Communication N001 Spring 2013

Student Learning Outcomes In addition to course SLO # 3 Please review lecture specific SLO's on Course objectives, lecture & lab outlines

NCLEX ® Question

Overview Introduction Stress & Coping Verbal communication Nurse client relationship Interviewing Communication with other members of the health care team Chain of command Define collaboration

Introduction Part I “Communication is an essential part of patient centered care. Patient safety also requires effective communication. (Potter 8th ed. P. 309)

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

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)

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

General Adaptation Syndrome Alarm reaction Hormones activated Pupils dilate Resistance stage Stabilization and repair Exhaustion stage Body can no longer resist effects Death may result

Coping Individual’s effort to manage physiological stress Coping strategies Effectiveness impacted by age, experience & cultural background Strategies differ according to the stressor

Coping Individual’s effort to manage physiological stress Coping strategies Effectiveness impacted by age, experience & cultural background Strategies differ according to the stressor

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

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)

Ego Defense Mechanisms Help regulate emotional distress Denial Regression See (Potter & Perry) for a more complete list

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

Critical Thinking Includes: Curiosity Motivated to learn more Creativity & Perseverance Attitudes that assist the nurse to communicate and identify innovative solutions

Critical Thinking A self confident attitude Attitude of fairness Listens to both sides of the issue

Critical Thinking Humility Willingness to ask for help Appropriate approach for each situation

II. Elements of Communication 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

Elements Feedback – message thru receiver receives and returns 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

Elements of Communication Interpersonal variables- factors within both the sender & receiver Impacts perception Environment- where the communication process takes place Example need for privacy

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

Verbal Communication Clarity Brevity Timing Relevance

Nonverbal Personal appearance / Presentation of self Posture & Gait Facial expression Eye contact Cultural ramifications Gestures Sounds

Presentation of Self Breath and depth of knowledge Flexibility Enthusiasm Sincerity Self perception

. Presentation of Self First impressions Communication enhanced by your credibility Good personal hygiene Good grooming Appropriate uniform

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

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

Personal Space Social zone– extends 4 to 12 feet Communication – formal Conducting a group Sensory involvement less intense Increased eye contact

Personal Space Public zone 12 feet and beyond Lecturing in a classroom

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 – special care Face neck / front of the body Intimate – sensitivity important Genitalia & rectum (Potter box 24 –3)

Forms of Communication Symbolic Art & Music Metacommunication All factors that influence communication Written communication

IiI. Nurse Patient Helping Relationships http://www.mynursesregistry.net/Portals/0/my_nurses_201.jpg

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. )

Nurse Patient Relationship Includes Specific time frame Goal directed approach Confidentiality Nonjudgmental Focus on client's needs

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)

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)

Professional Relationships Nurse family relationships Process is similar to assisting individuals Take into account family & group dynamics Family roles & responsibly Nurse Community relationships Participation in local activities Leadership

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

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

Clinical Assignment Interviewing members of the health care team

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

SBAR

IV. Application of the Nursing Process

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

Assessment Client interview Situational context Environmental context Reason for the communication Environmental context 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

Nursing Diagnosis 1. 2. 3. 4.

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

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)

Implementation Sharing observations Sharing empathy Comment on how other person looks, sounds or acts “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)

Implementation Sharing hope “ Sharing humor ‘

Implementation Sharing feelings Using touch 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

Implementation Use of silence Providing information Clarifying ‘ 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 …”

Implementation Focusing Paraphrasing 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”

Implementation Asking relevant questions Summarizing Seeking information necessary for decision making Summarizing Concise review of key aspects of the interaction Self disclosure by the nurse ‘

Implementation Confrontation Assist the individual to become aware of inconsistencies Improves client self awareness Only use after trust has been established

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

Clinical Skills Lab Assignment Posted on Moodle

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

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

Implementation Be sure and review the chart in Potter & Perry Page 357 – that focuses on clients with special needs.

Implementation Documentation

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?

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

V. Student responsibilities Communication with team leaders Check in – Report Check out – Report to RN Update client status – ex vital signs, care etc (SBAR) Situation Background Assessment Recommendation

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

Demonstrating Caring by Expressing Empathy Adapted from Marilyn Tagatac’s Presentation Physiology of Compassion 8/5/2009 Slides 48-50

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

Empathy Steps Enquire/explore client’s feelings in order to accurately identify them You feel __________________-? Because _________________ the reason the client identifies the feeling

Class exercise #1

In class exercise Part II

Remember Reflection Citing specific behaviors Asking for feed back “I feel” statements Reflection Citing specific behaviors Asking for feed back Open ended questions

Final Words Communication Should Be Complete Clear Concise Cohesive Courteous

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

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

References http://www.azhha.org/patient_safety/sbar.aspx http://www.stanly.edu/educational/public_services/ps_images/36.jpg (this link does not open) http://vtlmi.labor.state.vt.us/occvid/images/29-1111.00-1.jpg (this link does not open) http://www.ihi.org/IHI/Topics/PatientSafety/SafetyGeneral/Tools/SBARTechniqueforCommunicationASituationalBriefingModel.htm

References Google Images Microsoft Word images