Lesson 2: part 3 (just communication skills)

Active listening - example

conveys attention using nonverbal behaviors such as leaning forward, nodding head

Open-ending questions - example

“Can you tell me more about that”

Focused questions - example

“How severe is your pain on a scale of 1-10 with 10 being the worst ever”

Closed-ended question - example

“Are you in any pain right now”

Clarification - example

[Restate]

• “You seem to be saying you need to know more about this diagnosis”

• “I am not sure I understand what you mean. Can you give me an example”

Paraphrasing / Restatement - example

[Restate]

• "You seem to be expressing frustration about your lack of progress”

Reflection - example

[Nurse mirrors back expressed emotion]

• “It sounds like you are frustrated by your lack of treatment options”

Summarizing - example

This is what we covered today. Tell me if I got it right.

Silence - example

[Nurse sits calmly while remaining therapeutically silent so patient can process data]

Providing feedback - example

“Would you repeat back to me what you understand about your medicine”

Validation - example

“How do you feel about what I just said”

Using technology - example

[Text a message to patient]

• remember to send me your blood glucose reading for today

Active listening a dynamically focused

interpersonal process

• nurse hears message, decodes meaning, asks questions, provides feedback

Active listening: Transactional process

includes verbal and nonverbal components of message

Active listening: Goal is to

understand what patient is trying to communicate through his or her story

• requires full attention to understanding patient’s perspective

Active listening is a

intentional form of listening

• requires extra effort

  • note feelings and look for underlying themes

Active listening: Goal is for

mutual understanding of facts and emotions

Active listening contributes to

• fewer incidents of misunderstanding

• increase accuracy of data

• stronger health relationships

Active listening: Core clinical questions (open-ended)

encourage patient exploration, expand on ideas, voice confustion

Asking questions: Open-ended

patient expresses problem in own words; open to interpretation and cannot be answered by “yes” or “no” or one-word response

• usually begins with “what,” “how,” “can you describe for me”

• broader context for each patient’s unique

• without influencing

Asking questions: Focused

require more than a yes or no answer but place limitations on the topic. good for prioritizing, details, limited verbal skills

• Circular - form of focused, look at other people within patient’s support circle and identify differences in impact on each

• emergencies, concentrate on details, limited verbal skills, prioritize immediate concerns

Asking questions: Close-ended

narrow the focus to a single (yes, no, or simple phrase) answer. use when need to obtain information quickly and emotions come second

• emergency situation, when goal is to obtain information quickly

• emotional of reactions are of secondary

Clarification

• a brief question or a request for validation

• used to better understand the message

• neutral tone of voice

  • example: “tell me more about…” or “I’m not sure I understand"…”

Paraphrasing is used to

check the nurse’s translations of the patient’s words

• nurse informs core elements or patient’s original message

• a shorter, more specific statement

Paraphrasing objective

find a common understanding of the issues important to the patient

• Example: Patient - “I can’t take this anymore. The treatment is the worse…” Nurse - “It sounds like you’ve had enough.”

Restatement is used to

• broaden a patient’s perspective or

• give the nurse a sharper focus on a specific part of the communication

Restatement is when you

repeat parts of the message in the form of a query

• Example: “Let me see if I have this right…” you [repeat the patient’s words]

effective when a patient overgeneralizes or seems stuck in a repetitive line of thinking

Reflection focuses on

the emotional part of the message

• let’s the nurse “empathetically mirror” what they sense the patient may emotionally experiencing

• a simple observational common, expressed tentatively

Reflection gives the patient

an opportunity to validate or change the narrative

• way to use

  • reflect on vocal tones (anger or frustration in the voice)

  • link feelings to content or with past experiences (reminds of feelings)

Summarization is used to

review content and process

• pulls several ideas and feeling together, into a few succinct sentences

  • followed by a comment seeking validation

Summarization can bridge a

change in topic or focus of the conversation

• do before the end of the conversation

Silence is an

intentional short pause to

• allow patient to think and

• let nurse process what was heard before responding

Helps emphasize important points for patient reflection

Giving feedback

feedback is a message a nurse gives to the patient in response to a question, verbal message or observed behavior

Giving feedback: Effective feedback

• specific and directed to behavior

• offers a neutral mirror (allows pt to view a problem from a different perspective)

• most relevant when it only addresses the topic under discussion

• clear, honest, and reflective

• supported with realistic examples (believable)

Giving feedback: Avoid using

“why” questions as initial questions as they are often difficult to answer. instead ask “how” or “what” questions as they are more focused and easily answered

Giving feedback: Example when dealing with a difficult patient

• “Why are you behaving in this was?”, you can say

• “How can I help to make this situation better?” or

• “What are some coping mechanisms you have used in the past when you feel upset

Feedback: Timing

• Give as soon as possible after a behavior in need of change is observed

• consider the patient’s readiness to hear feedback

• to the point and empathetic

Feedback: Validation is a

special form of feedback

• used to ensure that both participants have the same basic understnading

Feedback: Validation is not simply asking

“do you understand?”

• used to uncover the patient’s reactions or questions about an issue

• allows the nurse to frame comments that match the patient’s needs