Unit 5: Building Therapeutic Relationships - Listening Skills Study Notes on Listening Skills

Course/Unit Identification: Unit 5: Building Therapeutic Relationships — Listening Skill (MNU/SN/NUR171).
General Goal: By the end of the session, $80\%$ of students should be able to master and apply specific listening competencies.
Specific Objectives:
- Define the concepts of hearing and listening.
- Differentiate between active and passive listening.
- List the benefits of effective listening for the patient, the nurse, and the therapeutic relationship.
- Identify 5 barriers that hinder effective listening.
- List characteristics common to effective listeners.
- Discuss the 5 core listening skills.
- Recall the meaning of the acronym "SOLER."
- State 2 specific tips to improve information recall.

Hearing Characteristics:
- According to Parbury (2014), hearing involves simply "being there" for the patient.
- It is a physical process performed "by the ears."
Listening Characteristics:
- According to Parbury (2014), listening involves "being with" the patient.
- It is a cognitive process that occurs "in the mind."
Reflective Question: "Can you recall a time when someone heard you but didn’t really listen?"

Active Listening:
- Defined as an interactive process between the nurse and the patient with the dual goal to understand and to be understood.
- Requires active observation to comprehend both verbal and non-verbal messages.
- It is a skill that can be developed and learned with consistent practice (Sheldon, 2009).
Passive Listening:
- Involves hearing without full concentration.
- Occurs when the listener is attending to another matter simultaneously, such as watching television or reading (Parbury, 2014).

For the Patient:
- Feeling comforted and valued.
- Feeling worthwhile because the nurse has dedicated time, energy, and attention to them.
- Improved sense of well-being and mental ease when nurses are fully present and available to interact.
- Real-Life Example: A patient admitted with chest pain suggests, "I think it’s just stress." By listening attentively and encouraging more sharing, the nurse discovers the patient recently suffered a bereavement and is experiencing panic symptoms. This leads to appropriate psychological support.
For the Nurse:
- Gathering more accurate information and data for nursing care activities.
- Enhancing effective clinical decision-making.
- Understanding the patient on a more personal level.
- Real-Life Example: A nurse listens closely to a diabetic patient who admits to skipping insulin during fasting periods. This specific information allows the nurse to adjust the care plan and provide tailored education.
For the Relationship:
- Encourages further interaction between the patient and the nurse.
- Serves as a means of promoting trust.
- Enables the relationship to progress (Parbury, 2014).
- Real-Life Example: A nurse consistently listens without interruption during daily rounds. Consequently, a previously withdrawn elderly patient opens up about the fear of returning home alone, which allows for proper discharge planning.

Environmental Factors: High noise levels, distractions, and unrelated activities in the surroundings.
Psychological Unpreparedness: The nurse is not prepared to listen because they are preoccupied with their own thoughts.
Mental Rehearsals: The health care professional is busy rehearsing what they will say next inside their head while the patient is still speaking.
Assumptions and Predictions: Being focused on one's own ideas and assumptions, leading to a failure to listen if the nurse predicts what they think they will hear.
Language Barriers: Poor language skills or the lack of a common language (Toole, 2013).

Availability: Being truly available to interact.
Time Management: Making and having the time to listen.
Non-Interruption: Refraining from interrupting the speaker.
Non-Judgmental Attitude: Not judging, evaluating, advising, or projecting their own ideas onto the speaker.
Selective Filtering Avoidance: Not merely listening for specific information the listener wants to hear.
Openness: Maintaining an openness to whatever the speaker is expressing (Parbury, 2014).
Self-Reflection Checklist:
- I make time to listen without rushing.
- I am present physically and mentally.
- I avoid interrupting.
- I resist the urge to judge or correct.
- I do not offer unsolicited advice unless clinically required.
- I focus on the message, not just specific words I want to hear.
- I stay open to verbal and non-verbal expressions.
- I use cues like nodding and eye contact.
- I use reflection and paraphrasing to check understanding.
- I avoid multitasking.

Attending:
- This is the external physical readiness to listen.
- It communicates that the nurse is available and accessible.
- Patients feel happy when a nurse gives their time in this manner.
Observing:
- Paying attention to how messages are expressed.
- Nurses observe non-verbal aspects (facial expressions, eye contact, body posture, and movements).
- These cues serve as signals for further exploration.
Perceiving:
- The nurse receives the message by integrating the interest shown in attending and the cues noticed in observing.
- The nurse must receive and perceive all parts of the patient's story, including actual content, related feelings, and the general theme.
Interpreting:
- Combining the content of the story with accompanying feelings to identify the general theme.
- Understanding these themes requires active interpretation by the nurse.
Recalling:
- The challenge of remembering what the patient said.
- Requires significant concentration and effort.
- If a nurse asks a patient to repeat their story multiple times, the patient may lose trust and believe the nurse wasn't listening.
- Two tips for improvement: Concentration and Effort are essential for recall.

S - Squarely face the person: Sit or stand directly facing the patient to show involvement and lack of distraction.
O - Open posture: Keep arms and legs uncrossed to suggest non-defensiveness and openness.
L - Lean forward: A slight lean toward the patient indicates interest, provided it is not so close as to be invasive.
E - Eye contact: Maintain gentle eye contact adjusted for cultural norms; avoid staring or looking away.
R - Relaxed posture: Appear calm and unhurried to put the patient at ease.

Culturally Diverse Settings:
- Respect silence and personal space.
- Be aware of different communication styles.
- Note: In some cultures, maintaining direct eye contact is considered disrespectful.
Telenursing (Technology-Based):
- Emphasis on tone, pacing, and pauses.
- Use active verbal acknowledgments (e.g., "I hear you," "Please go on").
- Avoid multitasking.
- Do not fear silence.
- Smile (it changes the vocal tone).
- Sit upright to improve breathing and vocal clarity.

Activity Prompt: "In groups, discuss a case where listening helped or harmed a patient outcome."
Concept Clarification:
- Empathy: "I understand how that must feel."
- Sympathy: "That sounds really bad, poor you."
Skill Application Challenge: "Write one change you’ll make in your clinical practice starting next week or soon."