Module 1A - Collaboration & communication

Techniques of Assertive Communication

(1) "I" statements (2) Fogging (3) Negative assertion (4) Repetition (5) confidence (6) Managing nonverbal communication (7) Thinking before speaking (8) Avoiding apologizing whenever possible (9) performing a post conversation evaluation

Nursing implications for advocacy

(1) Assess what the HCP has told the patient regarding the patient's condition. (2) Encourage the patient to clarify understanding with the HCP. (3) Help the patient identify and access high-quality sources of healthcare information. (4) Always advocate for the best interests of the patient and the patient's expressed wishes.

Nursing implications of mood and affect

(1) Be aware that people of all ages can experience from mental and psychiatric disorders. (2) Do not assume that someone does not have one of these conditions because of their physical appearance. (3) Screen patients for depression or other psychiatric illness by asking open-ended questions with empathy (4) Research medical records for histories of mental illness and cognitive issues and shape communication appropriately. (5) Be consistent and predictable in your nursing practice and communication.

Nursing implications for safety

(1) Create a supportive environment that promotes communication and safety. (2) Introduce opportunities for the patient to communicate needs and concerns. Be tactful and avoid abrupt, offensive, and accusatory statements. (3) Maintain a nonthreatening approach and validate cooperation. (4) Listen to the concerns of other members of the healthcare team. (5) Apologize when needed. (6) Agree when possible. (7) Encourage the team to follow national standards.

Nursing Implications for grief and loss

(1) Determine the effects of the loss on the patient. If the patient is grieving the loss of a primary caregiver or a spouse who provided financially for the patient, the individual may have a number of immediate needs. (2) Consider the stages of grief when communicating with patients. (3) Consider the cultural background of the patient and family related to expressions of grief and loss.

Nursing Implications of oxygenation

(1) Position patient in Fowler or semi-Fowler position as indicated to promote ease of breathing. (2) Administer medications and supplemental oxygen as ordered. (3) Consider other methods of communication for the patient (e.g., a tablet, a family member).

Nursing Implications of intracranial Regulation

(1) Recognize the communication difficulties caused by traumatic brain injuries early and respond appropriately. (2)Help the patient with cognitive and/or physical limitations find an appropriate therapist to help the patient regain lost abilities. (3) If patients have difficulty expressing their thoughts, calmly help them find ways of communicating.

Nursing Implications for comfort

(1) Take patient's report of pain levels seriously. Assess for nonverbal signs of pain such as wincing and guarding. (2) Communicate equally with patients across the lifespan. (3) Use a pain management scale such as a numeric rating scale or the FACES pain rating scale that is appropriate for the patient's age and ability to communicate. (4) Investigate palliative care options for patients at the end of life.

interpersonal attitudes -influencing communication

A caring, respectful attitude facilitates communication with and acceptance of others. In contrast, a condescending or judgmental attitude can inhibit communication and acceptance.

Environment - influencing communication

A comfortable environment is usually most conducive to effective communication ; lack of privacy may also interfere for example - a patient who is concerned about sexual dysfunction may not wish to discuss this concern with a nurse within hearing distance of others.

Mood and Affect - relationship to communication

A diagnosis of mental illness ↑ likelihood patient will experience discrimination/stigma and may ↑ reluctance to trust healthcare personnel. In addition, HCPs may miss signs that these patients are experiencing these disorders.

Development - influencing communication

A patient's stage of development affects the ability to communicate with and understand the communication of others. example - infants and toddlers who do not have well-developed language skills, the nurse may rely more on the child's nonverbal communications when assessing comfort and pain levels

Using Silence (therapeutic communication)

Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. example - Sitting quietly (or walking with the patient) and waiting attentively until the patient is able to put thoughts and feelings into words.

Paraphrasing (therapeutic communication)

Actively listening for the patient's basic message and then repeating those thoughts and/or feelings in similar words. This conveys that the nurse has listened and understood the patient's basic message and also offers the patient a clearer idea of what it said.

Avoiding apologizing whenever possible

An unnecessary apology immediately places the communicator in a somewhat submissive position. Apologies should be given only when warranted.

Managing Nonverbal Communication

By maintaining open, assertive body language and keeping a neutral voice, the nurse promotes shared decision making and compromise.

Probing (barrier to communication)

Asking for information chiefly out of curiosity rather than with the intent to assist the patient. These responses are considered prying and violate the patient's privacy. Asking "why" is often probing and places the patient in a defensive position. example - Nurse: "Tell me about how you were sexually abused when you were a teenager." Patient: "I didn't ask the doctor about that when he was here." Nurse: "Why didn't you?"

Testing (barrier to communication)

Asking questions that make the patient admit to something. These responses permit the patient only limited answers and often meet the nurse's need rather than the patient's. example - "Who do you think you are?" (forces the individual to admit to a lower status)

Being defensive (barrier to communication)

Attempting to protect an individual or healthcare service from negative comments. These responses prevent the patient from expressing true concerns. The nurse is saying, "You have no right to complain." Defensive responses protect the nurse from admitting weaknesses in the healthcare services, including personal weaknesses. example - Patient: "Those night nurses must just sit around and talk all night. They didn't answer my light for over an hour." Nurse: "I'll have you know we literally run around on nights. You're not the only patient, you know."

Incivility in the Workplace

Behaviors in the workplace that negatively affect others such as gossiping, spreading rumors, rudeness, or refusing to help a coworker. It can be peer to peer (lateral violence), supervisor to employee (vertical), and includes behaviors meant to harm, humiliate or distress another.

Advocacy - relationship to communication

Communication among nurses, patients, and physicians is a key component of effective healthcare. In addition to communication with patients, nurses directly or indirectly influence physician-patient communications.

thinking before speaking

Consider both the choice of words and the tone of voice before speaking. This helps the nurse avoid saying something they will later regret or that will reduce the effectiveness of the nurse's communication style.

Oxygenation - relationship to communication

Decreased level of consciousness (LOC) decreased ability to communicate verbally (due to shortness of breath and LOC) and nonverbally (due to decreased LOC).

Reflecting (therapeutic communication)

Directing ideas, feelings, questions, or content back to patients to enable them to explore their own ideas and feelings about a situation. example - Patient: "What can I do?" Nurse: "What do you think would be helpful?" Patient: "Do you think I should tell my husband?" Nurse: "You seem unsure about telling your husband."

Changing topics and subjects (barrier to communication)

Directing the communication into areas of self-interest rather than considering the patient's concerns is often a self-protective response to a topic that causes the nurse anxiety. These responses imply that what the nurse considers important will be discussed and that patients should not discuss certain topics. example - Patient: "I'm separated from my wife. Do you think I can start sleeping with other women?" Nurse: "I see that you're 36 and that you like gardening. I bet you're looking forward to summer."

Roles and relationships -influencing communication

Examples - the nurse who has cared for a patient previously and developed a relationship with that individual will communicate differently from the nurse who is meeting with that patient for the first time. - nurse may choose a more formal stance when communicating with HCPs or administrators and a more informal or comfortable stance when communicating with patients or colleagues.

Fogging

Finding some area, no matter how small, on which both parties agree and building from there is a technique that assertive communicators use. example - both the nurse and the HCP can agree that they want to maintain patient safety through careful monitoring of the patient's condition.

gender - influencing communication

From an early age, girls and boys may exhibit differences in language development and communication tendencies that can persist into adulthood example - the tendency of women to make requests and men to make demands, of men to address issues more directly and women to be more active listeners

Challenging (barrier to communication)

Giving a response that makes patients prove their statement or point of view. These responses indicate that the nurse is failing to consider the patient's feelings, making the patient feel it necessary to defend a position. example - Patient: "I felt nauseated after that red pill." Nurse: "Surely you don't think I gave you the wrong pill?" Patient: "I feel as if I am dying." Nurse: "How can you feel that way when your pulse is 60?" Patient: "I believe my husband doesn't love me." Nurse: "You can't say that. Why, he visits you every day."

Passing judgment (barrier to communication)

Giving opinions and approving or disapproving responses, moralizing, or imposing one's own values. These responses imply that the patient must think as the nurse thinks, fostering patient dependence. example - "You shouldn't do that."

Grief and loss - relationship to communication

Grief or loss can adversely affect the way in which an individual communicates. Not only does the person experiencing the loss have trouble communicating needs to others, but others often do not know how to communicate their condolences to those who have experienced a loss. Cultural differences can exacerbate communication issues.

safety - relationship to communication

Impaired communication ↑ risk for illness and injury.

Intracranial Regulation - relationship to communication

Impaired intracranial regulation → impaired communication. Traumatic brain injury → difficulty with word finding, sentence formation, and expression. Patients with severe increased intracranial pressure may enter a coma state.

personal space - influencing communication

Individuals have a natural protective instinct to maintain a certain amount of space immediately around them. This amount varies among individuals and cultures. (1) Intimate: touching to 1½ feet (2) Personal: 1½ to 4 feet (3) Social: 4 to 12 feet (4) Public: 12 feet or more

I PASS THE BATON—what does this acronym stand for?

Introduce self and patient Patient's name, identifiers, and basic information Assessment, including chief complaint, symptoms, diagnosis, and vital signs Situation: Current status of patient Safety issues: Critical lab values, allergies, falls, infection, social issues THE Background: Health and family history, medications Action: Interventions carried out or needed, with reasoning Timing: Degree of urgency, clear timing, prioritizing actions Ownership: Assign responsibility for actions Next: What are next steps?

Physical Attending (therapeutic communication)

Nonverbal communication that indicates the nurse is present and attending to a patient includes looking at the patient when speaking, maintaining an open posture, and leaning toward the person.

Stereotyping (barrier to communication)

Offering generalized and oversimplified beliefs about groups of individuals that are based on experiences too limited to be valid. These responses categorize patients and negate their uniqueness as individuals. Example - "Most people don't have any pain after this type of surgery."

comfort - relationship to communication

Pain → communication ability. Impaired communication may ↓ ability to report pain.

Territoriality - influencing communication

Patients often feel the need to defend their territory when it is invaded by others, such when a nurse removes a chair for use in another room. nurses should recognize the boundaries of the patient's territory and obtain permission from the patient to remove, rearrange, or borrow objects in the patient's hospital area.

Rejecting (barrier to communication)

Refusing to discuss certain topics with the patient. These responses often make patients feel that the nurse is rejecting not only their communication but also the patients themselves. example - "Let's discuss other areas of interest to you rather than the two problems you keep mentioning."

What are healthy ways nurses can express their own grief?

Self-care strategies might involve personal reflection, journaling, or some other form of expression such as art or poetry; or nurses may focus on the promotion of health and wellbeing in terms of healthy diet, physical exercise, social activity and getting adequate sleep.

Agreeing and disagreeing (barrier to communication)

Similar to judgmental responses, agreeing and disagreeing imply that the patient is either right or wrong and that the nurse is in a position to judge this. These responses deter patients from thinking through their position and may cause a patient to become defensive. example - Patient: "I don't think Dr. Broad is a very good doctor. He doesn't seem interested in his patients." Nurse: "Dr. Broad is head of the department of surgery and is an excellent surgeon."

Giving common advice (barrier to communication)

Telling the patient what to do. These responses deny the patient's right to be an equal partner. Note that giving expert advice that is appropriate for the patient's individual situation rather than common advice is therapeutic. example - Patient: "Should I move from my home to a nursing home?" Nurse: "If I were you, I'd go to a nursing home where you'll get your meals cooked for you."

confidence

The nurse should maintain an air of confidence in order to help others see their needs and wants as having merit.

Define and describe the roles and responsibilities of a professional nurse.

The nurse's role is to meet the unique healthcare needs of a patient, community, or population. A registered nurse (RN) uses the nursing process to assess health, identify health concerns, and develop, implement, and direct a plan of care. A licensed practical nurse (LPN) or licensed vocational nurse (LVN) assists in the delivery of patient care under the supervision of a RN, physician, or other licensed practitioner. The advanced practice registered nurse (APRN) diagnoses and treats healthcare problems, holds a graduate or doctoral degree, and includes the roles of nurse practitioner, clinical nurse specialist, nurse anesthetist, and nurse midwife.

Empathizing (therapeutic communication)

To be able to empathize with patients, the nurse must be able to understand and acknowledge the ideas that the patient is expressing or that the patient feels are important to the situation. The nurse must also accept and respect the patient's feelings as valid for the individual, whatever those feelings may be, even if the nurse would not feel the same way in similar circumstances. Using empathy allows the nurse to connect with patients, and it also validates the importance of the patient's message to the nurse.

Verbal Communication

Transmitting information through the spoken or written

Unwarranted or false reassurance (barrier to communication)

Using clichés or comforting statements of advice as a means to reassure the patient. These responses block the fears, feelings, and other thoughts of the patient. example - "You'll feel better soon."

Collaboration Health Care

a client-centered approach where different health care teams come together and work toward a common goal -promotes client safety, quality of care and health outcomes are significantly improved when a strong collaborative relationships are in place

interprofessional team

a setting in which two or more professionals work together benefits - Improved access to and coordination of health care services ; Greater efficient of client referral and client-care services ; Increased quality of community health services ; Decrease in complications, length of stay, sentinel event, mortality and staff turnover

Negative assertion

can agree with criticism without becoming upset or angry, thus moving the focus of the communication toward the desired goal. This can be particularly important to the nurse when receiving feedback related to the quality of the care the nurse delivers ; prevents debates example - when the evaluator says, "Although you are very caring, I would like to see you improve your decision-making ability," the nurse may respond, "I could stand to improve my decision-making ability, but I believe the quality of the care I deliver is excellent."

performing a post conversation evaluation

can continue to improve their skills by reviewing what was said and how the communication might have been handled differently to improve the final outcome. This should be done even when the communication interaction was successful because evaluation of what went well, in contrast to what did not, helps the nurse improve assertive communication skills.

Assessment (I-SBAR-R )

current and relevant social findings ; vital signs/pain level

Factors influencing Communication

development, Gender, Values and Perceptions, Personal Space, Territoriality, Roles and Relationships, Environment, Congruence and Interpersonal attitudes

Readback/Repeat (I-SBAR-R)

ensure the information is being understood and allows time for questions

how can you create a culture of civility and kindness as a nurse?

establishing a power balance, effective communication, self-reflection, setting clear expectations early, and instituting consequences for violating a culture of civility.

Situation (I-SBAR-R)

explain and describe what is happening with the client

Background (I-SBAR-R)

includes providing any important info of the client's current problem and relevant info about medical or social background

Active Listening (therapeutic communication)

involves paying attention to the patient's verbal and nonverbal messages and noting congruency between them. Active listening means that the nurse does not select or listen solely to what the nurse wants to hear. While listening to the patient the nurse maintains the focus on the patient's needs while exhibiting an attitude of caring and interest in order to encourage the patient to talk

How is I PASS THE BATON used in collaboration?

is a structured method of handing off a patient to another team member

Clarifying (therapeutic communication)

is an attempt to understand the basic nature of a patient's statement. example - You say you're feeling anxious now. What's that like for you?"

Recommendation (I-SBAR-)

nurse suggestions for clients care

congruence - influencing communication

promotes the patient's trust in the nurse and helps prevent miscommunication. for example - when teaching a patient how to perform wound care for a surgical site after an operation, the nurse may say, "It's easy, you won't have any problem doing this." However, if the nurse looks concerned or makes a disgusted face while saying this, the patient is less likely to trust what the nurse is saying.

I-SBAR-R technique

standardized communication tool for health care with the intention of ensuring uniform delivery of medical information throughout the health care team especially during handoff

Electronic Communications

transmitting information through email, social networking, text messaging and other electronic means

Nonverbal Communication

transmitting information through gestures, facial expressions or touch

Values and perceptions - influencing communication

unique to each individual and can influence how they receive and interpret communication and influences personal preferences example - one patient may want the curtain around the bed drawn in an effort to maintain privacy, whereas another patient may fear staff will forget if the curtain is drawn.

Avoiding Self-Disclosure (therapeutic communication)

use honesty, benign curiosity, refocusing, interpretation, seek clarification, respond with feedback and limit settings techniques to avoid

I statements

voice their own feelings and wishes based on sound evidence without placing blame or raising the defenses of the individual to whom they are speaking Example - "I have assessed that Patient A is . . . ."

identity (I-SBAR-R)

who you are and your role ; also includes identifying the client

Repetition

with resistance to a request, repeating the request can be useful. However, each time the request is repeated, the power of the words is diminished. This strategy is effective only if the nurse has power within the relationship.

is it essential for the nurse to recognize the collaborative effects of caring for the patient and their family?

yes because collaborative care is patient-centered and patient-directed, collaborative care empowers patients to be informed consumers and actively work in partnership with the healthcare team in the decision-making process