Part 2:

COMMUNICATION NCM
103

Level 1

By: ANA VICTORIA CHUAYANA, RN, MN

 COMMUNICATION is the interchange of Communication is
information between two or more people; a CRITICAL SKILL
in other words, the exchange of ideas or for nursing.
thoughts.

In NURSING, communication is a Integral part of

dynamic process used to gather the HELPING
RELATIONSHIP
assessment data, to teach and
persuade, and to express caring
and comfort.
 I. PROCESS AND
MODES OF
COMMUNICATION
 METHODS OF COMMUNICATION:
Talking And Listening
Writing And Reading
Painting
Dancing
Storytelling

*** Ideas and thoughts are expressed to others not only

by spoken or written words but also by GESTURES or
BODY ACTIONS.
 2 MAIN
❖ Communication is a PROCESS.
❖ Built in a TRUSTING RELATIONSHIP.
PURPOSES:
❖ EFFECTIVE communication is essential for 1. To Influence Others
the establishment of a NURSE-CLIENT
2. To Gain Information
RELATIONSHIP.
NURSES WHO COMMUNICATE EFFECTIVELY ARE BETTER
ABLE TO:
1. Collect Assessment Data
2. Initiate Interventions
3. Evaluate Outcomes Of Interventions
4. Initiate Change That Promotes Health
5. Prevent The Safety And Legal Problems Associated With
Nursing Practice
 COMMUNICATION CAN OCCUR IN 2
WAYS:
1. INTRAPERSONAL Level - Within A Single
Individual (SELF –TALK)
2. INTERPERSONAL Level And Group Levels –
Involve Others
 Example
Student Nurse Self-talk
FACE-TO-FACE THE
Communication
COMMUNICATION
PROCESS
TWO-WAY PROCESS
involving the
SENDING & the
RECEIVING
of a message.

Process is
ONGOING.
4 COMPONENTS OF
COMMUNICATION:
 ENCODING is the selection
of specific signs or symbols (codes)
1. SENDER – a person or group who to transmit the message, such as
which language and words to use,
wishes to communicate a message
how to arrange the words, & what
FEEDBACK can be either Verbal, to another: SOURCE-ENCODER.
tone of voice and gestures to use.
Nonverbal, or Both.

2. MESSAGE – is what is actually said

4. RESPONSE – is the message
or written, the body language that
that the Receiver RETURNS to accompanies the words, and how the
the Sender: FEEDBACK. message is transmitted.

DECODE Is to relate the

message perceived to
the receiver’s
storehouse of 3. RECEIVER – is the LISTENER,
knowledge & who must listen, observe, and
experience & to sort out attend: DECODER.
the meaning of the
message.
 1. VERBAL
COMMUNICATION
uses the spoken or 3 MODES
written word OF
2. NONVERBAL COMMUNICATION
COMMUNICATION
uses other forms, such
as gestures or facial
expressions, and touch

3. ELECTRONIC
COMMUNICATION in which
an individual can send a
message, by computer or any
devices, to another person or
group of people
NURSES NEED TO CONSIDER THE FOLLOWING WHEN CHOOSING
WORDS TO SAY OR WRITE:
a) Pace and Intonation - manner of speech, as in the rate or
rhythm and tone
b) Simplicity - commonly understood words
c) Clarity and Brevity - direct and simple
d) Timing and Relevance - sensitivity to the client’s needs and
concerns
e) Adaptability – adjustments are individualized
f) Credibility – worthiness of belief, trustworthiness,
and reliability
g) Humor - used with care
(laughter is the best medicine)
 TO OBSERVE NONVERBAL BEHAVIOR EFFICIENTLY REQUIRES A
SYSTEMATIC ASSESSMENT OF THE PERSON’S OVERALL:
a) Physical Appearance
b) Posture
c) Gait
d) Facial Expressions
e) Gestures
f) Culture

*** Nonverbal communication either reinforces or

contradicts what is said verbally.
 ADVANTAGES:
1) Fast
2) Efficient
ELECTRONIC
COMMUNICATION 3) Legible
4) Continuity Of Care

DISADVANTAGES:
1) Privacy Issue
2) Confidentiality Issue
3) Potential Misuse Of Information
4) Socio-economics
 Factors a) Developmental stages
Influencing b) Gender
the c) Values And Perceptions
Communication
d) Personal Space: DON’T!
Process: ELDERSPEAK is a
Intimate: 0 to 1 1/2 feet
speech style similar to
Personal: 1 1/2 to 4 feet baby talk that gives
Social: 4 to 12 feet the message of
Public: 12 feet and beyond dependence and
e) Territoriality incompetence and is
seen as
f) Roles And Relationships patronizing by older
adults.
g) Environment
h) Congruence
i) Interpersonal Attitudes
j) Boundaries
 II. THERAPEUTIC
COMMUNICATION
Promotes UNDERSTANDING and can help establish a
CONSTRUCTIVE RELATIONSHIP between the Nurse and the
Client.

❑ ATTENTIVE LISTENING
❑ VISIBLY TUNING IN
 THERAPEUTIC
COMMUNICATION
TECHNIQUES
They are specific responses that encourage
the expression of feelings and ideas and
convey acceptance and respect.
TECHNIQUE DESCRIPTION EXAMPLES

•USING • Accepting pauses • Sitting quietly (or

or silences that walking with the
SILENCE may extend for client) and waiting
several seconds or attentively until
minutes without the client is able to
interjecting any put thoughts and
verbal response. feeling into words.
 TECHNIQUE DESCRIPTION EXAMPLES

• PROVIDING • Using statements or • “Can you tell me how it

questions that (a) is for you?”
GENERAL encourage the client • “Perhaps you would
LEADS to verbalize, (b) like to talk about...”
choose a topic of • “Would it help to
conversation, and (c) discuss your feelings?”
facilitate continued • “Where would you like
verbalization. to begin?”
• “And then what?”
TECHNIQUE DESCRIPTION EXAMPLES
• “Rate your pain on a
• BEING • Making scale of zero to ten.”
SPECIFIC & statements that (specific statement)
TENTATIVE are specific • “Are you in pain?”
(general statement)
rather than • “You seem unconcerned
general, and about your diabetes.”
tentative rather (tentative statement)”

than absolute.
 TECHNIQUE DESCRIPTION
• USING • Asking broad questions that
lead or invite the client to
OPEN-ENDED explore (elaborate, clarify,
QUESTIONS describe, compare, or
illustrate) thoughts or
feelings.
• Open-ended questions
specify only the topic to be
discussed and invite
answers that are longer than
one or two words.
EXAMPLES
• “I’d like to hear more
about that.”
• “Tell me more. . . .”
• “How have you been
feeling lately?”
• “What brought you to the
hospital?”
• “What is your opinion?”
• “You said you were
frightened yesterday. How
do you feel now?”
TECHNIQUE DESCRIPTION EXAMPLES
• Providing appropriate • Putting an arm over the
•USING forms of touch to reinforce client’s shoulder.
caring feelings. Because • Placing your hand over
TOUCH tactile contacts vary the client’s hand.
considerably among
individuals, families, and
cultures, the nurse must
be sensitive to the
differences in attitudes
and practices of clients
and self.
 TECHNIQUE DESCRIPTION
• RESTATING & • Actively listening for the
client’s basic message and
PARA-PHRASI then repeating those
NG thoughts and/or feelings in
similar words. This conveys
that the nurse has listened
and understood the client’s
basic message and also
offers clients a clearer idea
of what they have said.
EXAMPLES
• Client: “I couldn’t manage
to eat any dinner last
night—not even the
dessert.”
• Nurse: “You had difficulty
eating yesterday.”
• Client: “Yes, I was very
upset after my family left.”
TECHNIQUE DESCRIPTION EXAMPLES
• SEEKING • A method of making the client’s • “I’m puzzled.”
broad overall meaning of the • “I’m not sure I understand that.”
CLARIFICATION message more understandable.
• “Would you please say that
• It is used when paraphrasing is
again?”
difficult or when the
communication is rambling or • “Would you tell me more?”
garbled. • “I meant this rather than that.”
• To clarify the message, the nurse • “I’m sorry that wasn’t very clear.
can restate the basic message or Let me try to explain in another
confess confusion and ask the way.”
client to repeat or restate the
message.
• Nurses can also clarify their own
message with statements.
TECHNIQUE DESCRIPTION EXAMPLES
• PERCEPTION • Client: “My husband never gives
me any presents.”
CHECKING OR • A method similar to • Nurse: “You mean he has never
SEEKING clarifying that verifies given you a present for your
CONSENSUAL birthday or Christmas?”
the meaning of specific
VALIDATION • Client: “Well—not never. He
words rather than the does get me something for my
overall meaning of a birthday and Christmas, but he
message. never thinks of giving me
anything at any other time.”
 TECHNIQUE DESCRIPTION EXAMPLES

• OFFERING • Suggesting one’s • “I’ll stay with you until

presence, interest, or your daughter arrives.”
SELF wish to understand the • “We can sit here quietly
client without making for a while; we don’t need
any demands or to talk unless you would
attaching conditions like to.”
that the client must • “I’ll help you to dress to go
comply with & to home, if you like.”
receive the nurse’s
attention.
TECHNIQUE DESCRIPTION EXAMPLES
• GIVING • Providing, in a simple and • “Your surgery is scheduled
INFORMATION direct manner, specific for 11 am tomorrow.”
factual information the • “You will feel a pulling
client may or may not sensation when the tube is
request. When information removed from your
is not known, the nurse abdomen.”
states this and indicates • “I do not know the answer
who has it or when the to that, but I will find out
nurse will obtain it. from Mrs. King, the nurse in
charge.”
TECHNIQUE DESCRIPTION EXAMPLES
• ACKNOWLEDGING • Giving recognition, in a • “You trimmed your beard
nonjudgmental way, of a and mustache and washed
change in behavior, an your hair.”
effort the client has • “I notice you keep
made, or a contribution squinting your eyes. Are
to a communication. you having difficulty
• Acknowledgment may be seeing?”
with or without • “You walked twice as far
understanding, verbal or today with your walker.”
nonverbal.
TECHNIQUE DESCRIPTION EXAMPLES
• CLARIFYING • Helping the client clarify • Client: “I vomited this
an event, situation, or morning.”
TIME OR happening in relationship • Nurse: “Was that after
SEQUENCE to time. breakfast?”
• Client: “I feel that I have
been asleep for weeks.”
• Nurse: “You had your
operation Monday, and
today is Tuesday.”
 TECHNIQUE DESCRIPTION EXAMPLES
• PRESENTING • Helping the client • “That telephone ring
REALITY to differentiate the came from the
real from the program on
unreal. television.”
• “Your magazine is
here in the drawer. It
has not been stolen.”
TECHNIQUE DESCRIPTION
• Helping the client expand on
• FOCUSING and develop a topic of
importance. It is important for
the nurse to wait until the client
finishes stating the main
concerns before attempting to
focus.
• The focus may be an idea or a
feeling; however, the nurse
often emphasizes a feeling to
help the client recognize an
emotion disguised behind
words.
EXAMPLES
• Client: “My wife says she will look
after me, but I don’t think she can,
what with the children to take
care of, and they’re always after
her about something—clothes,
homework, what’s for dinner that
night.”
• Nurse: “Sounds like you are
worried about how well she can
manage.”
TECHNIQUE DESCRIPTION EXAMPLES
• REFLECTING • Directing ideas, feelings, • Client: “What can I do?”
questions, or content • Nurse: “What do you
back to clients to enable think would be helpful?”
them to explore their • Client: “Do you think I
own ideas and feelings should tell my husband?”
about a situation.
• Nurse: “You seem unsure
about telling your
husband.”
 TECHNIQUE DESCRIPTION
• SUMMARIZING • Stating the main points of
a discussion to clarify the
AND PLANNING
relevant points discussed.
This technique is useful at
the end of an interview or
to review a health teaching
session. It often acts as an
introduction to future care
planning.
EXAMPLES
• “During the past half hour we
have talked about. . . .”
• “Tomorrow afternoon we may
explore this further.”
• “In a few days I’ll review what
you have learned about the
actions and effects of your
insulin.”
• “Tomorrow, I will look at your
feeling journal.”
BARRIERS TO COMMUNICATION

Non-Therapeutic Responses
TECHNIQUE DESCRIPTION EXAMPLES
• STEREOTYPING • Offering generalized and • “Two-year-olds are
oversimplified beliefs brats.”
about groups of people
that are based on • “Women are
experiences too limited to complainers.”
be valid. • “Men don’t cry.”
• These responses • “Most people don’t
categorize clients and have any pain after this
negate their uniqueness as
individuals. type of surgery.”
 TECHNIQUE DESCRIPTION EXAMPLES
• AGREEING AND • Similar to judgmental • Client: “I don’t think Dr.
responses, agreeing and Broad is a very good
DISAGREEING disagreeing imply that the doctor. He doesn’t seem
client is either right or interested in his clients.”
wrong and that the nurse
• Nurse: “Dr. Broad is head
is in a position to judge
of the department of
this.
surgery and is an
• These responses deter
excellent surgeon.”
clients from thinking
through their position and
may cause a client to
become defensive.
TECHNIQUE DESCRIPTION
• Attempting to protect a person
• BEING or health care services from
DEFENSIVE negative comments.
• These responses prevent the
client from expressing true
concerns.
• The nurse is saying, “You have
no right to complain.”
• Defensive responses protect the
nurse from admitting
weaknesses in the health care
services, including personal
weaknesses.
EXAMPLES
• Client: “Those night
nurses must just sit
around and talk all
night. They didn’t
answer my light for over
an hour.”
• Nurse: “I’ll have you
know we literally run
around on nights. You’re
not the only client, you
know.”
 TECHNIQUE DESCRIPTION
• Giving a response that
• CHALLENGING
makes clients prove their
statement or point of view.
• These responses indicate
that the nurse is failing to
consider the client’s
feelings, making the client
feel it necessary to defend
a position.
EXAMPLES
• Client: “I felt nauseated after that red
pill.”
• Nurse: “Surely you don’t think I gave
you the wrong pill?”
• Client: “I feel as if I am dying.”
• Nurse: “How can you feel that way
when your pulse is 60?”
• Client: “I believe my husband
doesn’t love me.”
• Nurse: “You can’t say that; why, he
visits you every day.”
 TECHNIQUE DESCRIPTION
• Asking for information
• PROBING chiefly out of curiosity
rather than with the intent
to assist the client.
• These responses are
considered prying and
violate the client’s privacy.
• Asking “why” is often
probing and places the
client in a defensive
position.
EXAMPLES
• Client: “I was speeding
along the street and didn’t
see the stop sign.”
• Nurse: “Why were you
speeding?”
• Client: “I didn’t ask the
doctor when he was here.”
• Nurse: “Why didn’t you?”
TECHNIQUE DESCRIPTION EXAMPLES
• Asking questions that • “Who do you think you
•TESTING make the client admit to are?” (forces people to
something. admit their status is only
• These responses permit that of client)
the client only limited • “Do you think I am not
answers and often meet busy?” (forces the client
the nurse’s need rather to admit that the nurse
than the client’s. really is busy)
TECHNIQUE DESCRIPTION
• 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.
EXAMPLES
• “I don’t want to
discuss that. Let’s talk
about. . . .”
• “Let’s discuss other
areas of interest to you
rather than the two
problems you keep
mentioning.”
TECHNIQUE DESCRIPTION
• Directing the communication
• CHANGING into areas of self-interest
rather than considering the
TOPICS AND client’s concerns is often a
SUBJECTS self-protective response to a
topic that causes anxiety.
• These responses imply that
what the nurse considers
important will be discussed
and that clients should not
discuss certain topics.
EXAMPLES
• “I can’t talk now. I’m on my way
for coffee break.”
• Client: “I’m separated from my
wife. Do you think I should have
sexual relations with another
woman?”
• Nurse: “I see that you’re 36 and
that you like gardening. This
sunshine is good for my roses. I
have a beautiful rose garden.”
TECHNIQUE DESCRIPTION EXAMPLES
• UNWARRANTED • Using clichés or • “You’ll feel better
REASSURANCE comforting statements soon.”
of advice as a means to • “I’m sure everything
reassure the client. will turn out all right.”
• These responses block • “Don’t worry.”
the fears, feelings, and
other thoughts of the
client.
TECHNIQUE DESCRIPTION EXAMPLES
• Giving opinions and • “That’s good (bad).”
• PASSING approving or
JUDGMENT disapproving responses, • “You shouldn’t do
moralizing, or implying that.”
one’s own values. • “That’s not good
• These responses imply enough.”
that the client must think • “What you did was
as the nurse thinks, wrong (right).”
fostering client
dependence.
TECHNIQUE DESCRIPTION EXAMPLES
• Telling the client what • Client: “Should I move
• GIVING to do. These responses from my home to a
COMMON deny the client’s right nursing home?”
to be an equal partner. • Nurse: “If I were you,
ADVICE • Note that giving expert I’d go to a nursing
rather than common home, where you’ll get
advice is therapeutic. your meals cooked for
you.”
III. THE HELPING
RELATIONSHIP
NURSE–CLIENT RELATIONSHIPS are

referred to by some as INTERPERSONAL

RELATIONSHIPS, by others as

THERAPEUTIC RELATIONSHIPS, or as

HELPING RELATIONSHIPS.
 1. Help clients manage their problems in
living more effectively and DEVELOP
UNUSED OR UNDERUSED
OPPORTUNITIES MORE FULLY.
2. Help clients become better at HELPING
THEMSELVES in their EVERY DAY LIVES.
3. Help clients develop an
THREE ACTION-ORIENTED PREVENTION

BASIC
MENTALITY in their lives.

GOALS
Of a HELPING RELATIONSHIP
*** A helping relationship may develop over
WEEKS of working with a client, or WITHIN
MINUTES.

THE KEYS TO THE HELPING RELATIONSHIP ARE:

(a) The development of TRUST and ACCEPTANCE
between the Nurse and the Client, and
(b) An UNDERLYING BELIEF that the Nurse CARES
and SINCERELY WANTS TO HELP the Client.
4 SEQUENTIAL PHASES 1. Pre-Interaction Phase

OF THE HELPING 2. Introductory Phase

RELATIONSHIP: 3. Working Phase

4. Termination Phase
 TASK
The nurse reviews
I. pertinent assessment data
PRE-INTERACTIO & knowledge, considers
N PHASE potential areas of concern,
and develops plans for
interaction
SKILLS
Organized data gathering;
recognizing limitations
and seeking assistance as
required.
 TASK
• Both client and nurse identify each other by
SKILLS
name.
• When the nurse initiates the relationship, it is • A relaxed, attending
important to explain the nurse’s role to give
the client an idea of what to expect.
attitude to put the client
II. INTRODUCTORY • When the client initiates the relationship, the at ease. It is not easy for
PHASE nurse needs to help the client express
all clients to receive
concerns and reasons for seeking help.
1. OPENING THE • Vague, open-ended questions, such as help
“What’s on your mind today?” are helpful at
this stage.
RELATIONSHIP
 SKILLS
TASK
2. Because the client initially may
Attentive listening, paraphrasing,
clarifying, and
CLARIFYING not see the problem clearly, the
other effective communication
techniques discussed in this chapter.
THE nurse’s major task is to help
A common error at this
stage is to ask too many questions of
PROBLEM clarify the problem. the client.
Instead focus on priorities.
3. STRUCTURING
TASK
AND Nurse and client develop a degree of SKILLS
FORMULATING trust and verbally agree about (a)
THE CONTRACT location, frequency, and length of Communication skills
meetings; (b) overall purpose of the
listed above and ability to
(Obligations relationship; (c) how confidential
overcome resistive
material will be
To Be Met By handled; (d) tasks to be accomplished; behaviors if they occur.
and (e) duration and indications for
Both The Nurse termination of the relationship.
And Client)
 TASK SKILLS
Listening and attending skills,
Nurse and client empathy, respect,
accomplish the tasks
III. WORKING genuineness, concreteness,
outlined in the self-disclosure, and
PHASE introductory phase, confrontation.
enhance trust and rapport, Skills acquired by the client are
Non-defensive listening and
and develop caring. self-understanding.
 TASK
1. EXPLORING The nurse assists the client to
explore thoughts and feelings and
AND acquires an understanding of the SKILLS
client.
UNDERSTANDING The client explores thoughts and
Attentive Listening
THOUGHTS AND feelings associated with problems,
develops the skill of
FEELINGS listening, and gains insight into
personal behavior.
 TASK
The nurse plans programs within the
client’s capabilities and considers SKILLS
2. long- and short-term goals.
The client needs to learn to take
Decision-making and
FACILITATING risks (i.e., accept that either failure goal-setting skills.
AND TAKING or success may Also, for the nurse:
be the outcome).
The nurse needs to reinforce
reinforcement skills; for
ACTION successes and help the client the client: risk taking.
recognize failures
realistically.
 TASK
SKILLS
Nurse and client accept
feelings of loss. For the nurse:
IV. TERMINATION The client summarizing skills; for
PHASE accepts the end of the the client: ability to
relationship without handle problems
feelings of anxiety or independently.
dependence.
 WAYS IN DEVELOPING A HELPING RELATIONSHIP:

1. Listen Actively 6. Use Your Ingenuity.

2. Help To Identify What The 7. Be Aware Of Cultural Differences

Person Is Feeling

3. Empathize 8. Maintain Client Confidentiality

4. Be Honest 9. Know Your Role and Your

Limitations.
5. Be Genuine and Credible 10. Respect
 IV. COMMUNICATION &
THE NURSING PROCESS
Nurses Use Communication Skills In EACH
PHASE Of The Nursing Process.
 i. ASSESSING
To assess the client’s communication abilities, the nurse
determines COMMUNICATION IMPAIRMENTS or BARRIERS and
COMMUNICATION STYLE.

Remember that CULTURE may influence when and how a client

speaks.

Language varies according to AGE and DEVELOPMENT. With

CHILDREN, the nurse observes Sounds, Gestures, and
Vocabulary.
(A.) IMPAIRMENTS TO COMMUNICATION

(1.) LANGUAGE DEFICITS – Assess: For The Primary Language

- Use An Interpreter

(2.) SENSORY DEFICITS – Assess: Hear; See; Feel; & Smell.

- Be Watchful: Medical Alert Bracelet; Hearing Aid; Lip Reading; & Use
Of Sign Language

(3.) COGNITIVE IMPAIRMENTS – Assess: Cerebrovascular Disease;

Alzheimer’s Disease; and Brain Tumors Or Injuries; Medications Taken)

(4.) STRUCTURAL DEFICITS – Assess: Cleft Palate; Artificial Airways (ex.

Tracheostomy).

(5.) PARALYSIS – Assess: Verbal Impairments with Paralysis

(ability to write and act).
(B.) STYLE OF COMMUNICATION
(1.) VERBAL COMMUNICATION – Assess: THE CONTENT OF THE MESSAGE, THE THEMES, AND
VERBALIZED EMOTIONS.

• COMMUNICATION PATTERN - slow, rapid, quiet, spontaneous, hesitant, & evasive.

• VOCABULARY USED - changes from the vocabulary normally used (ex: a person who
normally never swears).

• Hostility, Aggression, Assertiveness, Reticence, Hesitance, Anxiety, or Loquaciousness

(Incessant Verbalization) in communication.

• DIFFICULTIES WITH VERBAL COMMUNICATION, such as Slurring, Stuttering, Inability

To Pronounce A Particular Sound, Lack Of Clarity In Enunciation, Inability To Speak In Sentences,
Loose Association Of Ideas, Flight Of Ideas, Or The
Inability To Find Or Name Words Or Identify Objects.

• REFUSAL OR INABILITY TO SPEAK.

(2.) NONVERBAL COMMUNICATION

Assess: Nonverbal Communication In Relation To The Client’s

CULTURE.

Pay Particular Attention:

✔ Facial Expression
✔ Gestures
✔ Body Movements
✔ Affect
✔ Tone Of Voice
✔ Posture
✔ Eye Contact
ii. DIAGNOSING
(based on NANDA)
(a.) IMPAIRED VERBAL COMMUNICATION- “decreased, delayed, or absent
ability to receive, process, transmit, and/or use a system of symbols
- RECEPTIVE (e.g., difficulty hearing) or
EXPRESSIVE (e.g., difficulty speaking)
- Not applicable if with psychiatric ailment
(b.) ANXIETY
(c.) SITUATIONAL LOW SELF-ESTEEM
(d.) POWERLESSNESS
(e.) SOCIAL ISOLATION
(f.) IMPAIRED SOCIAL INTERACTION
iii. PLANNING
GOAL: To Reduce Or Resolve The Factors Impairing The
Communication.

THE CLIENT:
❑ Communicates that needs are being met.

❑ Begins to establish a method of communication:

✔ Signals yes/no to direct questions using vocalization or agreed on

physical cue (i.e., eye blink, hand squeeze).
✔ Uses verbal or nonverbal techniques to indicate needs.
❑ Perceives the message accurately, as evidenced by
appropriate verbal and/or nonverbal responses.

❑ Communicates effectively:
✔ Using dominant language
✔ Using translator/interpreter
✔ Using sign language
✔ Using word board or picture board
✔ Using a computer

❑ Regains maximum communication abilities.

❑ Expresses minimum fear, anxiety, frustration, and depression.

❑ Uses resources appropriately.

iv. IMPLEMENTING
❖ Nursing Interventions To Facilitate Communication With Clients Who Have
Problems With Speech Or Language Includes:

(a.) MANIPULATING THE ENVIRONMENT

(b.) PROVIDING SUPPORT

(c.) EMPLOYING MEASURES TO ENHANCE

COMMUNICATION

(d.) EDUCATING THE CLIENT AND SUPPORT

PERSON
v. EVALUATING
(a.) CLIENT COMMUNICATION – Client has positive
response.
Ex: The client stated, “I listened more closely to my
daughter yesterday and found out how she feels about our
divorce.”

(b.) NURSE COMMUNICATION – PROCESS RECORDING is

a verbatim
(word-for-word) account of conversation (Taped or
Written)
 NURSE & PHYSICIAN
COMMUNICATION
✔ Prepare before calling the primary care provider to report a client
problem.
✔ You will be using the SBAR METHOD.
✔ However, you also need to think about what information may be asked of
you and be prepared to answer those questions. This means knowing the
most recent client assessment data, including vital signs, laboratory data,
and other tests, if appropriate.
✔ Have the client’s medical record, MAR, and other
flow sheets as needed available to you.
 A FRAMEWORK FOR NURSE–HEALTH CARE
EXAMPLE OF USING SBAR
PROVIDER COMMUNICATION
S = SITUATION: What is the situation you are calling about? S: Health care provider called. Nurse has given name
Provide your name, health agency, client name, and brief and unit of health care agency. “I’m calling about Sally
information about the problem. Somers, a 19-yearold admitted this morning with a
ruptured appendix. She is now 6 hours postop and has
B = BACKGROUND: Provide information pertinent to the not voided.
current situation, such as admitting diagnosis, date of
admission, and important clinical information that relates B: Her bladder is distended. She is complaining of urgency
to the call. to void but unable to do so even with sitting on commode,
running water, etc. Everything else is stable.
A = ASSESSMENT: This refers to the current condition of the
client (e.g., VS, oxygen saturation, pain scale, level of
consciousness) and any change in the assessment since A: She is very uncomfortable and crying because of her
the previous communication. Indicate the severity of the urinary retention.
problem.

R = RECOMMENDATION: What is your recommendation for

resolving the problem or what do you need from the R: “Could you give an order for a straight urinary
health care provider (e.g., come see the client, transfer to catheterization?”
another unit, or an order for a medication)?
 WHAT IS SBAR:
Situation,
Background,
Assessment,
Recommendation
Model?
Reference:

Audrey Berman, et.al. (2016). Kozier & Erb's Fundamentals of

Nursing Concepts, Process, and Practice 10th Edition. Pearson.
Chapter 26, pages 411 – 435.