NURSING PROCESS
ASSESSMENT
MODULE 6
FACTORS INFLUENCING COMMUNICATIN
TIPS FOR IMPROVED COMMUNICATION WITH OLDER ADULT WHO HAVE
HEARING LOSS
NURSING AS AN ART: COMMUNITCATION AND SOCIOCULTURAL FACTORS
THE URSING PROCESS CULTURAL ASPECT OF CARING
IMPLICATION FOR PATIENT CENTERED CARE
GENDER
NURSING DIASNOSIS
IMPLEMENTATION
NONTHERAPEUTIC COMMUNICATION TECHNIUES
ADAPTING COMMUNICATION TECHNIUES
COMMUNICATIONG WITH PATIENT WHO HAVE SPECIAL NEEDS
EVALUATION
SAMPLE OF COMMUNCATION ANALYSIS
NURSING PROCESS
The nursing process provides a clinical decision-making approach for developing and implementing individualized plans of care. It
serves to guide care for patients, especially those needing special assistance with communication. Therapeutic communication
techniques play a key role in nursing interventions.
ASSESSMENT
Assessment is an essential component of the nursing process. It involves thoroughly gathering patient information and critically
analyzing findings to make patient-centered clinical decisions for safe nursing care.
Through the patient’s eyes: Gather information, synthesize findings, and apply critical thinking.
FACTORS INFLUENCING COMMUNICATION
1. Psychophysiological Context (Internal Factors):
Physiological status: Pain, nausea, hunger, weakness, and dyspnea.
Emotional status: Anxiety, anger, hopelessness, euphoria.
Growth and development status: Age, developmental tasks.
Unmet needs: Safety/security, love/belonging.
Attitudes, values, and beliefs: Impact of illness.
Self-concept and self-esteem: Positive or negative feelings about oneself.
Perceptions and personality: Optimist/pessimist, introvert/extrovert.
2. Relational Context (Nature of Relationship):
Social, helping, or working relationships.
Trust, care, and self-disclosure levels among participants.
Power balance.
3. Situational Context (Reason for Communication):
Information exchange, goal achievement, problem resolution, and emotional expression.
4. Environmental Context (Physical Surroundings):
Privacy, noise level, comfort, and distractions.
5. Cultural Context (Sociocultural Influences):
Language and cultural expectations, education levels, customs.
TIPS FOR IMPROVED COMMUNICATION WITH OLDER ADULTS WHO HAVE HEARING LOSS
Ensure the patient knows you're speaking to them.
Face the patient, and avoid chewing gum or speaking while chewing.
Speak clearly, slowly (but not too slowly).
Ensure hearing aids or adaptive equipment are in use.
Choose quiet, well-lit environments with minimal distractions.
Allow adequate time for responses.
Provide opportunities for questions.
Keep communication short and to the point.
SOCIOCULTURAL FACTORS
Be mindful of interaction patterns based on ethnicity but avoid bias.
Understand cultural differences in communication without assuming or stereotyping.
NOTE NI BINSSS
CULTURAL ASPECTS OF CARING
Communication with non-English-speaking patients:
o Provide interpreters.
o Speak directly to the patient.
o Use written materials in English and the patient's primary language.
IMPLICATIONS FOR PATIENT-CENTERED CARE
Recognize and assess your own cultural values and biases.
Understand the patient’s primary language and fluency in English.
Never use family members, especially children, as interpreters.
Learn about the cultures commonly encountered in your practice area.
GENDER
Men: Tend to use less verbal communication but are direct and more likely to address issues.
Women: Tend to disclose more personal information and use active listening skills.
NURSING DIAGNOSIS
Impaired Verbal Communication is commonly used for patients who have difficulty expressing themselves or receiving
messages.
Associated difficulties may lead to additional diagnoses like:
o Anxiety
o Social isolation
o Ineffective coping
o Powerlessness
o Impaired social interaction
IMPLEMENTATION
THERAPEUTIC COMMUNICATION TECHNIQUES INCLUDE:
Active Listening: Being attentive to both verbal and nonverbal messages.
o SOLER Technique: Sit facing the patient, observe an open posture, lean toward the patient, establish eye contact,
and relax.
Sharing Observations: Making observations that help patients communicate.
Sharing Empathy: Understanding and accepting the patient's reality.
Sharing Hope: Offering encouragement to foster hope.
Sharing Humor: Using humor to reduce anxiety and create a positive atmosphere.
Using Touch: Providing comfort with touch (with permission).
Using Silence: Allowing patients to reflect.
Providing Information: Giving relevant facts to reduce anxiety and empower decision-making.
Clarifying: Restating or asking for clarification to ensure understanding.
Focusing: Directing conversations to important topics.
Paraphrasing: Restating what the patient said in your own words.
Validation: Recognizing and acknowledging the patient’s feelings and needs.
Asking Relevant Questions: Asking one question at a time to get relevant information.
Summarizing: Providing a concise review of key points from the conversation.
Self-disclosure: Sharing personal experiences to show empathy (without therapy).
Confrontation: Helping patients see inconsistencies in their feelings or behaviors.
NONTHERAPEUTIC COMMUNICATION TECHNIQUES
These techniques block effective communication:
Asking Personal Questions: Questions not related to the patient's care.
Giving Personal Opinions: Inhibiting patient decision-making.
Changing the Subject: Shifting focus away from the patient’s concern.
Automatic Responses: Using stereotypes that diminish the patient’s experience.
False Reassurance: Giving reassurance not based on facts.
Sympathy: Taking on the patient’s emotional burden.
Asking for Explanations: "Why" questions can cause resentment.
Approval/Disapproval: Imposing personal values on the patient.
NOTE NI BINSSS
Defensive Responses: Reacting defensively to criticism.
Passive or Aggressive Responses: Avoiding or provoking conflict.
Arguing: Denying the patient's valid perceptions.
ADAPTING COMMUNICATION TECHNIQUES
Adapt to the patient's developmental, sensory, or cognitive needs.
With patients who have special needs (e.g., aphasia, hearing loss, cognitive impairment):
o Aphasia/Dysarthria: Use simple questions, visual cues, and patience.
o Cognitive Impairment: Use short, simple sentences, allow extra time for responses, and involve family.
o Hearing Impairment: Use hearing aids, reduce noise, face the patient, and speak clearly.
o Visual Impairment: Ensure proper lighting, use tactile communication, and describe the environment.
o Unresponsive Patients: Speak to them as if they can hear and provide orientation.
o Non-English-Speaking Patients: Use professional interpreters, pictures, and basic translation tools.
EVALUATION
Evaluate communication effectiveness through:
o Reviewing videotaped interactions.
o Process recordings: Written records of verbal and nonverbal exchanges.
o Assess whether you allowed the patient to express thoughts and feelings.
o Identify missed cues and therapeutic techniques.
o Review how responses impacted communication (positive, supportive, or judgmental).
o Evaluate the use of therapeutic techniques like humor, silence, and touch.
SAMPLE COMMUNICATION ANALYSIS
Nurse: “Good morning, Mr. Simpson.”
o Nonverbal: Smile, acknowledges name.
o Observation: Indicates openness to communication.
Patient: “What's good about it?”
o Nonverbal: Angry expression, arms crossed.
o Verbal: Frustration due to lack of information.
Nurse: “You sound unhappy.”
o Nonverbal: Pulls up chair, sits at bedside (encouraging conversation).
o Therapeutic: Sharing observation, encouraging patient to express feelings.
Nurse: “I'm going to test your glucose in a minute, and I'll tell you the results.”
o Verbal: Provides information to build trust.
Nurse: “I’ll pass along your concerns and discuss ways to control your glucose.”
o Therapeutic: Summarizes and sets goals for future care.
NOTE NI BINSSS
