Transcript Therapeutic Communication

Life Span
Introduction
Chapter 1&4
Life Expectancy
• “The average number of
years a person is
expected to live”
What is the life expectancy in the US
as of 2011?
A.68.3
B. 71.5
C. 78.4
D.81.7
E. 89.7
Life expectancy
1850
1890
1920
1950
1970
1990
2011
38.3
42.5
56.3
66.3
67.9
72.7
78.4
Why?
• Why is life expectancy going up?
• Why is the US not number 1?
Antibiotics
• When was penicillin first available as a
prescription drug?
A. 1782
B. 1824
C. 1868
D. 1927
E. 1942
Healthy Lifestyle
• Treatment should be
based on the belief that
nature has a strong
healing component
Hippocrates
Bacteriology
– Louis Pasteur
Bacteriology
– Louis Pasteur
– Robert Koch
Bacteriology
– Louis Pasteur
– Robert Kock
– Joseph Lister
What was the first vaccine available?
A. Small pox
B. Pertussis
C. Diphtheria
D. Tetanus
E. Polio
What was the first vaccine available?
A. Small pox (1796)
B. Pertussis (1904)
C. Diphtheria (1926)
D. Tetanus (1938)
E. Polio (1955)
1948 = DPT
• Measles (1963)
• Mumps (1967)
• Rubella (1969)
– MMR (1971)
• Hepatitis B (1981)
• Hib (1985)
• Chickenpox (1996)
• What happened to the
small pox vaccine?
• D/C 1971
– eradicated
Health
“A state of complete
physical, mental and
social well-being, not
merely the absence of
disease or infirmity”
Holistic
Health Promotion
• “Health care directed
toward the goal of
increasing one’s optimal
level of wellness.”
Empowerment
• “A form of selfresponsibility that
encourages people to
take charge of their
own decision making”
Disease prevention
• Primary
– Before there is any disease
• Secondary
– Begins with diagnosis
• Tertiary
– Begins when a permanent
disability occurs and is
stabilized
– Rehabilitation
– Restoring the person to an
optimal level of functioning
Healthy Lifestyle
• Nutrition
• Exercise
• Mental health
Mental Health
• Adjust to new situations
• Handles personal
problems
• Contributes to society
• See themselves and
others realistically
• Fluctuates
– Continuity
– Consistency
Stress
• “Anything that upsets
our psychological or
physiological
equilibrium”
Responses to stress
• Physiological
• Emotional
• Intellectual
Emotions
• “feeling state”
• Autonomic System
• Limbic System
Emotional Maturity
• When individuals are
able to control their
responses and can
express their emotions
in socially appropriate
ways.
3 Stages of Stress
• Alarm stage
• State of resistance
• State of exhaustion
Anxiety
• “Response to a stressful
situation”
Levels of Anxiety
•
•
•
•
Mild
Moderate
Severe
Panic
Stress  Health
• SRRS
Stress Reduction Techniques
• Relaxation Exercise
• Guided imagery
Chapter 4: Communication
• “An interaction
between tow of more
persons – an exchange
of information, ideas,
feelings or emotions.”
Communication Process
1.
2.
3.
4.
5.
Message
Sender
Method
Receiver
Feedback
Types of communication
• Verbal
• Non-verbal
Modes of Non-verbal Communication
• Physical Appearance
and dress
Modes of Non-verbal Communication
• Body movement and
posture
– Open
– Closed
Modes of Non-verbal Communication
• Facial expressions
Modes of Non-verbal Communication
• Gestures
Modes of Non-verbal Communication
• Eye contact
Modes of Non-verbal Communication
• Tone and volume of
voice
Modes of Non-verbal Communication
• Touch
Modes of Non-verbal Communication
• Silence
Personality Types
• Passive or Unassertive
• Allowing your own rights
to be violated by failing to
express honest feelings
• Goal: Avoid conflict no
matter what
• Little risk involved – very
safe
• Little eye contact, often
defers to others opinions,
usually quiet tone,
Examples of Passive communication
• “I don’t know.”
• “Whatever you think.”
• “you have more
experience than I. You
decide”
• “I’ll go with whatever
the group decides.”
• “I don’t care. It doesn’t
matter to me.”
Personality Types
• Aggressive
• Protecting ones own rights
at the expense of other’s
rights – no exceptions
• Goal: win at all costs
• Does not consider actions a
risk because this person
thinks they will always get
their way.
• Eye contact is angry and
intimidating; lots of energy;
loud and belittling, never
defers to others.
Examples of Aggressive
communication
• “I don’t know why you can’t see that this is
the right way to do it”
• “It’s going to be my way or not at all.”
• “You’re just stupid if you think that will work.”
• “That kid of logic will sink the company.”
• “Who cares what you feel. We’re talking
about making things work here.”
Personality Types
• Passive - Aggressive
• Forfeiting your own rights
initially, followed by
manipulation and vengeance
later.
• Goal: avoid conflict and then
make the other party wish
they had seen it your way
• Avoid risk initially, risks
relationships later, then acts
surprised when people are
mad
• Behaves passively to people’s
face, then aggressively when
they are not around.
Examples of Passive-Aggressive
communication
• “Sure doctor, I’d be happy to write that verbal
order” but back on the unit the order is
“forgotten”
• “I love your hair. Most people probably can’t
even tell it’s a wig”
• “I hear what you’re saying, and I wouldn’t
want to make waves, so I’ll do what you say
even though someone will probably get sued.”
Personality Types
• Assertive
• Protecting your own rights
without violating the rights
of others
• Goal: communicate with
respect and find a solution
to the problem
• Eye contact maintained,
listens and validates others,
confident and strong yet
also flexible, objective and
unemotional, presents
wishes clearly and
respectfully
Examples of assertive Communication
• “So what you’re saying is…”
• I can see that this is important to you and it is
also important to me. Perhaps we can talk
and try to solve the problem
• “I think… I feel… I believe that…”
• “I would appreciate it is you…”
Assertiveness Skills
1.
2.
3.
4.
5.
6.
7.
Persistence
Objectivity
Validation
Owning
Challenging False Information
Pumping the negatives
Humor
Okay in assertive Communication
• “I don’t know”
• “No” or “I cannot do that”
• It is OK to make mistakes as long as you take
responsibility
• It is OK to disagree and to verbalize that
• It is OK to challenge others opinions or actions
• It is OK to not accept another opinion as fact
• It is OK to ask for a change in behavior
Therapeutic Communication
• Purposeful
• Goal oriented
• Promotes trust
Components of Therapeutic
Communication
• Listening and observing
Components of Therapeutic
Communication
• Warmth
Components of Therapeutic
Communication
• Genuineness
Components of Therapeutic
Communication
• Attentiveness
Components of Therapeutic
Communication
• Empathy
Components of Therapeutic
Communication
• Positive regard
3 phases of Therapeutic
Communication
• Orientation phase
– Build trust
• Working phase
– Determine coping
– Plan of care
implemented
• Termination phase
– End of relationship
Factors affecting communication
• Congruence
Factors affecting communication
• Time and setting
Factors affecting communication
• Proxemics
Factors affecting communication
• Biases
Factors affecting communication
• Physical Handicaps
Blocks to Communication
• Belittling
Blocks to Communication
• Disagreeing
Blocks to Communication
• Agreeing
Blocks to Communication
• Defending
Blocks to Communication
• Stereotyping
Blocks to Communication
• Giving false
reassurances
Blocks to Communication
• Giving advice
Blocks to Communication
• Changing the subject
Blocks to Communication
• Asking closed-ended
questions
Blocks to Communication
• Asking “Why” questions
Blocks to Communication
• Probing
Techniques used to enhance
communication
• Giving information
• Clarifying
• Reflecting
• Paraphrasing or
restating
• Asking broad questions
• Using general leads
• Stating or making an
observation
• Offering self
• Using humor
Therapeutic Communication
• “Tell me about a time you struggled
caring for your family member.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Describe the circumstance that led you
to the crisis unit…”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Tell me about a time you felt confused
about a decision.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Tell me, what you do when you get
upset.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Why do you think your family does not
care.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Of all the concerns you mentioned
which is the most troublesome?”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Tell me when you feel anxious…”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Tell me your family problems.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “The decision your family made is for
your own good.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Why do you feel like that. Your family
seems to care.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “I would not worry about that…..”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “What you really mean is…”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “This hospital has a fine reputation.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “Everyone gets down in the dumps.”
A. Appropriate
B. Inappropriate
Therapeutic Communication
• “I am not sure that I follow what you are
saying.”
A. Appropriate
B. Inappropriate
• Clarifying
• Using broad opening
statements
• Giving information
• Reflecting
• Validating
• Acknowledging the patient’s
thoughts and feelings
• Using general leads
• Selective reflecting
• Requesting an explanation
• Belittling the patient’s
feelings
• Making stereotyped
comments
• giving approval
• Defending
• Using reassuring clichés
• Expressing disapproval
• Giving advice
• Agreeing with the patient
• Changing the subject
• Disagreeing with the patient
• Patient: “I don’t know. I hate to have my boyfriend
see me looking like this. Just thinking about him
coming to visit makes me nervous.”
Nurse: “You really should stop worrying. That may be
what’s keeping you from getting the rest you need.
And after all, no one expects you to look your best
when you’re in the hospital.”
• Patient: “You’d think my doctor would have
prevented me from getting phlebitis, but he’s
too busy to care about what’s happening to
me.”
• Nurse: “You’re wrong, Mr. Iverson. Of course
he cares.”
• Nurse: “You seem to be kind of restless
tonight.”
Patient: “Nobody cares. My doctor wants me
to go—just go on home. He doesn’t care?”
Nurse: “Go home?”
• Patient: “Maybe I should find a hobby or
something. I try not to get discouraged; I
know I shouldn’t let it get me down.”
Nurse: “That’s the right attitude. It really
doesn’t help to worry about it.”
• Nurse: “How are you feeling this morning, Mr.
Patterson?”
Patient: “Oh, fine, thanks.” (unenthusiastic)
Nurse: That’s good.
• Patient: “I can’t go home with this…AIDS. If
they want me out of here so bad, why don’t
they just let me die?”
Nurse: “You can’t go home because you have
AIDS?”
• Patient: “Well, I haven’t been able to work for
quite a while now, and the doctor says I might
not ever work as a carpenter again.”
Nurse: “It must be difficult for you right now,
but I’m sure everything will be all right.”
• Patient: "I'm just jumpy-I get like this
sometimes. I guess it's because I didn't get too
much sleep last night."
Nurse: "Yes, when you don't get a good night's
sleep it does make you edgy."
• Patient: "What's there to talk about? First they
say they have to operate, and then when I'm
beginning to feel better, I get this infection. I
don't think I'm ever going to get out of here!"
Nurse: "I know just how you feel. You know,
everyone gets frustrated when things aren't
going right."
Listening Exercise
• Pair up with another student.
• Person A will tell person B her/his most
memorable recent experience. Person B
should try to think about a problem they have
or an assignment coming up while person A is
speaking.
• Discuss how you felt about both roles and
experiences, with person A speaking first.
• Person A then tells the same story again,
taking about the same amount of time. This
time person B will concentrate as much as
possible on person A and on what he/she is
saying.
• Share the differences between these two
experiences and discuss the relevance this
may have when person A is a client and
person B is a nurse.
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Therapeutic Communication Techniques (6)
Initial Communication
“What should the nurse say initially?”
Goal of initial communication
is to open communication.
Empathy
Restatement
Reflection
• An elderly woman is admitted to the hospital with
a subdural hematoma. There are also numerous
ecchymotic areas and cigarette burns. Elder abuse
is suspected. The nurse’s aide says to the nurse ,
“Every time I see her family, I get so angry. How
could anyone deliberately hurt such a sweet old
lady?” Which initial response by the nurse would
be most helpful to the aide?
• “It is not appropriate for nursing personnel to
make judgments about people.”
• “It is very upsetting isn’t it.”
• “There is no proof yet as to who abused her.”
• “You should try to understand how frustrating it is
to care for the elderly 24 hours a day.”
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Who is client?
Nurse’s aide.
•What is the problem/behavior?
Nurse’s aid is angry with family of client.
•What are the details?
Suspects elder abuse.
•What does question ask?
Initial response to aide
•Answer: 2. Initially should encourage aide to
express feelings.
• The nurse is caring for an 18 yo male who is comatose
following a head injury. The parents ask whether they
should visit their son since he is comatose. Which of
the following is the best initial response for the nurse
to make?
• •Advise the parents thay should visit their son as often
as possible. •Suggest to the parents that their presence
is important even though their son does not seem to
be aware. •Tell them that they should arrange for his
teenage friends to visit in small groups. •Explain that
he is unaware of their presence and tell them
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Who is client?
Parents of 18 y/o
What is the problem/behavior?
Ask if they can visit son.
What are the details?
18 y/0 comatose after head injury.
What does question ask?
Initial response
Answer: 2. Look at the verbs. Suggest is only
collaborative verb. Advise, tell and explain are
authoritarian verbs.
• Think about the most fulfilling relationship
that you have experienced with a client, one
in which you felt you made a difference.
1. What were some of the aspects of this
relationship that made it fulfilling?
2. How did you make a difference?
3. What communication skills did you use?
• Now think about a relationship with a client
that was the least fulfilling; one in which you
think that you did not help.
1. What are some of the aspects of this
relationship?
2. What happened and why?