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 observe- how to observe- what symptoms indicate improvement- what the reverse- which are of importance- which are of none- which are the evidence of neglect- and 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: EnvironmentalManipulation Nutrition Nutrition Conservation of Patient Energy. Conservation of Patient Energy. y/florence.html y/florence.html y/florence.html y/florence.html

Florence also tells us what nursing is not: Nursing is not limited to, nor defined by medical acts. Nursing is not limited to, nor defined by medical acts.

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 Nurse’s Additional Role

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 Legitimizes the patient’s reaction Provides acceptance that their response is reasonable under the circumstances. Provides acceptance that their response is reasonable under the circumstances.

Benefits of BATHE Patient feels supported Enables you to identify: Depression Depression Anxiety Anxiety Other disturbing Other disturbing symptoms symptoms

Best time to BATHE Early in your contact with patient Provides time for interventions: referral social worker classesmedications 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.