HLTENN036-APPLY Communication Skills in Nursing Practice PDF

HLTENN036-APPLY COMMUNICATION SKILLS IN NURSING PRACTICE L E SSON 1 : I N TRODUCTION TO C O M M U N I C AT I O N R E W R IT T EN B Y T W I NK L E M A S HR U WA L A  RMIT Classification: Trusted Classroom Rules Arrive on time to (face-to-face or online)...

HLTENN036-APPLY COMMUNICATION SKILLS IN NURSING PRACTICE L E SSON 1 : I N TRODUCTION TO C O M M U N I C AT I O N R E W R IT T EN B Y T W I NK L E M A S HR U WA L A  RMIT Classification: Trusted Classroom Rules Arrive on time to (face-to-face or online) Professionalism always expected. Keep the chatter to breaks Consider other students This is a safe and confidential space to learn If any personal issues come up for you during discussions, please feel free to discuss these with your educator in private. RMIT Classification: Trusted Assessments Tasks Assessment Task 1: Theory Assessment (100%) Inclass & timed - under exam conditions. Due Date: 21st Aug Assessment Task 2: Theory Assessment (100%) Inclass & timed - under exam conditions. Due Date: 11th Sept Assessment Task 3: Simulation Assessment (Practical) : Clinical Handover (100%) Part 1 – Give Handover Part 2 – Document progress notes Part 3 – Give and receive performance feedback Part 4 - Self-reflection on your performance Due Date: 19th Sept Assessment Task 4: Clinical Placement Logbook (100%) – CP1 Due Date: As per CP team allocation  RMIT Classification: Trusted Objectives Gain an understanding of definition and types of communication. Identify factors that may facilitate and inhibit communication processes. Understand therapeutic communication between nurse and patient. Demonstrate knowledge required for conducting patient interviews using range of questioning techniques. Understand concept of active Listening  RMIT Classification: Trusted Definition of communication The transfer of information from sender to receiver with information being received and understood by receiver. Is a two-way process which involves the sending and receiving of messages between at least two people. Communication is a process which allows Information Thoughts Feelings Ideas Knowledge Attitudes Ideas to be exchanged  RMIT Classification: Trusted Levels of Communication Communication may take place at many different levels and as a nurse you need to be competent in all of them to be able to deliver high quality and safe holistic nursing care. Can you name few different kind of communications that we do everyday?  RMIT Classification: Trusted Level of communication Intrapersonal Communication (Communication that occurs within your head) Interpersonal Communication (Communication that occurs between two people) Transpersonal Communication (Occurs within a person’s spiritual domain. i.e. Prayers/meditation) Small group communication (Communication that occurs in group meetings, goal directed, group dynamics) Organisational Communication ( A system of disseminating and transferring information within an organisation)  RMIT Classification: Trusted Intrapersonal Communication Refers to the most basic level of internal communication within a person. Ideas Dreams Thinking how Imagination Self Talk to respond in an argument Feeling a Silently stimuli reviewing a through test senses such as heat etc  RMIT Classification: Trusted Interpersonal Communication Exchange of information, feelings and meaning through verbal and non verbal communication between two or more people.  RMIT Classification: Trusted Forms of communication A variety of verbal and non-verbal means of communicating exists; Body movement and gesture (body language) Facial Expression Eye behaviour Space Personal appearance Sign language Paralanguage (Tone and Pitch) Haptic communication (Touch and Tactile) Media such as pictures, graphics, sound & writing  RMIT Classification: Trusted Forms of communication cont’d Verbal Communication Vocabulary Meanings of words and phrases Pacing Intonation Speech/tone Non- verbal Communication Personal appearance Posture and gait Facial expressions Eye contact Gestures Sounds  RMIT Classification: Trusted Effective communication Effective Communication is a process. There are a number of elements required for effective communication. If one of these elements missing, communication will happen but not effectively. Why important? “With nurses accounting for about 45% of the health workforce the need for nurses to be able to communicate effectively with everyone in the health care environment, and with clients, becomes critical” (Berman et al, 2012 cited in Koutoukidis, 2014, p.98).  RMIT Classification: Trusted Promoting Effective Communication Prepare the environment- privacy, background noise, distractions Comfort Engage the listener’s attention Speak clearly and use appropriate terminology Appropriate tone Relevant message Eye contact where culturally appropriate Seek clarification Use body language congruent with words  RMIT Classification: Trusted Therapeutic communication Professional relationship of trust between patient and health care worker. Nurse uses personal attributes and clinical techniques while working with the client to bring about insight and behavioural change. Components of a therapeutic relationships include: Rapport Empowerment Collaboration  RMIT Classification: Trusted Therapeutic communication How to Build therapeutic relationship with your patients? Demonstrate respect and acceptance of clients Encourage the expression of the views, feelings and ideas of others Demonstrate a non-judgmental attitude towards the situations, views, feelings and ideas of others They include the skills of active listening, asking questions, providing feedback, paraphrasing, clarifying, reflecting, using silence and summarizing  RMIT Classification: Trusted Therapeutic Communication Watch following video on therapeutic and non-therapeutic communication (10:00mins) https://www.youtube.com/watch?v=W54yhhZ9DOQ&feature=emb_logo  RMIT Classification: Trusted Goal of Therapeutic Communication Identify patient’s most important needs to provide efficient nursing care. Assessing patient’s perception and the problem Facilitate patient expression of emotions or feelings or concerns Helps in realization, self-acceptance and an increase genuine self-respect Clarifies areas of conflict or anxiety with nurse  RMIT Classification: Trusted Active Listening Listening is defined “as hearing what is being said, whereas ACTIVE LISTENING is a dynamic process that includes what is being said as well as processing and interpreting the words that spokes (and/or unspoken to the complete message that is being delivered”. Not an automatic ability but a skill that is developed through practice and perseverance. Required attention and concentration, to hear not only the words but the feelings or meaning that are often hidden behind the words.  RMIT Classification: Trusted Classroom Activity – 15 mins Introduce your partner. Divide into pairs. Person 1 (speaker) will spend 4 minutes telling person 2 (listener) about themselves or their interests. For eg: Why have you decided to study nursing? What are you hobbies/interest? Holiday trips Then person 2 (listener) will talk about themselves to person 1 Lastly, you will be asked to introduce other person to the rest of the classroom Person 1 – How did it feel to have someone listening to you and accurately reflect their understanding back to you? Person 2 – How did you feel? Was it hard to listen actively?  RMIT Classification: Trusted Active Listening Nurses can demonstrate readiness to listen by minimizing environmental distractions and adopting a posture of involvement that includes: Elements of attending Squarely facing the person Open posture Leaning forward showing interest Eye contact at same level & maintained Relaxed posture and at ease  RMIT Classification: Trusted Active Listening An active listener becomes involved and focussed on the verbal and non-verbal content of the message being sent. Technique employed during active listening o Questioning – open & closed ended o Paraphrasing – summarise (own words) o Reflecting – using client’s words o Empathetic statements – builds rapport We are going to explore each of these as part of interview techniques.  RMIT Classification: Trusted Interview Techniques Purpose of patient interviews: To gather information about patient health, values and needs – otherwise also known as health assessment. Understand and clarify the patient's problems Based on date collected during the interview, develop nursing care plan to meet the patient needs. gateway to building an effective nurse–patient relationship that will make patients feel at ease, supported, and empowered. Collecting patient data is a core step in the nursing process  RMIT Classification: Trusted Foundation for Interviewing Affected by numerous factors: Physical setting Nurse behaviours Type of questions asked How questions are asked Personality and behaviour of patients How patient is feeling at the time of interview Nature of information being discussed or problem being confronted  RMIT Classification: Trusted Three Phases of the Interview Introduction: Greet the client by their formal name until invited to do otherwise. Acknowledge support person. Ensure client privacy and comfort Introduce yourself Sit in non-dominant position Explain purpose of interview Say how much time is available Explain need to take notes and ask if this is OK  RMIT Classification: Trusted Three Phases of the Interview Body - Discussion: (working): Facilitate, collect, and record health history and data. Keep it patient centered—that is, patients share their concerns, beliefs, and values in their own words. Nurse facilitates, collects, and records data. Nurse prompts questions and takes brief notes. Listen attentively, clarify and be alert to verbal and non-verbal cues Closing: Allows for clarification of data and provides validation of accurate understanding. Provides closure.- thank the person Discuss next steps – appointment, test, review, medication etc.  RMIT Classification: Trusted Interview Techniques Communication Strategies during interview should include: o Questioning – open, closed and probing o Seek clarification o Paraphrasing – summarise (own words) o Reflecting – using client’s words o Testing discrepancies o Empathetic statements – builds rapport o Summarize  RMIT Classification: Trusted Open Ended Questions Promotes long answers with thoughts, feelings and views. How, Why, Where, What? Examples: o How are you feeling at the moment? o Why did you go there? o Where are your favourite places to be? o What happened when you…?  RMIT Classification: Trusted Closed Ended Questions Obtain specific information fast! Promotes “yes”, “no” or factual answers. Who, when or where Examples: o Did you take your medication? o Have you seen the doctor? o Did you go to the hospital? o Who did u go with? o When was it happened?  RMIT Classification: Trusted Probes Helpful when seeking more information “You felt anxious last week. How have you been since then?” Used to pursue further detail about a specific area “Can you tell me more?”  RMIT Classification: Trusted Feedback Confirms understanding Feedback is a very important component of the communication process. If the listener is not providing any feedback, the sender has no way of knowing whether a message has been received or how well it has been understood. Feedback includes: Paraphrasing, Clarification and Reflecting Paraphrasing A restatement of a text in another form or other words, often to simplify or clarify meaning. o “So, you are saying that you feel mixed up about your studies – you are unsure, is that how it is for you?”  RMIT Classification: Trusted Feedback Clarification The process of making something clear and unambiguous…….working out what something means "What does that mean to you?" "How do you define ___?" "What do you perceive about ___?" Request clarification with warmth and empathy “I’m not sure I understood that completely, could you please tell me again”  RMIT Classification: Trusted Feedback Reflecting Used to check that a message received has been correctly interpreted and works particularly well to reiterate the individual's feelings. Reflection is the mirroring of feelings the nurse believes have been expressed by individuals Empathize with patient – encourage them to “tell their story” “It seems like you miss him very much” “Was that difficult for you?” Why Important? “Reflecting feelings is especially important in nursing because it conveys that the nurse recognises and accepts an individual's emotions as a valid part of the illness experience which furthers the trusting relationship” Arnold & Boggs 2011 as cited in Koutoukidis, 2017)  RMIT Classification: Trusted Testing discrepancies 1. Inconsistency between words, tone, gestures and body language in the one message e.g. “I feel fine” but crying & shaking 2. Conflict of information given between one time and another  RMIT Classification: Trusted Summarising Forces nurse to pull pieces of interview together for future recording Client has sense nurse has understood which builds rapport Client can add any missing pieces - summation is often where most important information emerges  RMIT Classification: Trusted Use of Silence Silence can be as effective and as supportive as words. Patient may need time to think about what has been said or to experience a feeling that has risen in the interview. There are instances where words seem inadequate when a person wishes to convey thoughts and feelings to another person like grief, sorrow or conflict. In some situations, silence is not productive and can cause discomfort.  RMIT Classification: Trusted Things to Avoid!! Using medical terminology confusing to patient: o Patient may not understand question or may be embarrassed to request clarification and therefore may give inaccurate responses. Expressing value judgments. Interrupting while patient is talking. Changing topic inappropriately Having an authoritarian or paternalistic demeanor. Asking “Why” questions that may threaten patient and make him or her defensive.  RMIT Classification: Trusted Classroom Activity – 10 mins Watch the following video (1:55mins) https://www.youtube.com/watch?v=3_dAkDsBQyk Discussions: 1. List as many examples of poor communication that you can identify from the start of this clip. 2. List as many skills of effective communication that you can see from this YouTube clip.  RMIT Classification: Trusted In Conclusion Good communication leads to:  The nurse, patient and family work together to solve problems  The patient and their family feel empowered, included and informed about their care  The nurse can gain essential health information more readily from the patient and their family  The family can often alert the nurse of potential deterioration of the patient  Nurses can provide nursing care and education that is holistic and individualised for each patient  Helps to establish good rapport, trust building and sharing of information  RMIT Classification: Trusted References Berman, A., Kozier, B., and Erb, G. (2015). Kozier and Erb’s Fundamentals of Nursing Vol 3. (3rd Ed.). Pearson Australia, Melbourne, Australia. Dempsey, J., and French, J. (2009) Fundamentals of Nursing and Midwifery A person-centred approach to care. Lippincott Williams & Wilkins Pty Ltd, Broadway, NSW. Funnel, R., Koutoukidis, G., and Lawrence, K. (2005). Tabbners Nursing Care (4th Ed.). Elsevier Churchill Livingstone, Sydney, Australia. Koutoukidis, G., Stainton, K., & Hughson, J. (2013). Tabbner’s Nursing Care Theory and Practice (6th ed.). Chatswood, Australia: Elsevier. Johnstone, K. (2007). Impro: Improvisation and the theatre. Bloomsbury, London. Lemone, P., and Burke, K. (2015). Medical-Surgical Nursing: Critical thinking for person-centred care. (2nd Australian Ed.). Pearson Australia, Melbourne, Australia Pachter, B. (2013). Essentials of Business Etiquette: How to greet, eat and tweet your way to success. McGraw Hill Education, USA.