Communication is one of the means in establishing rapport and a helping-healing

relationship to our clients. It is an essential element in nursing and this post will
help you understand the concept of communication. This is also a primer teaching
you documentation and reporting in nursing.
Definition
Communication is the process of exchanging information or feelings between two or
more people. It is a basic component of human relationship, including nursing.
Contents [show]
Communication
Is the means to establish a helping-healing relationship. All behavior communication
influences behavior. Communication is essential to the nurse-patient relationship for
the following reasons:

Is the vehicle for establishing a therapeutic relationship.

It the means by which an individual influences the behavior of another, which

leads to the successful outcome of nursing intervention.

Basic Elements of the Communication Process

1. Sender is the person who encodes and delivers the message
2. Messages is the content of the communication. It may contain verbal,
nonverbal, and symbolic language.
3. Receiver is the person who receives the decodes the message.
4. Feedback is the message returned by the receiver. It indicates whether the
meaning of the senders message was understood.
Modes of Communication
Verbal Communication
Verbal Communication use of spoken or written words.
1. Pace and Intonation

The manner of speech, as in the pace or rhythm and intonation, will modify
the feeling and impact of the message. For example, speaking slowly and
softly to an excited client may help calm the client.

2. Simplicity

Includes the use of commonly understood words, brevity, and completeness.

Nurses need to learn to select appropriate, understandable terms based on

the age, knowledge, culture and education of the client. For example, instead
of saying to a client, the nurses will be catheterizing you tomorrow for a
urinalysis, I would be more appropriate to say, Tomorrow we need to get a
sample of your urine, so we will collect it by putting a small tube into your
bladder.

3. Clarity and Brevity

A message that is direct and simple will be more effective. Clarity is saying
precisely what is meant, and brevity is using the fewest words necessary.

The goal is to communicate clearly so that all aspects of a situation or

circumstances are understood. To ensure clarity in communication, nurses
also need to speak slowly and enunciate carefully.

4. Timing and Relevance

No matter how clearly or simply words are stated or written, the timing needs
to be appropriate to ensure that words are heard.

This involves sensitivity to the clients needs and concerns. E.g., a client who
is enmeshed in fear of cancer may not hear the nurses explanations about
the expected procedures before and after gallbladder surgery.

5. Adaptability

What the nurse says and how it is said must be individualized and carefully
considered. E.g., a nurse who usually smiles, appears cheerful, and greets his
clients with an enthusiastic Hi, Mrs. Jones! notices that the client is not
smiling and appears distressed. It is important for the nurse to then modify
his tone of speech and express concern in his facial expression while moving
toward the client.

6. Credibility

Means worthiness of belief, trustworthiness, and reliability. Nurses foster

credibility by being consistent, dependable, and honest.

Nurses should convey confidence and certainly in what they are saying, while
being to acknowledge their limitations (e.g., I dont know the answer to that,
but I will find someone who does.

7. Humor

The use of humor can be a positive and powerful tool in nurse- client
relationship, but it must be used with care. When using humor, it is important
to consider the clients perception of what is considered humorous.

Nonverbal Communication
Nonverbal Communication use of gestures, facial expressions, posture/gait,
body movements, physical appearance and body language
1. Personal Appearance

When the symbolic meaning of an object is unfamiliar the nurse can inquire
about its significance, which may foster rapport with the client.

How a person dresses is often an indicator of how person feels. E.g. For
acutely ill clients n hospital or home care settings, a change in grooming
habits may signal that the client is feeling better. A man may request a
shave, or a woman may request a shampoo and some makeup.

2. Posture and Gait

The ways people walk and carry themselves are often reliable indicators of
self-concept, current mood, and health. Erect posture and an active,
purposeful stride suggest a feeling of well being. Slouched posture and slow,
shuffling gait suggest depression or physical discomfort.

The nurse clarifies the meaning of the observed behavior, e.g. You look like
it really hurts you to move. Im wondering how your pain is and if you might
need something to make you more comfortable?

3. Facial Expression

No part of the body is as expressive as the face

Although he face may express the persons genuine emotions, it is also

possible to control these muscles so the emotion expresses does not reflect
what the person is feeling. When the message is not clear, it is important to
get feedback to be sure of the intent of expression.

Nurses need to be aware of their own expressions and what they are
communicating to others. It is impossible to control all facial expression, but
the nurse must learn to control expressions of feelings such as fear or disgust
in some circumstances.

Eye contact is another essential element of facial communication

4. Gesture

Hand and body gestures may emphasize and clarify the spoken word, or they
may occur without words to indicate a particular feeling or give a sign

Electronic Communication

Electronic Communication- many health care agencies are moving toward

electronic medical records where nurses document their assessments and nursing
care.
E-mail

Most common form of electronic communication.

Advantage: It is fast, efficient way to communicate and it is legible. It

provides a record of the date and time of the message that was sent or
received.

Disadvantage: risk of confidentiality

When Not to Use Email:

a. When information is urgent

b. Highly confidential information (e.g. HIV status, mental health, chemical
dependency)
c. Abnormal lab data

Agencies usually develop standards and guidelines in use of e-mail

Characteristics of Good Communication

1. Simplicity includes uses of commonly understood, brevity, and
completeness.
2. Clarity involves saying what is meant. The nurse should also need to speak
slowly and enunciate words well.
3. Timing and Relevance requires choice of appropriate time and
consideration of the clients interest and concerns. Ask one question at a time
and wait for an answer before making another comment.
4. Adaptability Involves adjustments on what the nurse says and how it is
said depending on the moods and behavior of the client.
5. Credibility Means worthiness of belief. To become credible, the nurse
requires adequate knowledge about the topic being discussed. The nurse
should be able to provide accurate information, to convey confidence and
certainly in what she says.
Factors Influencing the Communication Process
1. Development

Language, psychosocial, and intellectual development move through stages

across the lifespan.

2. Gender

Girls tend to use language to seek confirmation, minimize differences, and

establish intimacy. Boys use language to establish independence and
negotiate status within a group.

3. Values and Perception

Values are the standards that influence behavior, and perceptions are the
personal view of event.

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 4 distances:

a. Intimate: Touching to 1
b. Personal: 1 to 4 feet
c. Social: 4 to 12 feet
d. Public: 12 to 15 feet
5. Territoriality

Is a concept of the space and things that an individual considers as belonging

to the self

6. Roles and Relationships

Choice of words, sentence structure, and tone of voice vary considerably from
role to role. (E.g. nursing student to instructor, client and primary care
provider, or parent and child).

7. Environment

People usually communicate most effectively in a comfortable environment.

8. Congruence

The verbal and nonverbal aspects of message match. E.g., when teaching a
client how to care for a colostomy, the nurse might say, You wont have any
problem with this. However, if the nurse looks worried or disgusted while
saying this, the client is less likely to trust the nurses words.

9. Interpersonal Attitudes

Attitudes convey beliefs, thoughts, and feelings about people and events.

Caring and warmth convey a feeling of emotional closeness

Respect is an attitude that emphasizes the other persons worth and

individuality. A nurse coveys respect by listening open mindedly even if the
nurse disagrees.Acceptance emphasizes neither approval nor disapproval
.The nurse willingly receives the clients honest feelings.

Communicating With Clients Who Have Special Needs

Clients who cannot speak clearly (aphasia, dysarthria, muteness)

Listen attentively, be patient, and do not interrupt.

Ask simple question that require yes and no answers.

Allow time for understanding and response.

Use visual cues (e.g., words, pictures, and objects)

Allow only one person to speak at a time.

Do not shout or speak too loudly.

Use communication aides: Pad and felt-tipped pen, magic slate, pictures
denoting basic needs, call bells or alarm.

Clients who are cognitively impaired

Reduce environmental distractions while conversing.

Get clients attention prior to speaking

Use simple sentences and avoid long explanation.

Ask one question at a time

Allow time for client to respond

Be an attentive listener

Include family and friends in conversations, especially in subjects known to

client.

Clients who are unresponsive

Call client by name during interactions

Communicate both verbally and by touch

Speak to client as though he or she could hear

Explain all procedures and sensations

Provide orientation to person, place, and time

Avoid talking about client to others in his or her presence

Avoid saying things client should not hear

Communicating with hearing impaired client

Establish a method of communication (pen/pencil and paper, sign-language)

Pay attention to clients non-verbal cues

Decrease background noise such as television

Always face the client when speaking

It is also important to check the family as to how to communicate with the

client

It may be necessary to contact the appropriate department resource person

for this type of disability

Client who do not speak English

Speak to client in normal tone of voice (shouting may be interpreted as

anger)

Establish method for client o signal desire to communicate (call light or bell)

Provide an interpreter (translator) as needed

Avoid using family members, especially children, as interpreters.

Develop communication board, pictures or cards.

Have dictionary (English/Spanish) available if client can read.

Reports

Are oral, written, or audiotape exchanges of information between caregivers.

Common reports
1. Change-in-shift report

2. Telephone report
3. Telephone or verbal orders only RNs are allowed to accept telephone
orders.
4. Transfer report
5. Incident report
Documentation
1. Is anything written or printed that is relied on as record or proof for
authorized person.
2. Nursing documentation must be:

accurate

comprehensive

flexible enough to retrieve critical data, maintain continuity of care,

track client outcomes, and reflects current standards of nursing
practice

3. Effective documentation ensures continuity of care saves time and minimizes

the risk of error.
4. As members of the health care team, nurses need to communicate
information about clients accurately and in timely manner
5. If the care plan is not communicated to all members of the health care team,
care can become fragmented, repetition of tasks occurs, and therapies may
be delayed or omitted.
6. Data recorded, reported, or communicated to other healthcare professionals
are CONFIDENTIAL and must be protected.
Confidentiality
1. Nurses are legally and ethically obligated to keep information about clients
confidential.
2. Nurses may not discuss a clients examination, observation, conversation, or
treatment with other clients or staff not involved in the clients care.
3. Only staff directly involved in a specific clients care has legitimate
access to the record.

4. Clients frequently request copies of their medical record, and they have the
right to read those records.
5. Nurses are responsible for protecting records from all unauthorized readers.
6. When nurses and other healthcare professionals have a legitimate reason to
use records for data gathering, research, or continuing education, appropriate
authorization must be obtained according to agency policy.
7. Maintaining confidentiality is an important aspect of professional behavior.
8. It is essential that the nurse safeguard the client right to privacy by carefully
protecting information of a sensitive, private nature.
9. Sharing personal information or gossiping about others violates nursing
ethical codes and practice standards.
10.It sends the message that the nurse cannot be trusted and damages the
interpersonal relationships.
Guidelines of Quality Documentation and Reporting
1. Factual

A record must contain descriptive, objective information about what a nurse

sees, hears, feels, and smells.

The use of vague terms, such as appears, seems, and apparently, is not
acceptable because these words suggest that the nurse is stating an opinion.

Example:
The client seems restless (the phrase seems restless is a conclusion without
supported facts.)
2. Accurate

The use of exact measurements establishes accuracy. (example: Intake of

350 ml of water is more accurate than the client drank an adequate
amount of fluid

Documentation of concise data is clear and easy to understand.

It is essential to avoid the use of unnecessary words and irrelevant details

3. Complete

The information within a recorded entry or a report needs to be complete,

containing appropriate and essential information.

Example:
The client verbalizes sharp, throbbing pain localized along lateral side of right ankle,
beginning approximately 15 minutes ago after twisting his foot on the stair. Client
rates pain as 8 on a scale of 0-10.
4. Current

Timely entries are essential in the clients ongoing care. To increase accuracy
and decrease unnecessary duplication, many health care agencies use
records kept near the clients bedside, which facilitate immediate
documentation of information as it is collected from a client

5. Organized

The nurse communicates information in a logical order.

Example:
An organized note describes the clients pain, nurses assessment, nurses
interventions, and the clients response
Legal Guidelines for Recording
1. Draw single line through error, write word error above it and sign your name
or initials. Then record note correctly.
2. Do not write retaliatory or critical comments about the client or care by other
healthcare professionals.

Enter only objective descriptions of clients behavior; clients

comments should be quoted.

3. Correct all errors promptly

Errors in recording can lead to errors in treatment

Avoid rushing to complete charting, be sure information is accurate.

4. Do not leave blank spaces in nurses notes.

Chart consecutively, line by line; if space is left, draw line horizontally

through it and sign your name at end.

5. Record all entries legibly and in blank ink

Never use pencil, felt pen.

Blank ink is more legible when records are photocopied or transferred

to microfilm.

Legal Guidelines for Recording

6. If order is questioned, record that clarification was sought.

If you perform orders known to be incorrect, you are just as liable for
prosecution as the physician is.

7. Chart only for yourself

Never chart for someone else.

You are accountable for information you enter into chart.

8. Avoid using generalized, empty phrases such as status unchanged or had

good day.

Begin each entry with time, and end with your signature and title.

Do not wait until end of shift to record important changes that occurred
several hours earlier. Be sure to sign each entry.

9. For computer documentation keep your password to yourself.

Maintain security and confidentiality.

Once logged into the computer do not leave the computer screen
unattended.