3106: Week 3

The following nursing actions reflect caring:

• Becoming sensitive and supportive to self and others • Being present and encouraging the expression of positive and negative feelings • Developing healing relationships • Instilling faith and hope • Promoting interpersonal teaching and learning • Providing for nursing care needs in a supportive way • Respecting and allowing for spiritual expression

Social Distance (4-12 feet)

• Giving directions to visitors in the hallway • Asking whether families need assistance from the patient doorway • Giving verbal report to a group of nurses

Intimate Distance (0-18 inches)

• Holding a crying infant • Performing physical assessment • Bathing, grooming, dressing, feeding, and toileting a patient • Changing a patient's surgical dressing

Personal Distance (18 inches-40 inches)

• Sitting at a patient's bedside • Taking a patient's nursing history • Teaching an individual patient

Public Distance (12 feet and more)

• Speaking at a community forum • Lecturing to a class of students

Zones of Personal Space

-Intimate Distance (0-18 inches) -Personal Distance (18 inches-40 inches) -Social Distance (4-12 feet) -Public Distance (12 feet and more)

anger can serve the following functions, which may turn negatives into positives:

-It is a survival mechanism to protect ourselves and keep us safe. -The discharge of anger releases tension, eventually calming the person. -Anger can both be energizing and provide a sense of control. -Anger can be triggered by injustice and denial of rights. -Anger may improve negotiating skills and induce cooperation. -Anger can motivate change.

Defensive mechanisms commonly used in anger include

-a penchant to withdraw and isolate oneself -the impulse to express anger openly in out-of-control rage, verbal abuse, and insults.

Anger

Anger is a transient but forceful emotion arising out of a threat. It may be expressed openly, or it may be suppressed quietly and persist as chronic resentment. Resentment is the long-term persistence of the pain of anger, long after the initial situation that sparked the anger has subsided. People may suppress their anger because it makes them feel ashamed or is inconsistent with their image of themselves as good people. -anger in -anger out

Increasing Self-Knowledge

Awareness and understanding of one's self and one's values, beliefs, motivations, goals, feelings, and actions are imperative to relating in a caring, healing manner. When we are aware of ourselves and understand who we are and the basis for our own attitudes, preconceptions, and reactions, we are in a much better position to empathize, appreciate other people's differences and uniqueness, and encourage their self-revelations. To nurture caring, healing communication and relationships, we need to conduct assessments of ourselves as individuals, as well as our communications, spirituality, and cultural beliefs and traditions. All these factors influence behavior and, without a thoughtful reflection and understanding of them, we deny the very people we care for the opportunity to understand themselves.

passive aggressive

Psychologically, some people are passive-aggressive. This implies that they remain passive and quiet externally, but they are repressing anger internally. The anger seeps out in small ways, such as going behind another's back to gossip about him or her in a spiteful way while remaining superficially pleasant to the other.

Chip on the shoulder symptoms

Because of your anger over past violation of your emotional and/or physical space and the real or perceived ignoring of your rights by others, you have a chip on your shoulder that declares, "I dare you to come too close!"

Boundary Setting

Boundaries are artificial separations between people that can be either healthy or unhealthy. They define the perimeter of a relationship. In psychotherapeutic work and the therapeutic nurse-patient relationship, the nurse or therapist should have therapeutic neutrality, implying he or she should not give directives about major life decisions to the patient. Nurses and others in therapeutic roles are frequently held in high esteem, and patients should not assume the child role. The patient-provider relationship assumes the provider has power because the patient is seeking help from the provider. This is an asymmetrical relationship. The nurse or therapist is not intended to remain totally neutral, and emotion can be expressed, but neither should the nurse or the therapist reveal significant personal information to the patient. This is a healthy boundary, with attempts to keep the relationship objective and helpful. -Professional working relationships require ground rules and structure -Boundaries must be present for the relationship to be successful -Degrees of self disclosure can be beneficial, but use with caution -Always act in the best interest of patient

Spirituality and Relationship to a Higher Power

Cardiologist and mind-body researcher Dr. Herbert Benson (1996) emphasized that human beings are wired for God in his classic work, and others have agreed. The implication is that every human being needs a relationship with a Higher Power, also variably referred to as the Source, the Divine, God, Christ, Buddha, Yahweh, Spirit, Universal Energy, and others. Maslow's hierarchy of needs suggests that those moving closer to self-actualization also move closer in their search for the Source. Nurses need to acknowledge that people of different religions may view relationship with a Higher Power in myriad ways.

Holistic Communication: Be CLEAR

Center Yourself: -Pause for a moment. -Breathe deeply. -Connect with a feeling of love and compassion. -Create a silent intention that your thoughts, words, and actions will be for the greater good. Listen Wholeheartedly -Set aside your own thoughts, emotions, and feelings. -Focus on the person's agenda. -Do not judge or analyze. -Open your heart to what is being communicated. Empathize -Come from a place of genuine concern. -Ask yourself: How does this person perceive the situation? What does the world look like through this person's eyes? What is he or she feeling? -Empathy involves an understanding that comes from sensing into the being of another. Attention: Be Fully Present -Be aware of what you are feeling and sensing. Stay present to yourself. -Bring the fullness of yourself to every moment: emotionally, mentally, physically, and spiritually. Respect -Respect all that is. -Respect yourself. Set boundaries if needed. -Respect person. Honor cultural, social, ontological, and ideological differences. -Welcome diversity.

Communication

Communication is a lifelong learning process. Nurses make intimate journeys with patients and their families from the miracle of birth to the mystery of death. As a nurse you communicate with patients and families to develop meaningful relationships. Within those relationships you collect relevant assessment data, provide education and counseling and interact during nursing interventions. The use of therapeutic communication promotes personal growth and helps patients reach their health-related goals.

Power and Control Issues

Dominant personality patterns can cause relationship conflicts. Controlling people tend to assert themselves over others and exert power over them. Although there are people who are willing to be subservient to controlling personalities, others reject this, and power battles ensue.

Special Zones of Touch

Social Zone (Permission Not Needed): Hands, arms, shoulders, back Consent Zone (Permission Needed): Mouth, wrists, feet Vulnerable Zone (Special Care Needed): Face, neck, front of body Intimate Zone (Permission and Great Sensitivity Needed): Genitalia, rectum

Creating Intention

Creating an intention ideally precedes interaction with a person and is part of the preaccess phase of the holistic nurse caring process. Intention can be defined as "the direction of one's inner awareness and focus for healing." -Creating an intention is a process that affects not only the mental and emotional realms but also the physical world. -creating an intention is a powerful way for the nurse to establish an optimal environment for a caring, healing interaction.

Core Value 4: Holistic Communication, Therapeutic Relationship, Healing Environment, and Cultural Care

Creation of a therapeutic relationship through holistic communication, and the context for its expression—an optimal healing environment—is an enduring tradition in holistic nursing use of self in interacting with another". Incorporating the processes and constructs of therapeutic communication, it acknowledges the infinite, spiritual, and energetic nature of being, the centrality of heart centeredness, and the incorporation of intention, self-knowledge, transcendent presence, and intuition in our interactions. The holistic nurse's communication ensures that each individual experiences the presence of the nurse as authentic, caring, compassionate and sincere. This is deep listening or as some say, "Listening with the heart and not just the ears." We are making a plan of care WITH the patient not FOR the patient

Intonation

Tone of voice dramatically affects the meaning of a message. Depending on intonation, even a simple question or statement expresses enthusiasm, anger, concern, or indifference. Be aware of voice tone to avoid sending unintended messages. If a patient interprets your patronizing tone of voice as condescending, this will inhibit further communication. A patient's tone of voice provides information about his or her emotional state or energy level.

Clarity and Brevity

Effective communication is simple, brief, and direct. For certain populations such as the elderly, fewer words result in less confusion. Speak slowly, enunciate clearly, and use brief examples to make explanations easier to understand. Repeating important parts of a message also clarifies communication. Phrases such as "you know" or "OK?" at the end of every sentence detract from clarity. Use sentences and words that express an idea simply and directly. "Where is your pain?" is much better than "I would like you to describe for me the location of your discomfort."

vital and essential attributes for therapeutic communication.

Empathy, unconditional regard, genuineness, respect, concern, caring, and compassion

Martha Rogers

Emphasis on the science and art of nursing, with the unitary human being central to the discipline of nursing

Engaging Your Observer

Engaging your observer is a process that is useful when confronting a situation or communication that is particularly difficult and emotionally charged. It also helps the nurse be present to a person or situation with clarity and without bias. This practice has its roots in Buddhist psychology. -involves centering, being aware of internal reactions, gratefully acknowledging these reactions, and responding from the higher Self.\

Forgiveness

Forgiveness A highly significant hallmark of a healing relationship is forgiveness. To be empowered to forgive, it is necessary to release the anger associated with resentment. There are all levels of forgiveness: of self, of spouse or significant other, of children, of parents, of coworkers, of friends, of family, and of God. Forgiveness has been linked to improved mental health, lowered anxiety, reduced anger, and lessened depression. Physiologically, forgiveness has demonstrated positive benefits.

Gestures

Gestures emphasize, punctuate, and clarify the spoken word. Gestures alone carry specific meanings, or they create messages with other communication cues. A finger pointed toward a person communicates several meanings, but when accompanied by a frown and stern voice, the gesture becomes an accusation or a threat. Pointing to an area of pain is sometimes more accurate than describing its location.

Grounding

Grounding is the process of connecting to the earth and the earth's energy field to calm the mind and focus one's inner flow of energy as a means to enhance healing endeavors.15 Centering and grounding may be considered a single, continuous process because one flows into the other. As such, grounding can also be viewed as part of the preaccess phase of the holistic communication process. -Grounding provides the nurse with a steady physical, psychological, and energetic platform on which to anchor the communication process.

Heart-Centering, Heart Coherence, and the Intuitive Heart

Heart-centering is one of the first processes the nurse engages in prior to any interaction. This process involves the nurse focusing her or his attention on the heart, setting aside concerns and thoughts, and connecting with feelings of love and compassion. -Maintaining this heart-centeredness throughout interactions has many positive effects for the nurse. -In addition to the positive mental, psychological, and physiologic effects, coherence may help to connect people with their intuitive inner guidance. -Research also shows that the positive mental and physiologic effects experienced by the nurse can be transmitted to the person.

Acknowledgment of the Infinite and Sacred Nature of Being

Holistic nursing acknowledges that people are infinite, sacred, and spiritual beings. Florence Nightingale spoke of human beings as a reflection of the Divine with physical, metaphysical, and intellectual attributes. Jean Watson teaches that we are sacred beings, and Martha Rogers speaks of unitary human beings as energy fields that are infinite in nature. The Model of Whole Person Caring combines these concepts to define person as "an energy field that is open, infinite, and spiritual in essence and in continual mutual process with the environment. Each person manifests unique physical, mental, emotional, and social or relational patterns that are interrelated, inseparable, and continually evolving." Thus, from the perspective of holistic nursing theorists and models, people are infinite and sacred in nature. This orientation makes a difference in how we approach one another. It shifts how we speak, listen, relate, and interact. When we perceive human beings as sacred, our words, actions, and behaviors are significantly affected.

Victimhood or martyrdom symptoms

In this symptom, you identify yourself as a violated victim and become overly defensive to ward off further violation. Or it can be that once you accept your victimization you continue to be knowingly victimized and then let others know of your martyrdom.

Channels

Individuals use communication channels to send and receive messages through visual, auditory, and tactile senses. Facial expressions send visual messages; spoken words travel through auditory channels. Touch uses tactile channels. Individuals usually understand a message more clearly when the sender uses more channels to send it. Feedback Feedback is the message a sender receives from the receiver. It indicates whether the receiver understood the meaning of the sender's message.

Intuition

Intuition is a useful and foundational element in the holistic communication process. It is defined as "the perceived knowing of things and events without the conscious use of rational processes; using all of the senses to receive information." The usefulness of intuition in the nursing process is well researched and documented. Although intuitive knowing is something that occurs more readily with the experienced nurse, it can be consciously cultivated through various practices. -When the nurse utilizes intuition, she or he engages the full use of self, which is essential in accessing and communicating with the whole person.

Trust

It has been traditionally felt that an ideal nurse-patient relationship requires the development of trust before patients can openly communicate. Trust is an essential element of the therapeutic and healing relationship. -vital step in building trust includes the ability to risk being vulnerable -Firm reliance on the integrity, ability, or character of a person or thing -Trust must be built, earned, and maintained -Maintain confidentiality, connect with the patient, follow through on obligations -Be honest

Jean Watson

Jean Watson defines person as "an embodied spirit; a transpersonal, transcendent, evolving consciousness; unity of mind-body-spirit; person-nature-universe as oneness, connected." -first nursing theorist to address the concept of soul -full use of the self -phenomenal field

Meditation

Meditation is a quiet turning inward—the practice of focusing one's attention internally to achieve clearer consciousness and inner stillness. Meditation is both a state of mind and a method. The state is one in which the mind is quiet, open, and receptive. The meditator is relaxed but alert. The method involves the focusing of attention on something such as the breath, an image, a word, or an action such as TaiChi. There is a sustained concentration, but it should be effortless. Meditation allows a better understanding of the self and increased receptivity to insights arising from one's deeper being. -perhaps the single most useful reflective practice to help gain self-awareness and self-knowledge, increase intuition, and enhance one's spiritual development. -takes discipline and practice

Nonverbal communication

Nonverbal communication includes the five senses and everything that does not involve the spoken or written word. Nonverbal aspects of communication such as voice tone, eye contact, and body positioning are often as important as verbal messages ( Lorié, 2017 ). Thus nonverbal communication is unconsciously motivated and more accurately indicates a person's intended meaning than spoken words ( Varcarolis, 2017 ). When there is incongruity between verbal and nonverbal communication, the receiver usually "hears" the nonverbal message as the true message.

Relationship to Other Living Beings

Often, relationships with animals can be as important as relationships with other people. Pets and therapeutic animals may provide unconditional love, affection, companionship, and fidelity. Animal-assisted therapy has become very popular, and studies have shown remarkable health benefits. Animals, particularly dogs, have been used to provide an incredible number of services for those with hearing and vision impairment, palliative care patients, elders and Alzheimer disease patients, and children with special needs.

Eye Contact

People signal readiness to communicate through eye contact. Maintaining eye contact during conversation shows respect and willingness to listen. Eye contact also allows people to closely observe one another. Lack of eye contact sometimes indicates anxiety, defensiveness, discomfort, or lack of confidence in communicating. However, people from some cultures consider eye contact intrusive, threatening, or harmful and minimize or avoid its use (see Chapter 9 ). Always consider a person's culture when interpreting the meaning of eye contact. Eye movements communicate feelings and emotions. Looking down on a person establishes authority, whereas interacting at the same eye level indicates equality in the relationship. Rising to the same eye level as an angry person helps establish autonomy.

obsessive-compulsive personality disorder

People with obsessive-compulsive personality disorder tend to be highly controlling, rigid, and perfectionistic. They have a preoccupation with details, rules, and orderliness. Being stubborn, inflexible, and miserly are other facets of this personality disorder. Another characteristic is failure to allow others to participate in projects or discussions, feeling that their way is the only right way. These people are capable of being highly devoted to their work, which can be seen in a positive or negative light.

Personal Appearance

Personal Appearance Personal appearance includes physical characteristics, facial expression, and manner of dress and grooming. These factors are a powerful means of nonverbal communications to patients and the health care team. In the health care setting research shows patients prefer that nurses employed in an agency all wear a single uniform and that the "RN" or "LPN" tag be displayed prominently. Many health care agencies restrict how much jewelry you can wear and whether certain types of tattoos need to be covered. For hygienic reasons nurses should have long hair pulled back and off the shoulders and short clean fingernails. Remember, first impressions are largely based on appearance. Nurses learn to develop a general impression of patient health and emotional status through appearance, and patients develop a general impression of the nurse's professionalism and caring in the same way.

Posture and Gait

Posture and gait (manner or pattern of walking) can be forms of self-expression. The way people sit, stand, and move reflects attitudes, emotions, self-concept, and health status. For example, an erect posture and a quick, purposeful gait communicate a sense of well-being and confidence. Leaning forward conveys attention. A slumped posture and slow, shuffling gait indicate depression, illness, or fatigue. Facial Expression The face is the most expressive part of the body.

Denotative and Connotative Meaning

Some words have several meanings. Individuals who use a common language share the denotative meaning: baseball has the same meaning for everyone who speaks English, but code denotes cardiac arrest primarily to health care providers. The connotative meaning is the shade or interpretation of the meaning of a word influenced by the thoughts, feelings, or ideas that people have about the word. For example, health care providers tell a family that a loved one is in serious condition and they believe that death is near; but to nurses serious simply describes the nature of the illness. You need to select words carefully, avoiding easily misinterpreted words, especially when explaining a patient's medical condition or therapy. Even a much-used phrase such as "I'm going to take your vital signs" may be unfamiliar to an adult or frightening to a child. "I'm going to check your blood pressure, heart rate, and temperature" may be more appropriate.

Sounds

Sounds such as sighs, moans, groans, or sobs also communicate feelings and thoughts. Combined with other nonverbal communication, sounds help to send clear messages. They have several interpretations. For example, moaning can convey pleasure or suffering, and crying can communicate happiness, sadness, or anger. Validate nonverbal messages with patients to interpret them accurately. For example, "I notice you frowning as you move, are you having pain?"

Territoriality and Personal Space

Territoriality is the need to gain, maintain, and defend one's right to space. Territory is important because it provides people with a sense of privacy, identity, security, and control. It is sometimes separated and made visible to others, as with a fence around a yard or a curtain around a bed in a hospital room. Personal space is invisible and individual and travels with a person. During interpersonal interaction people maintain varying distances between one another, depending on their culture, the nature of their relationship, and the situation. When personal space becomes threatened, people respond defensively and communicate less effectively. Situations dictate whether the interpersonal distance between nurse and patient is appropriate.

Environment

The environment is the setting for sender-receiver interaction. An effective communication setting provides participants with physical and emotional comfort and safety. Noise, temperature extremes, distractions, and lack of privacy or space create confusion, tension, and discomfort. Environmental distractions are common in health care settings and interfere with messages sent between people. You control the environment as much as possible to create favorable conditions for effective communication.

Pre-Access Phase

The holistic communication process acknowledges the importance of being centered and creating an intention before engaging in a caring, healing interaction with another. These two processes, being centered and creating intention, constitute the pre-access phase involved in holistic interactions. This phase lays the foundation for caring, healing communication and occurs before any person-to-person interaction takes place. As the nurse stays present to the moment, to self, and to the person, a healing environment is maintained. Consciously creating a healing environment, no matter where one is working, nurtures both the patient/client and the self at a deep level.

Message

The message is the content of the communication. It contains verbal and nonverbal expressions of thoughts and feelings. Effective messages are clear, direct, and in understandable language. Individuals with communication barriers may need assistance via clarification devices such as hearing aids, interpreters, or pictures to ensure that messages sent and received are understandable. Personal perceptions may also distort the receiver's interpretation of a message.

circular transactional communication process model

The model shows the situational contextual inputs, channels of communication, interpersonal contextual concepts, and factors affecting the sender and receiver. includes several elements: the referent, sender and receiver, message, channels, context or environment in which the communication process occurs, feedback, and interpersonal variables Potential for miscommunication at every step

Observer of Witness

The nonjudgmental aspect of your self is called the Observer or Witness. Some perceive this aspect as our higher Self.

Electronic communication

Use of technology. MyChart, Electronic Medical Record, Virtual Visits. is the use of technology to create ongoing relationships with patients and their health care team. Secure messaging provides an opportunity for frequent and timely communication with a patient's physician or nurse via a patient portal. An electronic portal enables patients to stay engaged and informed, though the empathetic nature of the therapeutic relationship with the health care team may be more challenging

Referent

The referent motivates one person to communicate with another. In a health care setting sights, sounds, sensations, perceptions, and ideas are examples of cues that initiate the communication process. Knowing a stimulus or referent that initiates communication allows you to develop and organize messages more efficiently. For example, a patient request for help prompted by his difficulty in breathing causes a different response than a patient request resulting from hunger.

Margaret Newman

The task of nursing intervention, according to Newman, "is not to try to change another person's patterns but to recognize it as information that depicts the whole and relate to it as it unfolds." -role of nurse is to assist people to recognize the power within them

Assessment Phase

The term assessment implies appraising, evaluating, and judging. An essential characteristic of holistic communication is the mutuality inherent in the experience—this means that both the nurse and the patient/client partner participate equally in the process. Utilizing language that supports the concept of partnership reinforces a commitment to mutuality.

Therapeutic Presence

Therapeutic presence is a relatively new concept being described in psychiatry. Its roots come from holistic nursing, however. Healthcare provider training in mindfulness improves providers' abilities to be present to patients, and this has demonstrated an increase in compassionate attitudes toward patients. A side benefit that has been noted is that physicians trained in mindfulness in preparation for providing psychotherapy have lower burnout levels and display more helpful traits in the patient-centered relationship. Mindfulness and therapeutic presence share a common quality of the ability to be very attentive to an internal experience while simultaneously being receptive to experiences in the environment.

Caring, Healing, Transcendent Presence

These perspectives each speak to different facets of the quality and characteristics of the attention that one person gives to another in a relationship.

Cold and distant symptoms

This symptom builds walls or barriers to ensure that others do not permeate or invade your emotional or physical space. This, too, can be a defense due to previous pain from being violated, hurt, ignored, or rejected.

Disassociation Symptoms

This symptom involves blanking out during a stressful emotional event. This blanking out results in your being out of touch with your feelings about what happened. It also may result in your inability to remember what happened.

Invisibility symptoms

This symptom involves your pulling in or overcontrolling so that others, even yourself, never know how you are really feeling or what you are really thinking. Your goal is not to be seen or heard so that your boundaries are not violated.

Aloofness or shyness symptoms

This symptom is a result of your insecurity from real or perceived experiences of being ignored or rejected in the past. Once rejected, you take the defensive posture to reject others before they reject you. This keeps you inward and unwilling or fearful of opening up your space to others.

Excessive detachment symptoms

This symptom occurs when neither you nor anyone else in the group or family is able to establish any fusion of emotions or affiliation of feelings. You and they seem to lack a common purpose, goal, identity, or rationale for existing together.

Overenmeshment Symptoms

This symptom requires everyone to follow the rule that everyone must do everything together and that everyone is to think, feel, and act in the same way. Uniqueness, autonomy, and idiosyncratic behaviors are viewed as deviations from the norm.

Smothering symptoms

This symptom results when another is overly solicitous of your needs and interests. It can be so overwhelming that you feel like you are being strangled, held too tightly, and lack freedom to breathe on your own.

Timing and Relevance

Timing is critical in communication. Even though a message is clear, poor timing prevents it from being effective. For example, you do not begin routine teaching when a patient is in severe pain or emotional distress. Often the best time for interaction is when a patient expresses an interest in communicating. If messages are relevant or important to the situation at hand, they are more effective. When a patient is facing emergency surgery, discussing the risks of smoking is less relevant than explaining presurgical procedures. Face-to-face time while performing assessments, administering medications, or performing procedures offers an excellent opportunity to talk with patients and provide support or education. Patients report improved satisfaction, understanding, and perception of safety with registered nurses (RNs) who provide a bedside hand-off and communicate information about the plan of care

Vocabulary

Vocabulary Communication is unsuccessful if senders and receivers cannot translate one another's words and phrases. When you care for a patient who speaks another language, a professional interpreter is necessary. Even those who speak the same language use subcultural variations of certain words. Medical jargon sounds like a foreign language to patients unfamiliar with the health care setting. Limiting use of medical jargon to conversations with other health care team members improves communication. Children have a more limited vocabulary than adults and often use special words to describe bodily functions or a favorite blanket or toy. Teenagers often use words in unique ways that are unfamiliar to adults.

Holistic nurses have a particular obligation to create what type of environment?

a therapeutic healing environment that values holism, caring, social support, and integration of conventional and complementary/integrative approaches to healing. They seek to create caring cultures and environments where individuals, both clients/patients and staff, feel connected, supported, and respected. A particular perspective of holistic nursing is the nurse as the healing environment and an instrument of healing. Holistic nurses shape the physical environment (e.g., light, fresh air, pleasant sounds or quiet, neatness and order, healing smells, earth elements), and they provide a relationship-focused environment by creating sacred space through presence and intention where another can feel safe, unfold, and explore the dimensions of self in healing. The focus on healing environments is extended to the creation of caring cultures and communities where families, populations, and nations can feel connected, supported, and respected. Holistic nurses have an integral role in revisioning and transforming organizational cultures into authentic healing healthcare systems and in trying to remove the political and financial barriers to the inclusion of holistic care in the healthcare system.

hostility

angry feelings motivate aggressive behavior.

Interpersonal variables

are factors within both the sender and receiver that influence communication. Perception provides a uniquely personal view of reality formed by an individual's culture, expectations, and experiences. Each person senses, interprets, and understands events differently. A nurse says, "You haven't been talking very much since your family left. Is there something on your mind?" One patient may perceive the nurse's question as caring and concerned; another perceives the nurse as invading privacy and is less willing to talk. Cultural sensitivity enables you to explore the interpersonal variables such as educational and developmental level, sociocultural background, values and beliefs, emotions, gender, physical health status, and roles and relationships that affect how a patient communicates. Interpersonal variables associated with illness such as pain, anxiety, and medication effects also affect nurse-patient communication.

Symmetrical relationships

are more equal. A group of patients discussing their plans after discharge is an example of a symmetrical role relationship

Defense Mechanisms

are thought processes that allow people to distance themselves from unpleasant feelings, behaviors, and thoughts. Nurses frequently encounter common defense mechanisms. -denial -regression -acting out -projection -displacement -rationalization -repression

integrality

continuous mutual human field and environmental field process

Facial expressions

convey emotions such as surprise, fear, anger, happiness, and sadness. Some people have an expressionless face, or flat affect, which reveals little about what they are thinking or feeling. An inappropriate affect is a facial expression that does not match the content of a verbal message (e.g., smiling when describing a sad situation). People are sometimes unaware of the messages their expressions convey. For example, a nurse frowns in concentration while doing a procedure, and the patient interprets this as anger or disapproval. Patients closely observe nurses. Consider the impact your facial expression could have on a person who asks, "Am I going to die?" The slightest change in the eyes, lips, or facial muscles reveals your feelings. Although it is hard to control all facial expressions, try to avoid showing shock, disgust, dismay, or other distressing reactions in a patient's presence.

Verbal communication

uses spoken or written words. Verbal language is a code that conveys specific meaning through a combination of words.

Traditional models of therapeutic communication do the following:

define and prescribe various stages or phases, delineate various roles for the nurse or therapist, identify verbal and nonverbal communication skills, and identify therapist characteristics that are essential to creating a therapeutic milieu.

The holistic nurse's communication ensures that

each individual experiences the presence of the nurse as authentic, caring, compassionate, and sincere. This is deep listening, or as some say, "Listening with the heart and not just the ears." It is done with conscious intention and without preconceptions, busyness, distractions, or analysis. It takes place in the now within an atmosphere of shared humanness—human being to human being. Through presence or being with in the moment, holistic nurses provide each person with an interpersonal encounter that the individual can experience as a connection with one who is giving undivided attention to his or her needs and concerns. Holistic nurses actively engage in the therapeutic use of self. Communication techniques used by holistic nurses to build therapeutic relationships include but are not limited to unconditional regard, respect, deep and active listening, active observing, demonstrating empathy and concern, instilling hope, mindfulness, relaxation, stress management, goal management, crisis intervention, negotiation, and problem solving.

the building of trust can be impaired if individuals have

experienced emotional and/or physical abuse and/or neglect; been chronically put down, belittled, or misunderstood; been emotionally injured in the past and are now fearful of getting hurt again; experienced loss of loved ones through death so that they fear trusting again will lead to abandonment or death; experienced the end of a relationship or a bitter separation or divorce; lived in an emotionally or physically unstable and unpredictable environment; experienced pain from another; experienced victimization; or have low self-esteem and do not believe they deserve anyone's care, having difficulty even trusting sincere, helpful people and developing healthy relationships.

the nurse is not the ____________ regarding another's health and illness experience but is actually a ___________.

expert; learner

Complementary role relationships

function with one person holding an elevated position over the other person. A complementary role occurs when a nurse provides education to a patient about a new medication.

Presence

has been defined as a way of being, a way of relating, a way of being with, and a way of being there.

theory of integral nursing

includes multiple dimensions of interrelationships. The theory describes four quadrants demonstrating how human beings experience their world through relationships: -The I quadrant represents the individual -the we quadrant demonstrates relationship to others within the context of culture, values, and vision -the it quadrant represents the physical body; and the its quadrant represents relationships to environment and social systems.

Small-group communication

interaction that occurs when a small number of persons meet. Usually goal directed requires an understanding of group dynamics. Examples include nurses working on committees, patient care conferences, patient-teaching classes. is the interaction that occurs when a small number of people meet. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees with nurses or other disciplines and participate in patient care conferences, they use a small-group communication process. Communication in these situations should be organized, concise, and complete. All participating disciplines are encouraged to contribute and provide feedback. Good communication skills help each participant better meet a patient's needs and promote a safer care environment.

Public communication

interaction with an audience. Conferences, classroom discussion, speaking with groups of consumers about health-related topics. is interaction with an audience. Nurses often speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. Public communication requires special adaptations in eye contact, gestures, voice inflection, and the use of media materials to communicate messages effectively. Effective public communication increases audience knowledge about health-related topics, health issues, and other issues important to the nursing profession.

Displacement

involves transferring unpleasant emotional pain from the direct source of the pain to another, less threatening person or thing. For example, someone who is angry with his or her boss but who does not feel comfortable confronting the boss instead may become angry with his or her significant other at home.

Denial

is a defense mechanism that involves refusal to accept reality, often to avoid dealing with painful issues. This mechanism can be harmful, as in addiction where the addict denies his or her addiction.

Projection

is a defense mechanism used when one does not want to take responsibility for one's own thoughts and feelings. With this mechanism, one ascribes one's feelings or thoughts to another person and does not take ownership of those thoughts or feelings. An example is when a person strongly dislikes another person but uses projection to assume that person does not like him instead.

Acting out

is a primitive defense mechanism where individuals may injure themselves, punch walls, or have tantrums because of being incapable of verbally expressing their feelings. Angrily throwing an object at the person who is the focus of the individual's anger, rather than verbally discussing the situation, is an example of acting out.

Rationalization

is a process of filtering or reframing reality to make that reality more acceptable. For example, a student might blame her poor exam grade on the professor, rationalizing that his teaching was ineffective, rather than taking responsibility for her lack of studying.

anger out

is directed at other people or things.

anger in

is directing anger at oneself, manifested with either suppressed hostility or depression

Pacing Conversation

is more successful at an appropriate speed or pace. Speak moderately slowly and enunciate clearly. Talking rapidly, using awkward pauses, or speaking excessively slowly and deliberately conveys an unintended message. Long pauses and rapid shifts to another subject give the impression that you are hiding the truth. Think before speaking and develop an awareness of the rhythm of your speech to improve pacing.

Regression

is reverting to an earlier stage of development because of overwhelming fear or stress. An older child can regress to an earlier stage of development, or an adult can refuse to leave his or her bed and function normally.

Receiver

is the person who receives and decodes the message

Repression

is the unconscious blocking of painful thoughts or feelings. However, this unconscious, repressed material may affect a person's behaviors, moods, and health in undesirable ways. An example of repression is when a victim of childhood abuse has trouble forming normal adult relationships. Defense mechanisms can interfere with healthy relationships and create distance from the truth.

Holistic nurses realize that suffering, illness, and disease are

natural components of the human condition and have the potential to teach us about ourselves, our relationships, and our universe. Every experience is valued for its meaning and lesson.

Interpersonal communication

none to one, the nurse and another person, nurse-patient, face-to-face. is one-on-one interaction between a nurse and another person that most often occurs face-to-face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice. It takes place within a social context and includes all the symbols and cues used to give and receive meaning. Because meaning resides in people and not in words, messages received are sometimes different from intended messages. Nurses work with people who have different opinions, experiences, values, and belief systems; thus it is important to validate meaning or mutually negotiate it between participants. For example, use interaction to assess understanding and clarify misinterpretations when teaching a patient about a health concern. Meaningful interpersonal communication results in an exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishment, team building, and personal growth.

Feedback

occurs continuously between a sender and receiver. A sender seeks verbal and nonverbal feedback to evaluate the receiver's response and effectiveness of a communicated message. The type of feedback a sender or receiver gives depends on factors such as their background, prior experiences, attitudes, cultural beliefs, and self-esteem. A sender and receiver need to be sensitive and open to one another's messages, to clarify the messages, and to modify behavior accordingly for successful communication.

Intrapersonal communication

the communication that you have with yourself - self talk. (Centering, Setting your intention). is a powerful form of communication that you use as a professional nurse. This level of communication is also called self-talk. People's thoughts and inner communications strongly influence perceptions, feelings, behavior, and self-esteem. Always be aware of the nature and content of your own thinking. Positive self-talk provides a mental rehearsal for difficult tasks or situations so that you can deal with them more effectively and with increased confidence. You use intrapersonal communication to develop self-awareness and a positive self-esteem to enhance appropriate self-expression. Positive self-talk can diminish cognitive distortions that lead to a decrease in self-esteem and impact your ability to work with patients. Transforming statements from "I'm scared to work with this type of patient" into "This is my opportunity to learn about this patient, and I can ask for help when it's needed" is an example of positive self-talk.

energy field

the fundamental unit of the living and non-living. Field is a unifying concept. Energy signifies the dynamic nature of the field; a field is in continuous motion and is infinite.

Sender

the person who encodes and delivers a message. The sender puts the message into verbal and nonverbal symbols that the receiver can understand. The sender's message acts as a referent for the receiver.

Three of the most essential concepts for healthy relationships are

trust, forgiveness, and appropriate boundary setting.