NUSC1P10-Lecture 4.pdf

NUSC 1P10 | Fall 2023 Relational Nursing Skills: Mindfulness Class Objectives 1. Describe how mindfulness or mindful practice can contribute to effective communication 2. Define nursing presence 3. Describe the importance of nursing presence in TNCRs 4. Discuss the States of Mind Framework to pro...

NUSC 1P10 | Fall 2023 Relational Nursing Skills: Mindfulness Class Objectives 1. Describe how mindfulness or mindful practice can contribute to effective communication 2. Define nursing presence 3. Describe the importance of nursing presence in TNCRs 4. Discuss the States of Mind Framework to promote more effective and deliberate responses 5. Describe empathy 6. Apply the mindfulness process to responding with understanding/empathy What is mindfulness for you? Mindfulness “awareness that arises through paying attention, on purpose, in the present moment, nonjudgementally” (Kabat-Zinn, 2018) Mind and body in the same place at the same time fully present Mindfulness Attitudes Nonjudging not in a day Letting go seeing things like they are nit how we want to see they are Patience Beginner’s mind Acceptance Nonstriving willing to see everything like its the first time Trust (Bernstein, 2019) mindfullness can be practice informablly or formally - informal meditation will be bring mindfullness into everyday life being able to take a momnet to reflect what is going on inside are selvels Examples of Mindfulness Practices focus on the mechansims of walking focus on what you eat and how you feel • Mindful breathing practice • Informal walking meditation • Mindful eating • Mindful handwashing • Body scan why is fmindfulness inportant in nusring? Helps use keeping an open mind with regards to all aspects of patient interaction Using your minfulness to re-center yourself RESPECT: being able to have an open mind and watch you biases reduce stress, focus on centered mindedness Mindfulness for nurses Mindfulness practices are beneficial for nurses • • • • • reduced stress reduced anxiety reduced depression reduced burnout increased job satisfaction (Ghawadra, et.al., 2019) how can you take care of yourself without taking care of yourself first becoming better for your clinets being able to center yourself, while other are going thorugh stages of emotional, or acceotance with regards to a diagnosised Mindfulness for nurses • Increased ability to see another’s perspective • Increased ability to identify and accept emotions • Strengthened neural pathways for empathy and compassion • Ability to see the person > biological processes (Bernstein, 2019) Mindfulness for therapeutic communication Expert nurses come to realize that their “being” is as valuable as their “doing.” Text (Ferrell & Coyle, 2008) watch a video - being able to perform a task that may be mandane but is being able to due it with meaning - being able to keep have a moment of clearness - being reminded of the humanity of what nurses due - try to talk extra time for your patients and remember everyone is human - people being able to hear about a patient in intensive care (beating of the machine, being present and remember that people still can hear, remeber that emotional care is just as important as physical care Mindful Presence • Mindful presence is the combination of mindfulness practice with the nursing concepts of compassionate or healing presence • Empathy and active listening are essential components of mindful presence (Wittenberg, et al., 2012) States of Mind Framework • Reason mind – analytical, measured, controlled • Emotion mind – emotional thinking dominates • Body mind – awareness of physical experiences • Wise mind – where the other domains are identified and purposefully examined Source: Raphael-Grimm, T. (2014). Art of Communication in Nursing and Healthcare. Springer States of Mind - Taking a Test “my heart is racing” “I hate tests they’re never fair” “I am prepared for this test – I studied hard and completed all the readings” States of Mind - Taking a Test “I don’t like tests, but I am prepared, and I can cope with this situation by taking a deep breath” The Mindfulness Process Assess physical sensations Look inward Assess emotional temperature Enter a place of wisdom Assess capacity for reason Case Study Mildred is a 44-year-old woman being treated in the oncology clinic for stage IV ovarian cancer. Mildred has opted for aggressive chemotherapy, hoping to extend her life to be able to see the birth of her first grandchild due in 3 months. Mildred’s nurse Karen has watched her patient decline with many signs that the tumor is progressing and not responding to treatment. Today as Karen is beginning the fourth chemotherapy infusion in the outpatient clinic, the physician enters the room and reports that the ultrasound and lab work have confirmed their worst fear and that the tumor has now extended to the liver. The physician, a very kind, older oncologist who is very fond of Mildred, quickly exits, telling Mildred he will be in touch once he has time to consider other options. Karen finishes connecting the chemotherapy but remains seated next to Mildred, gently touching her arm in silence, acknowledging the weight of the information she has received. Mildred begins to cry, and Karen avoids the urge to jump up and get a tissue or to provide false assurances, and instead, she sits in silence. Moments pass, then Mildred begins to speak, telling Karen that she knew she was getting worse and how difficult it has been to try to keep positive and protect her family. Karen remains silent, offering Mildred the space and security to absorb the latest news and its meaning. NUSC 1P10 | Fall 2023 Relational Nursing Skills: Listening Listening is important! • Ranked most important communication skill for family, social and career success • Listening is likely the most ancient of healthcare skills – a critical component of all aspects of nursing care • People desire to be listened to more than anything else during their experiences with health professionals (Brownell & Wolvin, 2010; Shipley, 2010) Listening Receiving, interpreting, and responding to spoken and non-verbal messages. Hearing vs. Listening Mindless vs. Mindful or Active Listening Listening Skills Attending Responding Silence Recalling Observing Interpreting Perceiving (Stein-Parbury, 2018) Attending • Attending is the outward, physical manifestation of a nurse’s readiness to listen • Attending is the spatial position of the nurse in relation to the patient + maintenance of eye contact S – squarely facing the person O – open posture L – leaning forward E – eye contact maintained R – relaxed posture (Stein-Parbury, 2018) Silence • Demonstrates respect and interest • Both people have a chance to collect their thoughts • Silent presence can be therapeutic Observing Non-verbal behaviours help us… - Regulate conversations - Communicate emotions - Modify verbal messages - Provide messages about the relationship - Give insights into self-perception - Gives clues that person is not saying what they are thinking This Photo by Unknown Author is licensed under CC BY-SA-NC Egan & Schroeder (2009). The Skilled Helper. First Canadian Editions. Toronto, ON: Nelson Education. P. 96. Observing Important non-verbal behaviours include: - Bodily behaviour - Eye behaviour - Facial expressions - Voice-related behaviour - Physiological bodily responses - Space - General appearance This Photo by Unknown Author is licensed under CC BY-SA-NC Egan & Schroeder (2009). The Skilled Helper. First Canadian Editions. Toronto, ON: Nelson Education. P. 96. Perceiving & Interpreting What am I listening for? • The content of a message contains the objective or factual data - e.g., what, who, when and where • Feelings can be expressed directly but are more often concealed or implicit • Content and feelings form a general theme Recalling • Can be the greatest challenge of listening • Accurate recall is important for understanding • Takes concentration and effort Recalling At about 2 am, Mr. Smithers became confused and agitated. He got out of bed, went into the next room, over to Mrs. Blue's bed and began to tell her about how to grow azaleas. Mrs. Blue became frightened, called her husband and asked him to come in immediately. She was so loud on the phone that all the other patients in the room were awakened. The patient in bed 18 reacted to Mrs. Blue, tried to get out of bed and fell to the floor. In the meantime, Mr. Smithers left the ward and headed towards the elevator. Fortunately, another nurse was getting out of the elevator and escorted him back to the ward. We contacted the MD to come to see the patient in bed 18 and Mr. Smithers. He ordered x-rays for the patient in bed 18 and a sedative for Mr. Smithers. Responding Active listening responses: • Minimal cues and leads • Clarification • Restatement • Paraphrasing • Reflection • Summarizing • Silence • Touch Listening Skills Attending Responding Silence Recalling Observing Interpreting Perceiving (Stein-Parbury, 2018) NUSC 1P10 | Fall 2023 Relational Nursing Skills: Empathy & Trust Listening à Understanding à Empathy • We listen to gain understanding • Empathy is the ability to understand the experiences of others and communicate that understanding • Empathy and understanding are the basis of the nurse-client relationship Empathy • Empathy is the ability to communicate that we understand something about the other person’s world. • As nurses we cannot claim to help patients without a clear understanding of how they perceive their situation and circumstances surrounding it Sympathy, Empathy & Compassion • Feeling sorry for another person • Imagining what it would be like to be that person Sympathy Empathy • Understanding what the person is experiencing • Feeling ‘with’ the person • The desire to alleviate the person’s distress • Taking action to do so Compassion Source: Stein-Parbury. (2018). Patient & Person. Chatswood, NSW: Elsevier Australia. Page. 152. The Skills of Understanding PARAPHRASING “would I be correct in saying …” SEEKING CLARIFICATION “I’m not certain what you mean…” REFLECTING FEELINGS “that must be really frustrating” CONNECTING THOUGHTS AND FEELINGS “you feel anxious when all the alarms start ringing” SUMMARIZING “Overall, I get the picture that…” How to communicate empathetically Pre-verbal aspects of empathy • aware that the feelings of the other are not their own • nurse's world à client's world à nurse's world Verbal aspects of empathy • responses demonstrate understanding of feelings or reasons for reactions • response neither exaggerates nor minimizes what you have been told Non-verbal aspects of empathy • response must also demonstrate warmth and genuineness (Riley, 2020) STATEMENT “You feel frustrated that the clinic is not open in the evenings when it is most convenient for you. I will raise this issues with out office manager” QUESTION “I can see that you are excited about being discharged earlier than expected. Have you considered a home-visit from the PHN to ease your transition home?” EXPLANATION “Being moved to a semiprivate room had really upset you, and you feel your privacy has been invaded. Switching rooms was truly our last alternative due to IPAC measures required” When to communicate empathetically • It is helpful to be empathetic any time people share thoughts and feelings with you • People engage more fully when we demonstrate understanding • Missed opportunities to convey empathy can leave speakers feeling hurt, frustrated, and ignored. The Mindfulness Process & Empathy Look inward Assess physical sensations Enter a place of wisdom Responding with Understanding/ Empathy Assess emotional temperature Assess capacity for reason Six steps to help you communicate more empathetically 1. Clear your head of distracting agendas 2. Remind yourself to focus on the speaker 3. Attend to your clients’/colleagues’ verbal and nonverbal messages 4. Ask yourself, “what does this person want me to hear” 5. Convey an empathetic response 6. Check to see if your response what effective Strategies to increase your ability to express empathy • Listening to your patients • Reflection • Knowing about illness conditions • Reading qualitative research about patient experiences • Literature • Blogs • Documentaries Mindfulness à Listening/Presence à Understanding à Empathy à Trust Establishing trust – creating a nonthreatening interpersonal climate where people feel comfortable revealing their needs Trust • Foundation of all relationships including TNCRs • Critical to accurate assessment of health needs • Does not take advantage of a patient’s position of vulnerability • Promoting trust (Box 12.1): • • • • • • Proper introductions Confidentiality Choice/share-decision making Attending/presence Congruence Respecting individuality Barriers to Therapeutic Relationships Heavy workload Time/Productivity Inconsistency To be continued in Lab • Listening Styles & Listening Self-assessments • Practicing attending • Listening for content, feelings and themes