Transcript Unit 2 - wbpracnsg.com

Rita Carey, MSN, RN
Therapeutic
Communication
Communication Process
 One-way communication
 Sender controls the message
 No opportunity for feedback
 Two-way communication
 Each person contributes equally
 Involves feedback or discussion
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Factors that Affect Communication
 Personal characteristics of sender and receiver
 Age, gender, income, marital status, attitude, etc.
 Cultural characteristics
 Space, language, touch, manners, gestures, etc.
 Situational influences
 Physical and emotional state, background noise,
interruptions, etc.
 Context
 Appropriateness/inappropriateness of the message
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Types of Communication
 Verbal
 Nonverbal
 Affective
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Types of Communication
 Verbal communication: spoken messages
 Speak clearly
 Speak professionally
 Speak only about what you know
 No slang
 No medical jargon
 Colloquial expressions may be appropriate
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Types of Communication
 Nonverbal communication: body language
 Expressions, posture, movements, gestures, physical
appearance
 Clues to the truth of the spoken message
 Indicators of patient discomfort
 Physical appearance is a part of nonverbal
communication
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Types of Communication
 Affective communication: feeling tone
 Tone of communication
 Emission of energy
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Communication Strategies
Active Listening
 Most important part of any therapeutic
communication
 Key factors include purpose, disciplined attention,
and focus
 A common mistake is to listen to the words, but
not really hear the words
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Communication Strategies
Types of Questions
 Open-ended questions
 Permit variety of responses
 Often begin with what, where, when, how, or why
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“What happened to your leg?”
 Closed-ended questions
 Require a specific answer
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“When did you first notice the pain?”
 Focused questions
 Provide more definitive information
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“On a scale of 1 to 10, with 10 as the worst possible pain, how would you
rate your pain right now?”
Communication
Strategies
Active Listening Behaviors
 Restating
 Clarification
 Reflection
 Paraphrasing
 Minimal encouraging
 Silence
 Summarizing
 Validation
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Patient: My knee hurts even while
I’m sitting in my chair.
Nurse: So you are telling me you
have pain in your left knee even at
rest?
 Restating
Nurse: “I am not sure I follow that.”
 Clarification
Nurse: “In this hour you and I
discussed….”
 Summarizing
Patient: “It’s a waste of time to talk
to anyone.”
Nurse: “You don’t think anyone
understands?”
 Paraphrasing
Nurse: “Tell me whether my
understanding is the same as
yours.”
Validation
Nurse: “Go on…I see.”
 Minimal encouraging
Patient: “Should I have the surgery?”
Nurse: “Do you think you should?”
 Reflection
Communication Strategies
Nurse/Patient Communication
Evaluation
 Communication is far more complex than just
talking
 Evaluate the characteristics that are working for
you and those you need to work on
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Blocks to Communication
 False reassurance guarantees positive outcome
 Probing pushes for information beyond medical
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necessity
Chiding or scolding for behavior such as smoking
Belittling, mimicking, or making fun of the patient,
downplaying symptoms
Giving advice
Providing pat answers negates individuality of the
situation
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Male/Female Differences
 Most males and females follow certain patterns
with regard to:
 Conversation
 Head movements
 Smiling
 Posture
 Differences in patient communication have
important nursing implications
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Cultural Differences
 Understanding cultural differences will help nurses
respond respectfully and therapeutically
 Differences apply generally to groups as a whole
 Individual patient differences should still be identified
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Role
Changes
for
the
Patient
 Dependent position
 Set tone by providing respect and information;
do not use first name unless specifically
requested by patient
 Avoid medical jargon
 Ask if patient has questions
 Be sensitive to personal or environmental
factors that may cause anxiety
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Communication Characteristics
Important in All Communications
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Respect
Trust
Honesty
Empathy
Sensitivity
Humor
Knowledge
Patience
Commitment
Self-esteem
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Communication Characteristics
 Self-esteem
 Earned, not learned
 Gives you permission to recognize that you have
something very special to offer in nursing
communication
 Thoughts
 Random thoughts usually pass through, unless you pick
a thought and change it into an active thought
 Straightforward communication
 Be direct in your conversation, remembering that
language is never innocent
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Life Span Communication
Each age group has different
communication needs
 Infants
 Cries have different meanings
 Influenced by the sound of the voice
 Respond to calm, low tones
 Preschool
 Cannot verbally express frustration, leading to tantrums
 Communicate by pointing
 Can help if coached
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Life Span Communication
 School-age
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Can be part of many discussions
Can use drawings or pictures to explain an illness
 Teenage
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Extend same courtesy as to adults
Encourage expression of feelings
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Life Span Communication
 Adult
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Collect data at all three communication levels
Limit questions to medical areas
 Elderly
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Check which side is best for hearing
Read directions aloud
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Conflict Resolution
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Accept conflict as a natural part of life
Shift your own attitude and behavior
Take time to think critically before reacting
Treat conflict as an opportunity to voice your own
opinion and listen to the other side of the story
Choose your approach
Listen and learn
Discover what is important
Respect each other
Find common ground, generally the patient’s highest
good
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Electronic Communication
 Fax machines
 Computer patient charting
 E-mail
 Keep sentences and paragraphs short; check spelling,
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punctuation
Skip a line to separate topics
Send message to the right person
Write “subject” line carefully
Be specific
Be cautious with humor
Avoid all CAPS
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Electronic Communication
Cell Phones and Text Messaging
 Shut off cell and text messaging phones during
class and clinical
 Avoid behaving in ways disruptive to the instructor
and other students
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Assertiveness: Expected in Nursing
 Helps nurse advocate for the patient
 Promotes honest, open communication and
behavior
 Considers others’ feelings and needs
 Benefits nurse, patient, and staff
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Communication Styles
 Translate into behavior patterns
 Nonassertive (passive)
 Aggressive
 Assertive
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Nonassertive (Passive) Behavior
 Automatic response not based on choice
 Emotional response based on fear
 Dishonest, self-defeating
 Overall message: “I do not count. You count.”
 Consequence: nurse unable to recognize and meet
patient needs
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Aggressive Behavior
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Automatic response not based on choice
Emotional behavior based in anger
Violates the rights of others
Attacks person instead of behavior
Overall message: “You do not count. I count.”
Consequence: distances aggressor from staff and
patients
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Assertive Behavior
 Assertiveness: current name for honesty
 Pro-active, not emotional response
 Positive, confident, open stand
 Overall message: “I count. You count.”
 Consequence: Nurse feels in control of emotions and
responses, and can be more effective patient advocate.
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Assertive Behavior
 Nonassertive (passive) and aggressive behaviors are
based on emotional hooks.
 These styles are ultimately damaging to all parties.
 Be alert to unresolved feelings that can lead to a cycle
of:
worry > fear > anger > rage
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Assertive Behavior
 Own your own feelings.
 Don’t blame others.
 Be direct.
 Use “I” statements to make your feelings known.
 Make sure verbal and non-verbal messages are
consistent.
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Work-Related Aggressiveness
 Workplace assaults take place more often against
health care workers, especially nurses, than people
in any other occupation.
 Contributing factors
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Personal Factors
Workplace Practices
Environmental Factors
Risk Diagnosis
 Nurses can and should
 protect themselves.
 advocate for a safer workplace.
Sexual Harassment
 Unwanted Sexual Advances
 Verbal or Physical Conduct of a Sexual Nature
 A condition of employment or advancement
 A hostile environment, where the advances intimidate,
offend, or interfere with the nurses’ ability to do their
work
 Not about sex or passion; about abuse of power
Sexual Harassment:
What the Nurse Can Do
 Respond assertively.
 Make sure verbal, nonverbal, and affective messages
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are consistent.
Document what happened.
Report to management.
Consider counseling.
Consider seeking legal redress.