This document discusses communication techniques for nursing. It begins with learning outcomes around communicating effectively with interprofessional teams, applying positive communication, and evaluating verbal and nonverbal cues. It then discusses various communication styles, listening skills, challenges, and managing conflicts. The key points are the importance of openness, empathy, supportiveness and positivity in communication as well as recognizing cognitive distortions and logical fallacies that can act as barriers.

1. Margaret Strong, MSN, RN, NE-BC
Cathy Stepter, DNP, RN, ACNS-BC, CNE

2.  Chapter 18
Learning Outcomes
 Communicate effectively with diverse intergenerational
and inter-professional team members.
 Apply positive communication techniques in diverse
situations
 Recognize negative communication techniques.
 Evaluate conflicting verbal and nonverbal communication
cues.
 Examine constructive methods of communicating in
conflict situations
Activity
 Complete conflict questionnaire and bring to class

3.  open
 purposeful
 passionate
 connect the dots
 succinct
 Use compelling evidence
 deliver a clear message
 put themselves in the others’ situations
 listen carefully (pick up cues) while they are
communicating with their audiences
(Disch, 2009, QSEN module by AACN)

4.  http://www.youtube.com/watch?v=rRW3Q9iG
2js

5.  Aggressive communication: limits the focus
on or understanding of the
opinions, values, or beliefs of others.
 Assertive communication: enables a person to
act in his or her own best interest without
denying or infringing on the rights of others.
 Passive (or non-assertive): timid or reserved
manner, resulting in limited concern for one’s
own rights regardless of the situation. Fails to
say what is meant.

6.  Effective communication
 Unclear and ineffective communication

7.  Multimodal (Baber & Mellor, 2001)
◦ More than one piece of information is interpreted to
convey meaning
 Verbal communication
 Nonverbal communication
◦ Major message
◦ People respond more
◦ Comment and observe on nonverbal
communication

8.  Personal space  Touch
 Eye contact  Locomotion
 Position  Pacing
 Posture  Latency of
 Paralanguage Response
 Facial Expressions  Context
 Gestures  Physiological
response

9.  Social Cognitive Theory (Bandura, 2001)
◦ Cognitive
◦ Emotional
◦ Behavioral
 Explains how people acquire and maintain
certain behavioral patterns which includes
communication.

10.  Behavioral capacity
 Expectations
 Observational Learning
 Self-efficacy
 Expectancies

11.  Listens attentively to others’ ideas and concerns
 Invites contact and is approachable
 Treats employees with respect
 Develops collaborative relationships within the
organization
 Builds and sustains positive relations in the
organization
 Shares information readily with staff
 Recognizes and uses the staff’s ideas
 Articulates ideas effectively both verbally and in writing
 Succinctly communicates viewpoints
 Involves staff in building consensus on issues
 Models healthy communication and promotes
cooperative behaviors
Nursing Leadership Institute
(2002)

12.  Perceive and identify emotions in others’ face, tone
of voice and body language and the ability to name
one’s own feelings, discuss emotions, and
communicate clearly and directly.
 Analyze, reason, solve problems, make
decisions, and guide what is important to think
about
 Understand how emotions, thoughts, and behavior
affect each other and how feelings can lead
behavior
 Take responsibility for one’s own emotions and
happiness, to turn negative emotions into positive
learning and growing opportunities, and to help
others identify and benefit from their emotions
Adapted from Steve Hein, (2005).
Emotional intelligence. Retrieved
April 15, 2007, from
http://eqi.org

13.  Listen and thanks others for positive criticism: it is
a vote of confidence that can lead to success
 Carry around a picture of an inspiring person and
use it to handle a particular situation
 Trust your feelings and behavior
 Use constructive inner dialogue as a guide.
 Learn to manage fear and anger by saying or
thinking positive coping messages
 Appreciate different viewpoints
 Avoid mind reading
 Keep things in perspective; don’t overplay the
significance of one bad encounter

14.  Remember that emotions are contagious, so use
positive messages.
 Tune into the emotional context within which
words occur, and read between the lines. Always
phrase findings as hunches, not verified facts.
 Remember past emotional experiences, and use
them to be empathic with others.
 Invite disagreement; it will lead to learning on both
sides.

15.  http://www.youtube.com/watch?v=40uIYiJRc
8c&feature=related

16. Positive Communication Techniques

17. ◦ Openness
◦ Empathy
◦ Supportiveness
◦ Positiveness
◦ Equality

18. ◦ Essential to effective communication between patient
and nurse
◦ Development of trust is enhanced by
 Openness on the part of the nurse
 Honesty, integrity, and dependability

19. Cognitive Distortions and
Logical Fallacies

20. ◦ Related to culture, gender, background, and
personal experiences
◦ Influential arguments based on flawed logic
◦ Barriers to meaningful communication
◦ Understanding logical fallacies will help the nurse
to recognize the difference between legitimate and
faulty reasoning and to promote effective
communication

21. ◦ Ad hominem abusive
 Attack the person instead of the issue
 The speaker hopes to discredit the other
person by calling attention to some irrelevant
fact about that person
◦ Appeal to common practice
 Something is okay because most people do it
 Could lead to significant professional and legal
problems

22. ◦ Appeal to emotion—Attempt to manipulate other
people’s emotions in order to avoid the real issue
◦ Appeal to tradition—Doing things a certain way is
best because it has always been done that way
◦ Confusing cause and effect—Assumes that one event
must cause another just because two events often
occur together
◦ Hasty generalization—Coming to a conclusion on the
basis of a very small number of examples
◦ Straw man—A person’s position on a topic is
misrepresented

23. ◦ Red herring—Introduction of an irrelevant topic in
order to divert attention away from the real issue
◦ Slippery slope—Belief that an event will inevitably
follow another without any real support for that belief

24. Listening

25. ◦ Framing an answer while the other person is still
talking
◦ Environmental disturbances that provide
significant disruption
◦ Preexisting concerns or worries that block
absorption of conversation
◦ Attempts to continue work in progress that leads
to inattention
◦ Ineffective engagement or peculiar mannerisms

26. ◦ Give undivided attention to the sender
 Move to a quieter area
 Stop the speaker and clarify points not
understood
◦ Provide feedback in terms of perceived meaning of
the message rephrased in the receiver’s own words

27. ◦ Give attention to positioning, so that sender and
receiver are facing each other and are able to
make eye contact
◦ Note nonverbal messages such as body language
◦ Finish listening before you begin speaking
◦ Active listening will dramatically improve the
likelihood that the correct message will be
received

28. Written Communication

29. ◦ Written documents should be descriptive
◦ Information should be quantified whenever
possible
◦ Descriptive categories for physical conditions
 Measurement, color, position
 Location, drainage, or condition
◦ Descriptive categories to document
meetings, conferences, evaluations, or other
interchanges
 Time, setting, people present
 Issues or goals discussed
 Direct quotes

30. ◦ Provide complete information to help avoid
communication breakdown
◦ Anticipate and answer relevant questions before they
are asked

31. ◦ State the necessary information clearly and briefly
◦ Determine what facts are pertinent to enable the
reader to understand the true message
◦ When in doubt and when appropriate, ask another
party to read the message and provide feedback
◦ Confidentiality and privacy must be observed
◦ Be as judicious in handling written material as in
handling any other form of communication

32. Electronic Communication

33. ◦ Email, attachments, chat rooms
◦ Lacks nonverbal cues to aid in communication
◦ Beware: Communication via computer can often be
retrieved even after it has been deleted
◦ Clarification—important to ensure that the correct
message is received

34. Special Influences on Communication

35. ◦ A plethora of observations indicate that men and
women solve problems, make decisions, and
communicate from different perspectives

36. ◦ Women
 Generally work toward compromise
 Preserving relationships is of paramount
importance
 Seek to communicate with sensitivity toward how
the information is being received
 Value the process of communication itself as a
significant part of relationships
◦ Men
 Generally work toward winning
 Focus on goals and move aggressively toward
accomplishment
 Communicate with a purpose in order to achieve
an identified goal
 Typically use communication as a tool to deliver
information

37. ◦ Traditionalists or Veteran, born 1925-1945
 Great Depression and World War II were
critical events
 Place a high premium on formality and the
top-down chain of command
 Respect from others, including the use of
formal titles, is preferred
 Comfortable making decisions based on what
worked favorably in the past

38. ◦ Baby Boomers, born 1946-1962
 Experienced the reshaping of corporate
culture
 Considered to be highly competitive people
willing to sacrifice to achieve success
 Strive for recognition
 Desire a personable style of communication
 Desire a top-down organizational approach
 Place value on earning respect

39. ◦ Generation X, born 1963-1979
 Associated with a high divorce rate among their
parents, working mothers, and the latch-key
phenomenon
 Characterized as skeptics who value a balance in
work and personal life
 Value efficiency and may agree to working extra
hours if the reason is deemed beneficial
 Expectations are immediate
 Chosen communication pattern is characterized by
brevity and directness

40. ◦ Millennial, born 1980-2000
 Newest members of the workforce
 Highly collaborative and optimistic
 Strive for a balance between work and home
life
 Need a voice in organizational decision
making
 Prefer communication that is framed in a
positive manner

41. ◦ Sensitivity to cultural differences is an integral
part of the nurse’s responsibility
◦ Obvious difficulty is a potential language barrier
 Preponderance of slang terms and
colloquialisms can confound a literal
translation
 Stress associated with illness and/or
hospitalization adds to the potential for
misunderstanding

42. ◦ Many communication components do not carry the
same meaning in various cultures
 Direct eye contact
 Touch
 Gestures

43. ◦ Variety of disciplines approaching health care from
the unique perspective of the theories and
therapies of the varied professions
◦ Listening is an essential tool for identifying the
intended message of other disciplines
◦ Frequent clarification and a sense of “safety” are
paramount
◦ Remember, the fundamental goal of all health care
professionals is to provide quality patient care

44. ◦ Breach of confidentiality and privacy through
careless gossip has ethical and legal
ramifications
◦ Communication about confidential or personal
patient issues must be controlled in all areas:
nurses’ station, utility rooms, etc...

45. Understanding and Managing Conflict

46.  http://www.youtube.com/watch?v=SyFArqge
nzU

47. ◦ Conflicts stemming from differences in goals or
desires are not good or bad
◦ Fundamental bases for conflict are information and
perception
 One person has information that another
doesn’t have, or two individuals have different
sets of information
 People see things on the basis of their unique
belief systems

48. ◦ Maintaining an environment supportive of
professional communication enables conflict to
be handled appropriately with positive outcomes

49.  Disagreement where the parties involved
perceive a threat to their needs, interests, or
concerns.
 Usually complex set of issues to address.
 Satisfactory resolution is challenging and time
consuming.

50.  Perceive a Threat
 Respond on the basis of their perceptions
 Conflicts contain substantive, procedural, and
psychological dimensions
 Predictable and expectable situations that
naturally arise
 Creative problem-solving strategies are
essential

51.  What are some key sources of conflict?
 When do they tend to occur?
 How do people respond to these conflicts?
 When we solve the problem do we do so long-
term?

52.  Culture of shame and blame
◦ IOM Reports
◦ Systems and Processes
 Research says overtime is dangerous
 Good physician-nurse relationships produce
better patient outcomes

53.  Hostile and aggressive behavior by an
individual or group towards others.
 Endemic in the workplace culture
 Unacceptable
 Destructive overt or covert behavior

54.  Belittling gestures
 Verbal abuse
 Gossiping
 Sarcastic comments
 Fault finding
 Ignoring or minimizing another’s concern
 Slur and jokes
 Comments that devalue
 Disinterest and discouragement

55.  Stage 1
◦ Reduced self esteem
◦ Sleeping disorders
◦ Free floating anxiety
 Stage 2
◦ Difficulty with emotional control
◦ Difficulty with motivation
 Stage 3
◦ A relative intolerance
◦ A loss of ability
◦ Changed response patterns

56.  Name the problem
 Raise issue-break the silence
 Ask about process
 Engage in reflective practice
 Ensure self caring behaviors
 Be willing to speak up

57.  http://www.youtube.com/watch?v=rLgEf4wU
oos
 http://www.youtube.com/watch?v=2sTAolw9
VDE&feature=related

58. Frustration
FFrustrationrustration
Outcomes Conceptualization
Action

59.  Frustration
◦ Perceive goals blocked
◦ Angry
 Conceptualization
◦ Own picture
 Action
◦ Non-action
◦ Administrative orbiting
◦ Secrecy
◦ Law and Order
◦ Appropriate actions

60.  Outcomes
◦ Degree which goals achieved
◦ Nature of subsequent relationships

61.  Come together voluntarily
 Work cooperatively on the issues
 Many times we need a third person to help
negotiate

62.  “I value the point being made more than our
relationship.” “It's them or me.” “I've got to
win this one!” “I'm sure they will see it my way
if they just think about it.” “I know I'm right.”
This is the “I win, you lose” position. A person
whose actions are expressed this way is
sometimes symbolized as a shark.

63.  - “I will be quiet and listen.” “It's not that big
a deal.” “I'd rather just forget it.” “It's not
worth the trouble.” “What difference could I
make anyway?” “I lose, you lose.” A turtle.

64.  “I value our relationship more than this
point.” “Let's just get this over with so we can
get on to other things.” “This tension is very
uncomfortable. I'll just do what they want.”
“Fine I give in, have it your way.” “I lose, you
win.” A teddy bear.

65.  - “I'm sure if we work together we can come
up with a better answer than either of us
individually.” “I'm not giving in yet, but I am
willing to hear your opinion, and give you
mine.” “I win, you win.” An owl.

66.  - “This isn't important enough to fight over.”
“I don't want to be unreasonable.” “If I give
her this, maybe she'll give me that.” “We
could both live with that.” A fox.

67.  New standard began January 1, 2009
 Survey of 4,530 healthcare employees
◦ 77% witnessed disruptive behavior from physicians
◦ 65% witnessed disruptive behavior from nurses
◦ 67% linked disruptive behavior to adverse outcomes

68.  Education of healthcare workers
◦ Courtesy during
 Telephone interactions
 Business etiquette
 General people skills
 Recommend organizations have a Code of
Conduct

69. Promoting a Professional Nursing Image

70.  Employ positive communication techniques
 Provide a “safe” environment in which patients and co-
workers can ask questions and learn
 Focus energy toward solving conflict
 Maintain clear, open, sensitive communication

71.  https://www.ncsbn.org/2930.htm

72. 6 Tips for Nurses Using Social Media
 Social networks and the Internet provide
unparalleled opportunities for rapid knowledge
exchange and dissemination among many
people, but this exchange does not come without
risk. Nurses and nursing students have an
obligation to understand the
nature, benefits, and consequences of
participating in social networking of all types.
Online content and behavior has the potential to
enhance or undermine not only the individual
nurse’s career, but also the nursing profession.

73. ANA’s Principles for Social Networking
 1. Nurses must not transmit or place online individually
identifiable patient information.
 2. Nurses must observe ethically prescribed professional
patient — nurse boundaries.
 3. Nurses should understand that
patients, colleagues, institutions, and employers may view
postings.
 4. Nurses should take advantage of privacy settings and
seek to separate personal and professional information
online.
 5. Nurses should bring content that could harm a patient’s
privacy, rights, or welfare to the attention of appropriate
authorities.
 6. Nurses should participate in developing institutional
policies governing online conduct.

74. 6 Tips to Avoid Problems
 1. Remember that standards of professionalism are the
same online as in any other circumstance.
 2. Do not share or post information or photos gained
through the nurse-patient relationship.
 3. Maintain professional boundaries in the use of
electronic media. Online contact with patients blurs this
boundary.
 4. Do not make disparaging remarks about
patients, employers or co-workers, even if they are not
identified.
 5. Do not take photos or videos of patients on personal
devices, including cell phones.
 6. Promptly report a breach of confidentiality or privacy.

75. References:
American Nurses Association.
(2011, September). Principles for social
networking and the nurse. Silver
Spring, MD: Author.
National Council of State Boards of
Nursing. (2011, August). White Paper:
A nurses' guide to the use of social
media. Chicago, IL: Author.
www.NursingWorld.org
September 2011