Intro Midterm: Professional Socialization & Communication

Techniques of Therapeutic Communication: Informing

- "The medication must be taken every day" - provides facts or recommendations

Techniques of Therapeutic Communication: Broad Openings

- "What's been going on"; "Tell me what's been on your mind" - initiates the conversation - puts the pt in control of the content

Barriers to Effective Communication: Stereotyping

- "What's the matter? Most people don't have pain after this type of surgery" - offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid - categorize pts and negate their uniqueness as individuals

Techniques of Therapeutic Communication: Confrontation

- "You are you're upset, but you are laughing" - presents contraindications and inconsistencies

Techniques of Therapeutic Communication: Minimal Encourager

- "go on" "uh-huh" "I'm listening" - indicate active listening to the pt and interest in what they are saying - prompts the pt to continue with what was being said

Techniques of Therapeutic Communication: Clarifying

- "Are you saying you want to move out of your apartment? Could you explain more about that to me?" - Puts the pt's ideas into a simple statement - makes the pt's ideas explicit

Techniques of Therapeutic Communication: Restating/Reflection of Content

- "Are you saying you were angry when your wife has to work late?" - provides feedback, letting the pt know you understoof the message - lets the pt know you are attentive

Techniques of Therapeutic Communication: Giving Recognition

- "I notice you're wearing a new dress, you look very nice" - a superficial level of communication that inidcates attention to the pt

Barriers to Effective Communication: Probing

- "I'm here to listen, I can't help you if you won't tell me everything" - these statements fail to respect the pt's decisions regarding privacy of feelings and thoughts - considered prying - asking "why" questions is often probing

Techniques of Therapeutic Communication: Focusing

- "Let's go back to the situation at school where you felt uncomfortable in class" - directs the conversation back to an area of importance - explores a topic in depth

Techniques of Therapeutic Communication: Summarizing

- "So far we have talked about..." - the goal is to help the pt explore significant content and emotional themes - helps move from one phase of the interaction to another

Techniques of Therapeutic Communication: Reflection

- "So you start feeling depressed when no one calls you over the weekend?" - presents themes that have emerged through a series of interactions - helps the pt focus on feelings and allows the nurse to communicate empathy

Barriers to Effective Communication: Belittling

- "That was 10 years ago, that shouldn't bother you now" - gives the message that you have not listened carefully - makes the pt feel that the nurse is ignoring the importance of the problem

Factors that Promote Effective Communication

- Dispositional Traits: warmth & friendliness; openness & respect; empathy; honestly, authenticity, trust; caring; competences; genuiness *always think about the image you are giving the pt the first time you walk into the room, don't get wrapped up in the skills part **always focus on the pt's FEELINGS (test) - Rapport Builders (things you can do to build the relationship within the environment): comfortable environment; privacy; confidentiality; pt vs task focus; utilization of nursing observations (tell pt you are observant and intereted in what is going on with them); optimal pacing; providing personal space (explain what you are doing and ask "do you mind if.."

Characterstics of the Helping Relationship

- Dynamic: relationship is constantly changing and evolving - Purposeful and time limited: therapeutic relationships are time limited; goals are established and assessed at some set point - Person providing assistance is professionally accountable for the outcomes; the nurse is always held professional accountable for the outcomes of the relationship

The Collaborative Process

- ID problems to be solved - ID barriers or roadblocks to solutions - Clarify desired outcomes - Clarify the process that will be used and who will be responsible to accomplish steps - Evaluate the degree of success in meeting the goals and generating a solution

Interviewing Techniques

- Open-ended ?s/comments: best way to get info; gets them to elaborate on info - Closed ?s/comments: to gather specific info quickly - Validating ?s/comments: rephrasing something back to them; checking to see if what you heard is what they said - Clarifying ?s/comments: put pt's ideas into a simple statement; "Are you saying.." - Reflective ?s/comments: take something the pt said and repeat it back to them - Sequencing ?s/comments - Directing ?s/comments - use minimal encouragers to get pt to open up and continue talking; periods of silence are also useful and important

Phases of the Nurse-Patient Relationship

- Orientation: introductory "getting to know you" phase; begins the development of trust; trust enables participation; each other as individuals; ID major problems and needs; estimate length of the relationship - Working: nurse and pt accomplish tasks towards goals outlined in phase 1; pt may exhibit alternating periods of effort and resistance to chage; regression as a defense mechanism in reaction to stress (usually precedes positive change) - Termination: nurse and pt take on those activities taht enable them to end the relationship in a therapeutic manner; positive and negative feelings often accompany this process

Nurse-Patient Collaboration

- Pts often feel intimidated in health care settings: fail to say what is on their minds or to convey important feelings - goal of nurses is to empower pts and families to partner with them - Pt's dependent/vulnerable role cause by: reluctance to ask questions; fearfulness; anger; argumenativeness; unappreciative; challenge authority

Factors Involved in Self-Awareness

- Reflective Practice: looking back at what happened during your time of pt care, how you felt about it, how other nurses acted toward you, etc; taking time to focus on own thoughts and feelings and understand how these can affect behaviors toward pts - Avoiding Stereotypes: prejudices and attitudes that are biased toward pts; goal: accept all pts as idividuals of dignity and worth who deserve the best nursing care possible

Professional Socialization

- Socialization involves a process by which a person acquires the knowledge, skills, and sense of identity that are characteristic of a profession - involved internalization of values and norms of that profession

Professional Role Development: Social Influences

- Stage 1: Complaince: doing things exactly as you are told; "this is how they taught me in lab, so that's how I'm going to do it" - Stage 2: Identification: looking at the nurses in your unit and taking on their characteristics - Stage 3: Internalization: values of nursing become your own

Benner's Stages of Skill and Knowledge Acquisition

- Stage 1: Novice: at least 1 year out of school; lots of questions and insecurities - Stage 2: Advanced Beginner: 1-2 years; getting good experience but still not a lot of self confidence - Stage 3: Competent: 2-3 years; feels competent, organized; plans and sets goals; thinks abstractly and analytically; coordinates several tasks simultaneously - Stage 4: Proficient: 3-5 years; views pt holistically; easily recongizes subtle changes and sets priorities; focuses on long-term goals - Stage 5: Expert: 5+ years; performs fluidly; grasps pt needs automatically; responses are integrated; expertise comes natrually

Cohen's Model of Professional Socialization: Cognitive Development

- Stage 1: Unilateral Dependence - extremely dependent on faculty; lots of concern about doing things right and being unsure of your knowledge - Stage 2: Negativity/Independence - like a toddler in terrible 2s ("no"); an I'll do it myself attitude where you are confident in your skills and stuff gets old and boring - Stage 3: Dependence/Mutuality - recognize that you may not know it all and can still use some guidance - Stage 4: Interdependence - recognize that you know so much but you will never know it all; use resources including faculty to help you throughout your nursing career

Barriers to Effective Communication

- Stereotyping - Agreeing or disagreeing - Being defensive - Challening - Probing - Changing topics and subjects - Giving reassurances - Being judgemental - Giving advice - Belittling

Socialization Process

- Structural Conditions: refer to the rules that determine roles - Cultural Conditions: are the idea systems prevalent in a society as expressed in words, symbols, and ceremonies - structural and cultural conditions are interrelated

Forms of Communication

- Verbal (language) - Nonverbal (body language): facial expression, posture, gait, gestures, general physical appearance, mode of dress and grooming, sounds, silence

Barriers to Effective Communication: Agreeing or Disagreeing

- agreeing and disagreeing imply the pt is right or wrong and that the nurse is in a position to judge that - deter clients from thinking through their position and may cause them to become defensive

Barriers to Effective Communication: Being Defensive

- attmepting to protect toher or services from negative comments - prevents pts from expressing concerns - blocks communication

Professional Nursing Values

- commitment to public service - Autonomy (having a unique body of knowledge; being accountable to ourselves and to the profession) - commitment to lifelong learning and education - belief in the dignity and worth of each person

Developing Conversational Skills

- control the tone of your voice - be knowledgable about the topic of conversation (always be prepared and go in with info about the diagnosis; be knowledgable about your pt) - be flexible - be clear and concise - avoid words that might have different interpretations - be truthful - keep an open mind

Factors Influencing Communication

- developmental level - gender - sociocultural differences - roles and responsibilites - space and territoriality - physical, mental, and emotional state - environment

Nurse-Assistive Personnel Collaboration

- ensure mutual respect and cooperation - attend to language and cultural barriers - differences in beliefs, values, perceptions, or priorities can cause conflict - problems can result in poor teamwork, reduced job satisfaction, and a negative impact on pt care

Blocks to Communication

- failure to perceive the pt as a human being - failure to listen - inappropriate comments and questions - using cliches - using closed questions - using questions containing the words "why" and "how" (never ask why!!) - using questions that probe for info - using leading questions - using gossip and rumors - using aggressive interpersonal behavior; getting defensive or arguing

Basic Components of Assertiveness

- having empathy - describing one's feelings or the situation - clarifying one's expectations - anticipating consequences *Assertive vs Aggressive: being assertive means you are guiding the conversation but you aren't being argumenative or leading the conversation in a way that the pt doesn't want to to go - you stay focused on the facts

Characteristics of the Professional Nurse

- high esteem for self and others - ability to view conflict as potentially positive - ability to be open to perspecitves of others - willingness to take risks with a stong sense of integrity and accountability - high tolerance to ambiguity (unclearness by virtue of having more than one meaning) - views power as that of power with others - confidence in practice and self-directed - values collaboration and interdependence - exhibits strong sense of internal locus of control, practice in intrinsically rewarding - practices caring for self and others - values self reflection

Techniques of Therapeutic Communication

- listening - silence - broad openings - restating or reflection of content - clarifying - reflection - focusing - informing - confrontation - minimal encourager - giving recognition - summarizing

Techniques of Therapeutic Communication: Silence

- not breaking the quiet - allows pt time to form thoughts - don't use too much or pt will think you aren't interested or aren't listening

Historical View of Nursing Values

- obedience, loyalty, and character development - shift from obedience to more self-directed practice

Barriers to Effective Communication: Changing Topics and Subjects

- often done because the nurse feels uncomfortable with a topic - conveys that what the pt is talking about is not important - nurse might do this to talk about a topic that is of interest to them rather than the pt

Professional Collaboration Skills

- professional collaboration skills are the key to effective teamwork - collaboration is working jointly with other professionals, all of whom are respected for their unique knowledge and abilities - collaboration involves willingness to work together and supportive attitude and behaviors of the organization - collaborating and working together in an interdisciplinary environment are the most important skills to have: medical errors are mainly due to lack of communication/collaboration - understand the roles of inidividuals in different disciplines in order to respect their role and work together

Distinguising Characteristics of a Profession

- requirement of prolonged, specialized training to acquire a body of knowledge specific to the work performed - commitment toward service - Profession: has a specialized body of knowledge and a commitment to service

Techniques of Therapeutic Communication: Listening

- silence, eye contact, attitude of being full present - permits pt to be heard - conveys interset in what the pt is saying

Developing Listening Skills

- sit when communicating with a pt - be alert and relaxed and take your time - keep the conversation as natural as possible - maintain eye contact if appropriate - use appropriate facial expressions and body gestures - think before responding to the pt - if you are unsure of what the pt is asking, rephrase the question back to them so you can answer their question to the best of your ability

Barriers to Effective Communication: Challenging

- statements that force pts to justify or prove their statement or point of view - nurse isn't considering pt's feelings - pt: "I didn't feel good after that pill" nurse: "surely you don't think I gave you the wrong pill?"

Barriers to Effective Communication: Giving Advice

- tell the client what to do - this can backfire is the nurse gives advice and its doesn't work out well - advising makes the nurse rather than the pt responsible for the outcome

Therapeutic Use of Self

- term originated by Hildegard Peplau in 1952 - Peplau believed that the nurse as a person is the most important tool in treating a pt - 3 phases in the traditional Nurse-Patient Relationship: orientation, working, and termination

Therapeutic Touch

- therapeutic touch may be used to convey a message - be aware of how people interpret touch - always let pt know before you are going to touch them

Barriers to Effective Communication: Giving Reassurances

- these statements block the feelings and thoughts of the pt - often cliches and things meant to comfort the pt - everything might not "be ok"

Barriers to Effective Communication: Being Judgemental

- these statements give the nurse's opinion, moralize, or imply the nurse's values - imply that the nurse's opinions and values are the best and the pt should think the same

Goals of Professional Socialization

- to learn the technology of the profession - to learn to internalize the professional culture - to find a personally and professionally acceptable version of the role - to integrate this professional role into all of the other life roles *professional nursing is a culture

Self-Awareness

- you have to know about yourself so you know how you will influence a relationship - self-awareness is basic to effective interpersonal relationships - Goal of self-awareness: nurses can distinguish their own emotional needs from their pt's needs and get their own emotional needs met outside of the nurse-pt relationship

Nurse-Physician Collaboration

Can be a problematic relationship because of: - education and status differences - different levels of willingess to work collaboratively - hierarchial and control-oriented model for physicians in medical schools - different personality sturctures between nurses and physicians