurses and clients use intrapersonal communication to develop self-awareness and a positive self-concept that will enhance appropriate self-expression.

11. For example, you may improve health and self-esteem through positive self-talk by replacing negative thoughts with positive assertions. Another type of intrapersonal communication, self-instruction provides a mental rehearsal for difficult tasks or situations so individuals are able to deal with them more effectively.

12. 2. Interpersonal communication Interpersonal communication is one-to-one interaction between one person with another that often occurs face to face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice. It takes place within a social context and includes all the symbols and cues use to give and receive meaning. Because meaning resides in persons and not in words, message received are sometimes different from message intended.

13. Nurses work with people who have different opinions, experiences, values, and belief systems, so it is important to validate meaning or mutually negotiate it between participants. For example, when teaching a client with a health concern, you use interaction to assess understanding and clarify misinterpretations. Meaningful interpersonal communication results in exchange of ideas, problem solving, and expression of feelings, decision making, goal accomplishment, team building, and personal growth.

14. 3. Transpersonal communication Transpersonal communication is a communication that occurs within a person’s spiritual domain. Study of influence of religion and spirituality has increased dramatically over the past decade, and ongoing research helps us understand the role of spirituality in health and coping. Many persons use prayer, meditation, guided reflection, religious rituals, or other means to communicate with their “higher power”. Nurses who value the importance of human spirituality often use this form of communication with clients and for themselves. Nurses have a responsibility to assess client’s spiritual needs and intervene to meet those needs.

15. 4. Small –group communication Small-group communication is interaction that occurs when a small number of persons meet together. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees, lead client support groups, form research teams, or participate in client care conferences, they use a small group communication process.

16. Small groups are more effective when they are a workable size, have an appropriate meeting place, suitable seating arrangements, and cohesiveness and commitment among group members. Group participants need to feel accepted, to feel able to communicate openly and honestly, and to actively listen to others in the group.

17. 5. Public communication Public communication is an interaction with an audience. Nurses have opportunities to speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students.

18. Public communication requires special adaptations in eye contact, gestures, voice inflection, and use of media materials to communicate messages effectively. Effective public communication increases audience’s knowledge about health-related topics, health issues, and other issues important to the nursing profession.

19. COMMUNICATION PROCESS The communication process is built on a trusting relationship with a client and support person. Face-to-face communication involves a sender, a message, a receiver and a response or feedback.

20. Structural model Has 5 functional components: Sender Message Receiver Feedback Context

21. Structural model Encode Decode Message Message- response Decode Encode

22. Elements of Communication: These are best explained by “ Berlo ” by - SMCRR model 1. S - Stands for source (Sender) the originator or source of the idea. 2. M - Stands for message the idea 3. C - Stands for channel the means of transmitting (either verbally or nonverbally) the idea 4. R - Stands for receiver-someone to receive and interpret the message 5. R - Response to the message.

23. 1. Source also known as sender-encoder: The person who initiates conversation or sending message. It suggests that source/ sender must have an idea or reason for communicating and must put the ideas or feelings into a form that can be transmitted. Encoding includes: choosing specific signs or symbols (codes) and words to use to transmit the message such as which language and words to use, how to arrange the voice and what tone of voice and gestures to use.

24. e.g. In a hospital settings, nurse as a source  starts Communicating with a newly admitted client, while considering her communication skill, attitude towards the client, knowledge, (health problems) and socio-cultural system, of the client.

25. Message: The second element of communication is a message. Message consist, of verbal or non-verbal expressions of thoroughly feelings instead to convey information to the receiver and require, interpretation by the persons. Encoding the, message appropriately requires a Clear, understanding of the receiver’s mental frame of reference.

26. Channel: The medium used to convey the message is the channel. It is important for the channel to be appropriate for the message. Channel can target any of receiver’s senses, such as seeing, hearing, touching, smelling and tasting . Face-to-face interaction is more effective than telephonic or written message, Written message is appropriate for long explanations or for communication that needy to be preserved. Communicating recorded message through radio tape/ television is effective for larger audience. Sometimes, channel of touch is high effective. eg . client with hearing problem.

27. Receiver: Receiver who must listen, observe and attend. This person is the decoder: to decode means to relate the message perceived to the receivers store house of knowledge and to sort out the meaning of the message. Perception uses all of the senses to receive verbal or non-verbal messages. Limitations of this Berlo’s model are that it has missed one important element of communication ie ; response.

28. Response: It is the message that the receiver conveyed to source/ sender. It is also known as feedback which may be verbal or non-verbal If the meaning of the decoded message matches the intent of the sender, then the communication has been effective. Either way, feedback allows the sender to collect reword a message.

29. TYPES OF COMMUNICATION There are mainly four types of communication: 1 . One-way communication 2.Two-way Communication 3.Types of communication based on the communication channels: a. Verbal communication b. Non-verbal communication  

30. 4. Types of communication based on the purpose and style: a. Formal b. Informal 5. Visual Communication 6. Tele-Communication and Internet

31. 1. One-way Communication: The flow communication is one way from the communicator to the audience. The familiar example is the lecture method in classrooms. The drawbacks of didactic method are: Knowledge is imposed. Learning is authoritative. Little audience participation. No feedback. Does not influence human behaviour.

32. 2. Two-way Communication: The Socratic Method is a two-way method of communication in which  both the communicators and the audience take part. The audience may raise question and add their own information, ideas, opinions to the subject, the process of learning is active and “democratic” it  is more likely to influence behaviour than one way communication.

33. Types of communication based on the communication channels: a. Verbal communication b. Non verbal communication

34. a.Verbal Communication: It an largely conscious because people choose the words they use. When choosing to say or write, nurses need to consider the following:

35. Pace and intonation: The manner of speech as in the pace or rhythm. Using pause at right time in order to make communication effective. Sender must speak slowly, clearly and use pauses to stress particular point. Giving pause helps the listener to understand. The pace of speech may indicate interest, anxiety, boredom or fear.

36. e.g. speaking slowly and softly to an excited client may help calm the client. Intonation can express enthusiasm, sadness, anger or amusement.

37. Dennotative and Connotative Meaning: The Denotative meaning is shared by individuals who use common language. e.g. Punjabi people using language “Punjabi”. Connotative meaning is the interpretation of words’ meaning, influenced by the thoughts, feelings or ideas people have about the word.

38. Simplicity: For effective verbal communication, the sender must use simple language, easily understood words, brevity and complete words. Language/message conveyed by nurse should be so simple that it could be interpreted easily by a layman. Thus, nurse should avoid using medical terminology. For this, nurse needs to learn the commonly used terms based on the age, knowledge, culture and education of client.

39. e.g. Instead of saying “your leg will be cut”. It can be stated as “due to gangrene formation, part of lower limb will be cut by keeping you unconscious”.

40. Clarity and Brevity: Conveyed message should be very simple and clear, short to minimize confusion. Sender use simple words and direct to make communication effective. Brevity means using few necessary Words for, making message easily understood.

41. Timing and Relevance: If the message, conveyed its in simple language, less time will be consumed for understanding it. Even the timing for interaction also matters. e.g. if client is undergoing for appendectomy in emergency Situation; it is not appropriate, time to collect information regarding his family interest etc. Message should be related to the person’s interest and concerns.

42. Adaptability: Spoken message should by modified as per client’s behavioural clues. This, adjustment is known as Adaptability. e.g. Nurse must know how to speak and express, her gestures while interacting with an elated client or depressed client. As per client’, behaviour nurse should alter her tone of speech and expression. e.g. On the death of clients in ward, nurse should express “‘sad expression”.

43. Credibility: Credibility means worthiness of belief, trust worthiness; reliability. Nurse fosters credibility by being consistent, dependable and honest. For this nurse must be knowledgeable as well as skilful and should provide accurate information to client. By doing so she can gain trust of client.

44. Humour: Humor is useful to help clients to adjust to difficult and painful situation in case client finds loneliness in hospital. Humour helps in promoting a sense of wellbeing.

45. Establishing the Setting: Provide a comfortable environment (lighting, temperature, furnishings). Establish a relaxed, unhurried setting. Sit down when speaking to the patient. Although you probably have dozens of things you need to be doing at that moment, try to relax. Don’t stand at the doorway or sit on the edge of your seat, as if you are preparing to jump and run as soon as you can get away. *Face the speaker and maintain eye contact. Provide for privacy. Avoid interruptions and other distracting influences.

46. Verbal Communication Skills Let the patient do the talking. Keep questions brief and simple. Use language that is understandable to the patient. Avoid acronyms and medical/ nursing jargon if the patient is nonmedical. Ask one question at a time. Give the patient time to answer. Clarify patient’s responses to questions, not just for your own use, but also to let the patient know that you are listening (be sure you really are) and that you understand.

47. * Avoid leading questions. You want the patient to tell you what he is feeling, not what he thinks you want to hear. So, avoid putting words in his mouth. e.g. it might be better to ask, “How are you feeling?” rather than “I suppose you’re feeling rested after your nap.” * Avoid how or why questions; they tend to be intimidating. * Avoid the use of cliche statements like, “Don’t worry; itll be all right.” or “Your doctor knows best.” * Avoid questions which require only a simple “yes” or “no” response. You want to encourage the patient to talk to you. * Avoid interrupting the patient. If you need to ask a question, wait until he has completed his thought.

48. B. Non-verbal Communication: Non-verbal communication includes use of: Body Language: Actions speak louder than words. A person will generally pay more attention to what you do than what you say. Think about the following non-verbal messages and what they might reveal. It helps in expression of feelings better than the spoken words. observing and interpreting clients non-verbal behavior efficiently is an essential skill for effective communication. e.g. Client with endotracheal intubation, on ventilator can’t speak. He can express his feelings by writing on paper.

49. Physical Appearance: * Facial expressions (smile, frown, blank look,  grimace). * Gestures/mannerisms (fidgeting, tapping, clenched fists). * Eye behaviours (avoiding eye contact, staring, wide eyes). * Use (and avoidance) of touch or physical contact. * Posture (erect, slouching, leaning toward/ away from someone). * Walk.

50. i . Physical/personal Appearance: Clothing, dressing, grooming, hygiene provide information regarding social, financial status, culture, religion, group association and even the self-concept. Changing client’s dressing sense.

51. ii. Posture and Gait: * The ways people walk and carry themselves are often reliable indicators of self-concept, current mood and health. * Slouched posture and a slow shuffling gait suggest depression or physical discomfort. * These posture of people when they are sitting or lying can also indicate feeling toe or mood. * In explaining how your pain is and if you might need something to make you more comfortable facial expression.

52. iii. Facial Expression: No part of the body is as expressive as the face. * Feeling of surprise, fear, anger, disgust, happiness and sadness can be conveyed by face only. * Although the face may express the person’s genuine, it is also possible to control these muscles so that emotion is expressed. * The smile expresses happiness, contempt is conveyed by the mouth turned down, the head titled back. * The expression of others in the same setting and the cultural background of the client. * A person who feels weak or defenseless often averts the eyes or avoids eye contact,

53. iv. Gestures: Hand and body gestures may emphasize and clarify the spoken word. A father awaiting information about his daughter may wring his hands. For people with special communication problems such as the deaf, the hands are invaluable. The clients may be able to raise an index finger once for ‘yes’ and twice for ‘no’. The client and the nurse to denote other meaning.

54. TYPES OF COMMUNICATION BASED ON THE PURPOSE AND STYLE: Based on style and purpose, there are two main categories of communication and they both bear their own characteristics. Communication types based on style and purpose are: a. Formal Communication b. Informal Communication

55. a. Formal Communication: * In formal communication, certain rules, conventions and principles are followed while communicating message. * Formal communication occurs in formal and official style. Usually professional settings, corporate meetings, conferences undergo in formal pattern.

56. b. Informal Communication: * Informal communication is done using channels that are in contrast with formal communication channels. It’s just a casual talk. * Informal communication, unlike formal communication, doesn’t follow authority lines. In an organization, it helps in finding out staff grievances as people express more when talking informally. Informal communication helps in building relationships.

57. Visual Communication: It comprises chart, graphs, pictograms, tables, maps and Posters, etc. Tele-communication and Internet: Tele, communication is the process of communicating over distance using electro, magnetic instruments designed for the purpose Radio, TV and internet etc., are mag, communication media, while Telephone and telegraph are known as point-to-point telecommunication system. The point-to-point system is closure to interpersonal communication. With the launching of satellites, a big explosion of electronic communication has taken place all over the world .

58. MODES OF COMMUNICATION Mode means the way by which communication occurs. There are: Three modes of Communication 1.Interpersonal Mode: Students engage in conversation, provide and obtain information, express feeling and emotion, and exchange opinions. 2.Interpretive Mod e: Students understand and interpret written and spoken language on a variety of topics. 3.Presentational Mode: Students present information, concepts and ideas to an audience of listeners or readers on a variety of topics.

59. Interpersonal Mode: The Interpersonal Mode is characterized by  active negotiation of meaning among individuals. Participants observe and monitor one another to see how their meaning and intentions are being communicated. Adjustments and clarifications can be made accordingly. As a result, there ts a higher probability of ultimately achieving the goal of successful communication in this mode than in the other two modes. The Interpersonal Mode is most obvious in conversation, but both the

60. interpersonal and negotiated dimensions can be realized through reading and writing, such as the exchange of personal letters or electronic mail messages. Examples: Exchange information via letters, e-mail/ video mail, notes, conversations or interviews on familiar topics (e.g. school events, weekend activities, memorable experiences, family life).

61. Interpretive Mode: The Interpretive Mode is focused on the appropriate cultural interpretation of meanings that occur in written and spoken form where there is no resource to the active negotiation of meaning with the writer or the speaker. Such instances of “one-way” reading or listening include the cultural interpretation of texts, oral or written, must be distinguished from the notion of reading and listening “comprehension,” where the term could refer to understanding a text with an American mindset .

62. Put in another way, interpretation differs from comprehension in that the former implies the ability to “read (or listen) between the lines.” Since the Interpretive Mode does not allow for active negotiation between the reader and the writer or the listener and the speaker, it requires much more profound knowledge of culture from the outset. The more one knows about the other language and culture, the greater the chances of creating the appropriate cultural interpretations of a written or spoken text.

63. It must be noted, however, that cultural literacy and the ability to read or listen between the lines are developed over time and through exposure to the language and culture. Examples: Follow directions, instructions and requests (e.g. recipes, travel directions, prompts on ATMs). - Use listening and reading strategies (e.g. skimming and scanning techniques) to determine main ideas and purpose.

64.   3. Presentational Mode: The Presentational Mode refers to the creation of messages in a manner that facilitates interpretation by members of the other culture where no direct opportunity for active negotiation of meaning between members of the two cultures exists Examples of the “one-way” writing and speaking require a substantial knowledge of language and culture from the outset, since the goal is to make sure that members of the other culture, the audience, will be successful in reading and listening between the lines.

65. Examples: Summarize information from authentic language materials and artifacts (e.g. TV programmes, articles from youth magazines, Internet, videos, currency) and give personal reactions. Use information acquired from target language sources to solve everyday problems and situations ( eg . using a newspaper to make plans to see a movie, perchasing a catalog to shop for a birthday gift, watching a weather forecast to help plan an activity).

66. Create and present a narrative (e.g. current events, personal experiences, school happenings). Present differences in products and practices (e.g. sports, celebrations, school life) found in the target culture. Prepare and deliver a summary of characters and plot in selected pieces of literature. Apply age-appropriate writing process Strategies (prewriting, drafting, revising, editing, publishing).

67. FACTORS INFLUENCING THE COMMUNICATION Many factors influence the communication process. Some of these are:

68. 1.Development: Knowledge of a client’s development stage will allow the nurse to modify the message accordingly. The use of dolls and games with simple language may help in explain in a procedure to one year old. With adolescents who have developed more abstract thinking skills a more detailed explanation can be given whereas a well - educated middle - aged business executive information provided older clients are apt to have had a wider range of experience with the health care system Which may influence their responses

69. 2. Gender: From an early age males and females communicate differently. Girl tends to use language to seek confirmation, minimize , differences and establish intimacy. Boy use language to establish independence and negotiates status within a group. 3. Valves and Perceptions: Values are the standards that influence behaviour, and perceptions are the personal view of an even Because each person has unique personality, traits, values and life experiences, each will perceive and interpret messages and experiences differently,

70. 4. Personal Space: Personal space is the distance people prefer in interactions with others. Proxemics is the study of distance between people in their interactions. Communication thus alters in accordance with four distances, each with a close and a far phase. ie ; a) Intimate: Touching to 1 1/2 feet b) Personal: 1 1/2 to 4 feet c) Social: 4 to 12 feet d) Public: 12 to 15 feet

71. a) Intimate Distance: Communication is characterized by body contact, heightened sensations of body heat and smell, and vocalizations that are low. Vision is intense, restricted to a small body part, and may be distorted. Intimate distance is frequently used by the nurse. b) Personal Distance: Personal distance is less overwhelming than intimate distance. Voice tones are moderate, and body heat and smell are noticed less, physical contact such as a handshake or touching a shoulder is possible.

72. c) Social Distance: It is characterized by a clear visual perception of the whole person. Body heat and odour are imperceptible, eye contact increased and vocalizations are loud enough to be over heard by others. Communication is, therefore, more formal and is limited to seeing and hearing. d) Public Distance: Requires loud, clear vocalizations with careful enunciation. Although the faces and forms of people are seen at public distance, individuality is lost. Instead the perception is of the group of people or the community.

73. 5.Territoriality: It is a concept of the space and things that an individual considers as belonging to the self. Territories marked off by people may be visible to others. e.g. curtains around the bed unit. 6. Roles and Relationship: The roles and relationship between the sender and receiver affect the communication process. Roles such as nursing student and instructor, client and physician or parent and child affect the content and responses in communication process. The nurse who meets the client for the first time communicates differently from the nurse who has previously developed a relationship with that client.

74. 7. Environment: People usually communicate most effectively in a comfortable environment. Temperature extremes, excessive noise and poorly ventilated environment all can interfere with communication. Also, lack of privacy may interfere with client’s communication. 8.Congruence: The verbal and non - verbal aspects of the message match. Clients more readily trust the nurse when they perceive the nurse’s communication as congruent. This will also help to prevent miscommunication.

75. 9.Attitudes: Attitudes convey beliefs, thoughts and feelings about people and events. Attitudes are communicated convincingly and rapidly to others. Attitudes like caring, warmth, respect and acceptance facilitate communication.

76. METHODS OF EFFECTIVE COMMUNICATION To make the communication effective, the nurse an follow some methods. These are: 1. Attending skills 2. Rapport building skills 3. Empathy skills

77. Attending Skills: * Face the other person squarely: This position says, “I am available to you”. Moving to the side lessen the degree of involvement. * Adopt an open posture: The non-defensive  position is one in which neither arms nor legs are crossed. It conveys that the patient wishes to encourage the passage communication, as the open door of a home or an effective means. * Lean Toward the Person: People move naturally towards one another when they want to say or hear something —by moving to the front of a class, by moving a chair nearer a friend or by leaning across a table with arms propped infront . The nurse conveys involvement by leaning forward, closer to the client.

78. * Maintain Good Eye Contact: Mutual eye contact, preferably at same level, recognizes the other person and denotes willingness to maintain communication. Eye contact neither glares at nor stares down another but is natural. * Restating or Paraphrasing: Actively listening for the client’s basic message and then repeating those thoughts and/ or feelings in similar words. * Seeking Clarification: A method of making the clients or board overall meaning of the message more understand. It is used when paraphrasing is difficult or when the communication is rambling or grabled .

79. * Perception Checking or Seeking Consensual Validation: A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of a message. * Offering Self: Suggesting one’s presence, interest or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurse's attention. e.g I’Il stay with you until your daughter arrives.

80. Giving Information: Providing, in a simple and direct Manner. Specific factual information the Client may or may not request. Acknowledging: Giving recognition, in non judgemental way of a change in behaviour, an effort the client has made, or a Contribution to a communication. Acknowledgment may be with or without understanding verbal or non-verbal  

81. Facilitation: Occasion brief responses which encourage the speaker to continue. A nod Of the head; an occasional verbal cue such as “go on” or “I See” and maintaining eye Contact throughout imply that you are listening and that understand.

82. 2.Rapport Building Skills: Using Silence : Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. e.g. Waiting attentively till client puts his feelings into words. Providing general leads: Using statements or questions such as: Encourage the client to verbalise Choose a topic for conversation. Facilitate continued verbalization

83. Being specific and tentative: Making Statements that are specific rather than general and tentative rather than absolute. Using open ended question s: Asking broad questions that lead or invite the client to explore thoughts and feelings. Closed-ended questions : Questions, which focus the patient on a specific topic. If you want a short, straight answer, ask a question which will allow only for a direct response, such as “When was your accident?” or “Do you have pain after eating?”

84. Broad openings: A few words to encourage the patient to further discussion of a topic; for example, “and after that or you are , saying...” Using touch: Providing appropriate of touch to reinforce caring feelings . Be, tactile contacts vary considerably am individuals, families and cultures, The nurse must be sensitive to the differences in attitudes and practices of clients and self e.g. Placing your hand over the client’s hand

85.   3. Empathy Skils : Empathy is the ability , understand, which allows one person to experience how another feels in a Particular situation and accept another person’s reality to accurately perceive feelings and to communicate this understanding to the other; Empathy is neither sympathy (feeling sorry for another person) nor compassion (that quality of love or tenderness that causes one person to suffer along with another). To express empathy, the nurse reflects understanding of the importance of what has been communicated by the other person on a feeling level. Empathic understanding requires the nurse to be both sensitive and imaginative, especially if the nurse has not had similar experiences.

86. Although nurses are rarely empathetic in every situation to show concern and communicating support for others. Statements reflecting empathy are highly effective because they tell the person that the nurse heard the feeling content as well as factual content of the communication. Empathy statements are neutral and non judgemental. These can be used to establish, trust in difficult situations.

87. Clarifying time or sequence: Helping the client clarify an event, situation or happening in relation to time. eg . client: “I vomited this morning”, Nurse: “Was that after breakfast?” Presenting Reality: Helping the client to differentiate the real from the unreal. e.g “The telephone ring came from the programme or TV". Focusing : Helping the client expand on and develop a topic of importance. It is important for the nurse to wait until the client finishes the stating the main concerns before attempting to focus.

88. Reflecting: Directing ideas, feelings, questions or content back to client enable them to explore their own ideas and feelings about a situation. e.g. Client: “Do you think I should tell my husband”? Nurse: You seem unsure about telling your husband. Summarizing and planning: Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end of an interview, a health teaching session. It often acts as an introduction to future care planning.

89. BARRIERS OF EFFECTIVE COMMUNICATION A message may be distorted by the following: Physical Barriers: Such as fatigue, illness, speech defects, deafness, pain and visual deficit, difficulty in expression. Psychological Barriers: Emotional disturbance (such as, severe stress, anxiety, crisis) suspicion, jealousy, anger, fear, resentment, antagonism, lack of interest, lack of listening, ego centricity and superior or inferior complex. intellectual Barriers: Such as low I.Q., lack of knowledge, misinterpretation of words etc.

90. Social Barriers: Such as differences in culture, language, race, professional status, socio-economic Status etc. Environmental Barriers: Lack of ventilation, light, extreme temperature, loud noise, congestion, lack of privacy, uncomfortable accommodations etc. Cultural Barriers: Level of knowledge and understanding personality traits, customs beliefs religion attitude and language

91. THE COMMUNICATION MAY BE BLOCKED BY FOLLOWING 1.Stereotyping: Offering generalized and over simplified beliefs about groups of people that are based on experiences to limited to be . 2.Agreeing and Disagreeing: A kind to  judgemental responses agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in a position to judge this. 3.Being Defensive: Attempting to protect person or health care services from negative comments. These responses prevent the client from expressing to concerns.

92. 4.Challenging: Giving a response that makes clients to proove their statement or point of view. These responses indicate that the nurse is failing to consider the client’s feeling making the client feel it necessary to defend position. 5.Probing: Asking for information out of curiosity rather than with the intent to assist to client. The responses are considered prying and violate the client privacy. 6.Testing: Asking question that makes the client admit to something. The response permits the client only. Limited answers often meet the nurse’s need rather than the client’s.

93. 7.Rejecting: Refusing to discuss certain topics with the client. These responses often make clients feel that the nurse is rejecting not only their communication but also the clients themselves, 8. Changing Topics and Subject: Directing the communication into areas of self-interest rather than considering the client’s concerns is often a self-protective response to a topic that causes anxiety. 9. Unwarranted Reassurance: False and inappropriate reassurance, using cliches or comforting statements as advice as a means to reassure the client. These responses block the fears, feelings and other thoughts of the clients.

94. 10. Passing Judgement: Giving opinions and approving or disapproving responses moralizing or implying one’s own value. These responses imply that the client must think as the nurse fostering client dependence. 11. Giving Common Advice: Telling the client what to do. These responses deny the client’s right to be an equal partner. Note that giving expert rather than common advice is therapeutic.

95. HELPING RELATIONSHIP (NURSE-PATIENT RELATIONSHIP) Nurse-patient relationship is a basic requirement of nursing practice. A nurse who is efficient and skillful uses the holistic approach in Caring for a patient with any type of problem. Many of the life’s greatest joys flow from the relationships. These relationships find encouragement when we are feeling down and comfort when we are hurting. The relationships also provide nurture for the selfconcept and sense of well-being. You will certainly agree that your relationships are characterized by variability e.g you may limit your interactions with your patient to formal, task related talk, preferring to keep him/her at a distance.

96. DEFINITION OF NURSE-PATIENT RELATIONSHIP * It is an interaction process in which the nurse fulfills her role by using her professional knowledge and skill in such a way that she is able to help the patient Physically socially and emotionally. It is an interaction process between two persons in which the nurse offers a series, of purposeful activities and Practices that are useful to a particular patient. * In other words, we can say that itty interpersonal communication so interpersonal communication ;. transactional process of exchanging messages and negotiating meaning to convey information and to establish, Maintain , relationships. * Interpersonal means between the people " may or may not be face-to-face, In establishing a relationship, there is an attempt to take the other person and that person’s need into account.

97. TYPES OF RELATIONSHIPS 1.Social Relationships : These relationships are primarily initiated for the purpose of friendship, socialization enjoyment and for accomplishing a task. Mutual needs are met during social interactions eg . participating in other’s parties, functions, sharing ideas, giving advices and helping others. These relationships are helpful for a person and family to be a part of society. 2. Intimate Relationships : These relationships are formed between the individuals who have emotional commitment to each other. Short term and long-term goals are set; the information shared between the individuals may be personal and intimate. People may want intimate relationships for many reasons, e.g. procreation, sexual or emotional satisfaction, economic security, social belongingness and to reduce loneliness. 3.Therapeutic Relationships: It is between the nurse and client, in which a nurse develops communication skills, understanding personal strengths in order to enhance the client growth. The focus of the relationship is on the client’s ideas, experiences and feelings.

98. PHASES OF HELPING RELATIONSHIPS The nurse-client relationship is a process that can be explained in terms of four sequential phases: 1.Pre-interaction Phase: Nurse may have some information regarding the patient before the first face-to-face meeting which includes patient’s name. age, sex, address, medical surgical history if any and Social history, 2. Introductory Phase (Orientation Phase): During this phase, the nurse and client closely observe each other and make judgement about each other’s behaviour. There are three stages of the introductory phase.

99. * Opening relationship when the nurse shows caring attitude, genuine interest in the client, trust and worthiness that can overcome resistive behaviour of the client. * Clarifying the problem. * Structuring and formulating the contract. 3. Working Phase: In this phase the nurse makes full use of the services to reduce the problem of the patient and to restore the health. It has two major stages: * Exploring and understanding thoughts and feelings. * Facilitating and taking actions. 4. Termination Phase: It is expected to be difficult and filled with ambivalence. The client becomes confident, independent and evaluates preventive measures. The termination discussions need to be started in advance of the termination interview. In some situations, referrals are necessary. Follow-ups, phone calls or emails that ease the client transition to independence.

100. PATIENT TEACHING Teaching is a system of activities intended to produce learning. Teaching is given to enhance specific learning of patient. Health teaching is defined as a flexible, person-oriented process in which the helping person provides information and support to client with a variety of health-related learning needs. Teaching can be delivered in hospital, community, assisted living and long-term care facilities. Such teaching process is characterized as content specific communication with knowledgeable health professionals related health and self-care needs of the client. Patient teaching involves teaching about reducing the health risk factors, increasing client’s level of wellness and taking specific protective health measures.

101. IMPORTANCE OF PATIENT TEACHING   Providing patient teaching is an important independent function of a nurse. As client has a “right to know” “right to information”, giving information regarding client's health Status is mandatory now-a-days. Patient teaching involves dynamic interaction between client and nurse. Patient teaching is important to communicate information, emotions, perceptions and attitude towards health or disease condition. Patient teaching ensures patient's safe transition from one level of care to another. It also helps in making appropriate plans for follow-up education in the client’s home. As client has a right to make informed decisions about his health, giving patient teaching is very important.

102. PURPOSES OF PATIENT TEACHING To promote health. To protect health. To maintain health. To identify relevant health care needs of client. To provide emotional and cognitive support during teaching-learning process. To keep nurse knowledgeable. To raise self-confidence of nurse in teaching.

103. PROCESS OF PATIENT TEACHING Knowledge of client’s previous learning enables nurse to encourage client and facilitate learning skill. Time for delivering teaching should be opted as per client’s convenience. Nurse should have all communication skills such as confidence, good voice and tone, eye contact, speak clearly and concisely etc. Language: Local language should be preferred as it will be easily understood by client. As per client’s non-verbal cues such as queries and confusion or confused teaching can be repeated or explained with example.

104. ROLE OF NURSE AND INTEGRATING TEACHING IN NURSING PROCESS While delivering patient teaching nurse works as a nurse educator. The foremost function of nurse is to identify client’s previous learning needs: - 1s he able to learn? This client wants to learn? Motivate the client: Motivation is the desire to learn. Nurse’s important role is to help the client personally work through the problems and identify needs. For example, a client with COPD (Chronic Obstructive Pulmonary Disease) may need to know the effects of smoking before he recognizes the need to stop smoking. One important role of nurse is to encourage to learn at specific time. Involving client actively in patient teaching is the important role of nurse. It promotes critical thinking and enables client to solve the problem more effectively. Topic of client teaching should match with the client’s needs.

105. As teaching is effective, if we proceed from simple to complex, nurse should organize the content of client teaching accordingly, Thus, while teaching client, nurse should organize and present the topic from simple to complex. The nurse should provide conducive environment while delivering information to client. She should observe light, ventilation, temperature and noise-free atmosphere. Nurse should observe the client’s emotional, physiological needs. Because in anxiety, pain, client cannot be attentive towards listening to you. Nurse should keep in mind the development, age, education, socioeconomic status, learning needs of client before providing teaching. The nurse should be knowledgeable and confident. Development and maintenance of rapport between nurse and client is very important.