Chapter 7 Patient Safety Risk Factors Affecting Communication Climates

Communication Climate Defined The tone, emotions, and attitudes of individuals in relationships

Patient-Safe Strategy Before interrupting or joining a conversation between two or more people, assess the communication climate

Communication Risk Factors Potentially Create Negative Communication Climates Emotional risk factors Fear of the unknown Anxiety Sadness, grief, loss Anger and resentment Physiological risk factors Physical disability Sensory impairment/memory loss Sedation Fatigue

Patient-Safe Strategies to Promote Positive Communication Climates Confirming Messages Recognition Acknowledgement Endorsement Complement Empathy

Avoid Disconfirming Messages Unreceptive Interruption Irrelevant Tangential Impersonal Ambiguous You are wrong; I am right

Illness: Affects Communication Climate Illness threatens self-esteem and self-worth, resulting in high risk for negative communication climates Illness threatens livelihood, role performance, and life itself Illness results in alterations in tone, emotions, and attitudes of patients, family members, and nurses

Impact of Illness on Communication Climate Physical stages of illness: Onset, course, prognosis Psychosocial stages: Damage to self-esteem and feelings of worthlessness associated with loss Transition to illness Acceptance Convalescence Patient responses to dependency and the sick role are unique, based on bio-psycho-social-cultural-spiritual makeup of the patient/family

Transforming Negative Climates Encourage emotional release by empathy Recognize emotions; acknowledge and accept emotional responses Create an atmosphere of safety and trust through patient-safe communication process

Empathic Conversations Between Patient and Nurse Patients and families must believe nurse understands their physical and emotional needs Nurse must clearly communicate to the patient that the message sent was interpreted correctly Nurse must clearly communicate what needs to be done next to manage the current situation

Patient-Safe Communicators Solicit feedback— verify all messages Observe body language —actions speak louder than words (face and body) Assess appearance —clues to physical and emotional state (clothing and hygiene) Respond to the real message- “It’s not what you say, but how you say it….”

Patient-Safe Strategy of Empathy Verbally and nonverbally recognize emotions Offer support: “We’ll work on this together,” “I’m here for you”

Empathy vs Sympathy Empathy means you remain emotionally separate from the other person: you can still be objective

What is Sympathy? Taking on the other’s problems as if they were your own Lose objectivity Can no longer solve problems (nurses are paid to think) No longer therapeutic

Managing Your Emotions to Promote Positive Communication Climates Recognize your feelings Cool off Take responsibility for your feelings Use “I” statements Responding to a personal attack