Chapter 12 Communication and Collaborating in Nursing

What is the Termination phase?

includes those activities that enable the patient and the nurse to end the relationship in a therapeutic manner. -positive or negative feelings may often accompany termination.

What is incongruent communication?

verbal and nonverbal do not match

Culture determines how aspects of life are ______ and __________.

viewed; experienced

What is Swanson's theory of caring and human relatedness?

(1981) Defined caring as a nurturing way of relating to a valued other, toward whom one feels a personal sense of commitment and responsibility.

What are conflict resolution skills?

-Acknowledge conflict -Recognize & affirm positive results -Facilitate debate over task issues -Promote expression of perspectives -Explore alternatives -Have an open mind to change -Share opinions -Stay focused on desired outcome

What are helpful responding techniques?

-Empathy -Open-ended questions -Giving information (sharing knowledge; providing information or giving opinions) -Reflection -Silence

What are the avoiding common causes of communication breakdown? (Negatives)

-Failing to see the uniqueness of individuals via preconceived ideas, prejudices, and stereotypes. -Failing to recognize levels of meaning -Using value statement (nurse has made a judgment either pos. or neg.) and clichés -Failing to give reassurance -Failing to clarify

What are the four major criteria of communication?

-Feedback -Appropriateness (the correct "fit" of a reply) -Efficiency (simple, clear words that are timed at a pace suitable to participants...oversimplification...specific patients who require special assistance) -Flexibility (bases messages on the immediate situation rather than preconceived expectation)

The steps for successful collaboration

-Identification of those who have stake in the outcome -Identify problems to be solved -Identify barriers to create solution -Clarify desired outcomes -Clarify the process -Identify who will be responsible -Evaluate

What are Baca's (2011) 5 ways in which self disclosure becomes problematic?

-If the nurse's problems or needs are disclosed. -If disclosure by the nurse becomes a common, rather than rare, event during interactions with a patient. -When the disclosure is unrelated to the patient's problems or experiences -If it takes more than a very short time during an interaction -The nurse discloses personal information even if it is clear that the patient is confused by the interaction.

What are strategies for trust?

-Introduce yourself -Uniform "scrubs" -Listen -Keep Promises -Respect Patient

Why might nurses have trouble listening?

-May be frustrated by the time it takes to be a good listener -May be planning on question or response without listening to what the patient is truly saying. -Distracted by colleague, cell phone, or worries of other patient. -Own personal and professional problems

Tasks of orientation:

-Patient will have developed enough trust to continue the relationship. -Patient and nurse see each other as individuals. -Patient's perception of major problems and needs identified -Length of the relationship has been estimated.

What is the RESPECT Model?

-Rapport -Environment/Equipment -Safety -Privacy -Encouragement -Caring & Compassion -Tact

What happens when the nurse-patient relationship crosses professional boundaries?

-Role confusion can result -Risks harm to both patient and nurse

What is the purpose of using SBAR?

-Structured way of relaying critical information. -Means to establish culture of quality, reliability, and patient safety due to shared set of expectations -Safety--format decreases the inherently unsafe and dysfunctional hierarchy of providers

What is wrong with this scenario? A patient presents to her provider with increased swelling and pitting edema to her left foot. While sitting on the examination table, the provider greeted the patient and states, "Let me see your Fred Flintstone foot." The patient is offended; people have referred to her foot as "big" before but never to this extent. She does not confront the provider, and does not plan to return for follow-up care.

-The care provider offends the patient by referring her foot as a "Fred flintstone foot" -The trust and introductory phase are ruined. The patient plans and not coming back. -Not all patients will take humor the same way.

What is wrong with the scenario? A patient with a history of morbid obesity is admitted to the hospital with pneumonia. A nurse and patient care technician enter the patient's room to give him a bed bath. This is the first time the two have cared for the patient, and after introducing themselves, the nurse calls to the nurses' station and says, "I am going to need about five more people to come in and help me bathe this patient." The patient gets upset and responds emotionally, "I know how to turn myself in the bed and I can bathe most of myself, but you never asked me."

-The nurse assumed that the patient could not clean/take care of himself. -The nurse embarrasses/humiliates the patient based on their weight.

What is the orientation phase?

-The orientation or introductory phase is the period ofter described as "getting to know you" in social settings.

What are the levels of communication?

-verbal and nonverbal -congruent -incongruent

What is interpersonal collaboration?

-working jointly with other professionals -implies interdependency -understand clearly delineated professional contributions of each member of the health care team

How does the nurse determine professional boundaries? (1)

1. The nurse, not the patient is responsible for delineating and maintaining boundaries.

What is Rapport (RESPECT)? Give examples

Acknowledge each patient as an individual and not his or her condition/disease. -Language sensitivity is not present when providers use the names of stigmatizing diseases or disorders (ex. psychiatric disorders, obesity, HIV/AIDS) -Use person-first language: say "patient with heart failure" rather than "heart failure patient" -Living with a mental illness instead of Mentally ill person or "schizophrenic"

What is nonjudgmental acceptance?

Acknowledging all patients' rights to be who they are and to express their uniqueness.

How does the nurse determine professional boundaries? (5)

Actions that overstep established boundaries to meet the needs of the nurse are boundary violations.

What is Tact (RESPECT)? Give examples

Always think before you speak to avoid offending patients. -recognize that "large size, obese, or obesity, and fat" may offend patients and instead use the preferred terms "unhealthy weight, high BMI, weight problem, or excess weight" -"you look like you are going to blow" during pregnancy -Get to know your patients to determine if humor is appropriate.

What is patient-centered care?

An approach to alleviated some of the difficult problems--poor care quality, limited access to care, and dehumanization of care.

What is Caring and Compassion (RESPECT)? Give examples

Avoid using inappropriate terms of endearment when addressing patients -Terms that appear to be affectionate or endearing can be perceived as patronizing and lacking language sensitivity. -"honey, sweetheart, darling, love" all considered informal and unprofessional when used in healthcare setting. Can make adults feels childlike or subservient.

What is Privacy (RESPECT)? Give examples

Be mindful not to disclose sensitive health information, such as during medication administration. -Avoid referring to medications using the name of the stigmatizing disease for which the medication is being taken. "It's time to take your HIV medication" or "Here is your happy pill"

What is Environment/Equipment (RESPECT)? Give examples

Be prepared and aware of the language used when communicating patient care needs regarding the environment and equipment. -Avoid "big boy chair" or "big boy bed" -Have equipment ready before patient is there

________ is difficult and is usually accompanied by conflict

Change

What is empathy (helpful responding technique)

Consists of awareness of, sensitivity to, and identification with the feelings of another person.

What is under-involvement? (In regards to professional behavior)

Distancing, disinterest, neglect

What is Hagerty and Patusky's theory of caring and human relatedness?

Each nurse-patient contact holds the potential for connection and goal achievement.

What is the difference between empathy and sympathy?

Empathy identifies with another person's emotions ("being in one's shoes") while sympathy is pitying or feeling bad for one's emotions.

What is over-involvement? (In regards to professional behavior)

Excessive personal disclosure by the nurse, secrecy, role reversal, touching, gestures, money or gifts, special attention, social contact, getting involved in a patient's personal affairs, and/or sexual misconduct.

What is a closed question? Give example

Falls into yes or no answer. "Are you in pain?"

What is SOLER?

How to position one's self with their patient. -Sitting at a comfortable angle and distance. -Open posture Arms and legs uncrossed. -Leaning forward from time to time. Looking genuinely interested; listening actively -Effective eye contact without staring. -Remaining relatively relaxed.

What are the CUS words?

I'm Concerned I'm Uncomfortable This is unSafe

What do most larger health care systems provide for patients on nursing units and clinics in order to communicate through language barriers?

Interpretor services

What phase is trust developed?

Introductory

What is active listening?

Involved focusing solely on a person and acknowledging feelings in a nonjudgmental manner. Uses open posture, good eye contact, nodding, encouragement, checking that you heard correctly.

What is I-SBAR-R?

Irrelevent data is quickly filtered through so most relevant is featured. I- introduction ("Hello this is Jane Doe. I am the RN for John Doe.") R- readback to improve communication even further (summary of what is going to happen)

What are prejudices?

Judging a person in advance of knowing him/her based on stereotypes and biases

What is an open-ended question? Give example

More than one word answer "What is your pain?"

Where were professional boundaries first addressed?

Nightingale Pledge

What are the three phases of nurse-patient relationship?

Orientation, Working, and Termination

How does the nurse determine professional boundaries? (7)

Post-termination relationships are complex because the client may need additional services, and it may be difficult to determine when the nurse-client relationship is truly terminated.

What is a reflection response? Give example

Respond as a mirror to patient; reflect/clarify on what they said. QUE: "Do you think I should go to a skilled care facility?" RES: "Do you think you should go?"

What us Therapeutic Use of Self?

Self-awareness---the ability to recognize one's own emotions, prejudices, and biases and how these are perceived by other. Being aware on one's needs and making conscious efforts to have those needs met in one's private life keeps relationships with patients professional and therapeutic for the patient.

What does SBAR stand for?

Situation Background Assessment Recommendation

What is the zone of helpfulness? (In regards to professional behavior)

The ideal space

What is the working phase? And give an example.

The nurse and patient address tasks outlined in the previous phase. -Patients may exhibit alternating periods of intense effort and of resistance to change.

How does the nurse determine professional boundaries? (6)

The nurse should avoid dual relationships in which the nurse has a personal or business relationship with a patient, as well as the professional one.

How does the nurse determine professional boundaries? (3)

The nurse should examine any boundary crossing, be aware of its potential implications, and avoid repeated crossings.

How does the nurse determine professional boundaries? (2)

The nurse should work within the "zone of helpfulness," which is neither aloof nor too intense/emotionally involved.

What does the NCSBN "A Nurse's Guide to Professional Boundaries" define professional boundaries as?

The spaces between the nurse's power and the client's vulnerability. The power fo the nurse comes from the professional position and the access to private knowledge about the client.

What is language sentisitivity?

The use of respectful, supportive, and caring words with consideration for a patient's situation and diagnosis.

What is Safety (RESPECT)? Give examples

Understand that when language sensitivity is lacking, it may contribute to negative psychological and behavioral outcomes. -Patients may avoid health care follow up or do not verbalize needs when language sensitive missing due to feelings of shame.

What does Encouragement (RESPECT) mean? Give examples

Use words that encourage rather than discourage patients -Using words such as "bad" or "big" refer to body parts that can be offensive to patients. - Instead of "bad arm" use "right", "left", or point to the arm.

How does the nurse determine professional boundaries? (4)

Variables such as the care setting, community influences, client needs, and the nature of therapy affect the delineation of boundaries.

What is congruent communication?

Verbal and nonverbal match and reinforce each other

When do boundary violations occur?

When there is confusion between the needs of the nurse and those of the client.

Define communication

all the modes of behavior that one individual employs, conscious or unconscious, to affect another; not only the spoken and written word, but also gestures, body movements, somatic signs, and symbolism in the arts.

A nurse shares personal stories with the patient. This nursing action is considered problematic when:

b. the nurse indiscriminately talks about personal issues.