Transcript Did You BATHE? - Sonoma State University

Did You BATHE?
Tools for Effective Communication
by
Robyn L. Mendoza RN, MSN, FNPs
"The most important practical
lesson that can be given to
nurses is to teach them:
what to observehow to observewhat symptoms indicate
improvementwhat the reversewhich are of importancewhich are of nonewhich are the evidence of
neglectand of what kind of neglect....
But if you can not
get the habit of
observation one
way or other, you
had better give up
being a nurse, for it
is not your calling,
however kind and
anxious you may
be." F.N.
Nightingale believed nursing is
about:
Environmental
Manipulation
Nutrition
Conservation of
Patient Energy.
http://www.valdosta.edu/nursing/history_theor
y/florence.html
Florence also tells us
what nursing is not:
Nursing is not limited
to, nor defined by
medical acts.
Nurse’s Additional Role
Make sure the patient’s environment is
clean, comfortable and safe
Make sure they are “manipulated”: get
up, turn, cough, sit up, etc…
Make sure they have adequate nutrition
Help them conserve their energy through
supportive interventions
Listening to Patients Is Part of
Assessment
Important skill
Allows understanding
Shows interest
Helps to pick up clues as to what the
concerns of the patient are
Establishes trust
Common Listening Problems
Attention wanders
Miss the real point of what is being said
Let personal emotions interfere with
judgment
Interrupt or “step on” statements
Think ahead to what we want to say next
and miss what is being said now
Non-Verbal Communication
Facial expressions:
Frown: displeasure,
unhappiness
Smile: friendliness,
happiness
Raised eyebrows:
disbelief, amazement
Narrowed eyes: anger
Blushing:
embarrassment
Eye Contact
Glancing: lack of
interest
Steady: active
listening, interest or
seduction
Hand and Arm Gestures
Pointing finger: authority,
displeasure, lecturing
Folded arms: not open to
change, preparing to
speak
Arms at side: open to
suggestions, relaxed
Hands uplifted: disbelief,
puzzlement, uncertainty
BATHE-ING the Patient
Case Study
DW is a 38 year old female who you
noticed looks very tense lately. She
nervously laughs, talks rapidly and does
not hold eye contact. She also looks
fatigued and has been gaining weight.
How do you start the conversation?
B
B = Background
What is going on in your life?
Reveals what is going on with the patient
Do not ask “what is new” or stressful. If they
respond “the same old thing” or “nothing” go on
to “A”.
A
A = Affect (the feeling state)
“How do you feel about that?”
“How does that make you feel?”
“What is your mood?”
Allows the patient to report their current state of
feeling as they are often not in touch with their
emotional responses. Expression is highly
therapeutic.
T
T = Trouble
“What about the situation troubles you the
most?”
Most important question! Helps you and the
patient to focus on the subjective meaning
of the situation. May be an “aha” moment
for patient.
H
H = Handling
“How are you handling that?”
Gives an assessment of functioning:
destructive behavior
helps patients to get in touch with answers they
already have, but are not aware of
E
E = Empathy
“That must be very difficult for you”
Legitimizes the patient’s reaction
Provides acceptance that their response is
reasonable under the circumstances.
Benefits of BATHE
Patient feels supported
Enables you to identify:



Depression
Anxiety
Other disturbing
symptoms
Best time to BATHE
Early in your contact with patient
Provides time for interventions:
referral
social worker
classes
medications
other therapy
Three Step Problem Solving
What are you feeling?
(label the actual
feeling)
What do you want?
(specifically state your
goal)
What can you do
about it? (focus on
what you can control)
Patient in the Driver Seat
Sends the message you care
Sends message they are capable
of handling their situation
Help engage patient in problem
solving: they will become aware
they have some control over the
circumstances of their lives
Patient’s Ability
They have demonstrated the
ability to survive
They are responsible
They can leave a bad situation
They can change a bad
situation
They can accept it as it is
They can interpret it differently
Resist Giving
Advice!!!
Less effective
and
does not empower
them
Nurses continue to light the way to
patient health and wellness.
Case Study
DW states: “I’m working full time, and in school
part-time. I can’t sleep, in fact, I take
Lunesta…two pills every night and it doesn’t
work anymore. I get maybe 2 hours of sleep
every night. My sister calls me all the time and
my brother is not taking care of my dad, who has
Alzheimer’s. He is his live in care taker and I find
dad dirty, hasn’t eaten, he (dad) sometimes
shows up at my work disoriented and I probably
need to report my brother for neglect.