PROFESSIONAL COMMUNICATION IN NURSING

Hana Rizmadewi Agustina, S.Kp., MN

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Fundamental of Nursing A 2010

Definition

Communication is an ongoing, dynamic and multidimensional process that convey thoughts, feelings and attitudes through verbal and non-verbal message in order to exchange ideas and construct human meaning
(Parbury, 2001)

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Level of Communication
Intrapersonal Interpersonal Transpersonal Small group Public

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COMMUNICATION AS A PROCESS
Interpersonal variables

Feedback Referent Channel Referent

Sender/ Receiver Feedback

Sender/ Receiver

Environment
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Forms of Communication
Verbal communication Non-verbal communication

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Verbal communication
Uses spoken & written words Vocabulary Meanings of words & phrases Pacing Intonation Clarity & brevity Timing & relevance
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Non-verbal communication
Uses body language Facial expressions Vocal cues Eye contact Gestures Sounds Territoriality & personal space
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Zones of Personal

Intimate zone Personal zone Social zone Public zone

Zones of touch
Social zone Consent zone Vulnerable zone Intimate zone
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Variables that affect the communication

Defensiveness Hostility Emotional blocks Preoccupation Mind wandering Past experiences Status Hidden agendas In articulates Stereotyping Physical environment
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Why nurses need to communicate?

Public expectation Professional standards Provides relevant health care information

EFFECTIVE COMMUNICATION SKILLS

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EFFECTIVE COMMUNICATION
Responsiveness High Effective communication Accommodating communication

Assertiveness

High

Low

Domineering communication

Unable to express own Ideas or understand others idea Low

Adopted from Potter & Perry (2004)

Kuliah Komunikasi Keperawatan 11 11/23/2010 Fundamental of Nursing A 2010 Program A 2006

PROFESSIONAL COMMUNICATION IN NURSING

NURSE CLIENT

NURSE FAMILY

NURSE NURSE

NURSE HEALTH TEAM

NURSE COMMUNITY

Helping Relationship

Collaborative care

Patient Safety Quality of care Risk Management

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Facts
31% was subjected to communication failures caused by disrupted flow of critical information from caregiver to caregiver or between patient and caregiver Communication failures appeared to contribute directly to the worsened adverse events treatment and diagnostic errors (Agency for Healthcare Research & Quality, Vanderbilt University, USA) Adopted from : Nursing Economics, May-June 2006/Vol.24/No.3

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Nurse-Client Helping relationships

Central to therapeutic nursing practice Nurse as a professional helper treats individual who has unique health needs, human responses and pattern of living Nurse should knowing client as an aid in clinical decision making

- to understand health events from client experiences - adapt their care to their unique needs - central to client participation in care - judge how they respond the health care events
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Nurse-family relationships
In community and home health settings Needs complexities of family dynamics and cultural system Essential in making positive change and facilitating a healing process Inadequate communication leads to misunderstandings, client and provider dissatisfaction, and termination of home care provider-client relationships
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Nurse-Health team relationships

Multidisciplinary interaction Needs assertiveness and responsiveness Functions in: team building, facilitating group process, collaboration, consultation, delegation, supervision, leadership and management Oral communication about the patient (e.g. case presentations, telephone requests and consultations, complications, critical event, emergency, transfer, discharge, death) Written communication (e.g. medical records, consult notes, email, discharge, transfer and death summaries, death certificate) Team communication (e.g. work rounds, attending rounds and treatment planning teams, referrals, consultations, negotiating differences in treatment options, negotiating turf issues, disagreeing with a superior)
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Nurse community relationships

Participating in local organizations, volunteering for community service or politically active To establish relationships with community to be effective change agents Occurs through channels such as bulletin boards, newspaper radio, radio, television, and electronic information sites To share information and discuss the important health issues to the community
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Elements of Professional Communication

Courtesy Use of names Privacy and confidentiality Trustworthiness Autonomy and responsibility

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Communication within the nursing process

Assessment Nursing diagnosis Planning Implementation Evaluation Documentation

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Assessment
Verbal interviewing & history taking Visual and intuitive observation of non-verbal behavior Visual, tactile and auditory data gathering during physical examination Written medical records, diagnostic tests and literature review
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Nursing diagnosis
Interpersonal analysis of assessment findings Validation of health care needs and priorities via verbal discussion with client Handwritten or computer-mediated documentation of nursing diagnosis

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Planning
Interpersonal or small-group health team planning sessions Interpersonal collaboration with client and family to determine implementation methods Written documentation of expected outcomes Written or verbal referral to health team members
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Implementation
Delegation and verbal discussion with health care team Verbal, visual, auditory and tactile health teaching activities Provision of support via therapeutic communication techniques Contact with other health resources Written documentation of clients progress in medical record
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Evaluation
Acquisition of verbal and non-verbal feedback Comparison of actual and expected outcomes Identification of factors affecting outcomes Modification and update of care plan Verbal and/or written explanation of revision of care plan to client
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Contextual factors influencing communication

Psycho physiological context internal factors - physiological status - emotional status - growth and development status - unmet needs - attitudes, values and beliefs - perceptions and personality - self concept and self-esteem
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Relational context
The nature of the relationships between participants social, helping or working relationships level of trust between participants level of self-disclosure between participants shared history of participants balance of power and control
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Situational context
The reason for the communication Information change Goal achievement Problem resolution Expression of feelings

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Environmental context
The physical surroundings in which communication takes place privacy level noise level comfort and safety level distraction level

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Cultural context
The sociocultural elements that affects the interaction educational level of participants language and self-expression patterns customs and expextations

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Three keys of good communication

A desire to communicate Openness to suspend judgment Sensitivity to protect patients dignity

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Strategies to manage an effective team communication

Composition of the health care team Balanced in knowledge and expertise Language and cultural differences Role and leadership ambiguity Ensure that the required flow of information is clear to all team members Ensure that junior staff understand their role and responsibilities Are the levels for decision making clear to all team members Lack of appropriate mechanisms for timely exchange of information Set up a system for formal transfer of information that includes all team members Ensure a well designed medical record system is in place Arrange for regular and scheduled team and staff meetings.
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ASERTIFITAS
A Type of interpersonal behavior which enables an individuals to act in his own best interest without anxiety, to exercise her own right without denying the rights of others Jadi perilaku asertif adalah jenis perilaku interpersonal yang memungkinkan seseorang bertindak sesuai dengan keinginannya tanpa disertai kekawatiran, mempertahankan haknya tanpa menyerang hak orang lain. Perilaku aserif adalah ungkapan yang jujur, terus terang dan tepat tantang perasaan,keyakinan dan pendapat seseorang

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Berperilaku asertif adalah bagaimana menggunakan metoda komunikasi yang memungkinkan seseorang dapat mempertahankan self respect, mencapai kepuasan akan kebutuhannya, mempertahankan haknya tanpa memperalat atau mendominasi orang lain

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Seseorang yang asertif berbicara jelas dan tenang, dia tahu bagaimana mempertahankan atau mempertanggungjawabkan tindakan yang dilakukannya, dan yang paling penting adalah dia tidak takut untuk mengemukakan apa yang dimaksudkannya. Seseorang yang asertif berbicara lantang, tetapi tanpa melukai merendahkan atau menyebabkan orang lain merasa tersinggung atau merasa dirinya kecil
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Seseorang yang asertif akan secara bebas mengemukakan keyakinannya dan memberikan reaksi yang jujur, untuk kebaikan dan kepentingan dirinya dan pihakpihak yang berkaitan. Perilaku asertif berbeda dengan perilaku agresif dan submisif
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Menjadi ASERTIF..

A means of making our needs known to someone else while treating the other person to the respect they deserve (Floyd Kimberly,2002) Langkah 1 : Tampil percaya diri Bersikap relaks Kontak mata tepat Berbicara fakta Nyatakan perasaan Nyatakan tujuan tindakan Minta umpan balikan
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Kemudian,

Untuk menjadi Asertif, anda perlu

Tahu apa yang diinginkan Memastikan bahwa yang diinginkan itu adil Ajukan keinginan itu secara jelas Tetap bersikap tenang Terima pujian dan kritik secara wajar

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ASSERTIVE PEOPLE are..

Confident percaya diri Set Goals merumuskan tujuan Make Decision membuat keputusan Accountable for result of action bertanggung jawab terhadap tindakannya Able & willing to berkemampuan dan berkehendak Accept the rights of others menghargai hak orang lain Self Directing - mandiri
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Begin with I mulai dengan Saya Learn to say NO belajar menolak Allow other person to disagree memberi kesempatan orang lain untuk tidak sependapat Do not disagree with personality hindari untuk apriori thd kepribadian seseorang Accept criticism terima kritik secara proporsional
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TEHNIK MENGEMBANGKAN PERILAKU ASERTIF

BROKEN RECORD

Upaya mencapai kompromi dengan tetap mengindikasikan apa yang diinginkan

FOGGING

Setuju terhadap kebenaran atau prinsip yang diajukan orang lain

NEGATIVE ASSERTION

Menerima aspek negatif tentang dirinya

NEGATIVE INQUIRY

Asertif terhadap kritik,meminta informasi lebih banyak tentang aspek negatif dari dirinya
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THANK YOU VERY MUCH

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Fundamental of Nursing A 2010