Fundamentals of Nursing Practice PDF - Session 5

Fundamentals of Nursing Practice - Lecture STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR Session # 5 LESSON TI...

Fundamentals of Nursing Practice - Lecture STUDENT ACTIVITY SHEET BS NURSING / FIRST YEAR Session # 5 LESSON TITLE: NURSING AS AN ART : COMMUNICATING Materials: Pen and notebook LEARNING OUTCOMES: Upon completion of this lesson, you can: 1. Identify ways to apply critical thinking to the communication process; 2. Use the five levels of communication with patients; 3. Describe features of the circular transactional communication process; 4. Incorporate features of a helping relationship when interacting with patients; 5. Identify a nurse's communication approaches within the four phases of a nurse-patient helping relationship; Reference: and, Potter, P. A., Perry, A.G., et al. (2021). Fundamentals 6. Identify desired outcomes of nurse–health care team of nursing (10th ed.). Singapore: Elsevier. member relationships. LESSON PREVIEW/REVIEW Answer the question in your SAS based on what you have learned. You may use the back sheet of this page for your answers. Here is your task: State and define two (2) out of the six attributes of caring (6 Cs of Caring). MAIN LESSON You will study the contents of this lesson and read your book, if available. Communication and Nursing Practice A lifelong learning process for nurses Therapeutic communication promotes personal growth and attainment of patients’ health-related goals Key to nurse-patient relationships Patient safety requires effective communication Improves patient outcomes and increases patient satisfaction This document and the information thereon is the property of PHINMA 1 of 12 Education (Department of Nursing) Communication and Interpersonal Relationships All behavior communicates, and all communication influences behavior. Nurses with expertise in communication express caring by: ⮚ Becoming sensitive to self and others. ⮚ Promoting and accepting the expression of positive and negative feelings. ⮚ Developing caring relationships. ⮚ Instilling faith and hope. ⮚ Promoting interpersonal teaching and learning. ⮚ Providing a supportive environment. ⮚ Assisting with gratification of human needs. ⮚ Allowing for spiritual expression. The Joint Commission (TJC) recognized the need to promote effective communication for patient- and family-centered care, cultural competence, and improved patient safety. TJC initiated a set of standards for hospitals that promote these improvements in communication, and they became part of the TJC requirements. Skilled communication empowers others to express what they believe and make their own choices; these are essential aspects of the individualized healing process. Developing Communication Skills Gaining expertise in communication requires both an understanding of the communication process and reflection about one’s communication experiences as a nurse. When you consider a patient’s problems, it is important to apply critical thinking and critical Critical thinking reasoning skills to improve communication in assessment and care of the patient. Perseverance and Also helpful because they motivate a nurse to identify innovative solutions. creativity Self-confidence Patients respond more readily to a self-confident attitude. An attitude of humility is necessary to recognize when you need to better communicate and Humility intervene with patients, especially related to their cultural needs. Integrity allows nurses to recognize when their opinions conflict with those of their patients, Integrity review positions, and decide how to communicate to reach mutually beneficial decisions. Thinking is influenced by perception ⮚ Five senses ⮚ Culture ⮚ Education Perceptual bias ⮚ Critical thinking helps nurses overcome perceptual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others. Emotional intelligence ⮚ Emotional intelligence (EI) is an assessment and communication technique that allows nurses to better understand and perceive the emotions of themselves and others. EI enables a nurse to use self-awareness, motivation, empathy, and social skills to build therapeutic relationships with patients. This document and the information thereon is the property of PHINMA 2 of 12 Education (Department of Nursing) You learn to integrate communication skills throughout the nursing process as you collaborate with patients and health care team members to achieve goals. Communication Throughout the Nursing Process ⮚ Assessment ▪ Verbal interviewing and history taking ▪ Visual and intuitive observation of nonverbal behaviour ▪ Visual, tactile, and auditory data gathering during physical examination ▪ Written medical records, diagnostic tests, and literature review ⮚ Nursing Diagnosis ▪ Intrapersonal analysis of assessment findings ▪ Validation of health care needs and priorities via verbal discussion with patient ▪ Documentation of nursing diagnosis ⮚ Planning ▪ Interpersonal or small-group health care team planning sessions ▪ Interpersonal collaboration with patient and family to determine implementation methods ▪ Written documentation of expected outcomes ▪ Written or verbal referral to health care team members ⮚ Implementation ▪ Delegation and verbal discussion with health care team ▪ Verbal, visual, auditory, and tactile health teaching activities ▪ Provision of support via therapeutic communication techniques ▪ Contact with other health resources ▪ Written documentation of patient's progress in medical record ⮚ Evaluation ▪ Acquisition of verbal and nonverbal feedback ▪ Comparison of actual and expected outcomes ▪ Identification of factors affecting outcomes ▪ Modification and update of care plan ▪ Verbal and/or written explanation of care plan revisions to patient Challenging Communication Situations People who are silent, withdrawn, and have difficulty expressing feelings or needs People who are sad and depressed People who require assistance with visual or speech disabilities (special needs) People who are angry or confrontational and cannot listen to explanations People who are uncooperative and resent being asked to help others People who are talkative or lonely and want someone to be with them all the time People who are demanding and expect others to meet their requests People who are frightened, anxious, and having difficulty coping People who are confused and disoriented People who speak and/or understand little English People who are flirtatious or sexually inappropriate Levels of Communication Intrapersonal communication is a powerful form of communication that you use as a professional nurse. This level of communication is also called self-talk. People’s thoughts and inner communications strongly influence perceptions, feelings, behavior, and self-esteem. Nurses use intrapersonal communication to develop self-awareness and a positive self-esteem that enhances appropriate self-expression. This document and the information thereon is the property of PHINMA 3 of 12 Education (Department of Nursing)  Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice. Meaningful interpersonal communication results in an exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishment, team building, and personal growth. Small-group communication is the interaction that occurs when a small number of people meet. This type of communication is usually goal directed and requires an understanding of group dynamics. Public communication is interaction with an audience. Nurses often speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. Electronic communication is the use of technology to create ongoing relationships with patients and the health care team. Secure messaging provides an opportunity for frequent and timely communication with a patient’s physician or nurse via a patient portal. Elements of the Communication Process Communication is an ongoing and continuously changing process. You are changing, the people with whom you are communicating are changing, and your environment is also continually changing. This simple linear model represents a very complex process with its essential components. This document and the information thereon is the property of PHINMA 4 of 12 Education (Department of Nursing) Circular Transactional Model The circular transactional model includes several elements: the referent, sender and receiver, message, channels, context or environment in which the communication process occurs, feedback, and interpersonal variables. In this model, each person in the communication interaction is both a speaker and a listener and can be simultaneously sending and receiving messages. Both parties view the perceptions, attitudes, and potential reactions to a sent message. Feedback from the receiver or environment enables the communicators to correct or validate the communication. This model also describes the role relationship of the communicators as complementary and symmetrical. Complementary role relationships function with one person holding an elevated position over the other person. Symmetrical relationships are more equal. This document and the information thereon is the property of PHINMA 5 of 12 Education (Department of Nursing)  Components of the Circular Transactional Model The referent motivates one person to communicate with another. In health care setting sights, sounds, sensations, perceptions, and ideas are examples of cues that initiate the communication process. The sender is the person who encodes and delivers a message, and the receiver is the person who receives and decodes the message. The more the sender and receiver have in common and the closer the relationship, the more likely they will accurately perceive one another’s meaning and respond accordingly. The message is the content of the communication. It contains verbal and nonverbal expressions of thoughts and feelings. Effective messages are clear, direct, and in understandable language. Communication channels are means of sending and receiving messages through visual, auditory, and tactile senses. Facial expressions send visual messages; spoken words travel through auditory channels. Touch uses tactile channels. Individuals usually understand a message more clearly when the sender uses more channels to send it. Feedback is the message a receiver receives from the sender. It indicates whether the receiver understood the meaning of the sender’s message. Interpersonal variables are factors within both the sender and receiver that influence communication. Perception provides a uniquely personal view of reality formed by an individual’s culture, expectations, and experiences. Each person senses, interprets, and understands events differently. The environment is the setting for sender-receiver interaction. An effective communication setting provides participants with physical and emotional comfort and safety. Forms of Communication Communication is unsuccessful if senders and receivers cannot translate one another’s words and phrases. When you care for a patient who speaks another language, a professional interpreter is necessary. Limiting use of medical jargon to conversations with other health care team members improves communication. Verbal communication o Vocabulary ▪ uses spoken or written words Denotative and connotative meaning ▪ Individuals who use a common language share the denotative meaning The connotative meaning is the shade or interpretation of the meaning of a word influenced by the thoughts, feelings, or ideas that people have about the word. Pacing o Conversation is more successful at an appropriate speed or pace Intonation o Tone of voice dramatically affects the meaning of a message. Be aware of voice tone to avoid sending unintended messages. Clarity and brevity o Effective communication is simple, brief, and direct. Repeating important parts of a message also clarifies communication. Timing and relevance Timing is critical in communication. Even though a message is clear, poor timing prevents it from being effective. Nonverbal Communication Personal appearance o Physical characteristics, facial expression, and manner of dress and grooming. These factors communicate physical well-being, personality, social status, occupation, religion, culture, and self-concept. Posture and gait o (Manner or pattern of walking) are forms of self-expression. The way people sit, stand, and move reflects attitudes, emotions, self-concept, and health status. Facial expressions o Convey emotions such as surprise, fear, anger,happiness, and sadness. Patients closely observe nurses. Although it is hard to control all facial expressions, try to avoid showing shock, disgust, dismay, or other distressing reactions in a patient’s presence. Eye contact o Maintaining eye contact during conversation shows respect and willingness to listen. This document and the information thereon is the property of PHINMA 6 of 12 Education (Department of Nursing)  Gestures o Emphasize, punctuate, and clarify the spoken word. Sounds o Sighs, moans, groans, or sobs also communicate feelings and thoughts. Combined with other nonverbal communication, sounds help to send clear messages. Territoriality and personal space o The needs to gain, maintain, and defend one’s right to space. Territory is important because it provides people with a sense of identity, security, and control. Metacommunication o A broad term that refers to all factors that influence communication. Awareness of influencing factors helps people better understand what is communicated. Zones of Personal Space Intimate Zone (0-8 inches) Holding a crying infant Bathing, grooming, dressing, feeding, Performing physical assessment and toileting a patient Changing a patient's surgical dressing Personal Zone (18 inches-4 feet) Sitting at a patient's bedside Teaching an individual patient Taking a patient's nursing history Socio-Consultative Zone (9-12 feet) Giving directions to visitors in the hallway Asking if families need assistance from the patient doorway Giving verbal report to a group of nurses Public Zone (12 feet and more) Speaking at a community forum Lecturing to a class of students Testifying at a legislative hearing Special Zones of Touch Social Zone (Permission Not Needed) Hands, arms, shoulders, back Consent Zone (Permission Needed) Mouth, wrists, feet Vulnerable Zone (Special Care Needed) Face, neck, front of body Intimate Zone (Permission and Great Sensitivity Needed) Genitalia, rectum Professional Nursing Relationships A nurse's application of knowledge, understanding of human behavior and communication, and commitment to ethical behavior create professional relationships. Having a philosophy based on caring and respect for others helps you be more successful in establishing relationships of this nature. A. NURSE-PATIENT CARING RELATIONSHIP Caring relationships are the foundation of clinical nursing practice. Therapeutic relationships promote a psychological climate that facilitates positive change and growth. Phases of helping relationship 1. Pre-interaction phase: occurs before meeting the patient 2. Orientation phase: when the nurse and the patient meet and get to know each other 3. Working phase: when the nurse and the patient work together to solve problems and accomplish goals 4. Termination phase: occurs at the end of a relationship There is a natural progression of four goal-directed phases that characterize the nurse-patient relationship. This document and the information thereon is the property of PHINMA 7 of 12 Education (Department of Nursing)  1. Pre-interaction Phase Before meeting a patient: Review available data, including the medical and nursing history. Talk to other caregivers who have information about the patient. Anticipate health concerns or issues that arise. Identify a location and setting that fosters comfortable, private interaction. Plan enough time for the initial interaction. 2. Orientation Phase When the nurse and patient meet and get to know one another: Set the tone for the relationship by adopting a warm, empathetic, caring manner. Recognize that the initial relationship is often superficial, uncertain, and tentative. Expect the patient to test your competence and commitment. Closely observe the patient and expect to be closely observed by the patient. Begin to make inferences and form judgments about patient messages and behaviors. Assess the patient's health status. Prioritize the patient's problems and identify his or her goals. Clarify the patient's and your roles. Form contracts with the patient that specify who will do what. Let the patient know when to expect the relationship to be terminated. 3. Working Phase When the nurse and patient work together to solve problems and accomplish goals: Encourage and help the patient express feelings about his or her health. Encourage and help the patient with self-exploration. Provide information needed to understand and change behavior. Encourage and help the patient set goals. Take action to meet the goals set with the patient. Use therapeutic communication skills to facilitate successful interactions. Use appropriate self-disclosure and confrontation. 4. Termination Phase During the ending of the relationship: Remind the patient that termination is near. Evaluate goal achievement with the patient. Reminisce about the relationship with the patient. Separate from the patient by relinquishing responsibility for his or her care. Achieve a smooth transition for the patient to other caregivers as needed. B. MOTIVATIONAL INTERVIEWING A technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior. The interviewing is delivered in a nonjudgmental, guided communication approach. C. NURSE-FAMILY RELATIONSHIPS Many nursing situations, especially those in community and home care settings, require you to form caring relationships with entire families. The same principles that guide one-on-one helping relationships also apply when the patient is a family unit, although communication within families requires additional understanding of the complexities of family dynamics, needs, and relationships D. NURSE–HEALTH CARE TEAM RELATIONSHIPS o Use of a common language such as the SBAR technique for communicating critical information improves perception of communication and information about patients between health care providers. The SBAR technique is a popular communication tool that standardizes communication. SBAR is the acronym for Situation, Background, Assessment, and Recommendation. o Lateral violence or workplace bullying between colleagues sometimes occurs and includes behaviors such as withholding information, backbiting, making snide remarks or put downs, and nonverbal expressions of disapproval such as raising eyebrows or making faces. o The nurse experiencing lateral violence can also use additional techniques such as the following: 1. Address the behavior when it occurs in a calm manner. 2. Describe how the behavior affects your functioning. This document and the information thereon is the property of PHINMA 8 of 12 Education (Department of Nursing)  3. Ask for the abuse to stop. 4. Notify the manager to get support for the situation. 5. Make a plan for taking action in the future. 6. Document the incidences in detail. E. NURSE-COMMUNITY RELATIONSHIPS o Many nurses form relationships with community groups by participating in local organizations, volunteering for community service, or becoming politically active. As a nurse, learn to establish relationships with your community to be an effective change agent. Elements of Professional Communication Appearance, demeanor, and behavior Courtesy ✔ A professional is expected to be clean, neat, well ✔ Part of professional communication. groomed, conservatively dressed, and odor free. ✔ Say hello and goodbye to patients and knock on ✔ Professional appearance, demeanor, and doors before entering. behavior communicate that you have assumed ✔ State your purpose, address people by name, the professional helping role, are clinically skilled, and say “please” and “thank you” to team and are focused on your patients. members. ✔ Introduce yourself and state your title. Use of names Trustworthiness ✔ Always introduce yourself. ✔ To foster trust, communicate warmth and ✔ Failure to give your name and status or to demonstrate consistency, reliability, honesty, acknowledge a patient creates uncertainty about competence, and respect. the interaction and conveys an impersonal lack of commitment or caring. Autonomy and responsibility Assertiveness ✔ Being self-directed and independent in ✔ Allows you to express feelings and ideas without accomplishing goals and advocating for others. judging or hurting others. Assertive behavior Professional nurses make choices and accept includes intermittent eye contact; nonverbal responsibility for the outcomes of their actions. communication that reflects interest, honesty, and active listening; spontaneous verbal responses with a confident voice; and culturally sensitive use of touch and space. CHECK FOR UNDERSTANDING You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to the correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in your answer/ratio is not allowed. 1. A nurse is talking with a young-adult patient about the purpose of a new medication. The nurse says, “I want to be clear. Can you tell me in your words the purpose of this medicine?” This exchange is an example of which element of the transactional communication process? a. Message c. Channel b. Obtaining feedback d. Referent ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 2. You are invited to attend the weekly unit patient care conference. The staff discusses patient care issues. This type of communication is: a. public. c. transpersonal. b. intrapersonal. d. small group. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA 9 of 12 Education (Department of Nursing) 3. This is a type of communication where the interaction involves an audience. a. Public communication c. Intrapersonal communication b. Interpersonal communication d. Electronic communication ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 4. Which of the following best describes intrapersonal communication? a. Use of technology to create ongoing relationships with patients and their health care team. b. Meeting with a small number of people. c. Self-awareness development d. One-on-one interaction between the nurse and the patient. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 5. Interpersonal communication is the most frequently used in nursing situations and lies at the heart of nursing practice. Which of these is NOT a result of this kind of communication? a. exchange of ideas c. expression of feelings b. problem solving d. self-talk ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 6. Which of the following statements about the communication process is accurate? a. Communication is a reciprocal process in which both the sender and receiver of messages take turns participating. b. One-to-one communication occurs when three or more people are involved in the communication process. c. Nursing instructors and students seldom experience the communication process in large groups. d. Communicating people receive and send messages through verbal and nonverbal means, which occur simultaneously. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 7. When attending a staff meeting, a nurse is participating in which of the following types of communication? a. Intrapersonal communication c. Small-group communication b. Interpersonal communication d. Organizational communication ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 8. Which of the following are parts of the Circular Transactional Model? (Select all that apply.) a. Message d. Channel b. Sender e. Component c. Subscriber f. Process ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ 9. In developing communication skills, when you consider a patient’s problems, it is important to apply critical thinking and critical reasoning skills to improve communication in assessment and care of the patient. This develops: a. Self-confidence. c. Integrity. b. Humility. d. Critical thinking. ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ This document and the information thereon is the property of PHINMA 10 of 12 Education (Department of Nursing) 10. Which of the following are levels of communication that the nurse engages in during nursing practice? (Select all that apply) a. Verbal communication d. Oral communication b. Small-group communication e. Non-verbal communication c. Public communication f. Interpersonal communication ANSWER: ________ RATIO:___________________________________________________________________________________________ _________________________________________________________________________________________________ RATIONALIZATION ACTIVITY The instructor will now provide you the rationalization to these questions. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 2. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 3. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 4. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 5. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 6. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 7. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 8. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 9. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ 10. ANSWER: ________ RATIO:________________________________________________________________________________________ ______________________________________________________________________________________________ ___________________________________________________________________ This document and the information thereon is the property of PHINMA 11 of 12 Education (Department of Nursing) LESSON WRAP-UP You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL STRATEGY: SUCCESS CRITERIA You will write 3 or more statements (“I can" statements) based on the learning targets stated above. This will assess your ability to familiarize and master this session’s topic. 1. I can_________________________________________________________________________________ 2. I can_________________________________________________________________________________ 3. I can_________________________________________________________________________________ This document and the information thereon is the property of PHINMA 12 of 12 Education (Department of Nursing)