Studied by 7 people
Gain the person’s attention before speaking (face the person).
• Use your active listening skills, especially eye contact.
• Use brief sentences (fewer words).
• Speak clearly and slightly slowly.
• Add nonverbal cues to your message.
• Observe the person for their nonverbal cues.
• Use positive reinforcement (keep messages short and sweet).
• Use familiar objects to give cues, such as holding up a hairbrush when you want to brush the person’s hair.
• Use memory books or family photos, especially when the person asks about someone.
• Verify the person’s understanding by having them restate (summarize, not just repeat).
Guidelines for communicating with people with dementia [10]
• Assess psychological readiness to communicate.
• Introduce yourself and convey respect, an understanding of the person’s frustrations, and your willingness to communicate.
• Be concise.
• Always maximize the use of communication aids, such as whiteboard and marker, communication boards, pictures, gesture, and electronic communication aids.
• Pick the means of available communication best suited to the person. Multiple pathways using both auditory and visual methods are standard recommendations.
• Always help people to use their assistive equipment (e.g., adjust hearing aids, provide their glasses, use a smartphone for texting).
• Assess the person’s understanding of what was said by having them signal or repeat the message.
Suggestions for helping people with communication disorder due to sensory loss [7]
• Tap on the floor or table to get the person’s attention via the vibration.
• Communicate in a well-lit room and face the person, so they can focus their attention, see your facial expression, and watch your lips move.
• Choose a quiet, private place; close doors and turn off TVs or radios to decrease environmental noise.
• Use facial expressions, hand signals, and gestures that reinforce verbal content, or request a sign language interpreter, perhaps a family member.
• Speak distinctly, without exaggerating words or shouting. People who are hard of hearing respond best to well-articulated words spoken in a moderate, even tone. Speak only as loudly as you need to.
• Write down important ideas and allow the person the same option to increase the chances of successful communication. Always have a writing pad or smartphone available.
• Arrange for a TTY or relay service or an amplified telephone handset for people who are hard of hearing, if they do not text.
• If the person is unable to hear, rely primarily on visual materials.
• Arrange for closed-captioned television.
• Use text messaging, email, and phone apps.
• Suggest to the person who is deaf or hard of hearing to verbalize speech, even if the person uses only a few words or the words are difficult to understand at first.
• Use an intermediary, such as a family member who knows sign language, to facilitate communication with people who are deaf and who sign.
Suggestions for communicating with people who are hard of hearing [12]
• Let the person know when you approach by identifying yourself and using a simple touch; always indicate when you are leaving.
• Adapt communication to compensate for lack of nonverbal messaging.
• Adapt teaching for people with low vision by using large print, audio information, or Braille.
• Do not lead or hold the person’s arm when walking; instead, allow the person to take your arm.
• Use touch and physical proximity while you are with the person; give the person something substantial to touch in your absence.
• Develop and use signals to indicate changes in pace or direction while walking.
Suggestions for communicating with people who are blind or visually impaired [6]
• Speak slowly, using simple sentences; ask yes or no questions.
• Talk about one thing at a time, or ask one question at a time; do not rush.
• Give extra time for the person to process what you say and formulate a response; do not interrupt.
• Avoid prolonged, continuous conversations; instead, use frequent, short talks. Present small amounts of information at a time.
• When the person falters in written or oral expression, supply needed compensatory support. Sometimes just giving the person extra time is enough.
• Encourage efforts to communicate.
• Provide regular mental stimulation in a non-taxing way.
• Help people to focus on the faculties still available to them for communication.
• Use visual cues; for print materials, use short, bulleted lists.
• Make referral to a speech pathologist and occupational therapist to help people obtain and use AAC devices.
Strategies to assist people with cognitive processing disorders of speech and language difficulties [10]
• Encourage the person to display pictures or a simple object from home.
• Orient the person to the people, place, and time.
• Ask questions, especially ones the person can answer with a yes or no.
• Frequently provide information about condition and progress.
• Reassure the person that cognitive and psychological disturbances are common.
• Give explanations before procedures by providing information about the sounds, sights, and feelings the person is experiencing.
• Make communication assistive devices available, ranging from paper and pencil, an alphabet board, or communication cards to electronic communication aids.
• Always assess whether your communication was successful by having the person signal back.
trategies for Communicating with People with Treatment Related Communication Disorders [8]
• Violating someone’s personal space
• Speaking in a threatening tone
• Providing unsolicited advice
• Judging, blaming, criticizing, or conveying ideas that try to create guilt
• Offering reassurances that are not realistic
• Communicating using “gloss it over” positive comments
• Speaking in a way that shows you do not understand the person’s point of view
• Exerting too much pressure to make a person change their unhealthy behaviour
• Portraying self as an infallible “I know best” expert
• Using an authoritarian, sarcastic, or accusing tone
• Using “hot button” words that have heavy emotional connotations
• Failing to provide health information in a timely manner to stressed individuals
Nurse Behaviours that can create anger in others [12]
• Listen to the person’s perspective
• Acknowledge you have heard by validating, using “I” sentences, avoiding “you”
• Stay focused on the current issue; know and control your own responses
• Use the “no blame” approach and discuss options, alternative solutions
• Negotiate and agree on a solution
• Summarize
• Follow through.
Principles of conflict resolution [7]
C: Clarify the behaviour that is a problem
Use communication skills, especially active listening skills, to identify issues of concern to the person. Factually state the problem, focusing only on the current issue.
A: Articulate why the behaviour is a problem
Explain the institutions policies, set limits
R: Request a change in the problem behaviour
Work with the entire health team so all use the same approach to the person’s demands.
E: Evaluate progress
Provide education: explain all options, with outcomes.
Nursing communication interventions CARE steps [4]
Show person’s response to care
Compile data from many people to identify best practice
Communicate person’s information and show response tocare
Compile data from many people to identify best practice
Give evidence for reimbursement
Provide proof of quality care
Make a permanent record of care given
Why do I document? [7]
Change your EHR password frequently
Enter notes in real time
Maintain confidentiality
Verbalize a summary of what you enter at the bedside, so person can validate information
Explain to the person the e-documentation process, etting them know they can ask questions as you enter data
Review or read back crucial data you have entered
Make eye contact periodically
Document all changes
Verbally Reinforce important information to staff, even if it has been entered into record
Participate in e-training updates
Correct errors per agency protocol
Tips for Electronic health record use to promote a culture of person safety [11]
Nuclear family:
a father and mother, with one or more children, living together as a single family unit
• Extended family
: nuclear family unit’s combination of second- and third-generation members, related by blood or marriage but not living together
• Three-generational family:
any combination of first-, second-, and third-generation members living within a household
Dyad family:
• husband and wife or other couple, living alone without children
• Single-parent family
: divorced, never married, separated, or widowed adult and at least one child; most single-parent families are headed by women
Stepfamily:
• family in which one or both spouses are divorced or widowed, with one or more children from a previous marriage who may not live with the newly reconstituted family
• Blended or reconstituted family:
a combination of two families, with children from one or both families and sometimes children of the newly married couple
• Common law family:
an unmarried couple living to-gether, with or without children
• No kin:
a group of at least two people sharing a nonsexual relationship and exchanging support, who have no legal, blood, or strong emotional ties to each other
• Polygamous family:
one man (or woman) with several spouses
• Same-sex family:
a same-sex couple living together, with or without children
• Commune:
groups of individuals that may or may not be related, living together and sharing resources
• Group marriage
: all individuals are “married” to one another and are considered parents of all the children
• Initiating: Identifies tasks or goals; defines group problem; suggests relevant strategies for solving problem
• Seeking information or opinion: Requests facts from other members; asks other members for opinions; seeks suggestions or ideas for task accomplishment
• Giving information or opinion: Offers facts to other members; provides useful information about group concerns
• Clarifying, elaborating: Interprets ideas or suggestions placed before group; paraphrases key ideas; defines terms; adds information
• Summarizing: Pulls related ideas together; restates key ideas; offers a group solution or suggestion for other members to accept or reject
• Consensus taking: Checks to see whether group has reached a conclusion; asks group to test a possible decision.
Task Functions: [6]
Task functions
Behaviours Relevant to the Attainment of Group Goals
Maintenance Functions
: Behaviours That Help the Group Maintain Harmonious Working Relationship
Harmonizing: Attempts to reconcile disagreements; helps members reduce conflict and explore differences in a constructive manner.
• Gatekeeping: Helps keep communication channels open; points out commonalties in remarks; suggests approaches that permit greater sharing.
• Encouraging: Indicates by words and body language unconditional acceptance of others; agrees with contributions of other group members; is warm, friendly, and responsive to other group members.
• Compromising: Admits mistakes; offers a concession when appropriate; modifies position in the interest of group cohesion.
• Setting standards: Calls for the group to reassess or confirm implicit and explicit group norms when appropriate.
Maintenance functions [5]
• Group tasks should be within the membership’s range of ability and expertise.
• Comments and responses should be non-evaluative, focused on behaviours rather than on personal characteristics.
• The leader should identify group accomplishments and acknowledge member contributions.
• The leader should be empathetic and assist members in giving effective feedback.
• The leader should help group members view and work through creative tension as being a valuable part of goal achievement.
Communication principles to facilitate cohesiveness [5]
Goals are clearly identified and collaboratively developed
Open, goal directed communication of ideas and feelings is encouraged
Power is equally shared and rotates among members
Decision making is flexible and adapted to group needs
Controversy is viewed as healthy because it builds member involvement and creates stronger solutions
There is a healthy balance between task and maintenace role functioning
Individual contributions are acknowledged and respected
Interpersonal effectiveness, innovation, and problem-solving adequacy is evident
Characteristics of effective groups [8]
Regression:
returning to an earlier, more primitive form of behaviour in the face of a threat to self-esteem
Repression
: unconscious forgetting of parts or all of an experience
Denial
: unconscious refusal to allow painful facts, feelings, or perceptions into awareness
Rationalization
: offering a plausible excuse or explanation for unacceptable behaviour
Projection
: attributing unacceptable feelings, facts, behaviours, or attitudes to others; usually expressed as blame
Displacement
: redirecting feelings onto an object or person considered less of a threat than the original object or person
Intellectualization
: unconscious focusing on only the intellectual and not the emotional aspects of a situation or circumstance
Reaction formation:
unconscious assumption of traits that are the opposite of undesirable behaviours
Sublimation:
redirecting socially unacceptable unconscious thoughts and feelings into socially approved outlets
Undoing:
verbal expression or actions representing one feeling, followed by expression of the direct opposite
Awareness
Balance
Choice
Detechment
Altruistic Egoism
Faith
Goals
Hope Integrity
ABCs of burnout prevention [8]
Inability to meet basic needs
Decreased use of social support
Inadequate problem solving
Inability to attend to information
Isolation
Denial
Exaggerated startle response
Hypervigilance
Panic attacks
Feeling numb
Confusion
Incoherence
Depression
Self-hatred
Feels strange
Perceived lack of control
Weeping
Grief/sadness
Irritability
Being on guard or jumpy
Physical symptoms (e.g., shaking, headaches, fatigue, loss of appetite, aches and pains)
Signs and symptoms of crisis [21]
Phase 1: Introductory Phase
Phase 2: Facts Phase
Phase 3: Feeling and Thoughts Phase
Phase 4: Emotions
Phase 5: Assessment and Symptom Phase
Phase 6: Teaching Phase
Phase 7: Re-entry Phase
7 phases of Critical incident stress debriefing
1. Always identify yourself.
2. Talk and think calm.
3. Ask people how they are doing or what’s going on.
4. Ask people if they are hurt (assess for medical problems).
5. Ask people if they were having some difficulty or what happened before they got upset.
6. Remember why the person is in the hospital.
7. Find a staff member that has a good rapport and relationship with the person and have them talk to the person. Let the person know you are there to listen.
8. Offer medication if appropriate.
9. Help people remember and use coping mechanisms they identified on the Patient Reported Therapeutic Interventions Survey.
10. If a person screams and swears, reply with a calm nod, say okay, and don’t react.
11. Use a team or third-party approach. If the person is wearing down one staff member, have another take over (10 minutes of talking might avoid a restraint incident).
12. Reassure people and maintain professional boundaries (tell people you want them to be safe, that you are there to help them).
13. Allow quiet time for people to respond—silent pauses are important.
14. Ask the person, if they would be willing to talk to you (repeat requests, persistently, kindly).
15. Respect needs to communicate in different ways (recognize possible language or cultural differences as well as the fear, shame, and embarrassment the person may be experiencing).
16. Empower people. Encourage them with every step they take toward calming themselves.
17. Make it okay to try to talk over the upsetting situation even though it may be very painful or difficult.
18. Acknowledge the significance of the situation for the person.
19. Ask the person how else you can help.
20. Ask the person’s permission to share important conversations with other caregivers for ongoing discussion.
De-escalation tips {20}
Confused,
paranoid,
disorganized,
poor impulse control
Mental indicators of potential violence [4]
Agitated, paging, exaggerated gestures, rapid breathing,
Motor indicators of potential violence [4]
eyes darting,
prolonged staring
lack of eye contact,
spitting, pale or
red-faced,
menacing posture,
throwing things
Body language indicators of potential violence [7]
Rapid
pressured,
incoherent,
mumbling,
repeating,
menacing tones,
raised voice,
use of profanity,
verbal threats
Speech pattern indicators of potential violence [9]
Birth- 2 years: sensorimotor
2-6 years: Preoperational
7-11 years: Concrete operational
12+ Years: Formal operational
Piaget’s Stages of Cognitive development [4]
• Let the child know you are interested in them; convey respect and authenticity.
• Let the child know how to summon you (e.g., call bell).
• Develop trust through honesty and consistency in meeting the child’s needs.
• Use “transitional objects” such as familiar pictures or toys from home.
• Assess:Level of understandingThe child’s needs in relation to the immediate situationThe child’s capacity to cope successfully with change
• Observe for nonverbal cues.
• Use nonverbal communication:Tactile (soothing strokes)Kinesthetic (rocking)
Get down to the child’s height; do not tower over them.
Make eye contact and use reassuring facial expressions.Interpret the child’s nonverbal cues verbally back to them.
Instead of conversation, use some indirect, age-appropriate communication techniques (e.g., storytelling, picture drawing, music, and creative writing).
• Use verbal communication:Use familiar words.Use age-appropriate vocabulary
Listen without interrupting.
Use humour and active listening to foster the relationship.
use open-ended questions.
Use “I” statements.
Help the child to clarify their ideas and feelings (“Tell me more…”; “You got scared when…”).
• Respect the child’s privacy.
• Accept the child's emotions.
• Help children to understand the difference between thoughts and actions.
• Increase coping skills by providing play opportunities; use creative, unstructured play, medical role play, and pantomime.
• Use alternative, supplementary communication devices for children with specialized needs (e.g., sign language and computer-enhanced communication programs).
Nurse-child communication strategies when a child is ill [22]
• Nonverbal communication is a primary mode.
• Infants are biologically “wired” to pay close attention to words. In their first year, infants are able to distinguish all speech sounds.
• Infants are bonded to primary caregivers only. Those older than 8 months may display separation anxiety when separated from parents or when approached by strangers.
Key points in communicating with infants [3]
• Child begins to talk around 1 year of age; learns nine new words a day after 18 months.
• By age 2, a child begins to use phrases; should be able to respond to “what” and “where” type questions.
• By age 3, a child uses and understands sentences.
Key points in communicating with 1-3 year-olds [3]
• Most children this age can make themselves understood to strangers.
• They speak in sentences but are unable to comprehend abstract ideas.
• Unable to recognize their own anxiety, at this age some will somaticize (i.e., complain only of physical concerns, e.g., stomachache).
• They begin to understand cause-and-effect relationships; they should be able to understand, “If you do …, then we can …”
• Can follow a series of up to four directions unless anxious about being hurt.
Key points in communicating with 3-5 year-olds [5]
• They are developing their ability to comprehend. Can understand sequencing of events if clearly explained: “First this happens …, then …”
• They can use written materials to learn.
Key points when communicating with 5-10 year olds [2]
• They have an increased comprehension about possible negative threats to life or body integrity, yet some difficulty in adhering to long-term goals.
• They continue to use mainly concrete rather than abstract thinking.
• They are struggling to establish their identity and be independent.
Key points with comunicating with 11 year olds or older [3]
Communication guidelines for assessing interviews [12]
• Palliative care improves the quality of life of people and their families who are facing challenges associated with life-threatening illness, whether physical, psychological, social, or spiritual. The quality of life of caregivers improves as well.
• Each year, an estimated 40 million people are in need of palliative care; 78% of them live in low- and middle-income countries.
• Worldwide, only about 14% of people who need palliative care currently receive it.
• Unnecessarily restrictive regulations for morphine and other essential controlled palliative medicines deny access to adequate palliative care.
• Adequate national policies, programs, resources, and training on palliative care among health providers are urgently needed in order to improve access.
• The global need for palliative care will continue to grow as a result of the ageing of populations and the rising burden of noncommunicable diseases and some communicable diseases.
• Early delivery of palliative care reduces unnecessary hospital admissions and the use of health services.
• Palliative care involves a range of services delivered by a range of professionals that all have equally important roles to play—including physicians, nurses, support workers, paramedics, pharmacists, physiotherapists, and volunteers—in support of the person and their family.
Key Facts of Palliative Care [8]
• Emphasis on autonomy versus collectivism
• Attitudes toward advance directives
• Decision making about life support, code status guidelines
• Preference for direct versus indirect disclosure of information
• Individual versus family-based decision making about treatment
• Disclosure of life-threatening diagnoses
• Provider’s choice of words in verbal exchanges
• Reliance on physician as the ultimate authority
• Specific rituals or practices performed at time of death
• Role of religion and spirituality in coping and afterlife
• Views about suffering
Cross-cultural variations in end-of-life care [11]
Note
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