L2_HLTENN036_V1.0_Complex Communication.pdf

HLTENN036 - APPLY COMMUNICATION SKILLS IN NURSING PRACTICE LESSON 2 : COMPLEX COMMUNICATION REWRITTEN BY TWINKLE MASHRUWALA RMIT Classification: Trusted Objectives Identify and address actual and potential constraints to communication. Discuss what is 'Cultural Safety'. How to communicate in a cultu...

HLTENN036 - APPLY COMMUNICATION SKILLS IN NURSING PRACTICE LESSON 2 : COMPLEX COMMUNICATION REWRITTEN BY TWINKLE MASHRUWALA RMIT Classification: Trusted Objectives Identify and address actual and potential constraints to communication. Discuss what is 'Cultural Safety'. How to communicate in a culturally safe manner Strategies to communicate with Hearing impaired person Visually impaired person Cognitively impaired person. Physically impaired person Discuss strategies to communicate with person from non-English speaking or culturally diverse background. Strategies to break bad news to a client RMIT Classification: Trusted Barriers to Communication Can you name few barriers which inhibits effective communication? Watch the following video (3:05mins) https://www.youtube.com/watch?v=slq1nAhZuqE&feature=emb_logo RMIT Classification: Trusted Barriers to Communication Identify and address actual and potential constraints to communication “Communication has been identified as an essential component for quality healthcare and patient safety” (The Joint Commission, 2010, as cited in Koutoukidis et al, 2014, p. 98) Classroom Discussion: Discuss some strategies that can be used to overcome these barriers RMIT Classification: Trusted Barriers to communication - did you get all of these! Koutoukidi et al., (2014) states that there are several aspects of communication skills that can impair effective communication. Which will have negative impact on building trust and therapeutic relationship between nurse and patient. Some barriers/constraints to communication may include; Language differences Religious differences Cultural differences Intellectual differences Educational differences Physical disabilities Inappropriate clothing Employment differences Situational differences Differing values Wait there is more!!! RMIT Classification: Trusted Barriers to communication - and these! Development differences Emotional states/Intelligence Illness -medication Pain Complex information/ information overload Environmental difficulties Stress Urgency of situation Time Personal bias RMIT Classification: Trusted What is Cultural Safety? Cultural safety is an environment that is spiritually, socially and emotionally safe, as well as physically safe for people; where there is no assault, challenge or denial of their identity, of who they are and what they need. Source: Sampson, M. (Oct, 2021). Moving towards cultural safety in communication. Literacy Works. https://www.litworks.org/post/moving-toward-cultural-safety-incommunication RMIT Classification: Trusted Why Cultural Competence is important Key strategy in reducing inequalities in healthcare access Improve outcome and quality of care received More efficient and effective healthcare services Reduce expenditure Greater client satisfaction RMIT Classification: Trusted Components of Cultural Competency 1. Cultural Awareness Aware of own's biases and prejudices Aware of your own attitude towards people when their backgrounds and experiences differs from their own 2. Cultural Attitude Taps into awareness and modify attitude 3. Cultural Knowledge Searching for information about the culture and beliefs of your patient to better understand and interact with them 4. Cultural Skill Nurse puts awareness, attitude and knowledge into practice RMIT Classification: Trusted Group Discussion – 25 mins 1. Research and think about different cultures or minority groups of people you will be caring for in Australia. 2. Choose one culture or minority group and identify five potential ways this group could be stereotypes or discriminated against. 3. How can you provide culturally safe care to these groups? Think about behaviours, attitude, knowledge etc required for safe practice RMIT Classification: Trusted Cultural Safety for First Nation people Watch following video (12:44 secs): https://www.youtube.com/watch?v=6vgfSgB5nkY RMIT Classification: Trusted Communication in Difficult Situations Nurses work in environments where they may be caring for people who exhibit challenging behaviours for different reasons. This is usually referred as behaviours of concerns or challenging behaviour. This can result in problem for health professionals or other in the environment What emotions results in such behaviours? RMIT Classification: Trusted Complex Communication Aggression & Anger Usually as a result of fear, frustration, and confusion or due to anxiety related to how a person perceives a threat. Patients react differently to situations when their needs or expectations are not met. It may range from mild annoyance to a person so consumed by anger that they become violent and pose a threat to others and themselves. Death, Grief, Loss & Disability As nurses, we need to be aware of our own personal feelings and the experience of death, loss, and disability to fully assist the patients we care for. The nurse’s role here is to allow patients time to experience and express their feelings and to feel validated. RMIT Classification: Trusted Complex Communication Death, Grief, Loss & Disability Activity Watch the Video- The Grieving Process: Coping with Death (4:03mins) https://www.youtube.com/watch?v=gsYL4PC0hyk Please discuss/consider: 1. As a nurse how does this affect you? 2. How would you help assist a patient or patient’s family member in coping with grief? RMIT Classification: Trusted Complex Communication Personal Threat, Aggression and Anger As a nurse if you feel threatened or uncomfortable in a situation you have the right to protect yourself, and you should immediately seek help from other colleagues. What code/s would you call in a situation if you feel threatened? Activity Watch the Video- The challenging Patient (6:68/mins) https://www.youtube.com/watch?v=1sXDGrjtQyQ Please discuss / consider: 1. What are some of the barriers to effective communication? 2. What are some of the positive strategies used or can be utilized? RMIT Classification: Trusted Strategies to complex communication ASSIST A S S I - Acknowledge -“you look really upset” - Sorry-“I’m so sorry this is happening to you.” - Story- “Tell me about it.” -Information “What would you like me to do to help you?” S - Specific Suggestion/Management “Here’s what I’d like us to do next.” T - Thanks/ Travel “Thank you so much for sharing your feelings me with, it’s really important that we understand each other completely, thank you.” RMIT Classification: Trusted Group Activity - 20 mins Divide class into five groups. Each group creates a mind map for communication strategies for the groups below: 1. Hearing impaired person 2. Visually impaired person 3. Cognitively impaired person 4. Physically disable person 5. Non-english speaking Person Points to consider: Think about what website you can utilise in your research. What assistive devices are available in the market for these group that can aid communication? Think about verbal and non-verbal communication in your strategies. Where would you direct your patient if they need further advice on their conditions? RMIT Classification: Trusted Communicating With a Person Who is Hearing Impaired Gain attention Face the person – to allows lip reading Avoid background noise Reduce distance Optimise lighting Speak clearly and slowly State the subject Check for understanding Repeat, rephrase or write down Use facial and body expression Check hearing aids are working & are in place Watch following video (2:00) https://www.youtube.com/watch?app=desktop&v=TIVDx-8kWZo RMIT Classification: Trusted Communicating With The Vision Impaired Client Identify yourself Speak naturally and clearly. Continue to use body language. Name the person when introducing yourself or when directing conversation to them in a group situation. Never channel conversation through a third person. In a group situation, introduce the other people present. Never leave a conversation with a person without saying so. Use accurate and specific language when giving directions. Avoid situations where there is competing noise. Always ask first to check if help is needed. RMIT Classification: Trusted Assistive Devices for People with Hearing, Voice, Speech, or Language Disorders Assistive listening device (ALDs) – amplify sounds Hearing Loop FM Systems Infrared Personal Amplifiers Augmentative and Alternative Communication (AACs) Touch Screens Picture boards Telecommunication Relay Service Alerting devices clocks, doorbells, phones, wake-up alarms, baby alarm RMIT Classification: Trusted Communicating with the Person with Cognitive Impairment or Intellectual Disability Use simple language – keep it short (bite size pieces!) Discuss one thing at a time Speak clearly, slowly and distinctly Ask ‘yes’, ‘no’, questions – “do you want an apple?” Use real objects, e.g., show them an apple Allow person to handle & explore equipment if possible Demonstrate an action, e.g., brushing your teeth Draw pictures Let the person draw pictures or write it down Repeat as often as needed RMIT Classification: Trusted Communicating with the Person with Cognitive Impairment or Intellectual Disability Ask one question at a time – listen & observe for the answer Include family & friends in the communication Reduce background noise Reduce distractions Ensure the person can see you – turn on the lights Face them, make eye contact – helps to focus their attention Watch their body language – is this telling you something? Ensure the person is wearing their glasses & hearing aids Don’t argue over the correct words or names Ensure you allow enough time RMIT Classification: Trusted Communication with Non-English Speaking Use of closed ended question (Yes or No) Use short sentence with simple explanation as needed Use of visual cue cards Use of family members to translate when appropriate Use interpreter to explain medical/nursing assessment & intervention Making sure your body language matches your verbal language When possible utilise the family members to write down some important words (pain, food, drink, not well) in patient’s language and in English Having an understanding of their cultural differences so that we can provide respectful, professional and holistic care RMIT Classification: Trusted Communicating with Limited English Speaking Person Assess the need of interpreter Generally a person of a non English speaking background who has been in an English speaking country less than 2 years may need an interpreter Minimal English proficiency - can use a flashcard in target language to ask some questions RMIT Classification: Trusted Interpreter Services Advise clients that interpreter services are available and free of charge Clients may not know that such a service is available to them Clients may not know that they are entitled to this service Clients may not be familiar with how to request or work with an interpreter Provide translated information (brochure) to patient and their family Assure client that interpreter service is confidential RMIT Classification: Trusted Concerns Using an Interpreter Avoid using a family member or a person in the workplace who is bilingual especially if information is distressing (Eg: end of life care discussion) o WHY? Client’s concerns: May feel uncomfortable discussing sensitive issues with a third person Confidentiality Accuracy The interpreters ethnicity and religion may be important to some clients Gender may be important if dealing with sensitive issues Ask client if they prefer male or female interpreter RMIT Classification: Trusted Interpreter Services Telephone Interpreting Service (TIS) use for basic or short communication, only type available in rural/remote areas On site interpreting for complex or lengthy sessions make sure booked in advance RMIT Classification: Trusted Working With An Interpreter Arrange appropriate time and place for all personnel's to be present Allow for extra time Arrange seating in a circle or triangle You are responsible for conducting interview not interpreter Speak directly to your patient and not to interpreter Use short sentences – 1 point per sentence. Always use the first person e.g. How are you? NOT to interpreter ‘ask him how he is’. Pause after 2-3 sentences so that the interpreter can explain the message RMIT Classification: Trusted Complex Communication Breaking Bad News What do you think constitutes news as “Bad”? Skillfully delivering complex information to the patient and their family is an essential skill required by all health care professional. It is difficult part of providing patient care such as delivering diagnosis, test results etc. Most often nurses are involved in re-clarification/reiteration of information that has already been discussed with the patient by another member of healthcare team. RMIT Classification: Trusted Best way to Break Bad News? Acronyms used to deliver distressing information to patient and their family in an organised manner. SPIKES S = setting P = perception I = Invitation K = Knowledge E = empathy S = summary RMIT Classification: Trusted GOAL This enable clinician four main objectives 1. Gathering information from patient 2.transmitting the medical information 3.providing support, and developing 4.collaborating a treatment plan for the future. RMIT Classification: Trusted SPIKES S = Setting: establish the setting physical context- privacy, family present, interpreter required ? Check patients ID Introduce yourselves, role Gain consent, if they are happy to talk to you Remember confidentiality Prepare yourself with background reading, ensure you are up to date with patients past medical history and recent events. Listening skills: maintain eye contact, nod and acknowledge, avoid interrupting the patient. Tissues, mobile phones, beepers turned off. RMIT Classification: Trusted SPIKES P = Perception: Establish what patient already knows, discuss events leading up to now. Explore what patient understand of their own illness. Aware of scans, biopsies result etc? Establish patient emotional state, concerns, expectations..” Could you tell me what's happened so far?’’ RMIT Classification: Trusted SPIKES I = Invitation: Check if the patient wants to receive their results, news or about their treatment. I have the results here today, would you like me to explain” They may want to put it off until family is present. RMIT Classification: Trusted SPIKES K = Knowledge Ensure you deliver the information 1. In sizable chunks and regularly check for answers. 2. Avoid overload of information 3. Refer to the most appropriate health care team member. 4. Allow pauses, give patient time to have an emotional reaction. RMIT Classification: Trusted SPIKES E = Empathy What is empathy – Understand without pity As you talk, you listen! As you listen, you acknowledge and respond – empathetic statements (validate & acknowledge). Explore emotions: “You sound shocked/upset/frustrated/angry/bewildered…”. “I know this is a lot to take in”. Do not give false hope. RMIT Classification: Trusted SPIKES S = Strategy & Summary Do not rush patient to make decisions about their treatment, allow time to process, check understanding Make another time to meet and inform on the next step Give support to come up with a move forward plan- refer to best specialist team Offer written material that is relevant RMIT Classification: Trusted When the meeting is over Be aware breaking news can be emotional and challenging for healthcare workers, us nurses! Think through your thoughts, reflect on how you are feeling. Take time out if you need it. RMIT Classification: Trusted Let’s watch a video on this https://www.youtube.com/watch?v=qHGvjv_7PLU RMIT Classification: Trusted Advocacy Advocating = speaking up for a client Work with the client & their family to establish needs Assessment of needs can be established by the healthcare team: social worker, case manager, medical officer… Know the supports & resources available to the client Do not attempt to support the client alone – link to experts, make appropriate and timely referrals RMIT Classification: Trusted References Berman, A., Kozier, B., and Erb, G. (2015). Kozier and Erb’s Fundamentals of Nursing Vol 3. (3rd Ed.). Pearson Australia, Melbourne, Australia. Dempsey, J., and French, J. (2009) Fundamentals of Nursing and Midwifery A person-centred approach to care. Lippincott Williams & Wilkins Pty Ltd, Broadway, NSW. Funnel, R., Koutoukidis, G., and Lawrence, K. (2005). Tabbners Nursing Care (4th Ed.). Elsevier Churchill Livingstone, Sydney, Australia. Johnstone, K. (2007). Impro: Improvisation and the theatre. Bloomsbury, London. Koutoukidis, G., Stainton, K., & Hughson, J. (2013). Tabbner’s Nursing Care Theory and Practice (6th ed.). Chatswood, Australia: Elsevier. Lemone, P., and Burke, K. (2015). Medical-Surgical Nursing: Critical thinking for person-centred care. (2nd Australian Ed.). Pearson Australia, Melbourne, Australia Pachter, B. (2013). Essentials of Business Etiquette: How to greet, eat and tweet your way to success. McGraw Hill Education, USA..