Professional & Therapeutic Communication Lecture 5 PDF

NUSC 1P10 | Fall 2023 Lecture 5 Land Acknowledgement Brock University acknowledges the land on which we gather is the traditional territory of the Haudenosaunee and Anishinaabe peoples, many of whom continue to live and work here today. This territory is covered by the Upper Canada Treaties and i...

NUSC 1P10 | Fall 2023 Lecture 5 Land Acknowledgement Brock University acknowledges the land on which we gather is the traditional territory of the Haudenosaunee and Anishinaabe peoples, many of whom continue to live and work here today. This territory is covered by the Upper Canada Treaties and is within the land protected by the Dish with One Spoon Wampum Agreement. Today this gathering place is home to many First Nations, Métis and Inuit peoples and acknowledging reminds us that our great standard of living is directly related to the resources and friendship of Indigenous people. NUSC 1P10 | Fall 2023 Stress, Anger & Assertive Communication Class Objectives 1. Define stress and associated concepts. 2. Identify concepts related to coping with stress. 3. Describe stress reduction strategies for approaching stressful situations. 4. Discuss the connection between stress and anger 5. Describe strategies for responding to conflict, anger, and aggression 6. Discuss basic skills for communicating with persons in crisis 7. Define assertive communication Stress Defined • Stress: A natural physiological, psychological, spiritual response to a stressor • Stressor: Any demand, situation, internal stimulus, or circumstance that threatens a person’s personal security or self-integrity • Distress: A negative stress level that creates a level of anxiety which exceeds a person’s normal coping abilities (Mallette & Younge, 2022) Sources & Levels of Stress Sources: • Physical stress • Psychological stress • Spiritual stress Levels: • Mild à High • Acute • Chronic (CAMH, 2022; Mallette & Yonge, 2022) Signs & Symptoms of Stress • Cognitive – difficulty concentrating, memory problems, difficulty making decisions • Emotional – moodiness, feeling hopeless or helpless, derepressed, agitated • Physical – headaches, muscle tensions, GI issues, rapid heart rate, high blood pressure • Behavioural – changes in eating or sleeping, nervous habits (e.g., nail biting), increased use of substances, decline in performance or productivity (CAMH, 2022) Stress Models • Systemic physiological response to stress – fight, flight, freeze • General adaptation syndrome – alarm, resistance, exhaustion • Allostasis – adaptation to stress Stress & Coping • Lazarus and Folkman’s transactional appraisal model of stress • Stress is about perception • Threat or no threat • Adequate resources or not • Perceptions can change • What can I do or change in this situation so that it no longer is perceived as a threat? • Are there things I can do to change my ability to cope? Coping Defined “The constantly changing cognitive and behavioural efforts to manage specific external or internal demands that are appraised as taxing or exceeding the resources of the person.” (Bayuo & Agbenorku, 2018, p. 47) “Any response to external life strains that serves to prevent, avoid, or control emotional distress.” (Pearlin & Schooler, 1978, p. 2) Types of Coping • Problem-focused strategies – confronting a problem, seeking support, taking action • Emotion-focused strategies – meditation, mindfulness, spirituality • Meaning-focused strategies – reframing, altering significance • Ego defense – Table 17.1 Sources of Stress in Health Care • Health-related – fear of death, uncertainty about diagnosis, clinical outcomes, changes in roles, disruption of family life, and financial concerns. • Hospital-related – physical discomfort, strange noises and lights, unfamiliar people asking personal questions, and strange equipment • Transitions – admission, transfer, discharge Assessing Stress • Measuring stress • Tools or scales to quantify level of stress e.g., Perceived Stress Scale • Identifying factors influencing stress and its impact – Box 17.2 • Person-centred stress assessment • Focuses on the patient experience of stress and plans interventions accordingly – Box 17.3 Pause & Think How do you typically respond when you are feeling stressed or overwhelmed? Common Stress Responses • Anger and hostility – common response to stress or loss of control • Anxiety – often underpins anger • Blame – frequent form of hostility • Social withdrawal – internalized stress Pause & Think Can you think of an example that we have talked about in past lectures or labs that may help minimize fear or uncertainty in our clients therefore reducing stress à anger? Stress Reduction Strategies • Providing information • Processing strong feelings • Developing realistic goals • Priority setting • Anticipatory guidance • Social support • Helping families reduce health-related stress • Promoting a healthy lifestyle Stress & Anxiety à Anger & Hostility • Anxiety is often at the root of anger or hostility • Patients may feel anxiety when they feel they have little certainty or control in a situation • Listening towards understanding can neutralize anger and hostility Escalation toward Anger & Aggression Source: Orr, E. & Jack, S.M on behalf of the PHN-PREP Project Team [2022]. Foundational Communication Skills: Verbal De-escalation with Clients and Families [Professional Resource]. School of Nursing, McMaster University. [https://phnprep.ca/resources/verbal-de-escalation/] Reminder: Stress Reduction Strategies • Providing information • Processing strong feelings • Developing realistic goals • Priority setting • Anticipatory guidance • Social support • Helping families reduce health-related stress • Promoting a healthy lifestyle Stress & Anxiety à Anger & Hostility à Conflict Conflict – An expressed struggle that occurs between at least two interdependent parties who perceive incompatible goals, scarce resources and interference from the other party in achieving their goals (Adler, et al., 2020) Conflict - Expressed struggle - Interdependence - Perceived incompatible goals - Perceived scarce resources - Inevitability (Adler, et al., 2020) Conflict Handling Strategies 1. 2. 3. 4. 5. Withdrawing Forcing Smoothing Compromising Problem solving or collaboration (Johnson, 2009 cited in Stein-Parbury, 2018) Withdrawing or Avoidance • Neither meet goals or maintain relationship • ‘burying your head in the sand’ Forcing or Competition • Meet goals at all cost • Force your solution/ways/goals on the other person Smoothing or Accomodation • Ignore achieving own goals • Want to ‘keep the peace’ Compromising • Give up part of the goal and sacrifice part of the relationship Problem Solving or Collaboration • Negotiate so that goals and relationships are maintained Conflict Handling Strategies Concern for Self High Low Collaboration Win-Win “our way” Competition Win-Lose “my way” Compromise “halfway” Avoidance Lose-Lose “no way” Accommodation Lose-Win “your way” Concern for Others High (Adler et al, 2020) Conflict Handling Strategies Concern for Self High Low Not enough time to seek a win-win Too important to compromise long-term relationship is important Issue is important but not enough for a stalemate Cost of confrontation outweighs benefit When the issue is of more importance to the other person Concern for Others High (Adler et al, 2020) Managing Conflict • We all have our own preferred approach/strategies • Requires self-reflection and self-knowledge to: • Recognize our conflict management tendencies • Development of new skills • Nurses use collaboration the least – suggesting this could be enhanced Conflict with Patients Causes: • Poor communication • Differences in values • Differences in personality • Demands • Stress • Incivility in mainstream society Nurse consequences: • Job dissatisfaction • Turnover • Anxiety • Illness • Burnout Patient consequences: • Care quality and safety Conflict Communication Skills • Be assertive • Demonstrate respect • Use “I” statements • Make clear statements • Use moderate pitch and vocal tone • Manage own anxiety or anger • Cooling off period • Mindful breathing • Focus on positive statements Remember ”wise mind” Assertive Communication Assertive Communication • I am OK + You are OK Nonassertive Communication • I am not OK + You are OK Aggressive Communication • I am OK + You are not OK What does an assertive nurse look like? Maintains eye contact Uses clear, concise speech Takes initiative Speaks firmly and positively Speaks genuinely Is nonapologetic Appears confident and composed Gives the same message verbally and non-verbally Building an Assertive Communication Style 1. Know your rights 2. Quiet irrational beliefs 3. Practice DESC script Your Assertive Rights You have the right to: • Be treated with respect • Determine your own priorities • Ask for what you want • Refuse without making excuses or feeling guilty • Make mistakes and be responsible for them • Give and receive information as a professional • Act in the best interest of the patient • Be human Irrational Beliefs Irrational Beliefs: • Other people will be upset, hurt, or angry • I will be devastated if the other person is angry • Assertive people are seen as cold and self-serving • Wrong to turn down legitimate requests Rational Counterpart: • Other person may prefer open and honest communication • Angry response is the choice of the other person • Assertiveness is honest, respects the other person’s opinion, builds relationships • I can consider my own needs What is an assertive response? D E S C • Describe the situation • Express what you think and feel • Specify your request • Consequences Crisis • A time-limited response to a life event that overwhelms a person’s usual coping mechanisms. • A response to situational, developmental, biological, psychological, socio-cultural, and/or spiritual factors • May involve a loss or change that threatens and impacts an individual’s sense of security, self-concept, self-efficacy, and selfesteem • Individuals who have experienced a crisis or multiple crises over their lives may have difficulty regulating emotions and navigating relationships, and they may have feelings of shame, hopelessness, and powerlessness (RNAO, 2017) Crisis - Phases 1. Self-concept threatened à anxiety 2. Usual problem-solving ineffective à extreme discomfort; trial-and-error attempts to restore balance 3. Attempts at balance fail à panic; automatic relief behaviours 4. Overwhelming anxiety à cognitive impairment, emotional instability, and behavioural disturbances From: Registered Nurses’ Association of Ontario (RNAO). (2017). Crisis intervention for adults using a trauma-informed approach: Initial four weeks of management (3rd ed.). Toronto, ON. Communicating in Crisis Assess Lethality and Mental Status Establish Rapport Identify Major Problems Explore Alternatives and Partial Solutions Action Planning Follow-up Communicating in Crisis Guidelines for Respect personal space Do not be provocative de-escalation Establish verbal contact Be concise Identify wants and feelings Active listening Agree or agree to disagree Set clear limits Offer choice and optimism Debrief patient and staff (Richmond, et al., 2011) To be continued in Lab • Learning how assertive you are • Practicing assertive responses • Applying de-escalation concepts • Preparing for the Standardized Patient Interviews Standardized Patient Interviews WHO – all 1P10 students – there is no make up day for this activity! WHAT – complete 5-7 minute with Standardized Patient (SP) WHEN – Tuesday November 21st, Wednesday November 22nd, OR Thursday November 23rd • Schedule will be posted Monday November 13th WHERE – Nursing Simulation Lab (EA-2) WHY – Practice communication skills and obtain the the content necessary the final assignment – Interpersonal Process Recording (IPR) – DUE December 3rd Standardized Patient Interviews HOW? • Preparation and practice during Lab 5 • Arrive 5-10 minutes prior to interview time slot • Bring device to record your interview (laptop with MS Teams preferred) • Interview SP based on scenario provided • Following interview ask for feedback from SP • Use recording to complete IPR assignment using IPR template NUSC 1P10 | Fall 2023