Non-therapeutic techniques. Barriers to effective communication. Communicating with the angry, demanding or manipulative patient. Important to consider: • • • • • • • • psychological and emotional state of the patient spiritual elements financial state educational background mental state social well being familial aspects physical state It is important working with patient to think differently of: –partnership –consumer rights –consultation –not forcing my views upon others –checking out with people what they want –giving people options. Subjective data • Client—'I feel really awful, hot and dizzy all the time.' • Client—'They told me it was really bad, much worse than they thought.' • Husband—'She went through a really bad patch after her dad died.' • Nurse—'He looks depressed to me.' • Client—'Fit as a fiddle all my life nurse, can't understand what all the fuss is about.' Objective data • measurements (like a client's temperature) • examination (like listening to the client's chest sounds with a stetho-scope) • laboratory tests (like blood or urine) • past records (previous admission notes etc). Loss, bereavement and grief • • • • • • • • • • • • • • • • abbreviated grief actual loss anticipatory loss bereavement death dysfunctional grief grief inhibited grief loss mourning pathologic grief perceived loss physical loss psychological loss terminal illness unresolved grief. Care of the dying • construct a list of common psychological and physical problems associated with dying • Suggest how these problems could be rephrased into a possible nursing diagnosis • What would the nursing goal be for each of these problems? • Outline nursing interventions for each of these problems • What would the desired outcome-criteria be for clients with grief and loss and the physical symptoms related to dying? • assist the family in dealing with the impending death of a loved one • facilitate their - coping response, - readjustment - bereavement and - participation in care. Modes of communication • • • • • • • Verbal communication - spoken or written word Be aware of: vocabulary - various subcultures clarity and brevity use layman’s terms – denotative and connotative meaning pacing when speaking Intonation Verbal communication • Timing and Relevance • Humor Nonverbal Communication • Transmission of messages without the use of words • Factors • Personal appearance • Facial expression • Posture / Gait • Eye Contact Nonverbal communication factors • Gestures • Touch • Territoriality and Space Factors to influence communication • • • • • • Perceptions - personal view of events Values Emotions Gender Knowledge Roles and relationships Factors to influence communication • Sociocultural background • European Americans more open • Native Americans comfortable with silence Zones of Personal Space • • • • Intimate (0-18 in) Personal (18-4ft) Social (4- 12 ft) Public (12 ft or greater) Forms of Communication • Therapeutic- Communication that is beneficial in developing a nurse-client helping relationship • Non-Therapeutic- Communication that is not beneficial or helpful to people involved Therapeutic Communication • Listening - nonverbal; conveys interest in the client; active listening • Listening vs. Hearing • Nod as client speaks • Appear attentive • Conveying Acceptance - listen without judging Therapeutic Communication • Paraphrasing • Focusing - centering information on the key elements of the message • Stating observations • Clarifying • Focus • Assertiveness • standing up for one’s rights without violating those of others • Summarizing - concise review of main ideas • Appropriate self-disclosure Barriers to Effective Communication • • • • • • • • • • • • • Inattentive listening Medical vocabulary Giving personal opinions Being defensiveness Showing disapproval Cultural differences Prying Offering false reassurance Being defensive Asking why Stereotyping - generalized beliefs held about people Changing the subject inappropriately Showing approval or disapproval Components of helping relationships • Trust - Belief that other people will provide help in times of need and distress • Empathy - Ability to try to understand and enter the patient’s frame of reference • Sympathy - expression of one’s own feelings about another’s predicament Components of caring relationships • • • • Caring - positive regard for another person Availability Courtesy/Confidentiality “ A Professional” Communication with special populations • Children • Nonverbal messages - avoid sudden movements or gestures • Calm and gentle • Be honest • Short simple concrete sentences and explanations Communication with the older adult • Changes in hearing • Tinnitus • Decrease in visual acuity The Nurse-Client Helping Relationship • • • • Helping relationships are created through the nurse’s: Application of scientific knowledge Understanding of human behavior and communication Commitment to caring *Therapeutic communication doesn’t happen. You have to work at it. Phases of Nurse/ Client Relationships • • • • Pre-interaction Phase Orientation Phase Working Phase Termination Phase Pre-interaction Phase • Before meeting client • Review data available ( diagnosis, medical history) • Assign appropriate room • Anticipate concerns or needs Orientation Phase • Introduce yourself • Set a positive tone with a warm empathetic manner • Assess client health status • Prioritize needs and goals of your client • Clarify client’s and your roles • Let the client know when to expect the relationship to end Working Phase • Encourage and help the client express feelings • Encourage and help client set goals • Take action to meet the goals set the client Termination Phase • Remind client that termination is near • Evaluate goal achievement • Help to achieve a smooth transition to other caregivers Techniques for improved therapeutic communication • • • • • • • • • • • • • • Professionalism Courtesy Confidentiality Availability Trust Empathy Sympathy Acceptance Respect Silence Hope Encouragement Socializing Gender/Cultural sensitivity CommunicationNursing Process • • • • • Assessment Physical and Emotional Factors Developmental Factors Sociocultural Factors Gender CommunicationNursing Process • • • • • • • • • Nursing Diagnosis Impaired verbal communication Anxiety Social isolation Ineffective coping Impaired social interaction Powerlessness Planning Goals and outcomes; priorities; continuity of care. Therapeutic Communications Implementation • Attentive Listening • Sharing observations • Sharing empathy • Sharing hope • Sharing humor • Sharing feelings • Using touch • Using silence • Providing information • Clarifying Therapeutic Communication -2 • • • • • • Focusing Paraphrasing Asking relevant questions Summarizing Self-disclosure Confrontation Barriers to Effective Communication-2 • • • • • Arguing Passive or Aggressive Responses Defensive Responses Asking personal questions Sympathy and not empathy CommunicationNursing Process - Evaluation • Analysis of communication patterns • Process recordings • Evaluate goal of improving communication. • If goal unmet, utilize new and different nursing interventions. Communication Summary • Communication is important. • Collect data and establish trusting relationship. • Share information with other team members. • Implement care and evaluate goals . Critical Thinking Exercise • Mr. Phillips is a 70 year old resident of the long term facility, who has begun making inappropriate sexual comments to the staff. He asks staff members for a “little hug” ( and worse ) and tries to pull young female members of the staff into empty rooms. The Nursing Assistant have asked you to help them create a plan to “deal with this”. What will you do then?” Thank you for your attention!