Transcript How to Prevent Harmful Events and Promote Patient Safety

Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Unit 2
Nurse-Patient Communication:
Patient-Safe Communication in
Professional Relationships
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Chapter 6
Introduction to Nurse-Patient
Relationships
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Nurse-Patient
Helping Relationships
 Phase I: Preinteraction
 Phase II: Orientation
 Phase III: Working
 Phase IV: Termination
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Critical Thinking:
Use the Patient-Safe Communication
Process when:
 Interpreting
 Analyzing
 Drawing conclusions
 Solving problems
 Making decisions
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
The Patient-Safe
Communication
Process
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
The patient-safe communication
process leads to:
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Recognition of patient needs
Identification of conflicting nurse-patient goals
Establishment of mutual goals
Appropriate use of patient-safe responses
Creation of common meaning
Formation of trusting relationship
Formation of collaborative relationship
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Flowchart of the
Nurse-Patient
Relationship
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Stress and Conflict in
Patients/Families
 All patients/families have reactions of emotional
anxiety, tension, and fear as they face challenges
needed to understand and manage a patient
care situation
 Reactions are both physical and emotional
 Physical: Fight-or-flight response
 Emotional: Tears, anger, inability to focus
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
When you are stressed and upset, what are
your usual verbal and nonverbal behaviors?
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Do you get angry or cry?
Do you try to reason with the person upsetting you?
Raise your voice?
Remain silent and walk away?
Remain in control of verbal and nonverbal behaviors?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Universal Styles of Emotional Responses to
Stress
Blamer
Placator
Computer
Distractor
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Blamer: Aggressive bully, hostile
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“You” statements
Putdowns
Expressions of superiority
Loaded words to start fights
Interrupt, yell, call names, demand, give orders
Tense, loud words or deadly quiet
Cold, narrowed eyes
Hands on hips, finger pointing
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Placator: Wants to please everyone
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Pleading looks, downcast eyes, soft voice
Difficult time making a decision
Stooped posture, nods head excessively
Fidgets, flutters, wrings hands, picks fingernails
Saying yes when really wants to say no
Apologize for things they did not do
Says cannot do something before even trying
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Computer: Nothing bothers me….
 Quiet, aloof, reserved, withdrawn
 Does not want feelings known
 Does not discuss or show emotion (considered sign
of weakness)
 Difficulty responding when others express feelings
 Tries to remain calm, no matter what
 Face and eyes expressionless
 Closed posture, upright
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Distractor: Disruptive
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Talks incessantly
Talks nervously
Inappropriate laughter
Makes little sense
Expends a lot of energy but does not focus on
problem or how to solve it
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Why do people act this way?
Aggressive, passive, nonemotional,
and disruptive people have low selfesteem
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
As a reaction to the stress and frustration
in a situation, ineffective styles cover up:
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Feeling isolated
Feeling helpless
Feeling incompetent
Feeling unloved
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
“I am unlovable and nobody cares
about me. I have to act this way
because it is how I am. I need to do
this to survive.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Aggressive Blamer Believes
 By yelling and giving orders, the person is strong and
in control
 If the person didn’t act this way, no one would do a
thing
 The person is feeling unloved; nobody cares
 By getting others to obey, the person bolsters selfesteem
 “I won’t let them put me down; I won’t be a
coward….”
 The person getting blamed feels fearful, helpless, and
resentful
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
The Super-Reasonable Computer
 Calm and collected on the outside, on the inside feels
vulnerable and weak
 Logic and ideas are all that count
 Emotions are a sign of weakness
 Rationalizes: “I’m not stupid; I’m too smart to make a
mistake.”
 Makes the other person feel inferior, stupid, bored,
frustrated
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
The Passive Person Wants to Keep
Everyone Happy
 Wants to feel liked or loved
 Wants to keep the other person from getting mad
 Experiences guilt, pity, and contempt for the person
who is being placated
 Wants to please to “get on another person’s good
side”
 Rationalizes: “It is selfish not to do what is being
asked”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Disrupting Distractors:
 Want attention
 “Nobody cares about me”
 Rationalizes: “It’s not good to be so serious;
we should live it up.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Communicators Are Assertive
and Empathic
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Honest statements—direct and to the point
Controls temper
Recognizes and responds to emotions (empathy)
Posture open and relaxed
Direct eye contact, hand gestures and body movements slow and
relaxed
 Asks questions to understand and analyze a situation
 Speaks up and asks for what he/she wants
 Can say no without feeling guilty
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
We all need to:
 Please others
 Criticize others
 Not get stepped on by others
 Use our intellect and explain to others
 Change the subject when appropriate
How does an assertive/empathic person do these
things?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Assertive/Empathic Professionals
 Accept responsibility and apologize for something
done incorrectly or not done
 When criticizing, evaluate the act rather than blame
the other, and make suggestions for improvement
 Show feelings while giving explanations
 Clearly say the subject needs to be changed without
confusing the other person
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Personal & Professional Rights Build
the Foundation of Assertive Behavior
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Right to be treated with respect
Right to be listened to and taken seriously
Right to change one’s mind
Right to a reasonable workload
Right to question and challenge
Right to make mistakes
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Why Aren’t More People
Assertive/Empathic?
 Fear making mistakes—no one is perfect
 Fear not being liked— always someone who does not agree
 Fear criticism— everybody can use some; no one is perfect
 Fear imposing on someone—each time you speak & interrupt
 Fear retaliation—legal counsel
Most people admire others who have the courage to speak
their mind, even if they do not agree
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Can we be assertive and
empathic all the time, in all
situations?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Analyzing Situations That Are Stressful
and Irritating
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What upset you?
How did you react?
What did you want from yourself?
What did you want from the other person?
How can I manage this better in the future?
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Responding to Aggression:
Hostility & Sarcasm
 Assertiveness without regard for the rights of
others is aggressive behavior—alienates
others
 People feel pushed to comply, even if it goes
against their own feelings rights and needs
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Open Hostility
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Expecting you to fight or give in to
others
Don’t do either:
Let them blow off steam while you
count to 10 and get some oxygen
flowing to your brain
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Hostility
 Don’t aggravate them by attacking in return:
“How dare you speak to me that way!”
“You must be crazy!”
“How could you possibly think that?”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for Hostility
• First get their attention: In a rage, the patient
is not thinking or hearing; make a noise, drop
a pen or chart….
 When the patient hesitates: “I’d like to help
you. Let’s go sit in the conference room and
talk.”
 Speak slowly, quietly; use calm gestures. If you
slow down, so will the other person.
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for Hostility
 Have the patient sit down. Sitting is a less
aggressive position.
 If the patient refuses to sit, you remain
standing.
 If you are sitting when approached by an
angry person, stand up slowly and calmly and
quietly ask the person to sit down.
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for Hostility
 Listen attentively as the person explains
 Send back what the person is telling you, using
techniques such as empathy and restatement
 Ask questions, without antagonizing, to get to
the root of the problem
 Always validate what you think the problem is
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-safe Strategies for Passive
Placators
 As you talk about goals and objectives, be
nonthreatening
 Watch out for unrealistic commitments
 “If you have other things to do, I would appreciate if
you would tell me that you can’t do what I’m asking”
 “I know it is difficult to decide, no matter what you
do. Someone is not going to be happy about the
decision.”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for the Person
Who Can’t Say No
The student nurse had given the home health patient a movie to
view on balancing food, insulin, and exercise to discuss during
the next visit in 2 days.
Patient: “I wanted to watch it, I’ll get to it today. I’m spread too
thin, I think. I can’t get things done. I’m wasting your time
here. But my family comes first, and I had to take care of
them. There’s been games to attend, homework, laundry,
cooking….”
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Complainer
 Complains to anyone who will listen but may not
have social skills to talk to the person who is the
source of the problem
 Extremely negative
 Keeps going over and over the same things
 Looks for someone to act on his/her behalf and to
solve the problem
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for
Complainers
 Complainers often speak in generalities; get
them to be specific—who, what, when,
where?
 Then state the facts as you understand them
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Patient-Safe Strategies for Sarcasm
 Less obvious form of disguised aggression
 Insults, nasty remarks, cynical comments
 Expect you to be hurt by the comment or to blow up:
 Don’t do either
 In a calm, quiet manner, ask: “Was there something in that
remark you just made?”
 “I don’t know what you meant by that comment; please explain
it to me.”
 If the person becomes angry and blows up, get the person to a
private area
Communication for Nurses: How to Prevent Harmful Events
and Promote Patient Safety
Managing Stress in Patients and Families:
Patient-Safe Professional Behaviors
 Management of professional identity
 Manners
 Professional conduct
 Appearance
 Hairstyle, makeup, clothing, body adornment
 Setting
 Creation of a safe and confidential environment