exam 2 - communication

competency 1: values/ethics for interprofessional practice

work with individuals of other professions to maintain a climate of mutual respect and shared values

influence as nurses was built on developed respect, trust, ethical communication and collaboration that created a foundation of global respect for nurses

growing competence in interprofessional values and ethics positions nurses to…

leverage interprofessional collaboration strategically

shape future successes

bring supportive recognition to nursing and other health professions

competency 2: roles/responsibilities

use knowledge of one’s role and those of other professions to appropriately assess and address the healthcare needs of pts and to advance the health of populations

9 recommendations for interprofessional based care

1. communicate one’s role and responsibilities to pt, families and other professionals

2. recognize one’s limitations in skills, knowledge, and abilities. know when to ask for help

3. engage diverse HC professionals who complement one’s professional expertise

4. explain the roles of other care providers and how the team works together to provide care

5. use the full scope of knowledge, skills and abilities of available health professionals and health care workers to provide care that is safe, timely, efficient, effective and equitable

6. clarify each team member’s responsibility in executing the treatement

7. forge relationships with other professions to improve care and advance learning

8. engage in continuous professional and interprofessional development to enhance team performance

9. use unique and complementary abilities of all team members to optimize pt care

competency 3: interprofessional communication

communicate with pt, families, communities and professionals in health fields in a responsive manner that supports a team approach to the promotion and maintenance of health and the prevention and treatment of disease

elements that are critical to effective communication

routine, reliable and secure forms of communication 

communication systems to facilitate interaction and improve efficiency

be comfortable when providing constructive feedback

be receptive when receiving constructive feedback

emphasis on the team in patient centered care

competency 4: teams and teamwork

growing complexities of tasks in HC make teamwork necessary to be successful

apply the principles of team dynamics to perform effectively in different team roles to plan, deliver and evaulate pt/population-centered care and policies that are safe, timely, efficient, effective and equitable

sender and receiver

person who encodes/delivers message to the one receiving/decoding

messages

content of the communication

channels

means to convey/receive messages

feedback 

message returned by receiver

interpersonal variables

factors withing sender/receiver that influence

environment

context/setting where takes place

ensure environment is therapeutic

why is therapeutic communication so important

establishes a therapeutic relationship with the client

creates possbility for positive outcomes of care

uses both verbal and nonverbal communication 

intrapersonal communication

that which is within the communicator’s internal environment

involves personal translation processes to constantly encode/create or decode/interpret messages

influencing factors → personality, past experiences and relationships

biggest influence on interpretation → context

self awareness

communication self-assessment

listening for the other person’s pov before replying?

allowing others to tell me differing ideas?

assuming that what is clear to me may not be clear to the receiver?

being influenced by a persuasive speaker because of appearance, manner and voice?

getting annoyed with others bc they do not seem to understand what I am saying?

interrupting others so as to interject my pov?

silence

critical part of listening process

allows for reflection and meaning 

allows time for client to gather their thoughts and absorb info that has been given

important to get comfortable with “uncomforable” silence, avoid urge to fill in blanks

open questions vs closed questions

open allows for continued discussion; “how are you feeling”; allows the client to talk more

closed looks for specific answer; “are you okay”; elicits a yes or no

interpersonal skills essential for nurses

good communication skills builds therapeutic relationships with pt, families, colleagues

nontherapeutic methods → negative consequences

4 rights of effective communication

right route

right dose

right time

right person 

right route

important to understand meaning of nonverbal (NV) cues

nurse must be skillful at interpreting NV communication in others and be careful with one’s own NV cues

types of nonverbal communication

facial expression

eye contact: be aware of cultural differences

hand, arm gestures: open gestures/posture, lean forward → willingness to talk

respecting personal space/boundaries: in appropriate setting with assurance of confidentiality

right dose

guidelines to determine intesity, depth and content of interaction 

strategies: mirroring, humor, reframing, sharing of personal info/self-disclosure, presentation of reality, use of metaphors are appropriate

right person

client’s decision about when, how much and who to confide in

nurse can: be there as needed, understand if pts wish is not to discuss/interact

nurse also communicates with pt family: must understand that complex family dynamics exist; confidentiality is of utmost priority

pt can designate family member or significant other that can or cannot or discuss info either in person or over phone

right time

pick a good time

pick the right place, avoid distractions

general tips: name

call by proper name, Mr. or Ms, unless insist otherwise

try to pronounce names correctly, or ask if in doubt

refrain from anglicizing/shortening names before asking, or calling clients “honey” etc

general tips: personal space

ask permission to sit on bed 

sit facing client, preferably at same level

general tips: keep communication with co workers professional

do not identify clients by name in open areas, use room number

do not ID or label clients by race, religion, handicap, disease

avoid inappropriate remarks/stories about clients, families, etc

other general tips about communication

always acknowledge the client’s feelings first, then given them time to talk

always let them know they have a right to feel how they feel

when clients become angry, don't get defensive, gently explore and try to find why they became angry, can remove yourself

adaptive techniques 

often necessary for clients with special needs

groups:
- age(infants, children, adolescents, older adults)
- disability(aphasia, dysarthria, mute)
- cognitive impairment(dementia) 
- unresponsive (hearing is last sense to go)
- non English speaking(language line)

tips when communicating with older adults

check for hearing aid, identify deficits first

get their attention before speaking

face them so he/she can read your lips

amplify voice only if needed

conductive environment, minimize distractions, turn off tv

speak slowly, clearly; maintain good eye contact

use short sentences, simple words

stick to one topic at a time and ensure understanding

match body language to speech

give plenty of time to respond, ask questions

summarize points

have family/caregiver present if possible

therapeutic communication techniques

active listening; both verbally and nonverbally

sharing observations

providing empathy; nonjudgmental, “do you want to talk about …”

sharing hope; “i believe/have faith” no false reassurance

humor

sharing feelings

using therapeutic touch

using silence

more therapeutic communication techniques

providing info; educating 

clarifying; don't understand, tell me more

focusing; specific details

paraphrasing; shows active listening

asking relevant questions; open ended, focus on one question at a time

summarizing and planning; “tmr we will…” if client is tired

self-disclosure; can share personal experiences

confrontation; only if trust is established

non therapeutic communication techniques

asking personal questions

probing giving personal opinions

changing the subject

automatic (stereotyped) responses

parroting

false reassurance

sympathy

asking for explanations

approval/disapproval

defensive responses

passive or aggressive responses

arguing

failure to listen and failure to probe