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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 stage Stabilization and repair Exhaustion 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
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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
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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
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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 – special care Face neck / front of the body Intimate – 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
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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 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
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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 members of the health care team
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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 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
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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 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)
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Implementation Sharing hope “ Sharing humor ‘
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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
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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 …”
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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”
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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 ‘
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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 client status – ex vital signs, care etc (SBAR) 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 Reflection Citing specific behaviors Asking for feed back
“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.aspx
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References Google Images Microsoft Word images
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