Transcript Module 3
Module 3 Communication & Interpersonal Skills Maslow’s Hierarchy of Needs Levels build upon each other Lowest level- Physiological Second level – Security Third level – Belonging Fourth level – Esteem Fifth level – Self Actualization Recognize/Report Behaviors Reflecting Unmet Human Needs Physical Needs unmet: – Irritable, cold, weak, c/o hunger or cold – Changes in VS & LOC Psychological Needs unmet: – Anxious, depressed, aggressive, angry – Physical ailment with no apparent cause – Expresses feelings of loneliness & worthlessness Unmet needs may result from illness, disease,or injury, but may also contribute to development of illness CNA Response to Behavior Look beyond the behavior – rude, uncooperative, demanding Remember there is an underlying need for comfort & understanding Respond with patience, caring, sympathy, concern, kindness, empathy If problem continues, ask licensed nurse Communication Definition – sharing of ideas, thoughts, information, & feelings with at least one person, even if unspoken Therapeutic communication – used to promote optimal wellness Routes – Internal senses – see, hear, touch – External senses – spoken, written, gesture Steps in Communication Message Sender Receiver Interpretation What happens when you play the telephone game? Methods of Communication Verbal – the spoken word Nonverbal – most honest – – – – Conscious vs. unconscious Body language Touch Written – red dots, name tags, uniforms, falling stars – Electronic – devices to create sound, computers, touch pads Reasons for Communication Breakdown Verbal barriers – – – – – – – – – Criticism Value statements Interruptions Judgment Language differences Changing subjects Excessive talking Pat answers – “Don’t worry, I know how you feel” Communication Breakdown Non-verbal – Body language – Eye contact – Cultural differences Communication Breakdown Physiological/aging factors – Hearing loss – Vision loss – Response time – Medications Communication Breakdown Not listening – Lack of concentration – preoccupied, distracting noises, monotone voice, negative attitude Selective hearing Emotional response to word/situation Effective Communication Skills Introduce self Call person by formal name or request Explain all tasks Use short sentences, ask for feedback Eye contact Speak clearly, avoid criticizing Clarify information Use words that are understood Friendly/positive tone Ensure confidentiality Effective Communication for Special Needs Language/cultural differences – Ask for INTERPRETER – Know cultural beliefs – word use, gestures, touching Visually impaired – – – – – – Describe surrounding Identify self, don’t touch until they’re aware Explore room with resident, don’t rearrange Explain, let resident know when finished Keep doors open, don’t speak loudly Monitor meals Effective Communication for Hearing Impaired Gain attention of resident, may use touch Determine which ear has loss Check for hearing aid function Determine % or loss & high/low tone loss Face resident – don’t chew gum, eliminate background noise, stand on side of better ear Speak slowly, directly, clearly, NOT LOUDLY Short sentences, simple words, repeat if need Watch nonverbal cues, ask to repeat info Effective Communication for Aphasia (physically impaired) Provide writing materials if speech difficulty Let use own words, give time to speak Use picture or point boards Conflict IS Occurs when what a person has & what a person wants are different A pattern of energy Nature’s primary motivation for change Conflict IS NOT Always negative Always a contest Always a sign of poor management Able to take care of itself if left alone Always resolvable Conflict Handling Modes Competing – Assertive & uncooperative – Power-oriented – Useful for: • Standing up for rights • Defending an important position • Trying to win Conflict Handling Modes Accommodating – Unassertive & cooperative – Involves self-sacrifice – Useful for: • Charitable causes/ generosity • Obeying orders • Yielding to another point of view Conflict Handling Modes Avoiding – Unassertive & uncooperative – Does not address the conflict – Useful for: • Diplomatic side-stepping • Avoiding until a better time • Withdrawing from a threatening situation Conflict Handling Modes Collaborating – Assertive & cooperative – seeks to satisfy both sides – Useful for: • Gaining additional insights • Avoiding negative competition for resources • Solving interpersonal problems Conflict Handling Modes Compromising – Somewhat assertive & cooperative – Solutions mutually satisfying – acceptable to all – Middle ground mode – Useful for: • Splitting the difference • Making concessions • Finding a quick middle ground position Areas of Concern for Conflict Attendance & Punctuality Safety – Personal & Resident Professional Behavior Attitude Appearance & Hygiene Performance Lines of Authority Communication with employee: Inquiry & Advocacy – Bracket – create an open mind so people can listen to another point of view – Paraphrase – validate & confirm what they heard – Check perceptions – Reads between the lines, helps to understand/empathize – Ask probing questions – get more information & deepen understanding Lines of Authority Communication with first line supervisor: objective reporting Timely reporting: when & where Plan for remediation – Clarification of concerns – Goals setting for behavior changes – Expectations & Time frame for remediation – Follow-up Line of Authority Confidentiality Constructive Feedback – Info given to & received by an individual about their performance – Goal is to improve performance – Vehicle to promote constructive relationships – Monitors how things are going – Creates a way to review ongoing issues – Keeps lines of communication open 4 E’s of Constructive Feedback Engage – set the stage – Preparation & link feedback to common goals – State what you want to discuss Empathize – Environment & Timing Educate – Describe observations & impact of behavior – Remain objective Enlist – Elicit person’s response & guide towards sol’n Touch as Communication Cultural beliefs regarding touch – Modesty – covering face, arms, head – Touch of body after death – Hugging Body Language – – – – Hands, eyes Gestures Posture Regression Personal Space Basic Defense Mechanisms Regression – reverting to childish behavior (thumb sucking) Rationalization – unconscious, developing socially acceptable reasons to explain behavior (can’t give up smoking because you might gain wt) Projection – unconscious, places own intolerable feelings onto others (Cheater accuses others of cheating) Basic Defense Mechanisms (cont) Displacement – substituting one innocent person for another (mad at your mom so you hit your brother) Denial – can’t believe that it is true (my children would never do that) Conversion – substituting acceptable physical symptoms for unacceptable emotions (feel sick when it is time to take the test) Basic Defense Mechanisms (cont) Repression – pushes thoughts & ideas into the subconscious where they do not recall them (has fond memories of an abusive mother) Sublimation – unacceptable emotions are expressed in socially acceptable way (exercises when angry) Basic Defense Mechanisms (cont) Substitution – replacing an unattainable goal with an acceptable one (can’t sing on tune so plays the guitar) Identification – patterning self after another, hero-worship (I want to be just like Mrs. McGrory) Family Communication Family structures differ – single parent, two parents, primary caregiver, extended family, & appointed guardian, conservator, or responsible party Show respect for all family structures – – – – Listen, courteous, respectful, supportive Avoid involvement in family matters – give privacy Maintain confidentiality Allow family to help with care Family Communication Family needs info – Telephone & visiting hours – Location of refreshments & business office – Gift shop & public restrooms – Orient to resident activity & appointment areas – Use family as resource to gather info about preferences Socio-cultural Factors Culture – characteristics of a group of persons (attitudes, beliefs, religion, values, likes, & dislikes) – Influences reaction of residents to health care like food preference, family practices, hygiene habits, & clothing styles – Rituals – beliefs, ceremonies – Beliefs about health care Emotional reactions to illness Stress as a result of illness – Individual differences • Heredity, experiences, environment Physical loss or disability – Many losses • Spouse, family, friends • Homes, control of life, disease, meals, driving • Function & independence Emotional response to illness Emotional reactions – – – – – Anger, grief, dependency Suspicion, loneliness, guilt Uselessness, feelings of damage Depression, helpless Anxiety, frustration, fear To help: – – – – Observe for signs of stress & listen Patience & understanding, promptly meet needs Focus on abilities Treat with dignity, be non-judgmental Communication Patterns Organizational chart of nursing unit – Methods of communication • Verbal vs. nonverbal • Written – chart, Kardex/care plan, report sheets, ADLs. What do you do when resident asks to see the chart? • Electronic – computer, fax, telephone, intercom Legal aspects – Must document what is reported verbally to nurse – Must document statements from family or resident – Subjective vs. objective data Effective Communication Identify self Verbal reports – brief, organized – Appropriate – diagnosis, changes, allergies, activity, elimination, special needs, diet, VS, code status – Timing – when to report changes – Place & location Effective Communication Take notes when on telephone – Name of person the message is for – Correct spelling of caller’s name – Time called – Clarify message by repeating it & telephone number to caller – Sign your name & title to the message Answering call lights Go to resident at once, quietly, and friendly manner If on intercom, call resident by name, I.d. yourself, politely inquire to need Make sure call light is ALWAYS within reach