Chapter 12 Communication and Collaboration in Professional Nursing

IOM made..

in disciplinary learning a core educational requirement with he assumption that education across health care sickliness will improve communication, increase collaboration and decrease errors -reduces stereotypes

Informal contract

in the termination phase

Non verbal communication

includes grooming, clothing, gestures, posture, facial expressions, eye contact, tone and volume, and actions -influenced by environment

value statement

indicate that the nurse made a judgment, either positive or negative -nurse is operating out of his/her own framework

Technology and talking with other colleagues during care comes off as...

insensitive and makes the patient feel like they are secondary -email: leads to misunderstanding

Active listening:

involves focusing solely on a person and acknowledging feelings in a nonjudgmental manner -best w/o distractions, enriched manner, good eye contact, nodding

Collaboration:

is a complex process that builds on communication -working jointly with other health care professionals

Communication defintion

is the exchange of thoughts, ideas, or information and is at the heart of all relationships

Prejudice definition:

judging a person in advance of knowing him or her -makes acceptance of others difficult

Open posture:

leaning forward, relaxed, arms uncrossed -reflect what you hear

Nurse managers use...

listening as a tool for dealing with staff members problems and concerns

Example of contact in the orientation phase

newly diagnosed diabetes patient agrees to work with the nurse to work together on the patient monitoring their glucose levels

Non judgmental acceptance

nurses acknowledge all patients rights to be who they are and to express their uniqueness

open ended questions:

one that causes the patient to answer fully, giving more than a "yes" or "no" answer -useful in data gathering

Orientation (Introductory phase)

period often describes as "getting to know you" in social settings -Nurse and patient assess each other in this phase -be calm and unhurried -Understanding patients needs and problems -Patient learns the nurses credentials and name ** initial development stage

Receiver:

person acquiring the message

Sender:

person sending the message

Hierarchy is dominated by..

physicians -nurses prefer collaboration interactions

Peplau

pioneer in nursing theory development, first focused on the importance of the nurse-patient relationship

Appropriateness:

refers to the correct fit of a reply -it matches the message -How are you? don't go into a lengthy reply -nurse needs to actually know how their patient is

Transmission:

refers to the expression of information, verbal or non verbal -teachers verbal and non verbal expressions when teaching a lesson (message)

ANA Code of Ethics...

requires nurses to be professional nurses with stereotypes

Reflective practice

requires taking tie to focus on their own thoughts, feelings, actions and beliefs

Reflection:

serving as a mirror for the patient -understanding and acceptance -encourages patients to think through problems themselves

Context:

setting in which an interaction occurs - including the mood, relationship between sender and receiver and other factors

Giving information:

sharing knowledge that the recipients are not expected to know -know the difference between providing intro and giving opinions -giving opinions is unhelpful

SBAR

situation background assessment recommendation

Verbal communication

speech and represents the most obvious aspect of communication -consists of nonverbal communication -develops last in children

SBAR is the...

structural way of relating critical information in spoken form -establishes culture of quality, reliability, and patient safety ** safety is key -means that info is clear, complete, concise and structured -most relevant and important data are featured

sympathy and empathy difference:

sympathy is more into feelings and empathy acknowledges their feelings and emotions but isnt swept along with them

Need to take a minute from care because of overstimulated emotions

talk to a colleague to assist you or receive you from care

Evaluation:

the analysis of received information. -people evaluate the content of their professors lecture

Example of the working phase

the diabetic patient may give the nurse some degree of difficulty in accepting the lifestyle changes that managing diabetes requires

The working phase

the nurse and patient address tasks outlines in the orientation phase -patients may exhibit alternating periods of intense effort and resistance to change

Perception:

the selection, organization and interpretation of incoming signals into meaningful messages -people perceive information differently -students in a lecture hall

Interpersonal skills

the skill set that includes communication is referred to as this

"twos steps forward and one step backwards"

the working phase

Boundaries violations occur when..

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

Secretive behavior of a nurse

thing to watch for.... crossing boundaries

Astute nurses...

use their communication skills throughout their personal and professional lives

Venting:

used to describe the verbal "letting off steam" that occurs when talking about concerns or frustrations -nurse may hear patient talking... can't take it personal

Efficiency:

using simple, clear words that are timed at a pace suitable to participants -dont just say that your patient will be having an angioplasty... you need to explain to them what it is (this would not be good for a small child though) -ex. physical said a patin had bugs in her bladder and she took it seriously

Congruent communication

verbal and non verbal aspects match and reinforce each other

Message:

what is actually being said plus applying nonverbal communication

Communication begins the moment...

when two people become aware of each others presence -no words can be spoken

Incongruent Communication

words and nonverbal communication do not match -creates confusion in receivers whoa re unsure of what levels of communications they should respond to -unexpressed feelings

translator:

works with written documents

Professional Relationships

- interactions are planned and purposeful - limited in time with termination date - goal directed - problem solving - nonjudgmental acceptance - outcome is improved health status of patient

Social Relationships

- not time limited - not necessarily goal directed - outcome is pleasure for both parties

Stereotypes are based on..

-ethnicity -gender -nationality -political affiliation

Developing trust

-straight forward, non defensive manner -follow through on promises -withhold judgments about patents and their situations -listen carefully to your own responses -congruence (equal) between verbal and nonverbal communication

Conflict resolution skills:

1. acknowledge conflict 2. Recognize and affirm task issues while redirecting 3. Facilitate debate over task issues 4. Promote expression 5. Explore alternative positions 6. Willing to change your position on an issue 7. Share power 8. Stay focused

Generations in nursing:

1. baby boomers 2. Generation X 3. Generation Y (millenials) 4. Net generation (digital age)

Full attention guidelines:

1. give your full attention 2. interrupted by a call that you must take them you must go into the hall 3. adopt a courteous tone in email and voicemail messages regardless of how rushed you are ** dont resort to :).... reword your letter/ email 4. avoid use of jargon 5. keep messages short 6. when leaving # in voicemail, make sure to enunciate 7. when receiving a message... read, listen and evaluate the entire message before reacting

Bacas 5 ways in which self-disclosure becomes problematic

1. if the nurse problems or needs becomes problematic 2. if disclosure by the nurse becomes a common, rather than rare, event during interactions with a patient 3. when the discloser is unrelated to the patients problems or experiences 4. if it takes more than a very short time during an interaction 5. the nurse discloses personal info even if its clear that the patient is confused by the interactions

Swanson's 5 caring processes germane to nursing practice:

1. knowing 2. being with 3. doing for 4. enabling 5. maintain belief

Three therapeutic nurse patient relationship

1. orientation 2. working 3. termination

Key component for effective interprofessional collaboration

1. respect for other collaborators 2. confidence in own knowledge 3. willingness to learn 4. cooperative spirit 5. Belief in common purpose 6. Value contributions 7. Willingness to negotiate 8. Excellent communication skills 9. Self-awareness 10. Tolerance of differing opinions 11. Not threatened by conflict 12. Knowledge of ones own limits

Principles for determining professional boundaries

1. the nurse is responsible for maintain and coming up with boundaries 2. the nurse should work within the zone of helpfulness 3. the nurse should examine any boundary crossing 4. care setting, community influences, client needs, and the nature of therapy affect the delineation of the boundaries 5. actions that overstep established boundaries to meet the needs of the nurse are violating 6. the nurse should avoid dual relationships 7. posttermination relationships are complex because the client may need additional services

Tasks of the orientation phase

1. the patient will have developed enough trust in the nurse to continue to participate in the relationship 2. the patient and nurse will see each other as individuals 3. the patents perception of major problems and needs will have been identified 4. approximate length of the relationship will have been estimated and the nurse and patient work together

Communication

Does not involve simply being able to talk, but to listen and engage with another person nonverbally

Termination phase

Includes those activities that enable the patient and the nurse to end the relationship in a therapeutic manner

Developing self-awareness

Is basic to effective interpersonal relationships and is especially important in the nurse patient relationship

Requirements for the working stage:

Patience, self-awareness, and maturity

Feedback, Appropriateness, Efficiency, Flexibility

Successful communciation

IOM

The institute of Medicine

Peplaus theory

The therapeutic use of self -helpful with relating effectively to patients, patents' families and other health care professionals

Boundaries

They get blurred and relationships become social, not professional - problem in long term care facilities (hospice/palliative)

Non verbal communication is...

a more reliable expression of feeling

Rusch

a pioneer communications theorist

Regression definition

a psychological device the occurs as a reaction to stress and that often proceeds positive changes in behavior

Feedback:

a response to a message

Contract

agreement, whether formalized in writing or informally agreed on

Patient center care has been proposed to..

alleviate vulnerabilities experienced by the patient is central to patient centered care in acute care settings

Therapeutic engagement is the key process in...

alleviating vulnerabilities and one of the mechanisms

false reassurance

another communication pitfall. -rather say... lets talk about your concerns

Stereotypes and Prejudices...

are irrational and illogical beliefs

Stereotypes

are simplistic, distorted images used to describe or characterize groups -they result in prejudices and negative attitudes through cultural and social interactions

empathy:

awareness of, sensitivity to, and identification with the feelings of another person -if nurses have had similar experiences, empathy is possible "i know exactly how you feel" is not usually helpful

Flexibility:

bases messages o the immediate situation rather than preconceived expectations -nurse walks into who is prepared to talk about the patients diabetes and finds them crying. They have to be flexile to show compassion to the patient -dog bite example

The process of the termination phase...

begins in the orientation phase when participants estimate the length of time it will take to accomplish the desired outcomes

Reflective practice also involves...

being self-aware. Look past your own negative or positive responses to particular patients

Receiving gifts

both the agency's policy on gifts and your clinical faculty should also be consulted -even if you're not allowed accept a gift from families, you should acknowledge their thoughtfulness

Failing to recognize levels of meaning is a cause of...

breakdown -ex. its getting hot in here.... nurse and patent conversation is getting uncomfortable

Failing to see the uniqueness of each individual is a common cause of...

breakdown -preconceived ideas, prejudices, and stereotypes

The nursing process

can only begin after the nurse and patient establish establish their initial therapeutic nurse-patient relationship

Crossing professional boundaries...

can result in role confusion, risking harm to both the patient and nurse

Priestly

chemist and theologian, philosopher, educator and political theorist -communication is highly valued in healthcare

Somatic language

consists of crying, reddening of the skin; fast shallow, breathing; facial expressions and jerking of the limbs -mothers know the difference between their childs cry -decreases with maturity

Action language

consists of reaching out, pointing, crawling toward a desired object, or closing the lips and turning the head when undesired food is offered -can be without sound

Acceptance

conveys neither approval nor disproval of patients and their personal beliefs, habits, expressions of feelings or lifestyles

National Council of State Boards of Nursing (NCSBN)

detailed the subject of professional boundaries

Underinvolvment and overinvolvment can be..

detrimental to the nurse and patient

Nightingale pledge

dressed personal boundary questions

Helpful responding techniques:

empathy, open-ended questions, giving information, reflection, silence

Failure to maintain professional boundaries with a patient is an offense reportable to your....

employer and/or your state board of nursing and violates nursing code of ethics

Factors influencing perception, evaluation, and transmission

gender, age, culture of sender and receiver; interest and mood of both parties; value, clarity and length of message; the presence or absence of feedback; and the context all are powerful influences -needs, values, self concepts, sensory and intellectual abilities or deficit and sociocultural conditioning

Silence:

good for emotions and growing communication relationships -sitting quietly with patients who just found out bad news

"sea change"

help physicians and nurses collaborate more effectively

Traditional nurse patient relationship

hospitalized patents are acutely ill, nurses workloads have increased, and the time nurses spend with patients may be limited