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Week 1 CH 1,2- Responsible, Assertive, Caring Communication in Nursing & The Client-Nurse Relationship Functions of interpersonal communication in nursing - Communication is: - The vehicle in establishing a therapeutic relationship - The means...
Week 1 CH 1,2- Responsible, Assertive, Caring Communication in Nursing & The Client-Nurse Relationship Functions of interpersonal communication in nursing - Communication is: - The vehicle in establishing a therapeutic relationship - The means by which people influence others - The relationship itself - Without it, there would be no therapeutic nurse-client relationship - Communication can either: - Facilitate the development of a therapeutic relationship or create barriers Assertive, nonassertive, and aggressive communication - Assertive - Be clear about what you need - Be respectful in your language and behavior - Be confident and comfortable - An “active” behavior - Nonassertive - Disregard own needs and rights - May be interpreted as lack of interest/knowledge - A “passive” behavior” - Aggressive - Loud - Forceful - Confrontational way of trying to get what we want - Rights are responded to out of proportion to those of others 3- step process to build assertiveness skills - Review the list of assertive rights - What rights are you not giving up by not asserting yourself? - Review the irrational beliefs - How do they interfere with acting in your own best interest? - Review the DESC script - How to formulate an assertive response Assertive rights - You have the right to: - Be treated with respect - A reasonable workload - An equitable wage - 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 - What rights are you giving up by not asserting yourself? Irrational beliefs that impede assertive communication Irrational beliefs Rational counterpart Other people will be upset, hurt, or angry ther person may prefer open and honest O communication I will be devastated if the other person is angry Angry response is the choice of the other person Assertive people are seen as cold and self-serving ssertiveness is honest, respects the other person’s A opinion, builds relationships Wrong to turn down legitimate requests I can consider my own needs The “DESC” script for developing an assertive response - Anatomy of an assertive response - De scribe the situation - Express what you think and feel - Sp ecify your request - Co nsequences Case Study/Scenario - The clinical instructor asks students to sign up to let her know the topic they want to talk about in post conference. You sign up to do “alcoholism” because the subject interests you a great deal. When the instructor goes over the list, you see another student’s name under that topic instead of your own. Your name has been crossed out, and instead “Brenda” is listed. You are quite angry and upset. a. Say nothing. The last thing you need right now is conflict. b. Ask around and see who might have erased your name. c. Immediately confront Brenda and ask her why she scratched out your name; you were there first. d. Approach the instructor to see if she had changed this for any reason. If this was not the case, approach Brenda letting her know you were first to sign and that the topic was important to you. 3 types of assertions - Basic - Expresses an idea, belief, or opinion; stands up for your rights or the rights of others - Empathetic - Conveys sensitivity to the situation while taking an assertive position - Escalating - Expresses more emphatically when a simple assertion did not accomplish your goals and your rights are still being violated 3 essential criteria for presenting an assertive response - Timing - Content - Receptivity How does an assertive nurse behave? - Appears self-confident and composed - Maintains eye contact - Uses clear, concise speech - Speaks firmly and positively - Speaks genuinely, without sarcasm - Is nonapologetic - Takes initiative to guide situations - Gives the same message verbally and nonverbally Advantages of assertive communication - You will likely get what you want when you ask for it clearly - People respect clear, open, honest communication - You stand up for your own rights and feel self-respect - You avoid the invitation of aggression when the rights of others are violated - You are more independent - You become a decision maker - You feel more peaceful and comfortable with yourself Responsible communication in nursing - A nurse who communicates responsibly: - Focuses on the nursing process and problem-solving process - Considers the world of the client and the client’s family - Is a client advocate - Appreciates the sacred role of intimate care of the sick - Maintains a sense of wonder at the human experience and treats each person as an individual - Is open to learning to trust intuition as another way of knowing about the client CH 25- Refusing unreasonable requests Right to refuse unreasonable requests - Unreasonable requests - Affect your right to provide nursing care consistent with your ethics, values, or beliefs - Escalate your negative feelings - Encroach on your right to feel good about the work you are doing - Are disrespectful of your safety/physical capabilities - Put you in the position of hurting yourself, physically or emotionally - Is the request reasonable? Check before you say yes - If a request is unreasonable, refuse - Better to refuse than to capitulate and risk a serious error - Failure to refuse can end up making you a sorry excuse for a nurse Types of refusals - Assertive refusals - Protect selves by declining a task we cannot comfortably handle - Respect the other’s rights by refusing in a polite, matter-of-fact manner - Nonassertive refusals - Weak excuses in attempts to avoid accepting a request - Feelings of guilt and helplessness - Offend the asker with attempts to justify our refusal - A simple no would suffice - Aggressive refusals - Unnecessary or irrational guilty about saying no leads to refusing a request in a hostile, defensive manner - Feelings of shame, unprofessionalism - Asker feels put down or hurt by explosive response The role of caring in nursing - Caring includes - Ongoing commitment to sharpening knowledge and skills - Identifying care needs and nursing actions that will bring about positive change - Protecting and enhancing human dignity Responsible, assertive, and caring communication - Cognitive domain - Demonstrated by the identification of behaviors that would be appropriate or inappropriate in an observed interpersonal citation - Affective domain - A belief in the value and impact of positive communication motivates the nurse to seek feedback and practice self-care strategies that build confidence - Psychomotor domain - Successfully implement communication strategies that are assertive and responsible CH 2- The client-nurse relationship: a helping relationship The purpose of the client-nurse relationship - “Friendly nurses seem like they know everything” - Client-nurse relationships differ from social, collegial, and kinship relationships - Entered into for the benefit of the client - More effective if it is mutually satisfying - Goals are directedtowardthe growth of clients - May also be a mutual learning experience - Established to help the client achieve and maintain optimal health Cognitive, affective & psychomotor abilities of nurses and clients - Cognitive - Knowledge and beliefs—ideas - Learning— ability to learn - Preferred ways of perceiving— - Sensing - Intuitive - Judging— making decisions - Thinking - Feeling - Affective - Values— cultural, health, family - Feelings - Attitudes - Psychomotor - Ability to relate to and communicate with others - Ability to perform needed tasks - Ability to learn and teach - The client needs to know what skills the nurse has, and the nurse needs to determine the client’s ability to participate in his or her own treatment plan Clients’ rights as consumers of healthcare service - To expect a systematic and accurate investigation of their health concerns by thorough and well-organized nurses - To be informed about their health status and have all their questions answered so that they clearly understand what nurses mean - To receive healthcare from nurses who have current knowledge about their diagnosis and are capable of providing safe and efficient care - To feel confident that they will be treated courteously and that their nurses show genuine interest in them - To trust that the confidentiality of any personal information will be respected - To be informed about any plans of action to be carried out for their benefit - To refuse or consent to nursing treatments without jeopardizing their relationship with their nurses - To secure help conveniently, without hassles or roadblocks - To receive consistent quality of care from all nurses Characteristics of a successful client-nurse relationship - Partnership between clients and nurses - Philosophy about human nature and what motivates humans in health and illness - Purposeful and productive objectives - Preservation of the client’s present level of health and protection from future health threats - Palliation of clients’ worries and fears through nurses’ reassurances: Easing of pain; A psychic or morale boost - Practicality: Efficacious, effective, and efficient - Portability: Present in any setting - Phasic—initiation, maintenance, and termination— occur for each encounter - Personally tailored—individualized - Platonic (not passionate) expressions of caring - Sense of privacy Therapeutic communication techniques - Listening/remaining silent - Establishing guidelines - Making open-ended comments - Reducing distance - acknowledging/restating/reflecting - Seeking clarification - Seeking consensual validation - focusing/summarizing/planning Nontherapeutic communication techniques - Failing to listen - Failing to probe - Parroting - Being judgmental - Reassuring - Rejecting - Defending - Getting advice - Making stereotyped responses - Changing topics - Patronizing Do’s and Don’ts in the Client–Nurse Relationship - DO - Be prepared mentally, emotionally, and physically to assist your clients - Be punctual and polite - Promote clients’ well-being and comfort - Be philanthropic in your approach to clients - Be plucky in planning and generating creative solutions - Be proficient in the nursing skills required to safely and successfully care for your clients - Praise and encourage clients - Be patient and understanding - Persevere in pursuing your pledge to help clients preserve their health - DON’T - Patronize clients - Preach at them or pressure them to change - Pigeonhole clients with labels such as “good,” “lazy,” or “uncooperative” - Procrastinate following through on clients’ reasonable requests - Put down clients by using medical jargon - Punish clients for acts of omission or commission that have negatively affected their health - Reveal prejudices against the race, religion, or creed of clients - Be pleasure seeking - Pretend to have knowledge that you do not Behavioral dimensions indicative of bonding in the client-nurse relationship - Shared experience between the client and the nurse that occurs when each feels connected to the other - Indicators of bonding - Openness - Engagement Behavioral dimensions indicative of bonding: the patient - Anticipates nurse’s arrival - Initiates greeting - Greets back the nurse in a verbal or nonverbal way - Acknowledges nurse’s statements by responding - Manifests at-ease behaviors - Volunteers information - Elaborates on physical condition, past and present health status even when not prompted to do so - Verbalizes feelings, psychosocial implication of disease in his or her life - Talks about support persons and other resources - Talks about other personal concerns Behavioral dimensions indicative of bonding: the nurse - Greets patient - Pauses to visually check on patient - Touches patient for further assessment - Exchanges friendly/light comments or jokes - Makes clarifications, asks follow-up questions for further assessment - Assesses patient’s current knowledge - Listens attentively to verbalization of patient’s feelings, health condition, and personal/family information - Asks patient/family about other pertinent information that may not be in the record Poor bonding - The patient - Shows avoidance of the nurse as she approaches - Interrupts nurse in mid sentence - Shows cold treatment toward nurse - Demonstrates irritation through facial expression - Converses in angry tone - The nurse - Ignores patient’s questions or comments - Discourages inquiries from patient - Has a stern or aloof facial expression - Focuses on tasks, not maintaining eye contact with patient - Projects irritable behavior - Converses in angry tone - Shows hurried behavior Engaged relationship - The patient - Accepts nursing care - Participates in care - Seeks clarification Demonstrates understanding/agreement with what nurse tells him/her and readily follows nurse’s instructions - Provides data asked by nurse - Asks about other anticipated procedures or interventions - Takes time to respond to questions or asks that questions or instructions be repeated - The nurse - Implements needed interventions/procedures promptly and competently - Completes routine tasks with friendly comments or other manifestations of high regard/caring for patient - Acknowledges and addresses inquiries of patient about care - Volunteers needed information without being asked by patient or family - Touches patient for reassurance when appropriate - Provides verbal reassurance Unengaged relationship - The patient - Demonstrates verbal or nonverbal cues of reluctance/refusal to comply with what nurse says - The nurse - Attends only to routine procedures and ignores the patient - Scorns patient’s questions by laughing with sarcasm or getting irritated - Sternly demands patient comply with instructions, demonstrating irritation F.O.C.U.S.E.D. model of presence - F=feel - O=observe - C=connect - U=understand - S=share - E=energize - D=disconnect - Nurse instead of focusing on being heard or understood, focuses on understanding people and disconnecting from personal distraction Power of a story - Story creates context → context highlights relationships and leads to holistic and connected action → connected action becomes a force for restoring/restorying the world - Hearing the client’s story is an important assessment tool that allows nurses to access a client’s self-care knowledge and gain greater understanding of their worldview - By listening to a person’s story, the nurse(the storycatcher) is able to learn what is important to the client and begin to create a personalized plan of care Power of the story: qualities of a storycatcher - Qualities of a storycatcher - Intrigued by human experience - Inquisitive about meaning and insight - Curious, not judgemental - More in love with questions than answers - Storycatchers are - Able to hold personal boundaries in relationships - Present while other experience emotions and have insight - Able to hold the sacred space for listening - Able to invite forgiveness, release, and grace - Aware of the power of story and use it consciously Listening skills - Body mechanics: arms open, eye contact, leaning in, focus on what is being said - Relax - Be present in the moment - Be aware of verbal and nonverbal communication Posting on social media Gastroschisis is a birth defect of the belly where the baby's intestines are exposed. The posts were made on accounts belonging to the name Sierra Samuels, a nurse at JMH. " In addition to the general HIPPA violation that we'd be looking at here there's a sense of decency about the rights and expectations we all have in our likenesses and our images," said Weinstein. Week 2-CH 3,4, 21 Wit and wisdom We must not talk to them, or at them, but with them Florence nightingale[on partnership with clients] Self-assessment as a starting point for building communication skills - Using quality tools to assess your natural talents, attributes, and life skills in order to grow your communication skills. - Strengths assessment - Emotional intelligence - Conflict management Identifying and Focusing on Personal Strengths - Concept was birthed from the Positive Psychology movement - Focuses on the study of human strengths and virtues and the factors that contribute to a full and meaningful life. (Lino, 2016) - Virtues (wisdom and knowledge, courage, humanity, justice, temperance, and transcendence). - The VIA list is intended to provide a shared language for describing human strengths. - Described as the backbone of Positive Psychology. - When you are using your highest strengths, you are more engaged, more productive, more successful, healthier, and happier. - Tools for measuring strengths: - Clifton Strengths-Finder - Values in Action Inventory of Strengths (VIA) - - http://www.viacharacter.org/www/Character-Strengths - A strength begins with a talent—a naturally recurring pattern of thought, feeling, or behavior that can be productively applied. - Strengths are defined as the ability to provide consistent, near-perfect performance in a given activity (Clifton et al. 2006). - Identifying and focusing on strengths is meant to balance the negative side of psychology which has been the historical focus of psychology. Applying your strengths to communication skills - Benefits of discovering your strengths - You will become more aware of your strengths and find new ways to apply them. - Validates your uniqueness and builds confidence - You will feel appreciation/thankfulness for your unique talents and how they effect your life. - New excitement for life and your own potential - New discernment for accepting or rejecting opportunities that fit or don’t fit your talents. - You will be able to choose to do the things you can do best— provides focus for your career and life. Emotional intelligence - Emotional intelligence is the “something” in each of us that is a bit intangible. - Affects how we manage behavior, navigate social complexities, and make personal decisions that achieve positive results. (Bleich & Kist, 2013) - Nurses need high emotional intelligence for: - Workplace functioning, quality patient-centered care, communication in therapeutic relationships, compassionate care, and teamwork and collaboration. - 4 key domains: - Self-awareness - Self-management - Social awareness - Relationship management Assessing emotional intelligence Improving your emotional intelligence - Self-awareness - Know your story and how it affects you - Make peace with your past: practice forgiveness - Know your beliefs, your emotions, and your behavior patterns - Take time to identify your individual feelings and emotions, such as anger, sadness, fear, and joy in various situations - Self-management - Learn new stress management techniques that will help you stay emotionally present in upsetting situations - Learn skills for soothing and motivating yourself - Maintain healthy eating and exercise habits - Social awareness - Work at understanding nonverbal social signals—focus on the other person in interactions - Develop a positive view of others - Work at understanding the basic human emotional needs of your clients and colleagues - Understand “games” people play and principles of personal integrity - Discomfort when hearing others express certain views tells you something important about yourself. Examine your responses and the reasons for them. - Relationship management - Develop skills for reflective listening and developing your capacity for empathy - Become aware of ways you use nonverbal communication - Learn skills for healthy assertiveness - Learn conflict resolution skills—see conflict as an opportunity to grow closer to others. - Develop skills for support and affirmation of others—become an encourager - Use humor and play to relieve stress Chapter 21- incorporating positive self-talk Self-talk’s influence on behavior - Self-talk is also known as : Inner thought, speech; Self-instruction; “Little voice” in your head - Self-talk can be - Rational or irrational - Based on reasoning, logic, or facts - Positive, offering encouragement or praise - Negative, offering discouragement and criticism - Internal dialogue has a powerful influence on our behavior - Our thoughts are our interpretations of the world - Our judgments about our own behavior and our assumptions about others’ reactions to us directly influence our feelings - How we construe our world provides the blueprint for our actions? - For any situation or interpersonal encounter we have, our self-talk determines the following - Our attitude toward the situation - What we see, hear, and attend to? - How we interpret what we take in? - What we think the outcome will be? - How we act (including what we feel, say, and do)? - How we appraise the consequences of our actions? Self- talk and interpersonal communication - You can gear your self-talk in many areas - When being assertive and responsible - When being empathetic - When confrontation is needed - When colleagues are distressed - When team conflict exists - Self-talk can help in 3 phases of interaction - Before - Take control of thoughts and focus on inner dialogue - Be confident in your ability! - During - Tune in to your inner voice - Stay in control - Concentrate on supportive dialogue - After - Review your performance Use of affirmations to create positive self-talk - Affirmations - Self-talk statements of what you want - Written in the positive tense, as if they have already happened - Can help you to take an optimistic point of view about your life and work - Can lead to favorable expectations of the future - How to create and use affirmations - Use the present tense - You want your mind to know it has already happened - Be POSITIVE - Avoid negative words - Write them - Keep them short and very specific - Believe - Always believe that what you say will happen - Repetition - Be repetitive and persistent - Time - Have a specific time daily set aside for your affirmations to set a pattern Discussion - Think of a situation that worries you as a class - Post 1 self-talk or affirmation that may help you/your classmates get through the issue Conflict management - Conflict can be defined as a disagreement in values or beliefs within oneself or between people that causes harm or has the potential to cause harm. - Also considered a catalyst for change—may be necessary for change. - Can stimulate either detrimental or beneficial effects. - Assertiveness and cooperativeness are the two basic dimensions for describing choices for dealing with conflict - Assertiveness—the degree to which you try to satisfyyour own concerns - Cooperativeness—the degree to which you try to satisfythe other person’s concerns. - To illustrate, assertiveness is placed on a vertical axis with cooperativeness on an horizontal axis - The five modes of conflict handling fit within the space between these axes. Modes of conflict management - Competing: assertive and uncooperative - Placed high on the assertiveness axis, but far to the left(low) on the cooperative axis - This person is determined to get their own way with no regard for the other person’s concern - This results in a win-lose solution in which only 1 party get their way - Collaborating: both assertive and cooperative - Placed at the the top of the assertiveness axis and on the far right end of the cooperative axis - This is when the participants work together to find a solution that satisfies both parties - Collaboration usually requires extra time and patience to reach the ideal, win-win solution - Compromising: an intermediate answer - Only partially satisfies both people’s concerns - Placed in the center of the space, midway on both axis - Each person gives in to some degree and loses some of what they wanted in the process - This is considered a lose-lose solution since neither party really gets what they wanted - Avoiding: both unassertive and uncooperative - Low on both axis - The avoidant person doesn't even air their concerns and the other person gets whatever they wanted - Considered a lose-win solution since the other person does get their way - Accommodating: cooperative and unassertive - Placed on the far right end of the cooperativeness axis and low end of the assertiveness axis - This person chooses to consider the other person’s issues without asserting their own wants or needs - This is considered a lose-win situation. This accommodator has chosen to satisfy the other persons concerns at the expense of their own Using personal strengths to manage conflict - How do your natural strengths influence the way that you tend to handle conflict? - Consider how you can use your strengths to modify the way that you handle conflict based on the situation - Any of the methods of handling conflicts may be appropriate depending on your situation - They key is learning to adapt your method to the situation Let’s Understand….. Self-Understanding as a Key to Building Responsible, Assertive, Caring Communication Skills - Continuing the journey - Post your top five strengths where you can view them. Add specific descriptors - Make specific plans to grow your emotional intelligence (EI) and journal your progress - Reassess your EI at a specific time in the future to note your growth. - Make note of conflict situations and how you handled them. - Experiment with alternative ways of managing conflict situations. Solving Problems Together: Mutuality in Nurse–Client Relationships - Mutualityis: - The convergence of two or more people brought together in a balanced relationship - Characterized by understanding and respect for others in order to achieve a shared goal. - Not always easy to achieve - Essential element in building relationships with the client - Characterized by: empathy, collaboration, equality, and interdependency - Ongoing sharing of knowledge between healthcare professionals and shared decision-making help ensure patient satisfaction - Interprofessional education (IPE)—“happens when twoor more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010) - In a 4-day hospital stay, a patient can interact with 50 different hospital staff with varying levels of education and occupational training according to the Joint Commission on Accreditation of Healthcare Organizations (2005). - Consider how many opportunities there are for inaccurate communication exchange that affects patient safety. Core competencies of interprofessional collaborative practice - Ethics for interprofessional practice to work together to maintain a climate of mutual respect with shared values - Responsibilities shared using the knowledge of your own role and that of other professions to appropriately assess and deal with the health care needs of clients and populations served - Communication with other health care professionals in a responsible and responsive way to work as a team for health maintenance and treatment of disease - Relationship-building in teams for shared values in health care that is client-centered, safe, timely, efficient, effective, and equitable. (Adapted from Schmitt, Blue, Aschenbrener et al., 2011, p. 1351) Teamstepps Mutual problem-solving process in nursing- VALIDATION - Validation means: - Consciously seeking out our clients’ opinions and feelings at each phase of the nursing process - Difference between problem-solvingforand problem-solvingwithclients - Unearthing any questions or concerns our clients have about plans for their healthcare and securing their understanding and willingness to proceed to the next step - Validation does: - Makes the difference between problem-solving for clients and mutual problem-solving with clients - Focuses on the rights and obligations of clients to make their own decisions about their health - Must be incorporated at each step of the problem-solving process in nursing - Stops us from moving too quickly and “doing” to our clients - Validation results in: - We obtain complete agreement and commitment from our clients about the plans of care - Gives clients a sense of control - Clients clearly understand their nursing diagnoses and have a say - Invites thecollaborationthat is essential for successfulclient change - Enriches the foundation for the rest of the nursing process - The trustdeveloped from working together is likelyto increase the accuracy and validity of the database Mutual problem-solving process in nursing - Assessment - Collecting data regarding the client, client-family system, or community - Identifying needs, problems, concerns, or human responses - Diagnosis - Analyzing data - Validating interpretation of data with the client - Identifying nursing diagnoses - Validating the nursing diagnoses with the client - Planning - Setting priorities for resolution of identified problems with the client - Determining expected and desired outcomes of nursing actions in collaboration with the client - Writing nursing interventions to achieve these outcomes in collaboration with the client - Implementation - Implementing nursing actions with assistance from the client - Encouraging client participation in carrying out nursing actions to achieve the outcomes - Continuing to collect data about the client’s condition and interaction with the environment - Evaluation - Evaluating the outcomes of nursing care in consultation with the client - Ongoing evaluation to revise the nursing care plan - Advantages - Contributes to growth and development of clients and nurses - Nurses and clients gain trust in each other - Clients who take more active roles in their treatments recover faster - Spin-offs from working with this philosophy - Opportunity tobring more nurturing and caring intotheir profession - Enjoyment of expanded autonomy and authority - Experience of amore equal relationship with physicianswho listen to their recommendations and even seek their counsel - Satisfaction of being client advocatesas they wereeducated to be Exercises to Practice a Mutual Problem-Solving Approach - Explore your own beliefs about clients having an active part in their healthcare - The extent to which you uphold clients’ responsibility for their health mirrors how you involve them in their care - Step back, listen, openly discuss the issue, and focus on collaboration - Know that an environment where “questioning, curiosity, risk taking, and skepticism” are tolerated and even encouraged, supporting critical thinking skills - Watch for “teachable moments” - Collaborate on where to begin with your client - Do not negotiate nursing strategy if there is in fact no choice for your client - The philosophy of the institution, technical policies, time, and/or staff shortages dictate the prioritization and methodology - Before you do something for your clients, ask yourself:Could my clients be doing this for themselves? - By doing for our clients we rob them of the opportunity to discover their own power to take care of themselves - Remember to evaluate with your clients - The only way to know if your clients are satisfied with the outcomes of care is to ask for, and listen to, their opinions - Keep in mind that validating is an assertive act Steps in making contracts with clients - Contract - An agreement between you and your client outlining activities and responsibilities for each party - It should be S.M.A.R.T. - Be realistic - Spell out measurable behaviors - Have dates of expected completion - Be worded positively - Build in rewards for success - Provide standards for evaluation - Components of a client-nurse contact for you to adapt to your workplace - Names of client and nurse - Purpose of the client–nurse relationship - Roles of client and nurse - Responsibilities of client and nurse - Expectations of client and nurse - Specific details such as meeting times and structure for confidentiality - Conditions for termination Let’s Discuss Further…Scenario - Your patient is a 19-year-old single postpartum woman who just gave birth to her first baby. This woman had three previous elective abortions, all with different men. You are observing her at this time and she shows little interest in the baby, teaching, or learning ways of caring for her newborn. She is preoccupied with telling her “labor story” to her friends on the phone. You are concerned over this new mother’s ability to care for her newborn. How might you initiate care for this new mom and meet the needs of her and her new baby? Review steps you would take and goals that would be accomplished. - The nurse cares for a client with abdominal pain who is scheduled for exploratory surgery. Which statement(s), if made by the nurse, indicates that the client’s rights in the helping relationship have been violated? (Select all that apply.) 1. “I do not have time right now to help you call your family.” 2. “I am available to answer questions that you may have about your surgery.” 3. “You seem frightened. I will stay with you until your family arrives.” 4. “Your neighbors called, and I told them that you will have surgery.” 5. “If you do not let me start your IV, I will not give you pain medication.” - The home care nurse visits a mother and her newborn 2 days after discharge from the hospital. The mother states, “My baby cries all the time. I must not be a very good mother.” Which response by the nurse is nontherapeutic? 1. “It sounds as if you are concerned about your ability to care for your baby.” 2. The nurse moves closer to the mother and places a hand on her shoulder. 3. “You just need to get away for a few hours. Find a babysitter and go to a movie.” 4. “I am not sure that I understand what you mean. Tell me more about how you feel.” Week 3 Definitions - Culture - Thelearned and shared beliefs, values, and life waysof a particular group - Transmittedintergenerationallyand influences one’sthinking and actions - A broader term because it refers to the patterned life ways of a group rather than to selected ethnic features or origins - Ethnicity - The social identity and origins of a social group due largely to language, religion, and national origin - Ethnocentrism - The universal tendency of people to believe that one’s own race or ethnic group is most important and/or that some or all aspectsof its cultureis superior to those of other groups - Perpetuates the attitude that beliefs differing greatly from one’s own are strange, bizarre, or unenlightened and therefore wrong Healthcare beliefs and behaviors of diverse cultures - Shifting demographics in country - Care - Central to the concept of nursing. - As technology becomes an increasingly important part of healthcare, the essence of human caring becomes the most valued aspect of nursing - Western Healthcare providers’ attitude - immigrants should adapt to “us” - Concerns that nursing education does not adequately prepare nurses to work with diverse populations - Economic imperatives - Insurance plans (MC/PPO) - incorporate culturally competent policies, structures, & practices to provide services for people from diverse ethnic, racial, cultural, and linguistic backgrounds - Do employees represent groups they serve? - Older adults/chronically ill - Issues are of immense importance - Different needs American values - May interfere with recognition and appreciation of diverse cultures - Ethnocentrism - Lack of knowledge when healthcare practitioners mishandle their encounters with individuals and groups viewed as different in terms of their backgrounds and experiences - Individualism - The individual adult client in America usually decides what treatment she or he deems to be most appropriate; this is very different in some cultures - Medical consultation - Most American families eventually consult a medical doctor if illness persists and home remedies do not work - Many cultures use the healthcare system as a last resort Your cultural background - How does it influence your healthcare beliefs and behaviors? - Without self-awareness nurses cannot recognize that their beliefs and behaviors are not necessarily common to all - Lack of knowledge about your own culture can distort perceptions of the beliefs and behaviors of clients from diverse cultures - If you do not understandthe reasons for a client’s behavior- impossible to implement appropriate interventions Components of communication for cultural competence - Purnell’s model for cultural competence - 12 domains for assessing the ethnocultural attributes - Communication - Family roles and organization - Workforce issues - Biocultural ecology - High-risk health behaviors - Nutrition - Pregnancy and childbearing practices - Death rituals - Spirituality - Healthcare practices - Healthcare practitioners - Dominant language and dialects - Identify the dominant language, or dialects that may interfere with communications - Explore contextual speech patterns - What is the usual volume and tone of speech - Cultural communication patterns - Explore the willingness of individuals to share thoughts, feelings, and ideas - Explore the practice and meaning of touch - Identify personal spatial and distancing characteristics - Explore the use of eye contact within the group - Explore the meaning of various facial expressions - Are there acceptable ways of standing and greeting outsiders? - Temporal relationships - Identify differences in the interpretation ofsocialtime versus clock time - Explore how time factors are interpreted by the group - Format for names - How does the individual expect to be greetedby strangersand healthcare practitioners? Enhancing communication with clients from diverse cultures - Use ofprofessional interpreters - Be aware of volume and toneof voice - Use of silence as a tool - Be attentive to both your own and the client’snonverbalcommunication - Pantomime simple words and actions - Until medical interpreters are available, use both formal and informal networking to locate a suitable interpreter - Guidelines for communicating with non–English-speaking clients - If there isNOT an interpreter available: - Determine if there is a third language that both you and the client speak - Remember that nonverbal communication is more important than verbal - If thereIS an interpreter available: - Use dialect-specific interpreters, when possible - Avoid using children and relatives as interpreters - Select same-age and same-gender interpreters - Address your questions to the client, not the interpreter Improving the care of clients from diverse cultures How age and gender relate to culture and communication - Age related issues - older adults use healthcare 2X as much - Definition:Ageism:devaluing of older people; existsin the American culture - Keyto effective delivery of healthcare to the elderly - Recognition and respect of intergenerational differences by healthcare professionals - Complex communication issues exist between young and old - Examples of ageism - AVOIDpatronizing speech (“honey”, “sweetheart”, “gramps”,granny”) - Assuming that the older person does not understand - Older adults can also patronize young adults - In 3 ways: - Nonlistening - Disapproving - Parental - Improving healthcare delivery to older adults - Increased awareness of ageist stereotyping - Reduce miscommunication - Develop a unique relationship with each client - Use of repetition and sensitive interrogation - Helps older adult clients understand technical jargon, diagnoses, and treatment options - Use metaphors/ examples relevant to individual client’s interests to explain medical terms and procedures - Develop a holistic understanding of each client - Listen to client narratives and historical life reviews How gender relates to culture and communication - Males and females are socialized differently worldwide - In the US: - Women are thought to value intimacy, more expressive and relationship oriented - Men are thought to value power and social status - Gender issues may interfere with nurse–physician communication and the retention of nurses Age, gender, culture and communication between HCPs - Communication between physicians and nurses in hospital settings - Single most important predictor of mortality rates - Improving communication between nurses and physicians - Level the playing field - Understand the rules rather than complain about them - Get to the point - Simplicity of speech is recommended - “Just the facts” - Focus on the goal, not the process - Use powerful prose - Powerful statements - Be direct! - Exude expertise - Speak confidently - Present yourself in a manner that makes it clear you do not expect to be refuted - Expect respect - If you believe that what you have to say is important, keep talking - Politeness allows us to let others speak Chapter 6: demonstrating warmth benefits of warmth in communication - Makes us feel welcomed, relaxed, and joyful & fosters feelings of well-being - Promotes healing - Warmth from caregiver—more client dialogue and personal information - Enhances closeness and makes us more approachable - Work has a more pleasant environment - Enhances the process of building an effective relationship - Displayed primarily in a nonverbal manner - facial expressions & gestures (small movements of hand, brow, or eyes) - Warmthindicators - Gestures: shift posture toward the other person; smile; make direct eye contact; motionless hands; verbal reinforcers - “I see…” Analyzing warmth in communication - Facial signals of warmth - Forehead - Muscles relaxed, forehead smooth; no furrowing of the brow - Eyes -Comfortableeye contact maintained - gaze is neither fixed nor shifting and darting - Mouth - Lips are loose and relaxed - not tight or pursed; gestures such as biting a lip or forcing a smile are absent - jaw is relaxed and mobile, not clenched; smile appropriate - Expression - Features of the face move in a relaxed, fluid way - Not looking worried or distracted - Face shows interest and attentiveness - Posture - Body position- Client is faced squarely, with shouldersparallel to client’s shoulders - Head position - keep at same levelas client’s; periodicnodding shows interest and attentiveness - Shoulders - Not hunched/tense - Arms - Loose and able to move freely rather than stiffly - Hands -avoid distracting mannerisms,( e.g. liketapping a pen) - Chest - Breathing is at an even pace; neither slouched nor extended too far forward in feigned attentiveness;slight forward leaning shows interest - Legs & Feet - Crossed or uncrossed, legs are kept in a comfortable and natural position; during standing, knees should be flexed and not locked - Avoid fidgeting, tapping, and kicking feet Displaying warmth and its importance - Spatial distance or closeness we display - Touching - The gentle, sincere touch of your hand can express warmth, caring, and comfort - Volume of the voice - Softer, modulated tones - Comfortable pitch, Soft words - Pacing of words (not rushed) - Relaxed with genuine interest - Body language indicates engagement Warmth in encounters with clients and colleagues - “Approach determines your success or failure” - It is easy to become focused on the technical skills you are learning in order to work with clients - Observe others displaying warmth; critique your way - Warmth you express should reflect your GENUINE feelings Chapter 7: showing respect benefits of showing respect - Makes people feel important, cared for, and worthwhile - Without it people feel hurt and ignored - Follows philosophy of holistic nursing - A person is body + mind + spirit - Warmth + respect—unconditional positive regard - Unconditional positive regard → maintains patient dignity - When body + mind + spirit are balanced → maximum well-being exists Behaviors that demonstrate respect - Respect begins as “attitude” - translated into behavior - Acknowledging clients - Feeling respect for your clients is not enough - Deliver the message that you think they are important and worthwhile clearly and directly - Means demonstrating your awareness of your clients as individuals - Concrete ways to show respect to your client - Look at your client - Offer your undivided attention - Maintain eye contact - Smile if appropriate - Move toward the other person - Determine how the other person likes to be addressed - Call the client by name and introduce yourself - Make contact with a handshake or by gently touching the individual - To respect a client is - To listen to what the person identifies as a need and work to incorporate meeting that need into nursing care - To recognize thepower of caring in nurse–client relationship(see Watson, 1979) Workplace bullying - Highly prevalent - Definition: “repeated health-harming mistreatment of one or more persons (targets) by one or more perpetrators” - Bullying is an abusive conduct - Seen as - Threatening, humiliating, or intimidating workplace interference - Sabotage - Verbal abuse - The JC mandated policies for addressing disruptive, disrespectful behavior among colleagues - In schools and colleges student “incivility” shows lack of value for human dignity and altruism, which are ESSENTIAL to professional nursing - Examples of student incivility: late to class, leaving early, inattentiveness, threatening language, and physical violence Week 4 The home care nurse is assigned to make the first home visit to a new client who has been discharged from the hospital. After initial introductions, the nurse should take which action to convey respect? A. Ask the client to develop a list of needs to discuss at the next visit. B. Wear a name badge that clearly identifies the home care agency. C. Provide contact information for several other clients who can serve as references. C. Tell the client that information obtained will not be shared with others. What is genuine? - Realness: congruence - It’s not enough to just go through the motions, trying to demonstrate qualities that are associated with emotional intelligence– you have to be genuine - “Authenticity requires a certain measure of vulnerability, transparency, and integrity” -janet stephenson Genuine behavior - Genuineness - Presentation of one’s true thoughts and feelings, both verbally and nonverbally - A real picture of you, not a distorted one; honesty - Willingness to present ourselves as we are and courage to risk rejection - A “what you see is what you get” phenomenon - Results in increased trust - Nurse genuineness - Speaks deep from within - Expresses thoughts, feelings, and experiences in here and now - Shows spontaneity, conveys openness - Nurse incongruence - Put up a facade or pretence - Mismatch between verbal and nonverbal messages - Communicates in a rigid and contrived way; sounds scripted Non Genuine behavior - Nongenuine - Verbal messages don’t correspond with facial expressions, posture, tone of voice, and body language - Interpreted as two distinct and dissimilar messages - Puts our credibility in question - Meaningful relationships - unlikely to ensue - Denial of awareness/defensiveness occurs when there is amismatch between nurses’ experiences of their thoughts and feelings and their awareness Being genuine - Give to our clients and colleagues the message “You are strong and worthy of my engaging fully with you.” - Being genuine takes a risk- can involve expressingnegative thoughts and confronting others with reactions - Being genuine is being respectful of yourself - We are more relaxed and self-assured when true to our thoughts and feelings - Others ( clients & colleagues) will react positively by wanting to communicate and trust you - Feel free to express their true thoughts and emotions - Develop a feeling of trust for the nurse - Are provided with information they can use in the relationship here and now - Can unwind in a relaxed atmosphere - Enjoy a climate of realness Importance of being genuine - Negative effects on clients and colleagues - Distrust nurse - Suspicious of nurse - Omit valuable information from the interchange - Decode message as two distinct and dissimilar ones - Feel confusion - Question the nurse’s credibility - Believe only the nonverbal message - Don’t feel that they are talking to a real person - Feel that the nurse is trying to impress rather than connect with them Chapter 9- empathy - Empathy - The act of communicating to our fellow human beings that we understand something about their world - Free of the judgment - Value-free message showing that you understand the other person’s point of view - Warmth you express with empathyshould convey genuinecaring, not honeyed insincerity - Occurs in three overlapping stages (Davis, 1990) - Self-transposition - Occurs when we listen, may put ourselves in the client’s place - Crossing over - Emotional shift, a deepening of understanding and awareness of the client’s experience - Getting our “self” back - When we stand with the other in heartfelt understanding about the experience just shared Preverbal, verbal, nonverbal aspects - Preverbal - Nurses understand what the clients’ situations feel like - Nurses feel tension and discomfort, which prompts them to action - Empathy istransformed into verbal connectionwithclient for the purpose of being helpful - Verbal - Goal is tooffer a verbal reflectionthat is accurate,without exaggerating or minimizing what is being told - Two qualities of verbal empathy necessary to be effective - Accuracy - Specificity - Nonverbal - Must be accompanied by warmth and genuineness for what clients/colleagues are experiencing Benefits of empathy - Increases thefeeling of being connected with anotherhuman - Helps reduce negative feelingsof loneliness and isolation - Empathy dissolves alienation; gives positive feeling of belonging - Provides comfortin times of challenging transitions - Creates a human bond that adds to your clients’ or colleagues’ personal strength - Contributes to feelings of increased self-esteem & self - acceptance - Helps clients/colleagues to trustthat you genuinelyaccept them as they are - Frees your clients and colleagues from having to defend or rationalize their feelings - They are then able to experience alternative reactions 6 steps to empathetic communication - Clear - Be present, clear your head of distracting agendas - Remind - Remind yourself tofocus on the speaker - Attend - To your clients/colleagues’verbal and nonverbal messages - Ask - Ask yourself, “what does this person want me to hear?” - Convey - Convey anempathetic response - Check - Check to see if your empathetic response waseffective Steps in breaking bad news (provider breaks news, nurse stays after) - Plan - Plan what it is to be said ahead of time and organize your thoughts - Establish - Establish rapport - Control - Control the environment as much as possible - Find out - Find out what the client and family already know - Find out - Find out how much given individuals want to know - Don't make assumptions about this - Use - Use language the client and family will understand - Be sensitive and respectful of cultural issues - Respond - Respond to the reactions of client and family using an empathetic approach - Explain - When appropriate, explain the treatment plan and prognosis, and summarize Practicing a centering exercise - Honor the sacred nature of your work. Take time each day to connect with your own purpose in your work - Before you interact with a client, family, or colleague, pause - Let go of any distractions or worries - Close your eyes briefly and take a deep breath - Say silently to yourself, “I’m here for the greater good of everyone involved and I’ll give my full attention to this moment.” - Bring to mind someone or something that evokes love and compassion - Hold the feeling of love and compassion, repeating to yourself, “I am present in this moment.” Chapter 10: self- disclosure in the helping relationship - Self-disclosure - Opening self to others - Reveal our thoughts and feelings; make known to others some of our personal experiences - Self-disclosure and nurses - Nurses are moved to offer self-disclosure where the need for connectedness “transcends theoretical connections. - Sharing … for the sake of connection and to give the interaction life, meaning and depth” (Drew, 1997) - Anything you reveal about yourself—your thoughts, feelings, and experiences—should be revealed for the benefit of your clients - The focus of the relationship is the client - Consider thewhy, what, when, and howof self-disclosingwith your clients (Stuart, 2009) - Maintain healthy boundaries - Characteristic of a professional relationship Guidelines for appropriate self-disclosure - Use judgment about what to reveal to clients - Two questions to answerbefore self-disclosing are - Is what I am planning to reveal likely to demonstrate to my clients that I understand them? - Do I feel comfortable (safe from repercussions and embarrassment; legally and morally secure) about revealing this information to my clients? - Both questions should receive a solid affirmative response before you self-disclose - Self-disclosure can - Let your client know that you are a normal human being - Lead the client into an exploration of deeper feelings - Self-disclosure may - Promote comfort, honesty, openness, and risk takingby the client but never burdens clients with your problems Steps of self-disclosure - Listen - Reply empathetically - Self disclose - Check out Helpful and nonhelpful disclosures - The purpose of a therapeutic self-disclosure is to let your clients know thatthey have been understood - Self-disclosureaugments an empathic reply and deepensthe trustbetween you - When you wish to increase your level of understanding and strengthen that trust, you feel comfortable revealing the content of your self-disclosure, then self-disclosure is the right choice - Need to set up a client-wins/nurse-wins situation - Win-Win - For client- your self-disclosure makes the client feel understood - For you - you feel good that you have been skillful in making your client feel better - Lose-Lose - Client - because your self-disclosure is irrelevant so that the client is distracted from the major issue of concern and left feeling misunderstood - You- because your self-disclosure leaves you feeling uncomfortably exposed or embarrassed Week 5- 11, 12,13 Specificity - Definition: - Being specific- being detailed and clear in the content of our speech - Communication is then focused and logical - Assists clients (colleagues) in moving from broad, elusive areas of discussion to narrower, more pinpointed areas of concern - Being specific is important when we are - Explaining our thoughts and feelings - Reflecting others’ thoughts and feelings - Asking questions - Giving information or feedback - Evaluation - Vagueness - Lack of clarity creates distance between people who are trying to communicate 5 key principles: - Team structure - 4 teachable skills: - Communication - Leadership - Situation monitoring - Mutual support Usefulness of specificity and its effect - Specificity benefits communication in 3 ways - Communication process to get everyone on “on the same wavelength” - Achieve clearer comprehension of own thoughts and full understand of others’ thoughts - It’s the foundation for complete and accurate problem-solving - Enhances success of further communications in our relationships with clients and colleagues - Strategies using specificity - Be specific when: - Explaining your thoughts and feelings - Reflecting others’ thoughts and feelings - Giving information or feedback - Evaluation - Providing specific documentation Specificity in nursing handoffs - Best handoffs - Provide pertinent, accurate, patient information - Encourage questions and answers - Encourage checking information for clarity, accuracy - Create trusting, respectful relationships with a shared goal of quality patient care - Occur at the bedside - Outgoing nurses - Organize relevant patient information (using unit-based checklists/forms, as required - Encourage incoming nurses to ask questions, clarify, verify - Facilitate positive patient relationship for incoming nurse - Incoming nurses - Listen carefully, pay attention - Take notes - Ask pertinent questions, clarify, verify - Offer useful information - Are respectful, appreciative, supportive Placebo and nocebo effects - The power of the choice of language can support or undermine your client’s healing - Placebo and nocebo effects are: - “clinical outcomes … not attributable to the actual pharmacologic or physiotherapeutic intervention and are susceptible to attention, expectation, suggestion, and conditioning”(Lang, 2005, in Schenk, 2008, p 57). - Placebo effect - Language or expectations of a clinician thatpositivelyaffectthe course of the client’s illness by suggestibility - Nocebo effect - Produces negative responses - Effect occurs when ahealthcare provider sends a negativemessage through choice of language, words, or voice tone “Many of life’s treasures remain hidden from us simply because we never search for them.Often we do not ask the proper questionsthat might lead us to theanswer to all our challenges.” Chapter 12: the skill of asking effective questions - Main reason for asking questions - Ensures that you collect the data you need to provide quality nursing care - Effective questioning - Saves time - Collects more pertinent and useful information - Enables a more effective interviewing experience Closed, open, and indirect questions - Closed questions: evoke a simple yes, no answer andmay provide little information - Are you feeling ok? Do you have pain? Have I answered your questions? - Open questions: invite details - Tell me about how you are feeling? What brings you to the emergency room today? - Indirect questions: may be more inviting and comfortable - I’d like to know how you are feeling. Can you tell me about what brings you here today? - I’m wondering if I have answered all your questions 6 points to keep in mind when asking questions - Why - Why do you need info? - If irrelevant, makes you sound “unfocused” - What - Be clear in your intentions - How - Know how to phrase well so patient wants to respond - Who - If patient can speak, ask him or her; if not possible, determine significant other who is most relevant - When - Quiet time, unhurried part of day - Where - Secure privacy, without interruptions or noise Common errors and strategies to avoid them - Long-winded buildup - Avoid long, rambling introductions - Keep it short - Thunder stealer - Listen to patient’s point of view before giving opinions - Multiple choice mix-ups - Too many questions fired in a row - Ask one more time - Incomprehensible and cryptic codes - Do not use medical terms and jargon - Word clearly in language they can understand Common errors and strategies to avoid them - Offensive misuse of “why” - Frequent use of “why” can be threatening - Use softer, more receivable words - Misuse of open and closed questions - Closed approach asks for short yes or no answers - How you ask can give you more data - Open ended questions can lead patients to answer in whatever way they want - Not focused - Mystery interview - Give feedback on how the data being provided will be processed - Make it known the data and questions are going to help problem-solve Discussion - What role does silence play within the interview? - Pay careful attention to building your skills at asking questions and remember to listen for what is said and what is left unspoken Chapter 13: Giving advice versus expression opinions - Expression opinions - Assertive behavior, offered as additional information - Aid clients’ problem-solving and decision-making - Provides clients with a fuller picture to make choices about their health and treatment plans - Giving people the benefit of your point of view - NOT telling people what to do - Giving advice - Unilateral process of solving problems or making decisions for others - Prevents clients from becoming independent - Gives colleagues the idea that you might think they are incapable of self-direction Expression opinions in an assertive way - Get the consent of your receiverbefore expressingyour opinions - Make allowances for the uniqueness of your client or colleague - Include the rationalefor your viewpoint - Compliment and commend people for their actions - Set the stage for others to feel comfortable in sharing their ideas in a friendly, accepting environment - Promote creativity and teamworkusing a non-invasive,cost-effective tool Effects of expression opinions - You make a choice about when to share your disagreement even if you see no choice but to comply with the decision - Being able to voice your disagreement makes you feel more authentic, more assertive - When you take appropriate risks to express your opinion, you will earn the respect of clients and colleagues - You may find that your input is requested because you are viewed as an authentic person who is willing to take a stand
