Chapter 3: Building Compassionate Relationships

Person-Centered Care

a healthcare approach that prioritizes an individuals personal values, preferences, beliefs, and socio-cultural needs alongside their medical diagnosis (focusing on what matters to you)

Core principles of Person-Centered Care (6)

respect for values and preferences,
coordination and integration,
information and education,
physical comfort,
emotional support,
involvement of family and friends

Caring vs Compassion

caring creates the relationship

What is compassion? (Three components)

notice another person’s suffering, feel emotionally moved by that suffering, take action to help

Compassion moves us to what

act

You can care for someone without…

responding to suffering

Compassion requires

noticing suffering and responding to it

Compassion is what?

action-oriented

Evidence for compassion improving clinical outcomes (9)

better symptom control,
lower stress hormones,
reduced blood pressure,
improved immune function,
less anxiety,
less pain,
better medication adherence,
greater patient satisfaction,
better trust in healthcare providers

Benefits of compassion to the healthcare provider

greater professional meaning,
greater job satisfaction,
less emotional exhaustion,
less burnout,
greater resilience

Small moments matter: Even ___ sec of genuine human connection can have meaningful effects

30-60

Compassion: Benefits to the HCP (5)

greater professional meaning, greater job satisfaction, less emotional exhaustion, less burnout, greater resilience

What is burnout more strongly linked to

system problems rather than lack of compassion

Benefits of compassion to the healthcare organization

fewer malpractice claims,
improved patient satisfaction,
stronger teamwork,
improved employee engagement,
greater staff retention,
higher quality care

Compassion as a clinical skill includes

listen effectively,
communicate respectfully,
recognize suffering,
respond intentionally,
develop presence,
practice curiosity,
build therapeutic relationships

Compassionate behaviors

introduce yourself,
sit rather than stand when possible,
maintain eye contact,
listen without interrupting,
ask open-ended questions,
use the patients preferred name,
ask what concerns you most today and what matters most to you,
validate emotions before offering solutions

The What Matters Framework: understanding what matters most to a patient:

helps nurses individualize care rather than assuming everyone has the same goals

Examples of what matters statements

I want to go home,
I dont want to be a burden,
I want to see my granddaughter graduate,
I want my pain controlled,
I want someone to explain whats happening

Compassion begins with what

curiosity

Instead of asking whats wrong with you, ask

can you tell me what has been happening

Instead of thinking how do I fix this…

wonder what is this experience like for this person

Connect to What Matters example: Instead of saying its time to walk down the hall, say…

lets walk down the hall now because you mentioned wanting to build enough strength to sit up for your daughters visit tonight

The Daily Focus question

Beyond your medical care, what is the most important thing I can do for you during my shift today

The Comfort Check question

What is one thing that would make you feel more comfortable or at ease right now

The Identity Check question

What is one thing you would like me to know about you as a person, not just as a patient

Share with care team through what?

electronic health record, white board, handoff

Why communication matters

each nurse-patient interaction builds trust,
reduces fear,
promotes dignity,
helps understand what matters most to the individual

Therapeutic communication

a purposeful form of communication that helps nurses establish caring relationships

Social relationship

mutual and spontaneous, which is not what nurses do

Therapeutic relationship

patient-centered, goal-directed, and bounded by ethics

Therapeutic communication lowers (4)

patient cortisol levels, reduce pain perception, prevents medical errors by eliciting accurate histories

Caring is more than being nice, Caring is demonstrated through: (6)

behaviors that help the patient feel safe, respected, listened to, included, hopeful, and understood

Communication as what kind of tool?

one of the nurses strongest advocacy tools

Simple advocacy question:

Can you tell me more about that

What can communication do? (5)

clarify misunderstandings, encourage questions, explore concerns, communicate patient preferences, ensure patient’s voice is heard

Cultural Humility (4)

recognizes that everyone brings unique beliefs, traditions, values, and experiences

Instead of why arent you taking your medication, try (cultural humility)

can you help me understand what makes taking this medication difficult

Therapeutic Presence: Patients remember the nurse who: (5)

sat down, listened, noticed they were afraid, gave them time, and treated them with dignity

Sometimes therapeutic communication is simply

remaining present

What are the therapeutic communication techniques? (7)

active listening, open-ended questions, sharing observations, empathy, silence, clarification and reflection, restating

Active listening

paying full attention to not just the patients words but their body language, gestures, and non-verbal cues

Active listening examples: (4)

making eye contact, leaning forward, nodding, and saying I see or go on Im listening

Open-ended questions

allowing the patient to take the lead in the conversation by asking questions that require more than a yes or no answer

Example of open-ended questions

what is on your mind today, tell me more about how you’ve been feeling since your surgery

Sharing observations

verbally noting the patients physical or emotional state without drawing unwarranted conclusions

Examples of sharing observations:

you look a bit more tired today than you did yesterday, I noticed you haven’t touched your lunch

Empathy in therapeutic communication

recognizing and acknowledging the patients feelings and letting them know you understand their perspective

Examples of Empathy: I am so exhausted form this illness

it must be very frustrating to feel this way while trying to recover

Using Silence as a technique

giving the patient deliberate time and space to process their thoughts, work through emotions, or figure out what to say next

Example of Slience

sitting quietly with a patient after delivering heavy

news, allowing them the space to speak first

Clarification and reflection

asking the patient to explain vague statements, or directing their thoughts and questions back to them to help them process their own feelings

Examples of clarification and reflection

could you clarify that for me, repeating the question back to them

Restating

repeating the main idea of what the patient said in similar words to confirm understanding

What to avoid in therapeutic communication (3)

asking why questions, providing false reassurance, and changing the subject

CARE Communication Framework: C

connect by introducing yourself and building rapport ask using open-ended questions

CARE Communication Framework: A

ask using open-ended questions

CARE Communication Framework: R

respond by listening actively and providing empathy

CARE Communication Framework: E

empower by supporting decision-making, reinforcing strengths and collaborate on next steps

Non-therapeutic fixer trap example flaws (4)

gives false reassurance, dismisses feelings, uses a judgmental why question, and shames the patient (causing the patient to shut down and withdraw)

Therapeutic response example techniques (4)

uses physical presence, validates emotion, utilizes strategic silence, and asks an open-ended question, (allowing the patient to open up and collaborate on care)

Reflection questions after a patient interaction (5)

did I learn what mattered most to this person,
did my communication build trust,
did I listen more than I talked,
did I respect this persons values and choices,
did I leave the patient feeling more supported than when I entered