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53 a focus 3 communication


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53 a focus 3 communication

  1. 1. ObjectivesNurse-Client Relationship • Explain the differences between a nurse/client interaction versus a socialand Effective interaction • Describe the nature of the nurse/clientCommunication relationship • Define the progressive phases of aTechniques nurse/client interaction • Discuss the different forms of Nursing 53A communication and the importance of each Judy Ontiveros, RN, MSN • Report the major factors affecting the nurse/client interaction Fall 2010 9/7/2010 9/7/2010 Characteristics of the Nurse-Client Objectives Interaction • Discuss principles of effective therapeutic communication. • Purpose • Define and illustrate techniques • Therapeutic or Helping of therapeutic communication. Relationship • Interact effectively with patient, • Growth facilitating process staff and peers. • Discuss ways to report and document important data • Initiation accurately and in a timely manner. • Development of trust/acceptance • Discuss influences of cultural • Belief that nurse cares and wants diversity in the communication process. to help 9/7/2010 9/7/2010 Characteristics of the Nurse-Client Characteristics of the Nurse-Client Interaction Interaction • Intellectual and emotional bond • Empathy • Focused on client • “Intellectual process that involves • Respects the client as an individual understanding correctly another person’s emotional state and point • Includes patient in decision making of view” Egan, 1998 • Considers ethical and cultural aspects • End result is comfort and care • Considers family relationships and • Helping, healing relationship values • Respects confidentiality • Focus on client’s well being • Based on mutual trust, respect, acceptance. 9/7/2010 9/7/2010 1
  2. 2. Nature of the Nurse-Client Relationship Nature of the Nurse-Client Relationship • Caring and Human Dignity • Caring – a multidimensional • People, relationships, and things concept matter. • Theories developed around this • A positive difference is made for concept clients • Leininger-Cultural Care • Caring practice • Ray – Bureaucratic Caring • Connection • Boykin and Schoenhofer-Nursing • Mutual recognition as caring • Involvement • Watson – Theory of Human Care • Ability to give focused attention • Swanson – Theory of Caring • Leave the egocentric self behind • Benner/Wrubel – Primacy of Caring9/7/2010 9/7/2010Six C’s of Caring in Nursing Maintaining Caring Practice • Compassion • Participating in the experience of others • Care for thine ownself • Competence • Healthy lifestyle • Knowledge/skills to respond appropriately • Mind body therapies • Confidence • Positive affirmations • Fosters trust • Meditation • Conscience • Yoga • Personal responsibility • Reflection on practice • Commitment • Journaling • Desires, obligations, deliberation • Comportment • Professionalism Caring, the Human Mode of Being. 2nd ed. M.S. Roach. 20029/7/2010 9/7/2010Phases of Nurse-Client Interaction Phases of Nurse-Client Interaction • Preinteraction Phase • Working Phase • Planning stage • Share each other’s uniqueness • Introductory Phase • Deep sharing and concern about • Orientation phase or prehelping the welfare of the client • Observation • Caring • Judgments • Empathy grows • Three stages • Two stages • Opening the relationship • Exploring and understanding • Clarifying the problem • Facilitating and taking action • Structure and formulate the plan • Develop trust • Dispel Resistive behaviors9/7/2010 9/7/2010 2
  3. 3. Factors Influencing Nurse-Client Phases of Nurse-Client Interaction Interactions • Termination • Age and Development • Can be difficult and filled with • Perception/knowledge level ambivalence • Value/belief • May have some feelings of loss • Emotion • Summarizing/reviewing process • Sense of accomplishment • Sociocultural background/human diversity • Discussions on termination start early in process • Role perception • Follow-up phone calls • Environment/space/territory 9/7/2010 9/7/2010 Factors Influencing Nurse-Client Interactions Forms of Communication • Speech Patterns • Verbal • Unknowing use demeaning or patronizing language • Non-Verbal • Elderspeak • Gestures • “we” • “Honey” • Facial Expressions • Loud, slow speech • Touch • Referring to cultural traits • Strive for congruency between the two • Electronic Communications 9/7/2010 9/7/2010Principles of Therapeutic Communication Therapeutic Communication Altruism • Purposeful Autonomy • Goal-directed Objectivity with sensitivity • Focused on the patient Empathy Veracity • Includes verbal and non- Appropriate setting verbal communication • Open/authentic exchange of information by developing rapport 9/7/2010 9/7/2010 3
  4. 4. Therapeutic Communication Therapeutic Communication • Questions are general to specific • Attentive to appearance • Less intrusive questions to • General demeanor indicate interest personal • Always greet in a professional • Develop rapport and trust manner • Give adequate time to respond • Avoid talking to others once begin with patient • Never answer own questions • Avoid judgmental questions • Use level of vocabulary matched to patient9/7/2010 9/7/2010Effective Communication Techniques Effective Communication Techniques • Personalize the interview • Use open ended questions • Convey sincerity • Prompt full answers • Focus on patient • Provide more information • Examples: • Link questions to something • Tell me about your family patient has talked about • What are your concerns in caring for • Make transition statements as your new baby? proceed through interview • Never ask “why” • Close-ended questioned result in a yes or no answer • Use in biographic data • Use in emergency situations9/7/2010 9/7/2010Effective Communication Techniques Effective Communication Techniques • Make Broad Opening Statements • Verbalize implied ideas • Patient plays an active role in the • Restating what patient has said • Adding some interpretation interview • Encourages further discussion • Establishes priorities for Discussion • Gives patient opportunity to verify what they • Examples: said • Tell me about your accident • Provide General Leads • What brings you to the clinic today? • Inject leading phrases or responses • Reflection • “Go on”, “And then what happened?” • Seek Clarification • Repeating or paraphrasing a • Clarify vague or confusing statements person’s words or questions • I’m not sure I understand, could you • Promotes further explanation and explain? descussion9/7/2010 9/7/2010 4
  5. 5. Effective Communication Techniques Effective Communication Techniques • Listen actively • Silence • Enhances assessment • Organize your thoughts • Concentrates attention on what patient is • May be uncomfortable saying • Observe non-verbal cues • Enables you to consider subtle messages • Posture, facial expressions, body • Block out environmental distractions movements • Attentive behavior • Open Body Language • Occasional verbal responses • Non-verbal cues • Share Perceptions • Maintain eye contact • Share observation with person • Sitting relaxed • “You appear to have some physical • Arms unfolded, lean toward patient discomfort today” • Facial expressions neutral • “It seems to me that ……”9/7/2010 9/7/2010Effective Communication Techniques Communication Patterns to Avoid • Confront Contradictions • Displaying Inappropriate Body Language • Explore contradiction directly • Continuous eye contact • “You tell me your not upset but you • Too intrusive and intimidating look like your about to cry” • Know cultural norms • Review the Discussion • Avoid showing alarm, anxiety, anger • Close with some type of summary • Avoid standing over the person • Discuss main points • Portrays inequality and domination • Review in relation to goals of • Proceeding Too Quickly interview • Avoid rushing through long list of questions • No time to reflect on responses9/7/2010 9/7/2010Communication Patterns to Avoid Communication Patterns to Avoid • Offering Advice • Minimizing Feelings • Generally not helpful • Disagreeing with person’s feelings = • May discourage decision making denying person right to his/her own • “What would you do?” to “What would you feelings like to do?” • Abruptly Changing Subjects • “There is nothing to worry about” • Disconcerting and disrupt rapport • Demonstrates lack of understanding or • Use transitional phrases when moving from empathy one subject to another • Offering False Assurance • Acting Defensively • Unfair and unrealistic • Don’t defend people being criticized • Implies judgment and inhibit further • Denies reality of situation expression of feelings • Forces person to hide fears and anxiety9/7/2010 9/7/2010 5
  6. 6. Cultural ConsiderationsCommunication Patterns to Avoid • Profound effect on way people communicate • Jumping to Conclusions • Sensitivity to culture influences interviews • Always check out the facts • Cultural difference of great impact • Overweight • Language • Verbal communication patterns • Wants to loose weight • Nonverbal communication patterns • Breast Cancer patient • Cultural variations • wants to have mastectomy • Beliefs about health and illness • Conclusions represent • Ways to express pain and emotions personal values and • Manner of decision making about health and health care judgments • May need to consult others of same • May antagonize patient cultural on how to best communicate9/7/2010 9/7/2010Cultural Considerations Cultural Communication Guidelines • Translators • Observe Personal Space • Rosters of translators • Distance between individuals • Family members or friends • Touch • May not always be objective • Reluctant to divulge personal information • Appropriate Eye Contact • Child, different gender, different age-group • Rude, intrusive, immodest • Right to confidentiality and privacy • Disrespectful for a woman to make compromised contact with man • Avoid Slang and Jargon9/7/2010 9/7/2010Cultural Communication Guidelines Cultural Communication Guidelines • Interpret Nonverbal Behavior • Understand Variations in • Clues for whether you are being Disclosing Personal Information understood • Direct questioning viewed as intrusive, • Frown / blank stare rude, embarrassing • Understand Variations in • May be reluctant to participate in the Expressions of Emotion and Pain interview or give vague responses • Crying may be childish or self-indulgent • Determine Family Decision- • Other vocal and physical in expressions Making Processes of pain • How are decisions made and by whom • Who responds to questions when the patient asked9/7/2010 9/7/2010 6
  7. 7. Report and Documentation SBAR Communication• Change of Shift Reports • Standardize communication among health care workers • Continuity of care • Promotes patient safety • Oral report • Improves efficiency • Given by charge nurse on all patients • Acronym • Given between care givers • Situation • Tape Recorded • Background • Walking Rounds • Assessment • Walk from bed to bed • Recommendations • Patient included in information shared • Uses • Report focused on patient • Calling physician • No socialization • Handing off to another nurse • Transferring patients to another facility or• Patient Record Forms level of care9/7/2010 9/7/2010 7