Non-therapeutic techniques.
Barriers to effective communication.
Communicating with the angry,
demanding or manipulative patient.
Important to consider:
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Professionalism
Courtesy
Confidentiality
Availability
Trust
Empathy
Sympathy
Acceptance
Respect
Silence
Hope
Encouragement
Socializing
Gender/Cultural sensitivity
CommunicationNursing Process
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Assessment
Physical and Emotional Factors
Developmental Factors
Sociocultural Factors
Gender
CommunicationNursing Process
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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
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Focusing
Paraphrasing
Asking relevant questions
Summarizing
Self-disclosure
Confrontation
Barriers to Effective
Communication-2
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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!