NUR 219

Examples of verbal communication techniques of acceptance

- Pt- I have done something terrible - RN- I would like to hear about it, it is okay to discuss it with me

UAP

- Recording and reporting - Hygiene - Elimination - Nutrition - Ambulation

Legal requirements of nurses

- Report abuse of children and elders - Preserve HIPAA - Preserve Patient Self- Determination Act - Be cautious of social media use - Preserve the NPA - Maintain standards of care

Information exchange strategies in healthcare

- SBAR - call out - handoff - CUS- concerned, uncomfortable, safety

Communicating effectively- written communication

- SBAR tool - Event information - Assessment/ orders

Competition

- These folks always want to be the winner. That gives them a sense of pride and achievement. Losing makes them appear as a weak, inadequate and failing individual. - They can attack, overpower, overwhelm and intimidate.

Compromise

- This method involves handling the conflict by reaching a resolution that involves a "win" on both sides of the table. Both parties are happy and find that middle ground!

Family member is upset about the care given to their loved one. Listen to them and their frustrations

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Know your resources!!! If you need back-up, you need to know who to call for help. (Code Yellow-need security and a supervisor STAT!!!) Don't be a hero!

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Recognize the signs that an issue may be escalating into a potential violent scene. Nurses are front-line in reducing aggression in patients, visitors and co-workers.

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CUS EX

- "im concerned that ms. c is not her usual self. Im uncomfortable that she is behaving so oddly. I believe she is not safe; she may have something going on we are missing"

Ex of conflict; interaction of patients

- A patient admitted with a small bowel obstruction was due for an AM abd. X-ray. By 11, the patient was pacing and anxious. After calling radiology, they were absolutely slammed with ER priorities. By 1, still NPO, the patient called our VP of Nursing to say how incompetent we were. Finally, he got his x-ray around 3, was discharged home and had a bad experience/review of his hospital stay because of one department.

Stakeholder

- A person or group of people that have direct interest in something you are trying to do or achieve

Ex of conflict; interaction with physicians

- A plastic surgeon came in to suture up a patient with a pretty bad facial wound. He asked for certain instruments and dressings to have at bedside. After we got started, the hemostat wouldn't click closed. He tried numerous attempts and got so frustrated, he threw the entire tray across the room. Later, he apologized for his behavior.

Call- out/ read back and verified

- A strategy used to communicate important or critical info - informs all team members simultaneously during emergency situations -helps a team member anticipate next steps

What does SBAR provide

- A tool for team members to effectively communicate info to one another Situation- what is going on with the pt Background- what is the clinical background or contex Assessment- what do i think the problem is Recommendation- what would i recommend

Handoff description

- A transfer of info (along with authority and responsibility) during transition of care across the continuum; to include the opportunity to ask questions, clarify and confirm info

Verbal communication

- Accurate - Straightforward - Professional without bias - Speak slowly and clearly - reflect

Malpractice can include failure to

- Assess and monitor - Follow standards of care - Use equipment in responsible manner - Communicate - Document - Act as patient advocate

RN

- Assessing - Analyzing - Delegating - Teaching - Evaluating - Supervising

What is essential for written communication

- Clarity: objective/ subjective info fm the pt and fam - Components of an assessment: clear understanding of normal values chart by exception - Event writing: objective info and facts chronological

Successful delegation

- Clear, specific instructions - Plan ahead - Empower capable personnel - Set deadlines and monitor progress - Evaluate performance Provide guidance

LPN

- Collecting - Basic teaching - Assisting in evaluating - Delegating

Conflict resolving methods DESC

- Describe the specific situation or behavior; provide concrete data - Express how the situation makes you feel (ex- uncomfortable) and what your concerns are - Suggest other alternatives and seek agreement - Consequences should be stated in terms of impact on established goals; strive for consensus

Team building/ collaboration

- Discuss the communication for a successful team - ID how to evaluate performance and give feedback

Ex of call-out/read back and verified

- Ex: you have called a code on your pt. you have to be certain all info is spoken out loud and correct - all responders have a role. MD., nurse, respiratory, supervisor

Lateral violence

- Examples - Discuss methods to resolve/ combat lateral violence

Conflict

- ID types - Recognize methods to resolve/ combat lateral violence

Intentional torts

- Invasion of privacy - assault and battery - defamation of character - libel - slander - false imprisonment - intentional infliction of emotional distress

Why is therapeutic communication so important?

- It eliminates fear, anxiety, and stress in your pt. The nurse recognizes their own beliefs, thoughts, biases, and limitations. - They avoid projecting their own emotional issues to the pt and foster a nonjudgmental attitude and effective engagement techniques

Process of communication

- It is a complex, ongoing process between participants who create a shared meaning in an interaction - It has content and value, the content regards to what was said, while the value pertains to how it was said. - Nursing is composed of knowledge, clinical work and interpersonal communication

Malpractice- minimize your risk

- Know and follow NPA - Assess patients frequently (use your nursing judgment!) - Report abnormals promptly - Follow up on care delegated to others- Communicate openly - DOCUMENT! - Report and file incident reports promptly

Barriers to delegation

- Lack of confidence or trust in co-workers - Lack of experience/ training - Licensure issues - Lack of staff - Unwilling delegate - Insecure delegator - Personal qualities (poor communication or interpersonal skills)

Non- verbal communication

- May be more powerful than words we speak - includes direct eye contact, tone of voice, gestures of hands - be aware of timing and environment - be careful of distractions

What can be done about workplace bullying

- Most organizations/facilities have created policies addressing the code of conduct addressing bullying. There is a zero tolerance in most healthcare environments. -They are hosting regular training sessions to empower employees when to recognize it and be coached on the proper way to communicate what is going on. -SPEAK UP!!! No one knows until you say something if incidents keep occurring between yourself and a co-worker. There is always ways to resolve situations, you must be your own advocate when you know a relationship is unhealthy. - most are caused bc of personality diff or completion wihtin workplace

Unintentional torts

- Negligence: failure of an individual to perform an act that a reasonable person in similar circumstances would - Malpractice: failure of a professional person to act as other prudent professionals with the same knowledge and education would act under similar circumstances

Principles of delegation

- Nursing profession determines scope & standards of practice - RN takes responsibility & accountability for provision of nursing practice - RN directs care and determines appropriate utilization of resources when providing care - RN may delegate tasks or elements of care but does not delegate nursing process itself - RN considers facility/agency policies & procedures and the knowledge, skills, training, and experience of any individual to whom the RN delegates elements of care - Decision to delegate is based on RN's judgement of complexity of the patient, availability & competence of the individual accepting delegation, and the type & intensity of supervision required - Organization is accountable for ensuring the RN has access to documented competency information for staff to whom the RN is delegating tasks - RN uses critical thinking and professional judgement when following the 5 Rights of Delegation

Patient rights

- Privacy - Confidentiality - Informed Consent - Advance Directives - Freedom from Restraint

Therapeutic communication

- Pt centered approach where nurses est effective interactions with their pt to deliver holistic and quality care

Examples of verbal communication techniques of restatement

- Pt- I hate this place. I dont belong here - RN- you dont want to be here?

Collaborating

- This style maximizes both assertiveness and cooperation. The attempt is made to fully satisfy the interest of both parties. It works best when the conflict in not intense and when each party has information that is useful to the other.

Horizontal (lateral) violence in the workplace

- When co-workers commit acts of aggression against their co-workers. -These are the people you work with on a daily basis, some are like family. But when tensions run high or you have a real difference of opinion. It can get ugly. -The acts can range from mild to severe.....

Therapeutic communication

- With each pt interaction, you are building an interpersonal relationship. -As senior students, there should be a deeper understanding of the real meaning of the message in interacting with the pt.

Communication

- Written - In person

Therapeutic communication

- You can confidently discuss pt's needs and preferences to improve pt safety and satisfaction and provide a quicker healing process.

Managing team communication

- active listening - assertive behavior - providing feedback - saying no - confrontation

Assertive behavior in team comm

- asking for what one wants and needs and doing it in a respectful way

The LPN

- cannot perform admission assessment - cannot give IV push medications - cannot provide most teaching - cannot take care of unstable patients - cannot take care of clients with acute conditions

Validation

- clarifying the nurses understanding of the situation

Group process

- coming together for a specific purpose or objective - each group will have a leader that motivates and moves the group towards decisions and details. There may even be a co- leader. That role can be formal or informal

4 Cs of teamwork

- communication - coordination - collaboration - consenus

Approaches to conflict resolution

- compromise - accommodation - competition - collaborating

Conflict resolution- key pnts

- consider the source - an ill pt, scared fam member, an overworkdr colleague - acknowledge their pain and feelings (listening is crucial in nursing) - reason with them/ explain the rationale - give them time to consider if appropriate - evaluate and re- visit the source of the conflict

Types of laws

- criminal laws - statutory laws - civil laws

Saying no in team comm

- est professional/ personal boundaries with those around you

CUS (concerned, uncomfortable, safety)

- getting the physcians attentions when you really need it

Handoff components

- increases accountability - decreases uncertainty - communicate verbally - opportunity for questions

Civil law

- involve the violation of ones persons rights by another person -contract law, intentional torts, unintentional torts - consequence of a guilty verdict: monetary damages

Group role- follower

- just goes along with the movement of the group

The UAP

- look for the lowest level of skill required for the task - look for the least complicated task - look for the most stable patient - look for the patient with the chronic illness

Tasks that can be delegated

- maintaining asepsis - personal hygiene - nutrition - ambulation - vital signs - toileting - observing, recording, reporting

Group roles

- monopolizer - silent member - energizer - follower - recorder

Confrontation in team comm

- process of directly expressing ones view of a prob situation with the person involved

Providing feedback in team comm

- provides reassurance and support. can be postive or negative

Example of verbal comm tech- validation

- pt- my doctor didnt explain my dx to me - RN- let me see if i understand

Acceptance

- receive info in a nonjudgmental manner

Restatement

- repeating the main idea expressed; lets pt know what was heard

Group role- energizer

- they attempt to stimulate the group to make decisions or provide motivation to accomplish tasks

Group role- monopolizer

- they constantly talk or interrupt others. They want to be heard and can be aggresive at times. they may be anxious and talking a lot subsides their fear. or they may be passionate about the topic of choice

Group role- silent member

- they function by being quiet. they may still be productive part of the group by doing other tasks. in general may be comfortable speaking in front of others

Conflict

- two or more individuals with different values, perspectives, goals or needs view things differently - can happen in any environment - intrapersonal- occurs within an individual - interprofessional- occurs bw 2 or more indiv. within an organization

Communicating effectively- in person communication

- verbal - non verbal

Group role- recorder

- writes ideas, types up data into comp. and serves as group memory

The charge nurse finds the mother of the child with a chronic bladder condition requiring clean intermittent catheterization (CIC) visibly upset. The mother states, "That other nurse said parents are not allowed to perform CIC in the hospital because of increased infection risk." The charge nurse should tell the parent:

-"You can use CIC on your child. I will talk with your nurse to clarify the policy."

A nurse is observing a newly licensed nurse and a UAP pull a patient up in bed. Which of the following statements indicates appropriate feedback by the observing nurse?

-"You used your body weight appropriately to counter the patient's weight when pulling the patient up."

Workplace violence

-Any violent act, including physical assaults and threats of assault, directed towards persons at work or on duty. People working in healthcare are particularly vulnerable to these attacks because of the intense environment we work in. -Can range from physical injuries, psychological trauma or death. -Violence from patients or family members is more likely to occur in Emergency departments, psychiatric settings, waiting rooms and geriatric units.

A nurse is hired to replace a staff member who resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following strategies is the manager demonstrating?

-Avoidance

-The nurse is caring for a client who had an open cholecystectomy 24 hours ago. The client's vital signs have been stable for the last 24 hours, but the client now has a temperature of 101.1F (38.4 C), a heart rate of 116 beats/min, and a respiratory rate of 26 breaths/min. Using SBAR communication, which of the following recommendations should the nurse make when calling the physician? Select all that apply.

-Draw stat Blood cultures X2, CBC and BMP. - Start broad-spectrum IV antibiotics after blood cultures are drawn. - Obtain UA with culture and sensitivity if indicated.

A nurse who has just assumed a position as unit manager is examining her skills fostering interprofessional collaboration on the unit. Which action supports interprofessional collaboration?

-Encourage team member's referral requests.

Statutory laws

-Federal laws: Patient self- determination act, HIPAA, ADA, EMTALA, reporting statutes - state laws: nurse practice acts, good samaritan laws, nurse pt ratios, reporting statutes

Horizontal (lateral) violence in the workplace ex

-Ignoring the person or giving the silent treatment -Making ugly remarks purposely within hearing -Ridiculing the individual or gossiping around others -Direct verbal abuse -Sexual harassment -Physical attack

Nurses can create a healthier workplace by:

-Modeling healthy workplace interactions

A client is brought to the Emergency Department dead on arrival (DOA) from a gunshot wound. The client's family arrives and is escorted to a private area. A multidisciplinary team composed of a physician, nurse and social worker interacts with the family. All members work together to complete the following tasks. Which are the priority nursing responsibilities? Select all that apply.

-Providing therapeutic touch and support as needed -Caring for body organs which are appropriate for transplantation. -Escorting the client's family for viewing of the body.

Standards of care

-The care a patient should expect to receive under similar circumstances; a constant. -Based on professional literature, journals, protocols, & expert opinions

Accommodation

-The person suppresses and smooths over differences because they dread conflict. They want to do whatever it takes to maintain harmony.

Cognitive rehearsal

-Way in which nurses can mentally prepare yourself to address threats from incivility or bullying.

A nurse answering the phone at the nurse's station receives a bomb threat. What should the nurse say?

-Where is the bomb and when is it set to explode?

A nurse on a telemetry unit is caring for a patient who was admitted with chest pain. The patient becomes angry, stating that there is nothing wrong with him and that he is leaving. What statement should the nurse use when talking with the patient?

-You came in here with chest pain and until the doctor finds out the reason for that, it is a good idea to stay here so we can treat you immediately.

Active listening in team comm

-telling others that you value both what they have to say and their participation in team activities

The nurse is monitoring a client, who is six hours post-embolectomy, for an acute arterial occlusion of the left leg. When a Doppler ultrasound fails to detect a pedal pulse, the nurse notifies the surgeon who requests that the client be prepared for immediate surgery. The client refuses to consider additional surgery. What is the nurse's initial intervention?

Notify the provider immediately

Responsibility vs accountability

R- the obligation to accomplish a task that you have agreed to do. A- accepting ownership for the results of a task or tasks that have been delegated. ***The delegating nurse holds the ultimate responsibility for accomplishment of the task, and that nurse is liable for the outcome.