LEC 2.2: Communication (Part 2)

Slides 50-99: Therapeutic Communication, Helping Relationship, Communication & Nursing Management, Communication Among Health Professionals, Assertive Nurse, Disruptive Behaviors, Communication and the Nursing Process

1. Attentive Listening

2. Physical Attending

2 Key components of therapeutic communication

Attentive Listening

Listening actively with mindfulness, using all the sense, paying attention as opposed to listening passively with just the ear.

1. Face the person squarely.

2. Adopt an open posture

3. Lean toward the person.

4. Maintain good eye contact

5. Try to be relatively relaxed

According to Egan (1998), what are the 5 specific ways to convey physical attending?

1. Using silence

2. Providing general leads

3. Being specific & tentative

4. Using open-ended questions

5. Using touch

6. Restating or paraphrasing

7. Acknowledging

8. Clarifying time or sequence

9. Presenting reality

10. Focusing

11. Reflecting

12. Summarizing and planning

13. Seeking clarification

14. Perception checking or seeking consensual validation

15. Offering self

16. Giving information

16 Therapeutic Communication Techniques (Check 2.3 Knowt for specific flashcards about this)

1. Stereotyping

2. Agreeing and disagreeing

3. Being defensive

4. Challenging

5. Probing

6. Testing

7. Rejecting

8. Changing topics

9. Unwarranted reassurance

10. Passing judgment

11. Giving common advice

11 Barriers to Communication (Check 2.3 Knowt for specific flashcards about this)

Helping Relationship

an intellectual and emotional bond

1. Manage their problems in living more effectively and develop unused or underused opportunities more fully

2. Become better at helping themselves in their everyday lives

3. Develop an action-oriented prevention mentality in their lives

3 Basic Goals of a Helping Relationship (according to Egan, 2014)

1. Pre-interaction

2. Introductory

3. Working

4. Termination

4 Phases of a Helping Relationship

1st Phase: Pre-Interaction

One of the 4 Phases of a Helping Relationship

• The nurse should have an information about the client before the face-to-face meeting.

• Includes “endorsement”

Endorsement

In which the nurse from the prior shift tells the next nurse about the patient, especially their problems

• Checking the chart, meds, procedures

• What should I be telling my patient during rounds?

Phase 2: Introductory/Orientation/Pre-Helping Phase

One of the 4 Phases of a Helping Relationship

• Sets the tone for the rest of the relationship

• Resistive behaviors -inhibit involvement, cooperation or change

• Key component is Trust

Trust

Key component of the Phase 2 of Helping Relationship: Introductory

• reliance on someone without doubt or question

• A belief that the other person is capable of assisting in times of distress and in all likelihood will do so

Phase 3: Working

One of the 4 Phases of a Helping Relationship

• The nurse and the client begin to view each other as unique individuals;

• Caring is sharing deep and genuine concern about the welfare of another person.

• 2 Major Stages: Exploring and understanding thoughts and feelings AND Exploring Facilitating and taking action

1. Exploring and understanding thoughts and feelings

2. Exploring Facilitating and taking action

2 Major Stages of Phase 3: Working of a Helping Relationship

Exploring and understanding thoughts and feelings

One of the 2 Major Stages of a the Phase 3: Working of a Helping Relationship

Includes

• Empathetic listening and responding

• Empathy - ability to experience, in the present, a situation as another person's circumstances and feelings (Boyd, 2012)

• Respect

• Genuineness

• Concreteness

• Confrontation

Empathy

Ability to experience, in the present, a situation as another person's circumstances and feelings (Boyd, 2012)

Exploring, Facilitating, and taking action

One of the 2 Major Stages of a the Phase 3: Working of a Helping Relationship

What the nurse should do to address what the patient is feeling

Phase 4: Termination

One of the 4 Phases of a Helping Relationship

• Often expected to be difficult and filled with ambivalence

• On the other hand, it is natural to expect some feelings of loss and each person needs to develop a way of saying good-bye.

Dying patient and must support S.O. rather than grieve with them

Example of Phase 4: Termination

1. Listen actively.

2. Help to identify what the person is feeling.

3. Put yourself in the other person's shoes.

4. Be honest.

5. Be genuine and credible.

6. Use your ingenuity.

7. Be aware of cultural differences that may affect meaning and understanding.

8. Maintain client confidentiality.

9. Know your role and limitations.

9 Ways to Develop Helping Relationships

1. Language Barrier

2. Sensory Deficits

3. Cognitive Impairments

4. Structural Deficits

5. Paralysis

5 Special Needs that should be Addressed in Communication & Nursing Management

Language Barrier

One of the 5 Special Needs that should be Addressed in Communication & Nursing Management

clients with limited knowledge of the dominant language often find it difficult to communicate their needs or respond to communication from healthcare providers

Sensory Deficits

One of the 5 Special Needs that should be Addressed in Communication & Nursing Management

Perpetual Alteration: Assess for hearing deficits, use of hearing aids, or visual problems

Aphasia

Part of Sensory Deficits

In which one is unable to normally communicate; 2 types

Receptive/Wernicke’s Aphasia

Part of Sensory Deficits

Type of aphasia

Inability to interpret verbal and nonverbal messages

Expressive/Broca’s Aphasia

Part of Sensory Deficits

Type of aphasia

Patient can hear and understand but can’t respond properly

Use pen and paper

Example of a way to manage Expressive/Broca’s Aphasia

1. Look for a medical alert bracelet indicating hearing loss

2. Determine presence of a hearing aid and whether it is functioning

3. Observe whether client is attempting to see your face to read your lips or to use hands to communicate with sign language

3 Considerations for a Client with Hearing Sensory Deficit

Cognitive Impairments

One of the 5 Special Needs that should be Addressed in Communication & Nursing Management

• Assess whether these clients respond when asked a question

• Assess for the client's ability to understand written words. Use large, clearly written words when trying to establish abilities in this area.

Ask a closed question like “Can you hear me?” and watch for nonverbal response

For unconscious clients this is an indication that suggest comprehension of what was communicated

1. Nod of the head for YES and shake for NO

2. Hand squeeze or blink of the eye for YES or twice for NO

2 nonverbal responses for unconscious clients to answer closed questions

Structural Deficits

One of the 5 Special Needs that should be Addressed in Communication & Nursing Management

Devise a communication system like writing on a paper.

Paralysis

One of the 5 Special Needs that should be Addressed in Communication & Nursing Management

Determine whether the client can point, shrug, blink, or squeeze a hand.

1. Verbal

2. Nonverbal

2 Styles of Communication

Verbal Communication

One of the styles of communication

Nurse should focus on the following 3 areas:

1. Content of the message

2. Themes

3. Verbalized emotions

1. Content of the message

2. Themes

3. Verbalized emotions

3 Stages focused in Verbal Communication

Nonverbal Communication

One of the styles of communication

• Consider client's culture

• Pay particular attention to facial expression, gestures, body movements, affect, tone of voice, posture and eye contact.

SBAR Model

Provides a standardized framework for communicating important information, especially between a Nurse and Physician

Situation

Background

Assessment

Recommendation

SBAR

Situation

Component of SBAR

Example: Nurse calls the primary physician and says “Hi I am ___ calling regarding Patient Sally aged 19 who is having difficulty voiding.”

Background

Component of SBAR

Provide information pertinent to the current situation

“She is now 6 hours post-operation complaining of urgency to void but unable to do so even while sitting on commode with running water”

Assessment

Component of SBAR

Refers to the current condition of the client and any change in the assessment since the previous communication.

“Her vitals are stable but she reports being very uncomfortable due to urinary retention”

Recommendation

Component of SBAR

“Can I have an order for a straight urinary catheterization?”

Emotional Intelligence

Ability to form a work relationship with colleagues, displaying maturity in a variety of situations and resolve conflicts while taking into consideration the emotion of others

Assertive Communication

• Promotes client safety by minimizing miscommunication with colleagues.

• People who use it are honest, direct and appropriate while being open to ideas and respectful to the rights of the others.

1. Submissive

2. Aggressive

2 Types of Non-Assertive Communication

Submissive

One of the types of Non-assertive communication

Meet the demands or request of others without regard to their own feelings and needs

Aggressive

One of the types of Non-assertive communication

Described as "directed toward what one wants without considering the feelings of others

1. Incivility

2. Lateral/Horizontal Violence

3. Bullying

3 Disruptive Behaviors

Incivility

One of the disruptive behaviors

Rude or disruptive behavior that may result in psychological or physiological distress for the people involved

If left unaddressed, may progress into threatening situations

Lateral/Horizontal Violence

One of the disruptive behaviors

Physical, verbal, or emotional abuse or aggression directed at RN coworkers at the same organizational level

Bullying

One of the disruptive behaviors

Repeated, unreasonable actions of individuals directed towards an employee (or group of employees), which are intended to intimidate, degrade, humiliate, or undermine or which create a risk to the health or safety of the employees

Create a respectful work environment that empowers nurses and enhances the well-being of their clients

What is the goal in responding to disruptive behaviors?

Nursing Academic Programs & Nursing Continuing Education

Part of responding to disruptive behaviors

1. Develop and implement curricula

2. Provide training in conflict management.

3. Develop educational programs

1. Establish a therapeutic nurse-client relationship

2. Identify the most important client concern at that moment

3. Assess the client's perception of the problem as it unfolds

4. Facilitate the client's expression of emotions

5. Teach the client and family necessary self-care skills

6. Recognize the client's needs

7. Guide the client toward identifying a plan of action to a satisfying and socially acceptable resolution

7 Goals of a Therapeutic Communication

1. Appreciate experiences and beliefs that differ from your own

2. Recognize and interpret verbal and nonverbal messages

3. Guide the interaction to accomplish goals

4. Determine whether communication is taking place

5. Speak and remain silent when appropriate

6. Adapt to the pace, tone, and vocabulary of the client

7. Evaluate your own participation in an interaction

7 Skills Needed in a Therapeutic Relationship

Nursing Assessment

• This essential to effective communication

• Should look for factors that alter a client's ability to receive, process, rotransmit information

Nursing Diagnosis

Several NANDA diagnoses directly pertain to communication problems may involve the inability to receive, interpret, or express spoken, written, and nonverbal messages

Evaluate whether patient exhibits “Readiness for Enhanced communication” or “Impaired Verbal Communication”

1. Readiness for Enhanced Communication

2. Impaired Verbal Communication

2 NANDA Diagnoses Related to Communication

1. Expressive aphasia or physiological problem that impairs the ability to speak

2. Receptive aphasia or sensory deficits (vision, hearing) that impair the ability to receive messages

Impaired Verbal Communication is an appropriate diagnosis if the client exhibits either of the 2

1. Manipulate the environment

2. Provide support

3. Employ measures to enhance communication

3 Nursing interventions Related to Communication

1. Direct Eye Contact

2. Concerned Facial Expression

3. Leaning Forward

4. Personal Space

5. Professional Appearance

6. Sitting down to talk with the client

7. Touch

7 Nonverbal Behaviors that Enhance Verbal Communication