ADN 151 CH. 8 Objectives

Use a standardized communication technique (e.g., SBAR) to communicate with other nurses and other health care providers.

SBAR Situation and Background provide objective data whereas the Assessment and Recommendation allow for presentation of subjective information.

Use effective communication techniques when interacting with patients from different cultures.

1. Asses your personal beliefs surrounding people from different cultures 2. Assess communication variables from a cultural perspective 3. Plan care based on the communicated needs and cultural background 4. Modify communication approaches to meet cultural needs 5. Understand that respect for the patient and communicated needs is central to the therapeutic relationship 6. Communicate in a nonthreatening manner 7. Use validating techniques in communication 8. Be considerate of reluctance to talk when the subject involves sexual matters 9. Adopt special approaches when the patient speaks a different language 10. Use interpreters to improve communication

Describe the interrelation between communication and the nursing process.

1. Assessing -The major focus of assessment is to gather info from both verbal and nonverbal communication forms. Before the assessment the nurse should determine if the patient needs any assistive devices in order to communicate effectively and understand conversations. ID patients preferred language and secure an interpreter if needed. The written word is used to obtain patient data and when reading patients records or charts before meeting them. the spoken word is used to give and receive reports to and from other health personnel. One to one communication is used with patients to obtain thorough nursing histories and physical exams 2. Diagnosing -An impaired ability to communicate may contribute to the development of other nursing diagnoses as well. The nurses communicate findings to other nursing professionals through the ise of written and spoken word. The written diagnosis becomes a permanent part of the patients health records. 3. Outcome ID and Planning -The planning steps requires communication among the patient, nurses, and other team members as mutually agreed-upon outcomes are developed and interventions are determined. Oral and written communications is needed to inform others of what needs to be done to meet the set objectives or goals 4. Implementing -Verbal and nonverbal communication methods enhance basic caregiving measures and are used to teach, counsel and support patients and their families during the implementation phase. Even a simple phrase "encourage patient to drink 100mL of fluid every hour while awake." requires countless messages to be sent and received between nurses and the patient and other healthcare providers. The nurse expresses the importance of fluid intake with freq and amount. The patient voices if there will be any problems with that. The nurse assesses the verbal and non verbal communication and then implementation of the nursing care plan is then documented in the patients record. 5. Evaluating -Communication through the exchange of positive and negative messages between the nurse and the patient, also facilitates the revision of parts of the nursing care plan

Describe how each type of ineffective communication hinders communication.

1. Cliches is a sterotyped, trite or pat answer examples are "Everything will be alright" "dont worry. You will be just fine in another day or two" "Your doctor knows best" "Cheer up tomorrows another day" or sweeping generalizations "Men tolerate pain poorly" That must be why you are complaining of severe pain" 2. Questions requiring only a yes or no answer tend to cut off discussion, even when the person might wish to continue. The problem with yes or no questions arises when seeking more detailed information or when the question might create difficulty. 3. Questions containing why and how are intimating to many patients. 4. Questions that probe for information too much can cut off discussion. Though gaining more information is neccessary it is important to follow the patients lead. Patients who are made to feel as though they are receiving the "third degree" become resentful usually stop talking and try to avoid further conversation. 5. Leading questions suggests what response the speaker wishes to hear. This can cause the patient to give an answer that pleases the nurse but might not be honest. 6. Comments that give advice makes it seem that the nurse knows best and this can deny the patient the right to make decisions and have feelings 7. Judgmental comments tend to impose the nurses standards on the patients this can cut off discussion. 8. Changing subjects The patient might be at a point of readiness to discuss something and will likely feel frustrated if put off by a change of subject 9. Giving false assurance might give patients teh impression that the nurse is not interested in their problems 10. Gossip and Rumor can produce detrimental effects on relationships and group building.

Describe the communication process and identify factors that influence communication.

1. Communication- Is the process of exchanging information and generating and transmitting meanings between two or more people. Communication is the primary aspect of a nurse-patient interaction. 2. Th communication process involves a source (encoder), message, channel , and receiver (decoder). this process is initiated based on stimulus, in this case a patient need that must be addressed. T -the sender or source (encoder) of the message is a person or group who initiates or begins the communication process -The message is the actual communication product from the source. It might be speech, interview, conversation, chart, gesture, memorandum. or nursing note. -The channel of communication is the medium the sender selected to send the message. Th channel might target any of the receivers senses. Auditory (spoken words or cues), Visual, Kinesthetic -The receiver (decoder) must translate and interpret the message sent and received -Conformation of the message provides feedback that the receiver understood the intended message. Noise-factors that distort the quality of a message These factors can be the tv or pain. .

Describe strategies that counteract disruptive professional communication and behaviors.

1. Education must be provided for all staff regarding respectful, professional behavior, and communication 2. All staff members must be held accountable for their behavior and use fo communication techniques 3. Zero-tolerance policies must be implemented regarding disruptive behaviors and communication 4. Those in leadership positions must attend training regarding professional standards of behavior and communication techniques and function as a positive role model 5. Surveillance and reporting systems must be available to ID unprofessional behaviors and communication 6. Emphasis must be placed on the importance of documenting bullying behaviors and disruptive communication

Identify patient goals for each phase of the helping relationship.

1. Helping relationships is characterized by an unequal sharing of information. The patient shares information related to personal health problems, whereas the nurse shares information in terms of a professional role. This follows the nursing process both process are continous and reciprocal 2. Phases of the helping relationship -Orientation Phase this where the tone and guidelines for the relationship are established. The roles of both people in the relationship are clarified. An agreement or contract about the relationship is established. the agreement is usually simple verbal exchange related to the goals and the means of achieving them or occasionally a written document, especially if the relationship extends over a long period of time. The patient is provided with an orientation to the health care faculty, its services, admission routines, and any pertinent information the patient requires to decrease anxiety, This orientation should be identified as one of the goals in the nurse-patient helping relationship. -Working Phase is usllay the longest phase of the helping relationship. During this phase the nurse works together with the patient to meet the patients physical needs. Interaction is the essence of the working phase. These interactions are purposeful in that they are designed to ensure achievement of health goals or objectives that were mutually agreed upon. The nurse provides whatever assistance is needed for ADL. The roles of teacher and counselor involve motivating the patient to learn and to implement health-promotion activities, to facilitate the patients ability to execute the nursing care plan, and to express feelings about health problems, nursing care, any progress or setbacks and any other concerns -Termination Phase occurs when the conclusion of the initial agreement is acknowledged. This might happen on discharge, nurse on vacation, or employment elsewhere. You'll examine patient goals of the helping relationship for indications of their attainment or for evidence. It is thoughtful to set the stage for the patient to establish a helping relationship with another nurse if appropriate, You can also assist the patient transferring from one facility to anoer from one unit in a facility to another by offering explanations concerning the transfer.

Evaluate yourself in terms of the interpersonal competencies needed in nursing.

1. Interpersonal Communication occurs between two or 2. more people with a goal to exchange messages. Disruptive Interpersonal Behavior ❖Incivility ❖Bullying oHorizontal violence oNurse bullying oNegative communication between nurse and physician ❖Organizational response to disruptive behaviors

Levels of communication

1. Interpersonal communication or self talk is communication with a person. This communication is crucial because it affects the nurses behavior and can enhance or detract from positive interactions with the patient and family. 2. Interpersonal Communication occurs between two or more people with a goal to exchange messages 3. Group communication -Small group occurs when nurses interact with two or more people. To be functional, members of the small group must communicate goals. An example is huddle at the beginning of shifts. -Organizational Communication occurs when people and groups within an organization communicate to achieve established goals. An example a nurses on practice council meeting to review unit policies. 4. Group dynamics-Involve how individual group members relate to one another during the process of working towards group goals.

Describe effective interventions for patients with impaired communication.

1. Patients who are visually impaired -Acknoeldge your presence -ID self and talk through actions knowing patient cant pick up on body language -Let patient know when leeaving 2. Patients who are hearing impaired -Move in sight of patient or gently touch patient to acknowledge your presence -talk face to face with patient be aware of nonverbal communication -If you know sign language if you know it -Write down things that needs more explanation 3. Patient with physical barrier (Laryngectomy or Endotracheal tube) -Select one or more simple ways to communicate that patient can use. Options include eye blinking or hand squeezes to communicate yes or no; writing pads or magic slates; communication boards with words, letters or pictures; flash cards -Make sure communication devices are known to everybody -Make sure to encourage patient and point out call light 4. Patients who are cognitively impaired -Maintain eye contact -Communicate important in quiet distraction free environment -Keep things simple and concrete. Do not use pronouns or abstract terms. Use pictures or drawings when appropriate. avoid open ended questions -Be patient and give patient time to respond 5. Patients who are unconscious -Be careful what is said in patients presence -Assume patient can hear you -Speak with patient before touching them. -Keep environment noise low 6. Patients who do not speak English -use interpreter -speak in simple sentences -demo or pantomime ideas -Be aware of nonverbal communications.

Discuss professional responsibilities when using electronic communication.

1. When using social media one must protect patient privacy and confidentially and preventing unintended consequences for the employer or the nurse. nurses should also be aware of their workplace policy of social media. 2. Social media are web based technologies that allow users to create, share and participate in dialogue in virtual communities and networks. nurses are accountable for their use of social media and can be reported to a regulatory authority for an allegation of inappropriate use of social media, reflective of deviation from required professional competencies and standards for practice. Describing a patient by using a room number or diagnosis rather than a name is still considered a breach of confidentiality and violation of patient privacy. 3. Emails and text messages should be concise and avoid test abbreviations. Any emails sent to a patient must be duplicated and become part of medical records for the patient.

Establish therapeutic relationships with patients assigned to your care.

1.Developing professional therapeutic communication skills -Conversation skills control your tone of voice to rely right message. Be knowledgeable of topic. Be flexible within the conversation discuss multiple topics if necessary. Be clear and concise and make statements as clear as possible. Avoid words that have different interpretations. Be truthful and keep an open mind. Take advantage of available opportunities. -Listening skills When possible sit while having a conversation. Be alert and relaxed and take sufficient time so that the patient feels at ease during the convo. Keep conversation as natural as possible, avoid sounding overly eager. If culturally appropriate maintain eye contact. Indicate that youre paying attention by using gestures and facial expressions. Think before responding to patient. Do not pretend to listen. Listen for themes in the patients comments. -Silence can be used to allow the patient to gather his or her thoughts and to process at his or her own pace to initiate a conversation or to continue speaking. During periods of silence you can reflect on what was said and observe the patient without having to concentrate simultaneously on the spoken word. silence can mean many things like comfortability, stoicism, self reflection, fear, anger, or culture. -Touch is a powerful means of communication with multiple meanings. It can connect people, provide affirmation, reassurance, and stimulation, decrease loneliness, increase self esteem and share warmth, intimacy, approval, and emotional support. It can also communicate frustration, anger, aggression and punishment and invade personals space and privacy. -Humor is increasingly valued as both interpersonal skill for the nurse and a healing stragery for patients.

Factors Influencing Communication

❖Developmental level ❖Gender ❖Sociocultural differences ❖Roles and responsibilities ❖Space and territoriality ❖Physical, mental, and emotional state ❖Values Environment

List at least eight ways in which people communicate nonverbally.

❖Nonverbal (body language) mismatch from what they say to how they act. oFacial expressions, touch, eye contact oPosture, gait, gestures oGeneral physical appearance oMode of dress and grooming oSounds, silence oElectronic communication

Interviewing Techniques

❖Open-ended questions or comments ❖Closed questions or comments ❖Validating questions or comments ❖Clarifying questions or comments ❖Reflective questions or comments ❖Sequencing questions or comments ❖Directing questions or comments