Communication for Nurses and Midwives - NUM1102 - Week 5 Lecture Notes PDF

Communication for Nurses and Midwives - NUM1102 Week 5 Overarching Goal of Health Care Communication Unit Coordinator: Sheridan Read NUM1102 - Week 5 Click this icon to insert image Overarching Goal of...

Communication for Nurses and Midwives - NUM1102 Week 5 Overarching Goal of Health Care Communication Unit Coordinator: Sheridan Read NUM1102 - Week 5 Click this icon to insert image Overarching Goal of Health Care Communication Learning Outcomes: Discuss the importance of the Therapeutic Relationship Describe Person Centred Care in nursing Consider ethical implications in delivering Person Centred Care Consider and discuss the professional nursing standards and how they relate. Overarching Goal of Health Care Communication Therapeutic Relationship Central to all nursing practice. Purposeful and goal directed relationship aimed at advancing the best interest and outcome of the patient Responsibility of the health care practitioner Necessary in the formulation of goals and intervention Forms Person Centred Care Demonstration of :  Respect  Empathy  Trustworthiness  Rapport  Active listening  Honesty Overarching Goal of Health Care Communication Therapeutic Relationship Improves client experience Reduced hospital costs Improved quality of living and patient wellbeing Reduced hospital length of stay Barriers to developing a Therapeutic Relationship Anxiety Fears Low confidence Inexperience Time constraints Lack of teaching resources Overarching Goal of Health Care Communication Therapeutic Relationship Requires:  Background Knowledge (nurse education, experience etc.)  Knowledge of interpersonal and developmental theory  Knowledge of diversity influences and determinants (social justice, cultural and racial diversity – impact of diversity and how this influences development of the therapeutic relationship)  Knowledge of the person (understanding the clients world, what is meaningful and concerning to that client, client life story)  Knowledge of Health or Illness (symptoms, interventions, pharmacology, best practices, determinants of health and illness)  Knowledge of broader influences (client expectations, health care system and multidisciplinary /interprofessional function and relationships)  Reflective practice and Self Awareness  Rapport and positive genuine connection between nurse and patient  Focus on needs of the patient not needs of the health care professional  Effective listening and the sharing of knowledge, skill, comforting, supporting, to facilitate wellbeing Overarching Goal of Health Care Communication Human connection – Vital to nursing care and the nurse patient relationship. The capacity to establish human connection is required for clinical competence in nursing practice. Nursing is a social activity, and nurses need to be socially competent. Skilled in the art of interpersonal communication and human relationship building. Interpersonal contact increases the therapeutic effectiveness of nursing activities.  Overarching Goal of Health Care Communication Person Centred Care– Understanding the patient’s experience and their life situation through forming an interpersonal relationship Healthcare quality and safety is improved when patients are actively involved in their care Better outcomes and fewer adverse events and errors. Improved quality and safety Patients are involved in health care decision making – they are partners in their own care. Patients are more satisfied, experience a greater sense of wellbeing and feel empowered when care is patient-centred Patient care focuses on their individual need and considers their individual values The terms ‘patient-centred’ and ‘person-centred’ are used interchangeably in the literature. However - Patient-centred care focuses on helping the person regain and maintain a functional life; the goal of person-centred care is a meaningful life Overarching Goal of Health Care Communication Changing paradigms: Person centred care and partnering with the patient Patients as active participants in health care challenges the traditional ‘sick role’ which prevents people from assuming responsibility for their own health. Places decision-making authority in the hands of healthcare professionals because ‘they know best’. However, patient participation alters the power balance. Patients are encouraged to engage in partnerships with healthcare professionals, with increased capacity to act on their own behalf and take charge of their own health. Patient moves from passive participant to active agent Nurse moves from provider of care to partner in care Change in traditional culture of health that is often characterised by authoritarian and paternalistic attitudes Overarching Goal of Health Care Communication Patient – nurse relationships in nursing practice Hildegard Peplau – nurse theorist who created the Theory of Interpersonal Relations – 1950’s Nursing relationship could be a vehicle for a corrective human experience Relationship is dependent on both the clinical context and the level of interpersonal involvement that is negotiated between patient and nurse. The helpful nature of effective patient–nurse interactions has the potential to reduce patient vulnerability Overarching Goal of Health Care Communication Knowing the patient Nurses take into account different sources of knowledge and different ways of knowing. Case knowledge - knowledge of anatomy, physiology, physical disease processes and pharmacology Patient knowledge - how individual patients are responding to their clinical situations. Nurses need interpersonal skills to understand a patient’s response to the clinical situation - patient- centred care. Person Knowledge - understanding of the unique individuality of the patient. Knowing the patient’s personal and private biography and understanding how that person’s actions make sense for them - person-centred care. The types of knowledge that are used in nursing will vary with clinical contexts. Consider a palliative care setting versus an outpatient care setting. Overarching Goal of Health Care Communication Holistic communication and person-centred care Important to understand that the individual perspectives of each Person/s, as well as previous and present events in their life. Genuine and sincere care, acknowledging the uniqueness of each individual Consideration of more than the symptoms of the Person or their or their physical aspect It requires exploration of all aspects (physical, social, cognitive, emotional and spiritual) to achieve care of the whole person. Understanding of their perspective to ensure both quality of care and also maintenance of health and social function Increases health and wellbeing, - improving health outcomes while decreasing workload and the cost of healthcare Overarching Goal of Health Care Communication Consider this – what would you do and how would you respond if a patient was to ask you the following questions? – Can you tell me where I can perform my daily prayers while I am here? – Can I talk with you about my religious beliefs? – Can I ask my family to bring me a copy of the writings of my faith? – May I keep my placenta please? – I must go back to where I was born to ‘finish off’ (die). When can I go? – Can I use the medicine made by my Elder (Aboriginal or Torres Strait Islander) or Tohunga (Māori)? – Can I use herbal remedies as well? – Can you tell me where I can have an abortion? My husband and I are not ready to have children. – Can I also have acupuncture while having your treatment? – Can I also have physiotherapy while having acupuncture? – You won’t tell my father he is dying, will you? It is not our way. How should healthcare professionals respond to these requests? Is there anything they should or should not do in response to these requests?  Overarching Goal of Health Care Communication Holistic communication and person-centred care Respect Respect is a foundational component in achieving Person-centred care and thus positive outcomes. More than an attitude or a value - interest, warmth, friendliness, approachability, active concern, humility, honesty, authenticity, Demonstration of respect requires commitment to person centred care. Respect is an interest in and acknowledgement of the Person/s, their viewpoint and their emotions Assumes that everyone has innate worth and value - Believes in the potential of each individual Allows everyone to be themselves and to express themselves honestly without condemnation, ridicule or criticism  Overarching Goal of Health Care Communication Holistic communication and person-centred care Respect No judgement - individuals are valuable, regardless of their appearance or actions, past and present - age, colour, racial group, position, uniform, state, relationship, social status. Demonstrating respect can be difficult – cultural differences – Use of names – ask your client/patient their preferred name Confidentiality demonstrates respect Empathy Understanding of the person’s emotions and experiences. Separating your values from the patient – affirm the person’s words and encourage further expression Overarching Goal of Health Care Communication Holistic communication and person-centred care An international WHO classification demonstrating the importance of effective communication WHO 2001. Towards a common language for functioning, disability and health: ICF. The International Classification of Functioning, Disability and Health. WHO, p. 9. Overarching Goal of Health Care Communication Holistic communication and care Overarching Goal of Health Care Communication Ethical Communication in Health Care Respect Demonstrates respect and rights of the person How to communicate to avoid harming the Person/s, ensuring safe and morally correct healthcare Essential and beneficial for therapeutic relationships A person has a right to comprehend everything they experience, hear and everything written about them. Relevant rules for conduct – Code of Conduct Motivation and self-awareness – may depend on your cultural background, values and beliefs Every communicative act has the potential to be constructive or destructive Overarching Goal of Health Care Communication Ethical Communication in Health Care Unconditional positive regard for all human beings: Ethical in accordance with – the Universal Declaration of Human Rights (United Nations 1948), the Human Rights Council (United Nations 2006) the Convention on the Rights of Persons with Disabilities (United Nations 2017) and the World Health Organization Resource Book on Mental Health, Human Rights and Legislation (WHO 2005). Overarching Goal of Health Care Communication Ethical Communication in Health Care Honesty ‘honourable character’ and ‘uprightness of disposition and conduct’ – underlying characteristic of an individual Opposed to cheating, stealing and lying QUESTION: What situations might you find difficult when communicating with patients that requires the upmost honesty? Clarification of expectations Overcoming vulnerability – reassuring the person – what is going to happen and when Asking the person to voice their expectations of the service clarifies uncertainties and reassures Overarching Goal of Health Care Communication Ethical Communication in Health Care Informed Consent Key information that needs to be communicated effectively Removes the vulnerability from the patient and provides them with control. What does this mean when caring and supporting: A child A sensory impaired person A cognitively impaired person An uneducated person Overarching Goal of Health Care Communication Ethical Communication in Health Care Protecting shared information Foundation for this is a trusting therapeutic relationship “Safe space" – for a patient to speak with a health professional. Mandatory communications Mandatory reporting or Mandatory notification – ‘on reasonable grounds’ Overarching Goal of Health Care Communication Ethical Communication in Health Care Ethical responsibility to protect information about the person. Failing to protect confidentiality can destroy any trust between the healthcare professional and any Person/s, including colleagues, as well as potentially having legal ramifications, possibly including the risk of deregistration. Question time - Consider this following scenario: You meet an ex-classmate after work. You naturally talk about your experiences at work. They ask about a Person/s you are assisting by name – a close relative of theirs. How will you respond? This is a ‘small’ city but you want them to value you, and you also want to be respected and successful in your profession. Overarching Goal of Health Care Communication Ethical Communication in Health Care Ethical responsibility to protect information about the person. There are many times when healthcare professionals simply need to ‘unload’ their experiences Is it appropriate for the healthcare professional to talk to a close and trusted family member if they need to ‘offload’? Overarching Goal of Health Care Communication Ethical Communication in Health Care Ethics in Health Care The four principles of medical ethics are: 1. Beneficence (doing good) 2. Non-maleficence (to do no harm) 3. Autonomy (giving the patient the freedom to choose freely, where they are able) 4. Justice (ensuring fairness) These four principles represent a framework for analysing the best action to take in a given situation. To use this approach, you must consider whether your actions are in compliance with each of the four principles. Overarching Goal of Health Care Communication Ethical Communication in Health Care Ethics in Health Care Go back now and think about all of the information presented in this lecture so far. How does what we have talked about relate to the four principles of medical ethics. Perhaps you may want to go back to the slide about “changing paradigms” and also consider the consent process. Effective communication is essential to ensure that our patients are given an opportunity to be autonomous – one of the principles of medical ethics. What about beneficence and justice and non-maleficence how do they relate? Overarching Goal of Health Care Communication https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/ registered-nurse-standards-for-practice.aspx  References Liaschenko, J., & Fisher, A. (1999). Theorizing the knowledge that nurses use in the conduct of their work. Scholarly inquiry for nursing practice, 13(1), 29–41. Luo, Y., Liu, L. W., Lin, Y., & Sun, W. (2021). Student’s experiences on learning therapeutic relationship: a narrative inquiry. Canadian Journal of Nursing Research, 53(1), 78–87. https://doi.org/10.1177/0844562119873760 O'Toole, G. (2020). Communication : core interpersonal skills for health professionals (Fourth). Elsevier. Registered Nurses’ Association of Ontario (2006). Establishing Therapeutic Relationships. (rev. suppl.) Toronto, Canada: Registered Nurses’ Association of Ontario https://rnao.ca/sites/rnao-ca/files/Establishing_Therapeutic_Relationships.pdf Stein-Parbury, J. (2021). Patient and person: Interpersonal skills in nursing (7th ed.). Elsevier. United Nations. Universal declaration of human rights Available www.un.org/en/universal-declaration-human-rights/index.html 1948; Online 14 October 2019. 283 United Nations. Human Rights Council Available unhrc.org 2006; Online. United Nations. Convention on the rights of persons with disabilities Available www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html 2017; Online 14 October 2019. World Health Organization. WHO resource book on mental health, human rights and legislation 2005; WHO Geneva. Thank you – Any Questions? Please post to the discussion board