Transcript Communication

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Communication
N001
Spring 2013
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Student Learning Outcomes
In addition to course SLO # 3
Please review lecture specific SLO's on
Course objectives, lecture & lab outlines
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NCLEX ® Question
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Overview
 Introduction
 Stress
& Coping
 Verbal communication


Nurse client relationship
Interviewing
 Communication
with other members of the
health care team
 Chain of command

Define collaboration
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Introduction Part I
“Communication
is an
essential part of patient
centered care. Patient
safety also requires effective
communication.
(Potter 8th ed. P. 309)
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Introduction
 Nurses
need to know about stress so that
they can recognize it in the clients,
families, & themselves
 Stress ….”Physical, emotional, or
psychological demand that often leads
to growth or overwhelms a person and
leads to illness (Varcorlis & Halter 2010)
Potter & Perry p. 731
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Caring & Empathy
 Caring
is a universal phenomenon
influencing the ways is which people
think, feel, and behave in relation to one
another (Potter)
 Empathy is the ability to understand and
accept another person's reality ….
(Potter)
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Physiology of Stress

Fight or flight
response due to the
arousal of SNS


Increased heart
rate, shift of blood
from extremities to
core
Engaging the
Medulla oblongata,
reticular formation,
& pituitary gland
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General Adaptation
Syndrome
 Alarm


reaction
Hormones activated
Pupils dilate
 Resistance

Stabilization and repair
 Exhaustion


stage
stage
Body can no longer resist effects
Death may result
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Coping
 Individual’s
effort to manage
physiological stress
 Coping strategies


Effectiveness impacted by age, experience
& cultural background
Strategies differ according to the stressor
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Coping
 Individual’s
effort to manage
physiological stress
 Coping strategies
 Effectiveness impacted by age,
experience & cultural
background
 Strategies differ according to the
stressor
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Coping Strategies
 Effectiveness
impacted by age,
experience & cultural background
 Strategies differ according to the stressor
 Most individuals use a combination of
problem focused and emotion focused
coping strategies
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Coping Strategies
 An
individual may seek info and takes
action as way to deal with it (problem
focused)
 While others or at another time might
avoid thinking about the situation
(emotion focused coping)
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Ego Defense Mechanisms
 Help
regulate emotional distress
 Denial
 Regression
See (Potter & Perry) for a more complete
list
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Impact on Nursing
 Nursing
is responsible for developing
interventions to prevent or reduce stress
 Client must initiate the change
 Accurate assessment critical
 Effective communication vital
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Critical Thinking
Includes:
 Curiosity
Motivated to learn more
 Creativity & Perseverance
Attitudes that assist the nurse to
communicate and identify
innovative solutions
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Critical Thinking
A
self confident attitude
 Attitude
of fairness
Listens to both sides of the issue
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Critical Thinking
 Humility
Willingness
to ask for help
 Appropriate approach for each
situation
II. Elements of
Communication
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 The
referent – motivation
 The
sender – encodes & sends message


Includes feelings
Ensures accuracy
 The


receiver – decodes & receives message
Sender’s message acts as referent
Must translate & respond to message
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Elements

The message – verbal, nonverbal, & symbolic
language



“Meaning comes from individuals and their
unique perspective” (Schuster & Nykolyn 2010)
“ Exciting” – means …
The channels–means of conveying &
receiving messages


Auditory, tactile, & visual
Written or non written
 Feedback
– message thru receiver
receives and returns
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Elements of Communication
 Interpersonal
variables- factors within
both the sender & receiver

Impacts perception
 Environment-
where the communication
process takes place

Example need for privacy
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Verbal Communication:
Overview
 Vocabulary
 Denotative

meaning
Common meaning
 Connotative

meaning
Interpretation of the word based on thoughts or
feelings people have about the word
 Pacing
 Intonation
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Verbal Communication
 Clarity
 Brevity
 Timing
 Relevance
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Nonverbal
 Personal
appearance / Presentation of
self
 Posture & Gait
 Facial expression
 Eye contact

Cultural ramifications
 Gestures
 Sounds
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Presentation of Self
 Breath
and depth of
knowledge
 Flexibility
 Enthusiasm
 Sincerity
 Self perception
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. Presentation of Self





First impressions
Communication enhanced by your
credibility
Good personal hygiene
Good grooming
Appropriate uniform
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Types of Personal Space
 Intimate





– 0 to 18 inches
May produce discomfort, anxiety or fight or flight
response
Explain to client what & why
Respect client’s space
Do not whisper but speak quietly & clearly
Avoid eye contact during intimate care
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Personal Space
 Personal
zone - 1.5 to 4 feet
 May produce discomfort, anxiety or fight or
flight response
 Usually maintained with friends
 Able to read nonverbal communication
 Conversation
 One to one teaching
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Personal Space
 Social
zone– extends 4 to 12 feet
 Communication – formal
 Conducting a group
 Sensory involvement less intense
 Increased eye contact
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Personal Space
 Public
zone
 12 feet and beyond
 Lecturing in a classroom
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Zones of Touch
 Nurses

use touch
Caring touch, Task touch, Protective touch
(Schuster & Nykolyn )
 Social
–permission not needed ex. hands
 Consent – permission is needed

Mouth, wrists, feet
 Vulnerable

Face neck / front of the body
 Intimate

– special care
– sensitivity important
Genitalia & rectum
(Potter box 24 –3)
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Forms of Communication
 Symbolic

Art & Music
 Metacommunication

All factors that influence communication
 Written
communication
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IiI. Nurse Patient Helping
Relationships
http://www.mynursesregistry.net/Portals/0/m
y_nurses_201.jpg
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Nurse Patient Relationship
 Nurse
Client Relationship
 Student/RN – professional
relationship
 Therapeutic climate that facilitates
positive change
 Goal
- clients to achieve optimal
personal growth (Potter & Perry 8th
ed. )
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Nurse Patient Relationship
 Includes
Specific
time frame
Goal directed approach
Confidentiality
Nonjudgmental
Focus on client's needs
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Phases of the helping
relationship

Pre interaction





Before meeting the client
Review data
Anticipate concerns
Plan time frame and location
Orientation






Client and nurse begin to know one another
Nurse presents positive attitude
Client may test RN
Prioritize client’s needs identify problems
Clarify roles
Discuss termination (Potter)
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Phases of the helping
relationship

Working





RN & client work together to solve the issues
Assist the client with self exploration
Take action
Use therapeutic communication to achieve
goals
Termination



Ending of relationship
Remind client end of relationship is near
Evaluate goal achievement
(Potter)
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Professional Relationships
 Nurse



Process is similar to assisting individuals
Take into account family & group dynamics
Family roles & responsibly
 Nurse


family relationships
Community relationships
Participation in local activities
Leadership
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Health Care Team
Relationships
 Collegial
relationships
 Focused on the client safety and the role
that the health professional s have in
taking care of that client
 Communication



Respectful
Clear
Concise
 Collaboration
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Strategies for Health Care
Team Communication &
Collaboration









Respectful
Active listening
Try to understand the other individual’s view
point
Identify bottom line – client safety
Be direct
Use “I” statements
Learn to say I was wrong
Adaptability
Flexibility & Adaptability
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Clinical Assignment
 Interviewing
team
members of the health care
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Institutional Relationships
 Chain




of command
Process for communication client status
Process of communicating concerns
Important to identify the sequence
Example - EVC Nursing students
 Collaboration

“Different perspectives are synthesized for
better understanding of complex problems
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SBAR
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IV. Application of the Nursing
Process
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Assessment*
 Note
the context(helps determine
meaning) of the situation that influences
the communication (Potter)

Psycho physiological context
 Internal
factors
 State of health & age, attitudes, perceptions
etc.

Rational Context
 Relationship
between participants
 Trust & Caring
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Assessment


Client interview
Situational context


Environmental context



Reason for the communication
Privacy
Noise level
Cultural Context




Socio cultural elements that impact the communication
Culture influences feelings, perceptions & behaviors
Language Spoken (use of interpreter)
Gender, education level, economic status
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Nursing Diagnosis
1.
2.
3.
4.
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Nursing Process (Goals &
Planning)
 Planning
your interventions – to meet
the needs of your specific clients




Motivation
Priority setting
Setting goal for interview or intervention
Insuring continuity of care


Communication with others caring for these
clients
Will need to apply refine these concepts when
education clients
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Implementation
Therapeutic communication techniques
 Active listening






Attentive to client
Sit facing client
Observe open posture
Lean toward client
Establish and maintain intermittent eye
contact
Relax (calmness)
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Implementation

Sharing observations




Comment on how other person looks, sounds or
acts
Sharing observations
“I see you have not eaten today.”
Sharing empathy



“Ability to understand and accept another
person’s reality”
Reflect the importance of what the other person
has said on a feeling level
“It must be very frustrating to know what you want
and not be able to do it.” (Potter)
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Implementation
 Sharing


“
“
 Sharing



hope
‘
‘
‘
humor
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Implementation

Sharing feelings






Making observations
Acknowledging feelings
Give permission to express negative feelings
Sharing feelings of caring are appropriate
The focus should be on the client not on the nurse
Using touch



Most personal
Appropriate – example touching some one’s
hand is ok
Gentle yet firm
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Implementation

Use of silence




Providing information



‘
‘
‘
Relevant
Sensitively
Clarifying



Check if the interviewer's understanding is accurate
Ask the client to restate
“I am not sure I understand what you mean when you
use the phrase …”
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Implementation

Focusing



Centering on key elements
Use to guide the discussion – so not interrupt the
client
Paraphrasing


Briefly restating the other’s message
Requires practice
States “I have been overweight my whole life.”
 RN responds “You are not convinced you need
a diet”

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Implementation

Asking relevant questions


Summarizing


Seeking information necessary for decision
making
Concise review of key aspects of the interaction
Self disclosure by the nurse



‘
‘
‘
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Implementation

Confrontation



Assist the individual to become aware of
inconsistencies
Improves client self awareness
Only use after trust has been established
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Implementation *
 Open
ended and closed ended questions
 Open- ended questions



Ask for longer interpretative response
Phrased as a request
“Describe your symptoms
 Closed


questions
Call for specific, short, responses
Do you have pain
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Clinical Skills Lab Assignment
Posted on Moodle
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Implementation: Focus older
adults








Obtain the client’s attention before beginning
Assist client with glasses and hearing aides if
necessary
Make sure your face is visible to the client
Well lit environment
No glare
Lower register of voice
Provide time for questions
Approach client as adult
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Implementation:
Cultural competence




Keep instructions simple & to the point
Incorporate member of community or family
Negotiate if necessary
Interpreter:




Professional
Working with
Written materials – can client read in their
own language
Videos
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Implementation
 Be
sure and review the chart in Potter &
Perry
 Page 357 – that focuses on clients with
special needs.
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Implementation
 Documentation
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Evaluation
 Communication
analysis
 Are client able to state in their own words
– what was discussed.

In lab exercise
 Were
the goals of the therapeutic
communication met?
 Were there any missed verbal and
nonverbal cues?
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Nontheraepeutic
Communication Techniques






Asking personal
questions
Giving personal
opinions
Changing the
subject
Autonomic
responses
False reassurance
Sympathy






Asking for
explanations
Approval or
disapproval
Defensive responses
Passive or aggressive
responses
Arguing
Use of idioms
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V. Student responsibilities
 Communication


with team leaders
Check in – Report
Check out – Report to RN
 Update
(SBAR)
client status – ex vital signs, care etc
Situation
 Background
 Assessment
Recommendation


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Clinical applications
 Address

client formally –
“Introduce yourself
 “Tell
them what you are going to do and obtain
their consent. (within reason)
 Remember – do not whisper and avoid eye
contact during intimate care
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Demonstrating Caring by
Expressing Empathy
Adapted from Marilyn Tagatac’s
Presentation Physiology of
Compassion
8/5/2009
Slides 48-50
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Empathy
 Use of Therapeutic communication
 Giving broad openings
 Encouraging description of perceptions
 Verbalize the implied
 Inquiring about client’s decisions
 Empathetic response can be learned
 Sincere
 Inquire about client’s feelings
 Validate your observations with the client
 Try to be in tune with client’s style
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Empathy
 Steps



Enquire/explore client’s feelings in order to
accurately identify them
You feel __________________-?
Because _________________ the reason the
client identifies the feeling
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Class exercise #1
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In class exercise Part II
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Remember
 “I
feel” statements
 Reflection
 Citing specific behaviors
 Asking for feed back
 Open ended questions
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Final Words
Communication Should Be
 Complete
 Clear
 Concise
 Cohesive
 Courteous
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Summary
 All
parties must participate in the
communication process.
 The verbal and nonverbal message must be
congruent
 How you present your self can impact the
dialogue
 Important to treat everyone in a respectful
manner
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References
Doenges, M.E, , Moorhouse, M.F. & Murr, A.,
(2010) Nursing diagnosis manual (3 rd ed.)
Philadelphia, PA: F.A. Davis.
Potter, P.A., Perry, A. G. (2013)
Fundamentals of nursing (8th ed.) St.
Louis, MO: Mosby.
Schuster, P. M. & Nyklolyn, L. (2010)
Communication for Nurses. Philadelphia,
PA: F.A. Davis.
Tagatac, M. , Presentation Physiology of
Compassion 8/5/2009
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References




http://www.azhha.org/patient_safety/sbar.as
px
http://www.stanly.edu/educational/public_se
rvices/ps_images/36.jpg (this link does not
open)
http://vtlmi.labor.state.vt.us/occvid/images/2
9-1111.00-1.jpg (this link does not open)
http://www.ihi.org/IHI/Topics/PatientSafety/Sa
fetyGeneral/Tools/SBARTechniqueforCommun
icationASituationalBriefingModel.htm
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References
 Google
Images
 Microsoft Word images