IHC Midterm 2023-2024 PDF

Republic of the Philippines North Eastern Mindanao State University Formerly Surigao del Sur State University Tandag City, Surigao del Sur Telefax No. 086-214-4221 086- 214-2723 www...

Republic of the Philippines North Eastern Mindanao State University Formerly Surigao del Sur State University Tandag City, Surigao del Sur Telefax No. 086-214-4221 086- 214-2723 www.nemsu.edu.ph INTRODUCTION TO HEALTH CARE (IHC) MIDTERM First Semester, SY 2023-2024 INSTRUCTOR: MARY COLEEN C. ONDONA, RN, MAN CLASS SCHEDULE A TUESDAY 8-11AM B TUESDAY 8-11AM C TUESDAY 5-8PM LECTURE ROOM 2ND D TUESDAY 5-8PM FLOOR E FRIDAY 8-11AM F FRIDAY 8-11AM October 3RD OR 4TH week, 2024 – MIDTERM EXAM AND RATIONALIZATION PHILOSOPHY NEMSU believes that higher education is an instrument for the improvement of life through democratized access to quality education in the development of a well-rounded person. VISION A transformative leading University in Asia and the Pacific. MISSION NEMSU shall provide competency-based higher education training driven by relevant and responsive instruction, research, extension and sustainable resource management. Particularly, NEMSU is committed to:  Produce competent and skilled graduates prepared for gainful employment;  Develop graduates who shall not only foster economic progress but also care for the environment, adhere to positive value system, and preserve cultural heritage;  Engage in high-impact research for instruction and develop technology for food security and renewable energy;  Collaborate with government and non-government agencies to help improve the lives of the marginalized groups; and  Promote cooperation/partnership among regional, national, and ASEAN institutions in Higher Education. CORE VALUES Competence A combination of observable and measurable knowledge, skills, abilities, and personal attributes that contribute to enhance NEMSU employee and student performance and ultimately result in organizational success. Accountability Responsibility for own actions, decisions and commitment to accomplish work in an ethical, efficient, cost-effective and transparent manner manifesting the value of sound stewardship in the wise use of resources for common good. Responsiveness A prompt action, consistent communication, quality information, and a focus on providing a superior experience to stakeholders. Excellence The quality spectrum at exceptional levels demonstrated by learning outcomes and the development of shared culture of quality consistent with the vision, mission and goals of University. Service Dedication for a continuous improvement of services, stakeholder’s relationships and partnership which stresses interdependence and collaboration for a sustainable success of clients and their communities in helping build a just, peaceful, stable and progressive Filipino nation. NEMSU CARES… These core values are not descriptions of the work we do, nor the strategies we employ to accomplish our University vision. They are the core values that underlie our works and interactions as we internalize responsibilities to fulfil our mission. They are the basic elements of how we go about our work and how we deal with stakeholders, molds students to become competent, innovative, globally competitive and service-oriented. to individuals, family and community. POLICIES AND GUIDELINES 1. Only officially enrolled students are allowed to attend their classes. 2. All students are required to attend their classes regularly on face to face. 3. Attendance is counted from the first regular class meeting. 4. Punctuality is a must to all students. 5. A validated student identification card must always be worn by all students while attending classes. 6. Any form of dishonesty shall be dealt with accordingly. 7. Cheating is strictly prohibited. Any form of dishonesty and/or deceit, especially cheating during examination, recitation or any class work, shall be subject to penalty by a grade of five (5.0). 8. Students who incur absences equivalent to more than 20% of the course hours required shall be dropped from the course provided he/she has not taken any exam. 9. Should a student midwife be absent from his/her class, he/she has to secure and fill up an excuse slip duly signed by parent/guardian (supported by a medical certificate from the University Physician, if student is sick) and to be signed by the subject teacher/s, College dean and to be submitted to their respective subject teachers or Clinical Instructors thereafter. A student shall be given three (3) days grace period in the submission of the excuse slip otherwise the absence will be considered unexcused. 10. No special quiz shall be given to any student who comes in late or absent during classes. 11. Honesty is always called for. 12. Special examination shall be given only for the following reasons (with respective documentary evidence): Medical emergencies Death in the family Fortuitous event(s) Participation in official school activities Schedule of exam in conflict with religious obligations as per CHED Memo dated November 15, 2010. 13. A student who is found guilty of false claims on any of the reasons listed in number 14 shall be given a grade of zero in the missed exam. 14. In the event that the student fails to take the special examination as officially scheduled, there shall be no more reconsideration. CLASS RULES BE RESPECTFUL AT ALL TIMES LISTEN CAREFULLY RAISE YOUR RIGHT HAND WHEN ASKING QUESTIONS DO NOT GO OUT OF THE ROOM WITHOUT PERMISSION TURN OFF PHONES/KEEP IN SILENT MODE NO TO UNEXCUSED ABSENCES  SECURE MEDICAL CERTIFICATE FOR SICK ABSENCES GRADING SYSTEM: 6 References: Books and e-books: 1. Kozier, B., Erb, G., Berman, A., & Snyder, S. J. (2019). Fundamentals of nursing: Theory, concepts, and applications (12th ed.). Pearson. 2. Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2021). Fundamentals of nursing: The art and science of nursing care (10th ed.). Elsevier. 3. Black, J. M., Hawks, J. H., Keene, A. M., & Catalano, J. J. (2023). Saunders fundamentals of nursing (11th ed.). Elsevier. 4. LeMone, P., Burke, K. M., Baughan, M. C., & Gubrud-Howe, E. (2020). Fundamentals of nursing: An adaptation of Potter and Perry (9th ed.). Elsevier. 5. Carpenito-Moyet, L. J. (2022). Fundamentals of nursing: Concepts, process, and practice (11th ed.). Wolters Kluwer. 6. Leininger, M. (1979). Transcultural nursing. New York: Mason. 7. Leininger, M. (1978). Transcultural nursing concepts, theories and practices. New York: Wiley.  Topics Learning Outcomes Methodologies Assessments Values Remarks Integration Course Outline: 1. Culture Illustrated lecture Quiz Work Ethics 2. Historical and Theoretical Describe different cultural context Foundations of Transcultural Care in transcultural care Role Playing Assignment 3. Culture and Cultural Values 4. Culturally Competent Health Care 5. Transcultural Health Care Delivery Small Group Oral Perspectives Discussion Recitation 6. Healthy Lifestyle 7. Elements of Healthy Lifestyle Quiz Identify concepts of healthy lifestyle 1. Communication Illustrated Lectures Quiz Positive 2. Principles Underlying Effectively communicate by Relationship Communication demonstrating active listening skills, Group Discussion Assignment between clients 3. Types of Communication using appropriate verbal and and the provider 4. Elements of Communication nonverbal communication Individual and Group Counselling 5. Factors Affecting Communication techniques, and expressing their Exercises skills practice Interpersonal 6. Techniques of Communication ideas clearly and concisely. checklist Communication 7. Communication Process Role Playing 8. Midwife-Client-Interaction (MCI) OBJECTIVES AT THE END OF THE DISCUSSION, THE STUDENTS MUST BE ABLE TO: a. Understand the Theoretical Foundations of Transcultural Care; b. Recognize the role of beliefs, values, culture in providing effective care to patients; c. Identify guidelines for developing cultural competency; d. Discuss the relevance and meaning of culture understanding and culturally appropriate care in health care delivery system; e. Apply the elements of Healthy Lifestyle; f. Distinguish the elements of communication, its process, techniques, and the factors affecting it; g. Demonstrate skills in: 7.1 applying communication principles; 7.2 ensuring therapeutic midwife-client interactions; and 7.3 providing therapeutic communication to patients. CULTURE The patterns and characteristics of human behavior. CULTURE The first person to use the term “culture” is anthropologist , Edward B. Tylor Complex whole which includes knowledge, belief, art, law, morals, custom, and any other capabilities and habits acquired by man as a member of society. (Primitive Culture, 1871). It consists of both intangible things like beliefs and thoughts (expectations about personal space) and tangible things (bus stops, trains, and seating capacity).  CULTURE IS UNIVERSAL -Everyone belongs to one or more cultures; -It is the way to organize and interpret experience; -It simplifies living by giving structure to daily life, minimizing interpersonal stress. -it is shared. -it is learned, and it is not biological. -Culture is developed as we seek to fill our basic needs. -Culture is everywhere – (It’s is in art, music, dance, the way we decorate our pottery) WHY DO YOU NEED TO LEARN ABOUT CULTURE IN HEALTH CARE? Culture is important in healthcare because: Cultural respect is critical to reduce health disparities. It helps improve access to high-quality health care that is respectful of and responsive to the needs of diverse patients. Cultural diversity ensures that patients from all backgrounds receive high-quality, culturally competent care. It helps to create a more diverse and inclusive healthcare workforce, which can help to improve patient outcome.  HISTORICAL AND THEORETICAL FOUNDATIONS OF TRANSCULTURAL CARE In 1950’s Madeleine M. Leininger Foundress of Cultural Care Theory/Transcultural Nursing (TCN), noted cultural differences between patients and nurses while working with emotionally disturbed children Experience led to study clinical difference in perception of the care She recognized that health and illness states are strongly influenced by culture and Thus, formulated the theory of Transcultural Nursing. Established in 1991‘Culture Care Diversity And Universality  TRANSCULTURAL NURSING (TCN) OR CULTURAL CARE THEORY GOAL OF TCN DEVELOP A SCIENTIFIC AND HUMANISTIC BODY OF KNOWLEDGE IN ORDER TO PROVIDE NURSING CARE THAT IS BOTH CULTURE SPECIFIC AND CULTURE UNIVERSAL LEININGER'S THEORY OF CULTURE CARE DIVERSITY AND UNIVERSALITY: ❖Is a foundational framework for transcultural nursing. ❖It emphasizes the need to understand and respect cultural differences and similarities in caregiving practices. ❖The theory suggests that care is culturally shaped, and that effective care must be culturally congruent, meaning it aligns with the patient's beliefs, values, and practices.  CULTURE CARE UNIVERSALITY Culture care universality refers to the shared aspects of care that are common across cultures. These are the fundamental human needs and values that underpin caregiving practices, regardless of cultural background. Example: The Need for Nourishment - Universality: All humans require nourishment to survive and thrive. This fundamental need is universal across cultures. - Cultural Variations: The ways in which nourishment is provided and consumed can vary greatly across cultures. - Food: Different cultures have unique dietary traditions, ingredients, and cooking methods. - Mealtimes: The timing and frequency of meals, and the social context surrounding them, can vary significantly. - Feeding practices: Infants and young children may be fed differently in different cultures, with variations in breastfeeding practices, weaning methods, and the introduction of solid foods.  CULTURE CARE DIVERSITY Culture care diversity refers to the unique and varied ways in which cultures approach caregiving practices. This diversity reflects the distinct values, beliefs, and traditions that shape how individuals within a culture provide and receive care. Example: Death and Dying - Universality: Death is a universal human experience, and all cultures have practices surrounding it. - Cultural Variations: The ways in which death is approached, mourned, and remembered can vary significantly across cultures. - End-of-life care: Cultural beliefs influence decisions about medical interventions, pain management, and the involvement of family members in end-of-life care. - Mourning rituals: Different cultures have unique mourning practices, including specific periods of grief, rituals for preparing the body, and ways of commemorating the deceased. - Burial customs: The manner in which the body is buried or cremated can vary depending on cultural beliefs and traditions. INFLUENCES  - refers to those cognitively based assistive, supportive, facilitative, or enabling acts or decisions that are tailor- fit with an individual’s, group or institution’s cultural values ,beliefs and lifeways in order to provide meaningful, beneficial, satisfying care that leads to health and well-being CULTURALLY CONGRUENT CARE CULTURALLY CONGRUENT CARE MODALITIES ASSIGNMENT GIVE AT LEAST ONE AN EXAMPLE OF A HEALTH RELATED SITUATION THAT RELATES TO EACH OF THESE 3 MAJOR CARE MODES , IDENTIFY A 2 MIDWIFE APPROACH TO ADDRESS THE SITUATION, AND CITE A DESIRED OUTCOME.  Culture Values: The Guiding Principles: - Culture values are the fundamental beliefs and principles that guide a culture's members in their thoughts, behaviors, and interactions. These values are often deeply ingrained, passed down through generations, and serve as a framework for interpreting the world and making decisions. Cultural knowledge - What a healthcare worker knows about other cultures and their beliefs, behaviors, and customs. In an increasingly interconnected world, understanding and respecting cultural values is crucial for fostering positive relationships, promoting effective communication, and achieving successful collaborations.  HEALTH PRACTICES IN DIFFERENT CULTURES: ❖Use of Protective Objects: Protective objects can be worn or carried or hung in the home - charms worn on a string or chain around the neck, wrist, or waist to protect the wearer from the evil eye or evil spirits. ❖Use of Substances: It is believed that certain food substances can be ingested to prevent illness. (E.g., eating raw garlic or onion to prevent illness or wear them on the body or hang them in the home.) ❖Religious Practices: Burning of candles, rituals of redemption etc.. ❖Traditional Remedies: The use of folk or traditional medicine is seen among people from all walk of life and cultural ethnic background. ❖Healers: Within a given community, specific people re known to have the power to heal. CULTURALLY COMPETENT HEALTH CARE WHAT IS CULTURALLY COMPETENT CARE? Is the ability of the practitioner to bridge cultural gaps in caring, work with cultural differences and enable clients and families to achieve meaningful and supportive caring to increase the quality of services, thereby producing better outcomes. CULTURALLY COMPETENT HEALTH CARE CULTURAL COMPETENCE INCLUDES ▪Self-awareness ▪Cultural understanding ▪Multiple perspectives ▪Intercultural communication ▪Relationship building ▪Flexibility/adaptability ▪Intercultural facilitation/conflict resolution skills ▪Multicultural organizational development skills  TRANSCULTURAL HEALTH CARE DELIVERY PERSPECTIVES TRANSCULTURAL PERSPECTIVES IN CHILDBEARING ▪Fertility Control and Culture ▪Religion and Fertility Control - A woman’s fertility depends on several factors, - Cultural practices tend to arise from religious including the likelihood of sterility, the probability beliefs, which can influence birth control of conceiving, and of intrauterine mortality. choices. ▪Contraceptive Methods ▪Food Taboos and Cravings - The religious beliefs of some cultural groups might - Another traditional belief in many cultures is affect their use of fertility controls such as abortion that a pregnant woman must be given the food or artificial regulation of conception. that she smells to eat; otherwise, the fetus will move inside of her and a miscarriage will ▪Refugees and Reproductive Health result (Spector, 2008). - Women living in refugee situations encounter many barriers to contraceptive use.  TRANSCULTURAL HEALTH CARE DELIVERY PERSPECTIVES CULTURAL BELIEFS REGARDING ACTIVITY AND PREGNANCY 1. CROW INDIAN - remain active during 1. MEXICAN,HAITIAN, ASIAN - avoid cold air during pregnancy to aid the baby’s circulation pregnancy. 2. PUEBLO AND NAVAJO, INDIAN, MEXICAN, 2. AFRICAN AMERICAN, HISPANIC, WHITE, ASIAN - do not reach over your head or the cord will wrap JAPANESE - remain happy to bring the baby boy around the baby’s neck. and good fortune. 3. VIETNAMESE - avoid weddings and funerals or 3. MEXICAN AND CAMBODIAN CANADIAN - keep you will bring bad fortune to the baby. active during pregnancy to ensure a small baby 4. VIETNAMESE, FILIPINO, SAMOAN - do not and an easy delivery. continue sexual intercourse or harm will come to you and baby. 4. HAITIAN, MEXICAN - continue sexual intercourse to lubricate the birth canal and 5. NAVAJO INDIAN - do not tie knot or braid or prevent a dry labor. allow the baby’s father to do so because it will cause difficult labor. 5. FILIPINO - continue daily baths and frequent 6. PUEBLO INDIAN, ASIAN - do not sew shampoos during pregnancy to produce a clean baby 7. IRANIAN CANADIAN - avoid heavy physical work, eat rich and healthy foods, and get frequent rest.  TRANSCULTURAL HEALTH CARE DELIVERY PERSPECTIVES The world consists of many diverse cultures with vastly different values and beliefs. Regardless of similarities and differences, individuals from each culture deserve healthcare that upholds good quality care. Transcultural healthcare allows patients to feel comfortable no matter their health concerns or where they receive treatment. 1.Culture of the individual. Each person has their own beliefs that are shaped by their culture. These beliefs might contrast that of the midwives but should still be upheld and valued. 2.Culture of the midwife. Midwives have their own valid beliefs, but they must be aware of them and determine where they fit in with patients' comfort levels. 3.Culture of the environment. To make the patient feel more comfortable, healthcare organizations should have cultural indicators representing particular cultures within the hospital environment. CONCLUSION Midwives need to be aware of and sensitive to the cultural needs of clients. The practice of health care today demands that the Midwives identify and meet the cultural needs of diverse groups, understand the social and cultural reality of the client, family, and community, develop expertise to implement culturally acceptable strategies to provide nursing care, and identify and use resources acceptable to the client (Andrews and Boyle, 2002).  APPLICATION OF THE THEORY METAPARADIGM PERSON ENVIRONMENT HEALTH NURSING CARE “REST” “QUIZ” HEALTHY LIFESTYLE  HEALTHY LIFESTYLE 1.Health as “the state of complete, physical, mental and social well-being, and not merely the absence of a disease or infirmity.” World Health Organization (WHO) 2. Healthy lifestyle is one which helps to keep and improve a person’s health and wellbeing. This focuses on incorporating the eight aspects of wellbeing into one’s life (emotional, environmental, financial, intellectual, occupational, physical, social and spiritual). (WHO)  To ensure a healthy lifestyle, WHO recommends eating lots of fruits and vegetables, reducing fat, sugar and salt intake and exercising. Based on height and weight, people can check their body mass index (BMI) to see if they are overweight.  Global WHO recommendation of 18.5–24.9 as a normal BMI. According to data from Department of Science and Technology-Food and Nutrition Research Institute (DOST-FNRI) 2021 Expanded National Nutrition Survey showed that 14 percent of children 5 to 10 years old, 13 percent of individuals 10 to 19 years old, and 38.6 percent of adults 20 to 59 years and older were obese. Obesity is a disease that can no longer be ignored. It is associated with many leading causes of death such as heart disease, cardiovascular disease, strokes and some forms of cancer. The good news is obesity can be avoided with a healthy lifestyle. WHY DO WE NEED TO BE HEALTHY? To live longer To thrive not just survive Have more energy Avoid disease and illness Keep medical costs down Look and feel better Better mental care Better lifestyle COMPONENTS OF A HEALTHY LIFESTYLE There are six factors at the forefront of lifestyle management: 1. Balanced Diet 2. Physical Activity 3. Stress Management 4. Avoidance of Risky Substance 5. Restorative Sleep 6. Social Connection  COMPONENTS OF A HEALTHY LIFESTYLE 1. Balanced Diet (PLANT-BASED NUTRITION) According to the American Academy of CPR and First Aid, Inc. (2020). There are a variety of factors that affect your health, one of which is the diet that you consume. Extensive scientific evidence supports the use of a wholefood, predominantly plant-based diet as an important strategy in prevention of chronic disease, treatment of chronic conditions and, in intensive therapeutic doses, reversal of chronic illness.  Such a diet is rich in fiber, antioxidants, and nutrient dense.  Choose a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds.  COMPONENTS OF A HEALTHY LIFESTYLE 2. Physical Activity Regular and consistent physical activity combats the negative effects of sedentary behavior. It is important that adults engage in both general physical activity as well as purposeful exercise weekly as part of overall health and resiliency. To begin with, a slow jog or brisk walk in the park is good enough to keep that blood flowing. The American Academy of CPR and First Aid, Inc. (2020). The recommendation for adults 18-64 years old is to do at least 150-300 minutes of moderate intensity or 75-150 minutes of vigorous intensity activity weekly along with two or more days weekly of strength training  COMPONENTS OF A HEALTHY LIFESTYLE 3. Stress Management Stress can lead to improved health and productivity - or it can lead to anxiety, depression, obesity, immune dysfunction and more. Helping patients recognize negative stress responses, identify coping mechanisms and reduction techniques leads to improved wellbeing. A faulty immune system can make you susceptible to multiple chronic illnesses. Try as much as possible to get rid of any form of negativity from your life. In order to nurture your mind, you should take up some hobbies that keep you away from negativity.  COMPONENTS OF A HEALTHY LIFESTYLE 4. Avoidance of Risky Substance Use of tobacco and excessive alcohol consumption have been shown to increase the risk of chronic diseases and death. Treatments often take time, different approaches and many attempts. Patience and support are an important part of breaking risky substance habits.  COMPONENTS OF A HEALTHY LIFESTYLE 5. Restorative Sleep Sleep delays/interruptions have been shown to cause sluggishness, low attention span, decreased sociability, depressed mood, decreased deep sleep, decreased caloric burn during the day, increased hunger and decreased feeling of fullness, insulin resistance and decreased performance. Strive for 7 or more hours of uninterrupted sleep per night for optimal health.  Your bedroom should be conducive for sleeping and free from any form of disturbance.  COMPONENTS OF A HEALTHY LIFESTYLE 6. Social Connection Positive social connections and relationships affect our physical, mental and emotional health. Leveraging the power of relationships and social networks can help reinforce healthy behaviors Surrounding yourself with like-minded individuals provides you with a sense of belonging. By doing so, you feel protected and loved, which increases the quality and longevity of your life. The American Academy of CPR and First Aid, Inc. (2020). CHAIR EXERCISE “REST” “QUIZ” COMMUNICATION  COMMUNICATION Communication(“communicare”) Make common ,share, participate, or impart. The means by which culture is transmitted and preserved. Verbal and nonverbal patterns of communication vary across cultures, and if midwives do not understand the client’s cultural rules in communication, the client’s acceptance of a treatment regimen may be jeopardized. The use and preservation of communication takes several forms - verbal, nonverbal, and written - and differs in terms of expression, language and dialect, voice tone and volume, context, emotional implication, facial expression, gestures, and body language, space or other symbols COMMUNICATION To produce effective communications, we can follow a list of suggestions called the C’s of communication Effective communication will always enhance teamwork and improve the quality and quantity of the work. We can learn effective communication skills through understanding our own style and by observing others. We are comfortable with our own communication style, but how others perceive our communication is very important. For example, those who communicate aggressively may seem angry or rude to those with a more passive style, whereas the passive may appear timid and weak to those with the aggressive style. PRINCIPLES UNDERLYING COMMUNICATION THE Cs OF COMMUNICATION THE Cs OF COMMUNICATION THE Cs OF COMMUNICATION  ELEMENTS OF COMMUNICATION Communication process as such must be considered a continuous and dynamic inter-action, both affecting and being affected by many variables. (1) Sender: The person who intends to convey the message with the intention of passing information and ideas to others is known as sender or communicator. (2) Messages: This is the subject matter of the communication. This may be an opinion, attitude, feelings, views, orders, or suggestions. This information is transmitted to the receiver through certain channels which may be either formal or informal. (3) Receiver: Receiver is the person who receives the message or for whom the message is meant for. It is the receiver who tries to understand the message in the best possible manner in achieving the desired objectives. (4) Feedback: Feedback is the process of ensuring that the receiver has received the message and understood in the same sense as sender meant it. COMMUNICATION PROCESS FACTORS AFFECTING COMMUNICATION People and tools of communication When it comes to communication, people are the key factor. Whether trying to improve a team’s communication or improve personal communication skills, understanding how people communicate is essential. ❖There are four main learning styles of people: visual, auditory, read/write, and kinesthetic. (VARK, 2022). FACTORS AFFECTING COMMUNICATION Cultural differences When communicating with people from another country, awareness of their behavior and culture is very important. For example, in the Western culture, hand shaking is common when meeting someone; however, in Korean culture, bowing is common. Likewise, there are some gestures that are unacceptable in certain cultures. FACTORS AFFECTING COMMUNICATION Language Language is one of the major factors affecting communication. Therefore, to have effective communications, the language used must be familiar to the receiver. Likewise, use of jargons, technical words, poor choice of words, weak sentence structure, unusual font size, excessive and irrelevant use of visual aids, and use of certain colloquial expressions may hinder communication badly. FACTORS AFFECTING COMMUNICATION Length of communication The length of a message needs to be consistent with what has been intended to channel. Sender needs to ensure that the length of the message serves the purpose and is appropriate for the receiver. Sometimes, a message may be too long that makes the reader bored. On the other hand, a very brief message may exclude key details causing confusion and conflicts. FACTORS AFFECTING COMMUNICATION Time of communication Speaking to people who are preoccupied with some important tasks may not be useful as they may not pay attention to the message delivered. Therefore, the sender needs to identify the right time to send the message to the receiver. Technology Technology is also one of the key factors affecting communication. It enables communication across various platforms. In fact, Internet has been a key to removing numerous barriers affecting communications. FACTORS AFFECTING COMMUNICATION Environment The environment in which the communication takes place can affect the outcome. Loud background noises, a messy environment, and distractions can make communicating certain messages very difficult. Therefore, it is imperative to ensure that the environment is conducive to communications.  THERAPEUTIC COMMUNICATION TECHNIQUES Therapeutic Communication Techniques There are a variety opens of therapeutic communication techniques midwives can incorporate into practice. Using Silence At times, it’s useful to not speak at all. Deliberate silence can give both midwives and patients an opportunity to think through and process what comes next in the conversation. It may give patients the time and space they need to broach a new topic. Midwives should always let patients break the silence. Accepting Sometimes it’s necessary to acknowledge what patients say and affirm that they’ve been heard. Acceptance isn’t necessarily the same thing as agreement; it can be enough to simply make eye contact and say “Yes, I understand.” Patients who feel their midwifes are listening to them and taking them seriously are more likely to be receptive to care. THERAPEUTIC COMMUNICATION TECHNIQUES Giving Recognition Recognition acknowledges a patient’s behavior and highlights it without giving an overt compliment. A compliment can sometimes be taken as condescending, especially when it concerns a routine task like making the bed. However, saying something like “I noticed you took all of your medications” draws attention to the action and encourages it without requiring a compliment. Offering Self Hospital stays can be lonely, stressful times; when midwifes offer their time, it shows they value patients and that someone is willing to give them time and attention. Offering to stay for lunch, watch a TV show, or simply sit with patients for a while can help boost their mood. THERAPEUTIC COMMUNICATION TECHNIQUES Giving Broad Openings Therapeutic communication is often most effective when patients direct the flow of conversation and decide what to talk about. To that end, giving patients a broad opening such as “What’s on your mind today?” or “What would you like to talk about?” can be a good way to allow patients an opportunity to discuss what’s on their mind. Active Listening By using nonverbal and verbal cues such as nodding and saying “I see,” midwifes can encourage patients to continue talking. Active listening involves showing interest in what patients have to say, acknowledging that you’re listening and understanding, and engaging with them throughout the conversation. midwifes can offer general leads such as “What happened next?” to guide the conversation or propel it forward. THERAPEUTIC COMMUNICATION TECHNIQUES Seeking Clarification Similar to active listening, asking patients for clarification when they say something confusing or ambiguous is important. Saying something like “I’m not sure I understand. Can you explain it to me?” helps midwifes ensure they understand what’s actually being said and can help patients process their ideas more thoroughly. Placing the Event in Time or Sequence Asking questions about when certain events occurred in relation to other events can help patients (and midwifes) get a clearer sense of the whole picture. It forces patients to think about the sequence of events and may prompt them to remember something they otherwise wouldn’t. THERAPEUTIC COMMUNICATION TECHNIQUES Making Observations Observations about the appearance, demeanor, or behavior of patients can help draw attention to areas that might pose a problem for them. Observing that they look tired may prompt patients to explain why they haven’t been getting much sleep lately; making an observation that they haven’t been eating much may lead to the discovery of a new symptom. Encouraging Descriptions of Perception For patients experiencing sensory issues or hallucinations, it can be helpful to ask about them in an encouraging, non-judgmental way. Phrases like “What do you hear now?” or “What does that look like to you?” give patients a prompt to explain what they’re perceiving without casting their perceptions in a negative light. THERAPEUTIC COMMUNICATION TECHNIQUES Encouraging Comparisons Often, patients can draw upon experience to deal with current problems. By encouraging them to make comparisons, midwifes can help patients discover solutions to their problems. Summarizing It’s frequently useful for midwifes to summarize what patients have said after the fact. This demonstrates to patients that the midwife was listening and allows the midwife to document conversations. Ending a summary with a phrase like “Does that sound correct?” gives patients explicit permission to make corrections if they’re necessary. THERAPEUTIC COMMUNICATION TECHNIQUES Reflecting Patients often ask midwives for advice about what they should do about particular problems or in specific situations. Midwives can ask patients what they think they should do, which encourages patients to be accountable for their own actions and helps them come up with solutions themselves. Focusing Sometimes during a conversation, patients mention something particularly important. When this happens, midwives can focus on their statement, prompting patients to discuss it further. Patients don’t always have an objective perspective on what is relevant to their case; as impartial observers, midwives can more easily pick out the topics to focus on. THERAPEUTIC COMMUNICATION TECHNIQUES Confronting Midwives should only apply this technique after they have established trust. It can be vital to the care of patients to disagree with them, present them with reality, or challenge their assumptions. Confrontation, when used correctly, can help patients break destructive routines or understand the state of their situation. Voicing Doubt Voicing doubt can be a gentler way to call attention to the incorrect or delusional ideas and perceptions of patients. By expressing doubt, midwives can force patients to examine their assumptions. THERAPEUTIC COMMUNICATION TECHNIQUES Offering Hope and Humor Because hospitals can be stressful places for patients, sharing hope that they can persevere through their current situation and lightening the mood with humor can help midwives establish rapport quickly. This technique can keep patients in a more positive state of mind. TRUST Without trust a midwife-client relationship would not be established and interventions won’t be successful. For a client to develop trust, the midwife should exhibit the following behaviors: Friendliness Caring Interest Understanding Consistency Suggesting without telling Approachability Listening Keeping promises Providing schedules of activities Honesty That ends our topic for today ! CHEERS FOR LEARNING!