BNUR1900 Nursing Fundamentals Module 4: Communication PDF

BNUR1900 Nursing Fundamentals Module 4: Communication Karin Zekveld Thursday October 3rd, 2024 Learning Objectives During this module, students will: Describe the importance of communication to the lives of older persons Discuss how ageist attitudes affect communication with the older pers...

BNUR1900 Nursing Fundamentals Module 4: Communication Karin Zekveld Thursday October 3rd, 2024 Learning Objectives During this module, students will: Describe the importance of communication to the lives of older persons Discuss how ageist attitudes affect communication with the older person Describe interventions that facilitate communication individually and in groups Understand the significance of the life story of an older person Discuss the modalities of reminiscence and life review Identify effective communication strategies for older person with speech, language, hearing, vision, and cognitive impairments Entry to Practice Competencies 1.22 incorporates knowledge from nursing science, social sciences, humanities, and health- related research into plans of care. 2.5 Identifies the influence of personal values, beliefs, and positional power on clients and the health care team and acts to reduce bias and influences 2.6 Establishes and maintains professional boundaries with clients and the health care team. 3.2 Engages in active listening to understand and respond to the client’s experience, preferences, and health goals. 3.3 Uses evidence-based communication skills to build trusting, compassionate, and therapeutic relationships with clients. 3.5 Incorporates the process of relational practice to adapt communication skills. 4.5 Contributes to health care team functioning by applying group communication theory, principles, and group process skills. Plan Discuss communication Break Perpetual case study Midterm review Following Directions activity What is Communication? The exchange of information between individuals through a system of signs, symbols, speech, and behaviour How we communicate is important Now say the word oh differently, giving it the following interpretation or meaning each time: 1. Shock 2. Pleasure 3. Questioning 4. Doubt 5. Displeasure TONE 6. Detachment TURN TO THE PERSON 7. Resentment SITTING NEXT TO YOU AND 8. Anticipation JUST SAY THE WORD ‘OH’ 9. Surprise What are your “take aways” from this activity?  Communication is the most important ability of human beings (Boscart et al., 2023) Communication: Allows us to express thoughts, feelings, An Overview likes, dislikes Verbal and nonverbal Communication is an essential skill for nurses Communication: An Overview We must ensure the messages we send are interpreted as we intended; conversely, we must ensure that we clearly understand and interpret the messages sent from others Communication can be impacted by a variety of factors: Personal/perceptual biases Use of non-therapeutic techniques Alterations in sensory and neurological functions Communication: An Overview The ‘normal’ aging process can affect communication Communication involves numerous techniques and strategies that must be consciously practiced in order to ensure effective therapeutic nurse client relationships Meaningful communication and active involvement in society can contribute to: Healthy aging Improving longevity Improving the older person’s response to interventions Maintaining optimal function Contextual Factors which Influence Communication Psychosocial Relational Situational Environmental Cultural Therapeutic Communication Standard Statement 1: Therapeutic Communication Nurses use a wide range of effective communication strategies and interpersonal skills to appropriately establish, maintain, re-establish, and terminate the nurse-client relationship. Therapeutic Communicati on Communication and the Older Person  Ageism and Communication Ageism A term used to describe prejudice expressed toward older persons through attitudes and behaviours Found cross-culturally, but prevalent in the Western world Elderspeak A common speech style used when talking to older persons that presupposes their dependence, incompetence and control by the speaker Includes baby talk, using terms or petnames like ‘honey’ and ‘dear’, and speaking louder and more slowly Therapeutic Communication Basic therapeutic communication strategies are applicable when communicating with older persons Attentive listening Authentic presence Non-judgmental attitude Cultural competence Clarifying Providing information Seeking validation of understanding Keeping focus Using open-ended questions  Photo Activity In groups of 3 – 4 Share your photo (if you have it) / or your story Describe the important person/people/event Tell the group WHY it was an important memory in your childhood. We will take 15 minutes. Each person has about 4 minutes depending on your group size  Reminiscing Any recall of the past Considered the most important psychological task in older age May enhance socialization and connectedness with others Provides cognitive stimulation and improves communication Can cultivate: 1. a sense of security through the recounting of comforting memories 2. a sense of belonging through sharing 3. self-esteem through the confirmation of uniqueness The Life Story Can be an important component of communication Tells us a great deal about the person Important part of the assessment process It takes time, and patience It is a gift and an honour to hear someone’s story They are hoping that you are listening and interpreting their story ‘correctly’ Constructed through reminiscence, journaling, life review, or guided autobiography Life Review A critical analysis of a person’s past life, with the goal of facilitating integrity Often occurs as an internal review of memories, therefore, it is often a very personal and private reflection Considered more of a formal therapeutic technique than reminiscence – meant to guide a person through their life in chronological order Communication with Older Persons with Sensory Impairments  Activity Back to Back …or… Front to Front Hearing Impairments in the Older Adult Central Auditory Conductive Presbycusis Processing Hearing Loss Disorders Cerumen Otosclerosis Tinnitus Accumulation  Unfair Hearing Test https://www.youtube.com/watch?v=LVPjb19ur9Y  Communicating with Older Persons with Hearing Impairments Ensure you have the person’s attention. Do not approach from behind or startle Face the person and sit or stand at eye level Ensure the person has any sensory aids in place Speak slowly and articulate in a normal tone of voice Rephrase as opposed to repeat information Speak towards the unaffected ear (when appropriate) Ensure that others team members are aware of the hearing impairment (documented in the plan of care) Visual Impairments in the Older Adult Most vision loss in Canada is caused by Cataracts Age related macular degeneration (AMD) Glaucoma Diabetic retinopathy  Communicating with Older Persons with Visual Impairments Ensure you have the person’s attention before you begin speaking – use their name and or a light touch on their arm Clearly identify yourself and others with you Make sure you get down to the persons level and face them when speaking Speak normally, but not from a distance Do not lower or raise your voice Use the analogy of a clock face to help locate objects Do not change room arrangement Ensure the person has their glasses/visual aid prior to initiating communication Communication with Older Persons with Neurological Disorders Impaired Verbal Communication Persons with neurological disturbance may experience impaired verbal communication arising from: 1) reception: impaired by anxiety or related to a specific disorder, hearing deficits, or altered level of consciousness 2) perception: distorted by stroke, dementia, delirium 3) articulation: hampered by mechanical difficulties such as dysarthria, respiratory disease, cerebral infarction  Aphasia A communication disorder that can affect a person’s ability to use and understand spoken or written words Can affect a person in more than one way: speaking, understanding, reading, writing, gesturing Involving a Speech Language Pathologist (SLP) is imperative to develop a plan of care Alternative or augmentative speech aids may be used Alphabet or picture boards Electronic boards and computers (can be voice activated)  Communicating with Individuals with Aphasia Explain situations, treatments, or anything else that is pertinent to the person Treat the person as a person (adult) Be patient, allow time for communication, provide a quiet environment Speak naturally and slowly, ask one question at a time (consider using close-ended questions) Include the person in social gatherings and conversations Ensure the person has access to sensory aids  Communicating with Individuals with Aphasia Use visual cues, objects, pictures, gestures, and touch in conjunction with words when appropriate Encourage all speech, give the person the opportunity to complete their thoughts and struggle with words Do not be too quick to finish their sentences or assume what they are trying to communicate Use any augmentative devices available Minimize external noise when communicating (e.g., radio, TV) Dysarthria A speech disorder caused by weakness or incoordination of the muscles used for speech Impairment in the ability to articulate words as a result of damage to the speech mechanism controlled by either the central or peripheral nervous system  Tips for Communicating with Individuals Experiencing Dysarthria Pay attention to the person speaking, and watch them as they talk Allow more time for conversation, and provide a quiet environment Be honest, and let the person know if you have difficulty understanding – don’t pretend to understand If the person’s speech is very difficult to understand, repeat back what they said to ensure you understood Ask the person how you can best support them (e.g., guessing, finishing sentences, or writing) Cognitive Impairments - Dementia Cognitive impairment that affects memory, speech, and communication Individuals may have difficulty expressing their ‘personhood’ in a way that is easily understood by others Communication requires special skills and patience Anomia (difficulty with word finding) Difficulty expressing thoughts and emotions Difficulty with expressive and receptive communication Limits with verbalization may occur in later stages  Tips for Communicating with Individuals with Dementia Do not assume that they can not understand you Continue to communicate with them – verbal and non-verbal Learn about the person – use that knowledge Ask questions and provide time for response Meet the person where they are at Recognize and respond to feelings, thoughts, behaviours Provide care and connect with respect and dignity  Jenny and Robert are out at a local restaurant; they are meeting David and Sandra for a family brunch. During the initial conversations, Jenny and Robert notice that David seems to be missing some parts of the conversation. When he is asked to respond, he appears unsure of what he should say. The server eventually comes to the table and David needs to ask her to repeat herself several times. The server Perpetual begins to speak in a higher pitched, sing song, voice and continually pats David on his shoulder. David jokes about it Case with his family, but the server’s behaviour has annoyed Jenny. Study Jenny is already frustrated with the server, and this spills over to her attempts to speak to her dad. She finally raises her voice and says “Dad, you aren’t paying attention to me. You have to go get your hearing checked!! It is so annoying to try to speak with you.” David, sits silent, until he quietly says “This makes me feel old; I don’t want to know if my body is showing signs of aging. I am sorry I am such a burden to talk to.”  Answer the following questions based on the information you have about the family, and your knowledge from today’s class. 1. What are your thoughts on how the server responded to David? What is this called? As a student nurse, what would you say to the server to help them to understand how they could/should respond to someone like David? Perpetual 2. Consider the process of communication discussed in today’s Case Study - class. Apply this process to the above conversations. What might be some factors that have influenced the types of conversation? Questions Reflect back to the lecture on aging, where we discussed societal attitudes; also reflect back on human development lecture- what might Jenny be experiencing in terms of her relationship with her parents (consider Erikson’s theory here)? Apply Erikson’s theory to David’s response to Jenny’s comments. 3. Discuss with a classmate how the CNO Therapeutic Nurse Client Relationship communication components would apply to any interactions you may have with the Lu and Brant-Lu families. Key Points Communication is an integral component of and essential skill in nursing We can gain great insight into patients and families when we communicate effectively, listen appropriately, and observe carefully Consider communication for each person you work with – people may have unique needs – ask questions Questions to 1. Consider the different circumstances in which you communicate with your family, friends, and peers. How Contemplate would this be applied to communicating with the older person? 2. In relation to the list of communication strategies listed on page 5 of the CNO Therapeutic Nurse-Client Relationship Standard, which of these do you think will be the most challenging for you? Can you think of potential situations where these strategies might be used? 3. Consider your past and future interactions with people who have difficulty with communication. How will you ensure that you best meet their needs as you apply the nursing process? Midterm Thursday October 10, 2024 2 hours Begins at 12:30 in class Bring your own device (make sure it is fully charged) MAKE SURE YOU HAVE RESPONDUS!!!! Class theory, lab theory, nursing practice lab, and all associated readings will be included as testable material There will be about 5 numeracy questions  Midterm The test will be worth approximately 85-90 marks and may include multiple choice, fill in the banks, matching, case study, labelling, The test will be approximately 125 minutes Please bring your student ID and place it on the side of your desk No smart phones or other technology on your person You may bring a non-programmable calculator, pencil, pen, etc. Please do not enter the classroom until we are set up and ready to have you seated All bags must be placed at the front of the classroom Review the exam rules posted. Questions