NURS 204 BSN 2024 Communication & Professional Relationships PDF

NURS 204 BSN 2024 Communication and Professional Relationships Beebe, S. A., Beebe, S. J., Redmond, M. V., & Salem-Wiseman, L. (2020). Interpersonal communication: Relating to others. (8th ed.). Pearson-Canada. Reg...

NURS 204 BSN 2024 Communication and Professional Relationships Beebe, S. A., Beebe, S. J., Redmond, M. V., & Salem-Wiseman, L. (2020). Interpersonal communication: Relating to others. (8th ed.). Pearson-Canada. Regine Gerow-Scissons RN, BSN, MN College of Nursing  Land Acknowledgment As we come together in this course, we acknowledge that the College of Nursing is located on the Territory of Treaties 4, 6 and 10, and the Homeland of the Metis.  Wahkohtowin: being connected to others and our responsibilities to maintain good relationships. It is a WORLDVIEW based on the idea that everything has spirit, and we are all connected.  I want to reaffirm my commitment to reconciliation, shared stewardship of the land and building respectful restorative relationships…to work together and learn in a nonhierarchical manner Lecture 1: Outline 1800-1950  Review the Syllabus  10 min BREAK  Lecture 1 PowerPoint  Syllabus Review How to Contact Me In Person  Please ask questions during class time or during breaks  Office hours  Please contact me by email to schedule an appointment. (in person or online) Emails  I try to respond to emails within 24-48 hours on business days (Monday – Friday).  Use NURS 204 in the subject line.  Send emails using your USASK paws email and NOT through Canvas or other external accounts such as Hotmail, gmail, etc. as they may be quarantined by the University system and not received.  Syllabus Review Intents of the Course (aka….what you will learn) Learners will: 1. Display self-awareness and establish effective, professional relationships with clients and other members of the health care team. 2. Provide a culturally safe environment for themselves and their clients. 3. Demonstrate verbal and non-verbal communication techniques to establish a relational practice, maintaining professional boundaries. 4. Support clients in making informed decisions and advocate for clients using principally ethical and sound decision making. 5. Demonstrate skills that support professional, effective conflict resolution. 6. Demonstrate skills to manage potentially abusive situations.  Syllabus Review How the course works Lectures: Thursdays Sept 5- Nov 21, 2024  12 weekly Lectures (2hrs each)= 24 hours of lecture content  Weekly lectures to be delivered synchronously in person (unless otherwise posted)  Lecture content will be posted on Canvas (PowerPoint slides, required and optional readings/videos other resources)  Lecture content may include material that is in addition to the required readings and beyond the PowerPoint content. Any material presented in lecture should be considered testable, unless it is specifically labeled “optional”. Mandatory Lab Seminars: Wednesdays Sept 18-Oct 23, 2024  labs 1-5= 2.5 hrs. lab 6=1.5 hrs. = 15 hours of MANDATORY lab seminar content.  MANDATORY lab prep- must watch week 1, 2, 3, 4 lab videos BEFORE lab 1,2,3,4 labs  Lab seminar time is considered part of your clinical hours in nursing. a) See Canvas for lab rooms per lab group LAST DAY TO WITHDRAW: DEC 5, 2024 (last day of classes)  Syllabus Review Appropriate use of course materials U of S policy:  Recording (pictures or audio) of class lectures without permission from your instructor is not allowed, as stated in the University of Saskatchewan Academic Courses Policy  Students who utilize AI or record pictures/audio of lectures put themselves at risk of academic dishonesty https://library.usask.ca/copyright/students/your-course-materials. php#Coursematerials  Syllabus Review Student Learning Evaluation Questionnaire (SLEQ)  Teaching evaluations are an important way in which students can give feedback on teaching quality and effectiveness, courses and their general academic experience at the University of Saskatchewan.  Students are encouraged to provide feedback on the instructor and course at the midterm point and at the end of the term.  Students will receive a PAWS email with links to the SLEQ  These are Unanimous – but please be respectful = developing professionalism  Syllabus Review Required Resources American Psychological Association. (2020). Publication manual of the American Psychological Association (7 th ed.). Beebe, S. A., Beebe, S. J., Redmond, M. V., & Salem-Wiseman, L. (2020). Interpersonal communication: Relating to others. (8th ed.). Pearson-Canada. NOTE: The 2020 version is available in an online version (e-text or Revel) or a loose-leaf text version (if available). The Revel digital version has additional resources and interactive elements, whereas the e-text does not have interactive elements. Canadian Nurses Association. (2017). Code of ethics for registered nurses. Canadian Nurses Association. (2017). Code of ethics for registered nurses. https://cdn3.nscn.ca/sites/default/files/documents/resources/code-of-ethics-for-registered-nurses.pdf College of Registered Nurses of Saskatchewan. (2019a, October 30). Registered nurse entry-level competencies. https://www.srna.org/wp-content/uploads/2019/09/RN-Entry-Level-Competencies-2019.pdf College of Registered Nurses of Saskatchewan. (2020, March). RN entry-level competency interpretations. https://www.crns.ca/wp-content/uploads/2022/05/RN-ELC-Interpretations.pdf Gerow- Scissons, R. (2024). Recorded Lab Skills Videos: See Canvas for recordings Gerow-Scissons, R. (2024). NURS204 BSN SYLLABUS Mussell, W. J., Canadian Electronic Library, & Aboriginal Healing Foundation. (2005). Warrior-caregivers : understanding the challenges and healing of First Nations men : a guide prepared for the Aboriginal Healing Foundation. https://canadacommons.ca/artifacts/1184339/warrior-caregivers/1737466/  Syllabus Review Recommended Resources Ivey, A.I, M.B. & Zalaquett, C.P. (2022). Intentional interviewing and counseling: Facilitating client development in a multicultural society. (10th ed.) Cengage Learning. Mallette, C., Yonge, O., Arnold, E. C. & Boggs, K. U. (2022). Arnold and Bogg’s Interpersonal relationships: Professional communication skills for Canadian nurses. (1st ed.). Elsevier. NOTE: This is the newly published Canadian version. Purdue Owl Online Writing Lab. APA Formatting and Style Guide (7 th Edition). https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_form atting_and_style_guide/index.html  Syllabus Review Evaluative Components * = Essential component= MUST pass to pass the course All components of the course must be COMPLETED to receive credit for the course Component Title Due Date Grade Weight Lab Seminars * Wednesdays Sept 30% 18- Oct 23, 2024 Self-Reflective Monday Oct 7, 2024, 20% Paper utilizing at 2359 Mussell, W.J. (2005) interpretation of the Medicine Wheel Midterm Exam Thursday Oct 17, 15% 2024, Final Exam * TBA 35% Comprehensive Total 100% The Midterm/Final and You… “Did she just use my name”  What to do if you are feeling sick VISIT U of S COVID-19 and Seasonal Respiratory Illness Information IF you are SICK – Stay Home regardless if you think it is COVID-19. Make sure you are feeling better from any illness before returning to campus It is the responsibility of the Student to stay aware of the Province of Saskatchewan Public Health Guidelines Follow the Follow the Government of Saskatchewan Isolation Guidelines Regardless of vaccination status, it is recommended you self isolate for 5 days from the date of test OR 24 hours after fever has resolved without the aid of fever-reducing medications and all other symptoms have been improving for at least 48 hours, whichever is later.  What to do if you are sick https://covid19.usask.ca/ For a missed LAB: EMAIL your instructor and CC the coordinator For a missed LECTURE: Find a friend and get the notes…. Or better yet…find two friends and get both their notes  Do I need to let Regine know if I am going to miss a lecture?  Syllabus Review Lab Seminar Content and Coordinator  Lab Coordinator: Regine Gerow-Scissons   Each Lab:  Has an assigned Lab Facilitator  IF you have a question related to labs email lab facilitator first then lab coordinator  All Labs are on Wednesdays  It is Not possible to switch labs or go to different one if you miss yours  WHY?  Attendance and Participation in LABS is MANDATORY = lab hours are considered clinical hours  Lab content and material is TESTABLE  MUST watch the required lab recording BEFORE each lab to demonstrate that you are prepared  Syllabus Review Lab Seminar information DRESS CODE:  UNIFORMS : Are not required  DO NEED College of Nursing name tags and dress professionally  College of Nursing: Professional appearance policy Labs 1-5= 2.5 hours Lab 6= 1.5 hours There are three (3) MAIN components to the lab:  Practice integrating the interview framework  Practice using therapeutic communication skills and conflict resolution skills  Integrate feedback from peers and faculty  Syllabus Review How do I best prepare for the lab seminars? Step one: Review Textbook and Lecture content Step two WATCH/ LISTEN/ Take notes during the required ‘Take it to the Lab’ Videos- (asynchronous) Step three: (Review the Module in Canvas: Lab preparation) REVIEW the Frameworks: Ivey & Ivey and Eclectic model REVIEW the Ivey and Ivey Documents REVIEW the Basic Counseling Skills Website Lecture content supports your practice in lab Each Lab builds on communication skills from the previous week AND incorporates NEW communication skills  Syllabus Review How am I evaluated in the lab seminars? (see rubric in syllabus) Midterm (formative) during lab 3  Not graded – BUT will be given a literal descriptor – intent is to provide formative feedback to guide learning for 2nd half of lab Final (graded) during lab 6  Will have a numerical grade in line with the literal descriptors and personalized comments demonstrative of the student's performance from all the labs Integration of Communication Skills 10 Integration of Interview Framework 10 Integration of Constructive Feedback 10 Weighted at 30% of the final mark AND is an ESSENTIAL component  Can a student be SATISFACTORY at the midterm lab evaluation and then still be SATISFACTORY at the final lab evaluation? Yes or No Why or why not?  Why do we need a communication theory class AND a lab?........ What makes a Competent communicator? Select all that apply, partial marks a) They have been taught communication skills b) They have practiced their communication skills/craft c) They are usually outgoing and extroverted d) They are born, not made  Syllabus Review Academic Self-Reflective Paper What is the purpose?  The reflective process allows you to act purposefully rather than automatically.  It is NOT a summary of an activity or event nor is it strictly an emotional outlet.  The goal of this critical reflection paper:  Identify, question, and assess your own behaviors, thought patterns and assumptions of your knowledge, and thus change your behavior and gain insight into your INTRA/INTERpersonal and INTERPROFESSIONAL communication skills SEE SUGGESTED STEPS for writing this paper in Canvas  Syllabus Review Academic Integrity Complete this self-administered assessment and review any resources it points you to. THIS LINK IS ALSO POSTED IN CANVAS https://usask.libwizard.com/f/Academic_Integrity_Skill_Set_Q uestionnaire  Use of Artificial Intelligence Policy See Syllabus:  Scholarship, including the development of scholarly writing skills, is an essential learning outcome of undergraduate and graduate nursing education (CASN, 2022). To effectively develop and evaluate student writing skills, students are expected to create and submit their own original assignments.  In addition to the definition and examples of Academic Misconduct outlined in the University of Saskatchewan Academic Misconduct Regulations, students are NOT permitted to use Artificial Intelligence (AI) text generators (such as ChatGPT) for assessments (e.g., written assignments, open book exams, other evaluations).  How to be successful in this course “Should I come to class”  READ the SYLLABUS and RUBRICS  Know when assignments are due and where to find rubrics/information  Make a calendar in your phone or on paper with due dates. Color code it if you need  ATTEND lectures in a meaningful way …aka actively listen= cuts down on reading and reviewing time  Study in short bursts rather than long marathons….be aware of your stress levels and take breaks  Log onto CANVAS COURSE N204  READ YOUR EMAILS: check for announcements/emails DAILY  Follow the outline and required material for each Lecture and Lab  Engage with your peers- form INTERPERSONAL relationships = MAKE FRIEND(S)  Don’t compare yourself to other students: Everyone has their own journey  Access Feedback and accept responsibility as a student  Remember that it is your responsibility to read and understand the assignment before you begin it. I spend a lot of time grading and will provide feedback.  Pay attention to the feedback in labs  Break Time (10 min) What Questions do you have for me?  Lecture One Introduction to Interpersonal Communication and Nursing Eighth Canadian Therapeutic Relationships Edition Introduction to Interpersonal Communication. Copyright © 2021 Pearson Canada, Inc.  Lecture One: Learning Outcomes By the end of this:  1.2 Explore why it is useful to study interpersonal communication.  1.1 Compare and contrast definitions of communication, human communication, and interpersonal vs impersonal communication  1.3 Discuss the communication process, including key components and models of communication: action, interaction, and transaction.  1.4 Discuss five principles of interpersonal communication.  1.6 Identify and discuss strategies that can improve your communication competence  8.4 Describe interpersonal power  9.1 Understanding Interpersonal Relationships  9.2 Genesis of Relationships  Discuss the Therapeutic Nursing Relationship: A type of interpersonal relationship  Why is it useful to study Interpersonal Communication? In the beginning we needed to survive….. Early humans who lived in groups, rather than alone, were more likely to survive….. those with the capability to develop interpersonal bonds were more likely to pass these traits on to the next generation (Leary, 2001) AKA they lived longer and could reproduce…..thanks Darwin  Communication and Health Care: Why it matters https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589483/ Some nursing experts believe that appropriate communication skills are the cornerstone of all nursing care activities.  Improve vital signs  Decreased pain and anxiety  Increased satisfaction  Improved treatment outcomes  Enhanced participation in programs  Lack or loss of a relationship can cause depression What is Depression? THE BASICS Widespread emotional disorder in which the person has problems with sadness, changes in appetite, difficulty sleeping and a decrease in activities, interests and energy  Why Communication matters for Nurses An inability to form therapeutic relationships is considered a demonstration of unsafe practice: College of Nursing Policy: Unsafe Practice  "ineffective interpersonal interactions, including communication and relational difficulties”  SAFE practice is MORE than being able to do skills: start IV, catheter, dressing changes As a nurse you will need to communicate – BUILD RELATIONSHIPS with Individuals of all ages Families Communities- homeless, mental health, acute care, long term care, Health care team members Peers  What happens in health care if there is POOR communication? Research suggests 80% of medical errors related to poor communication  Patients misunderstand and do not follow the treatment or medication schedules  Patients not trusting us= don’t tell us the full story (drugs used or lifestyle)  Workflow breakdowns “I though you were going to take the catheter out”  Communication Definitions (1.1) Communication:  The sharing of information, ideas and feelings aimed at a mutual understanding.  Need a Sender (person sharing), recipient (person receiving) and the transaction(way the message is delivered)  Complex process Human communication is the:  Process of making sense of the world AND sharing it with others via verbal and nonverbal communication  Includes the senses, variety of modes & mixed media  Today’s technology has forced us to reconsider the definition of Face-to-face communication  Communication Definitions (1.1) INTERpersonal communication Occurs when you treat the other as a UNIQUE human being and not as an object A distinctive form of communication Transaction involving mutual influence between individuals Helps us manage our relationships Interaction contains a true dialogue and honest sharing of self with others  Often occurs with someone you care about and depend on IMpersonal communication occurs when we treat people as objects or when we respond to their roles rather than to who they are as unique person Interaction is mechanical and stilted; no honest sharing of feelings; with people with whom you share no history and expect no future ex) salesclerks INTRApersonal communication Communication with oneself; thinking (upcoming lecture 2) INTRAprofessional communication (upcoming lecture 9) Involves a level of formality = formal communication with other professions (your professor or physician, pharmacist) Needs to be TRUTHFUL, ACCURAGTE, CLEAR, CONCISE and COMPREHENSIVE  Relationship Definitions (1.1) https://www.nursingprocess.org/interprofessional-collaboration-in-nursing.h tml Relationship Definition Ongoing connection made with another person through interpersonal communication Interpersonal Relationship is: Perception shared by 2 people that here is a connection Development of relational expectations and varies in interpersonal intimacy (more on this lecture 8- related to conflict) Intrapersonal Relationship (Lecture 2) Interprofessional Relationship (Lecture 9)  Teamwork or COLLABORATION via communication between health care members of different departments to accomplish a common goal.  Each profession enters into practice with different skill sets, knowledge, and professional identity  Examples of INTERPROFESSIONAL Collaboration in Nursing https://www.nursingprocess.org/interprofessional-collaboration-in-nursi ng.html  If you have a question about the ordered dose, or the Pyxis is missing ordered medication = call pharmacy= Interprofessional  A patient experiences an ANAPHYLAXIS attack after a medication admin= call doctor, contact pharmacy= Interprofessional  A patient is struggling to breastfeed= call or consult Speech language professional, Lactation consultant, physician for possible TT= Interprofessional  You are in N206 clinical and want to implement a nursing interventionto ambulate your patient= collaborate with PT, the CCA schedule, Social or other planned activities = Interprofessional  5 Principles Common to ALL Interpersonal Communication (1.4) 1) Connects us to others IS NOT optional- WE can’t not communicate 2) Is irreversible Can apologize but you can’t take it back and it determines the interpersonal relationship outcomes 3) Is complicated 4) Is governed by rules Implicit or Explicit rules 5) Involves both content and relationship dimensions  1) Interpersonal communication connects us to others  We interact with others EVERYDAY  Opportunities for communication are everywhere – We can’t not communicate  Social media has dramatically increased communication Example: Even when you are silent in an elevator your lack of eye contact communicates with others= not willing to interact 2) Interpersonal Communication is irreversible  Once spoken the message cannot be unheard  Communication is more than information it CREATES meaning for others that cannot be deleted from your memory or perceptions AND affects all future interactions Ex) Gossip, accidents, verbal abuse 3) Interpersonal communication is complicated  Humans interpret information as Symbols-  Words, sounds or visual device that represents thought/concept/object  We exchange symbols that stand for ideas AND = complicates messages  Messages are not always interpreted as we intend them  IF communication can fail, it will  If a message can be understood in just the way in which it does the most harm– IT WILL be  The MORE communication there is = the more difficult it is for communication to succeed  4) Interpersonal Communication is governed by rules: Implicit or Explicit Rules= A prescription to follow that indicate which behavior is preferred or prohibited in communication situations or contexts. Implicit rules- We learn these rules from EXPERIENCE and observing others- prescription that we follow which indicates what behavior is preferred or prohibited  Respect each others privacy  Keep secrets  Take hat off at dinner table….observed others doing this  Look the other person in eye during conversations  Do not criticize the other person publicly Explicit rules- clearly communicated rules and expectations either verbally or written (syllabus) Ex) Exam instructions say to put your ID on the desk and use a HB pencil, so you do this  5) Interpersonal communication involves: Content and Relationship dimensions Content- The actual words and how you say them Relationship dimension = HOW the message or content is said within a relationship Example of ‘dear’ Metacommunication – the secondary expression of intent (non verbal's) that either supports or conflicts with what you are VERBALLY saying. We all INSTICTIVELY look for these signals to decipher the verbal message accurately Accurately decoding unspoken or verbalized meta-messages help you understand what people really mean Being able to READ BETWEEN THE LINES can be a very important tool in the therapeutic setting. = helps build relationships and gain insight into the underlying issue or real concern.  How do these Principles apply to Nursing? Scenario – Rihanna arrives to care for their 80y.o patient, but they are nervous and avoid making eye contact when entering the patient's room…which makes the patient nervous who glares at the floor and then yells at Rihanna. Which principle applies or which principle(s) should Rihanna have considered before going in the room ? a) We cannot not communicate b) Communication is irreversible c) Communication is complicated d) Communication is governed by rules e) Communication involves context and relationship dimensions  Which of the following statement(s) are an example of the first principle of interpersonal communication? a) We cannot NOT communicate b) Interpersonal communication is irreversible c) Interpersonal communication involves ability to trust d) People construct meanings in Interpersonal communication  Principles of Interpersonal Power (8.4) How are you using power to influence others….and how others using it ? 1. Power exists in all interactions and all relationships When you talk, you are attempting to exert power over others (even to get them to listen) 2. Both people in a relationship have some power Sometimes one has more power (parent/child) When we have power: may use it to get our way= POSITIVE or NEGATIVE Compliance Gaining 3. Power is circumstantial Balance of power changes in a relationship over time and circumstances As you grew up no longer needed parents to meet certain needs 4. Power is negotiated You pick the movie, and I will pick the snack BUT can be more intense: (sex, money, children) NURSING EXAMPLE: Breaks  5 sources of Power in an Interpersonal relationship (8.4) What type of power does the nurse have in a therapeutic relationship? Legitimate power: Comes from a respect for a position another holds (teachers, nurses, parents, police, company presidents) Referent power: Comes from our attraction to another person, or the charisma a person holds.  WE LET PEOPLE WE LIKE INFLUENCE US …..is this important for nurses? Expert power: based on persons knowledge and experience.  WE GIVE POWER TO THOSE WHO KNOW MORE THAN WE DO OR HAVE SOME LEVEL OF EXPERTISE WE DON’T HAVE. (teen daughter knows more about computers so you let her try to help you) Reward power: Give power to others based on their ability to satisfy our needs with rewards of money, gifts etc.  Most common form of power in interpersonal relationships  Withholding rewards (like affection) is a form of punishment called COERCIVE POWER Coercive power: Involves the use of sanctions or punishment (something they  Relationship Genesis (9.2) aka: how do relationships start Relationship Genesis Relationship of Circumstance-interpersonal relationships that exist because of life circumstances Determines whether we then establish a relationship of choice. Relationship of Choice- interpersonal relationships you CHOOSE to start, maintain or end (friends, lovers, spouse) We ACT and COMMUNICATE differently in the two types of relationships because the stakes are different.  Something to think about…..  Relationships of Circumstance and Choice are NOT mutually exclusive  Relationships of circumstance can also be a relationship of choice: a) Brother, sister or work/school colleague can also be your best friend, or classmate can become a spouse In a sense all relationships begin by __________________  The Therapeutic Nursing Relationship Therapeutic Nurse-Client Relationship (cno.org) It is considered a helping relationship with 2 main goals: a) helping clients manage their health and live effectively b) promote optimal independence in their daily lives Varies in length: Emergency room: lasts a few minutes to help deal with situational crisis- immediate needs Short term: goals and outcomes documented in the care plan and evaluated Long term care settings: can last several months or years Requires both the SCIENCE and ART of Nursing  Science: Nursing knowledge and skills  Art: applying caring attitudes and behaviours = EMPATHY and BEING other orientated Example: Science and ART in a relatioship TITANIC Movie  Hildegard Peplau’s (1952) Theory of Interpersonal Relationships https://rnao.ca/bpg/guidelines/establishing-therapeutic-relationships Basic tenants (Deane & Faine, (2016) There is a relationship between the nurse and patient The nurse-patient relationship evolves and develops The nurse utilizes communication skills to develop the relationship Self-reflection is necessary to support the relationship and ensure client focus: Did I cross any boundaries, am I listening to the patient, am I exerting power? Her model emphasizes that the nurse patient relationship is an integral part of nursing practice  Peplau’s Theory of Interpersonal Relationships 3 phases of the nurse patient relationship Orientation Phase Working Phase  Mostly one way  Major work occurs here= a) Nurse identifies self and interventions state's purpose and  Nurses are resources for available time information: meds, safety, how b) Nurse seeks essential to assess self information, history taking,  Physical care provided: assessments= questions assisting with nutrition,  Aim is to set the tone for future toileting, dressing, washing VS interactions= RAPPORT  Health Teaching provided:  Begin to know patient as a Begin Discharge teaching, build person on health knowledge they have  Focus is on listening= hearing  Nurses should REFLECT on what is said and asking their own verbal and nonverbal questions to stimulate participation in the relationship descriptions and stories Peplau’s Theory of Interpersonal Relationships 3 phases of the nurse patient relationship Termination Phase  Summarizing and closure of the work that was accomplished in the working phase Discharge planning: Should begin in working phase and summarized in this phase  Unlike other relationships- the nurse patient relationship is LIMITED= needs to end  Self-Reflection - Required by the nurse in this phase Nurses use a WIDE range of effective communication skills to appropriately establish, maintain, re- establish and terminate the nurse-client relationship 5 Components ALWAYS present in the Nurse-Client Relationship ://www.cno.org/en/learn-about-standards-guidelines/educational-tools/learning-modules/therapeutic-nurse-client-relationship/ Regardless of the Context, length of interaction and whether or not the nurse is the primary or secondary care provider these components are ALWAYS present 1.Trust  CRITICAL in the nurse-client relationship because:  Client is in a vulnerable position  Beginning of relationship TRUST is fragile= Important to keep promises 2.Respect  Recognition of the inherent dignity, worth and uniqueness of every individual regardless of socio-economic status, personal attributes and the nature of the health problem 3. Professional Intimacy: closeness  Intimacy is inherent in the type of care and services nurses provide  Physical activities such as bathing that the nurse provides for and with the client  Also includes psychological, spiritual and social elements that are identified in the plan of care- Access to intimate personal details  Emotional Distance to ensure BOUNDARIES (CNO, 2023) Nurses are responsible for EFFECTIVELY establishing and maintaining the boundaries in the therapeutic nurse client relationship What is a Boundary:  Invisible structure which protects rights, privacy, and functional integrity of the nurse-client relationship What is a Boundary Crossing:  When a NURSE crosses a boundary the nature and dynamic of the relationship changes from professional to unprofessional and personal  The balance of power becomes even more unequal = increases client's vulnerability  It is the nurse’s responsibility to set the boundaries HOW the nurse sets boundaries: Develop and USE a comprehensive plan of care – to meet the clients needs Recognizing that certain practice settings require increased vigilance to maintain boundaries EX) providing care in a client's home= increased risk of becoming involved in private life of family Meet your personal needs outside the therapeutic relationship Initiating, maintaining and terminating the nurse-client relationship appropriately. Consider the setting, time, purpose, focus of conversation, length of contact DO not accept gifts – UNLESS in the RARE instance the refusal would harm the relationship APPROPRIATE: upon discharge the client wants to buy the nurses a ‘treat’ and provides donuts for the break room NOT APPROPRIATE: For a nurse to accept an offer from the client to buy them something individually 5 Components ALWAYS present in the Nurse- Client Relationship 4.Empathy “ability to enter into the client’s relational world to see and feel the world as the client does, explore the meaning for the client”  Expressing an of understanding of what the HEATLH CARE EXPERIRENCES means from the client's perspective and meaning of the experience 5.Power  Interpersonal Power: the degree to which a person is able to influence or control his or her relational power. (Chapter 8.4)  NURSE Client relationship is of unequal power  a misuse of this power is considered abuse  appropriate use of power in a caring manner enables the nurse to meet the client’s needs  The nurse has MORE power than the client (legitimate/expert/referent)  Specialized knowledge, access to privileged information and the ability to advocate  Strategies to improve your Communication Competence (1.6) “How can I get better at this”. Become Knowledgeable, Skilled, and Motivated  Knowledgeable- learn about communication theory and other assessment skills (N202)  Skilled- skills are practiced (labs)  Motivated- must want to improve= reflect on self Become Other-Oriented  Consider others needs, thoughts experiences personality emotions motives desires culture and goals  Consider the interests of others  Empathize  Adapt  Be ethical  ALL Quality interpersonal relationships have an emphasis on being other orientated The world does not revolve around us  Becoming OTHER orientated  A collection of skills and principles to help you understand others.  DOES NOT mean you abandon your own thoughts/feelings  Maintain your own integrity  TRUE empathy, emotional intelligence and sensitivity are only possible when we feel secure ABOUT OUR OWN identities (must know yourself)  Example: Empathizing … Understanding Alzheimer's via The Science: An adult-onset dementia characterized by progressive cognitive decline, identified on autopsy by neurofibrillary tangles and amyloid deposits, diagnosed from clinical findings of memory and personality changes over time, and treated with medications  Example: Science and Art of Nursing Understanding Alzheimer's via The empathetic or Art of Nursing: From the Clients perspective (Frei, J., Alvarez, S. E., & Alexander, M. B. (2010). Ways of seeing: Using the visual arts in nursing education. The Journal of Nursing Education, 49(12), 672–676. https://doi.org/10.3928/01484834-20100831-04)  Comparison between Therapeutic and Interpersonal Relationships (adapted from Nova Scotia, 2020) Characteristic Therapeutic Nurse-Client Interpersonal Relationship s Relationship Behavior Regulated by the CNA code of Guided by personal values Ethics and provincial standards and beliefs Renumeration Nurses are paid to provide service No renumeration Location Defined and limited Not defined, unlimited Purpose Goal-directed: provision of nursing Pleasure and interest directed care Power Nurse has knowledge, influence Most often equal and access to privileged information about client Responsibility Nurse establishes and maintains equal boundaries Preparation Nurse has formal knowledge No formal knowledge Time Limited by need for nursing care Personal choice and hours of work Nurse responsible for maintaining  Key Elements of the Communication Process (1.3) Source or Participants– the senders/ receivers of messages Encode- put ideas, thoughts and feelings into communication Decode- the process of turning a communication message into thoughts Message – the verbal or nonverbal elements of communication Channel – the pathway or method through which messages are sent Receiver- the person who decodes the message Noise- the interference that keeps a message from being understood- needs to be minimized for accurate communication Feedback – verbal or nonverbal response to the message Context – emphasizes the ENVIRONMENT where communication occurs (physical, number of people, relationship, the goal, culture) Nicole listened carefully to the teacher's instructions. When the teacher said to take out their calculators for the test, she realized that she didn't have her calculator in her backpack. What process did Nicole use to interpret what the teacher was saying? a) Context b) Feedback c) Encoding d) Decoding  Communication Channels Communication-Rich and Communication-Lean Channels (fig 1.5)  Noise: Is always present and may interfere with a message being accurately received and sent Physical Noise- or Literal Noise- anything in the environment that is loud enough to prevent one communicator from hearing the other.  Depending on the channel- physical noise may or may not interfere Ex) Texting at a concert….may not affect message from being sent Talking at a concert….may affect message as need to yell NURSING example: crowded hallway or room INTERFERS with message Psychological Noise- ‘noise within ourselves’ …our thoughts or plans. Ex) Need to plan supper and get groceries = not able to fully concentrate on the lecture  Contexts that Influence Communication Physical Context Relational Context  Size, layout, temperature, # of people and lighting of space  Previous interpersonal history and  Nursing Ex) shared hospital room vs type of relationship private…. Or when giving feedback to  Ex) communicate differently with students someone we just met vs best friend/spouse Psychological Context-  Mental and emotional factors (stress, Cultural and language context anxiety….or feelings of love/anger)  cultural traditions or rituals  Ex) dinner table vs classroom (unintentional insults, confusion)  Ex)gender, ethnicity, sexual Social Context orientation, class and ability Stated rules or unstated norms (formal or nonformal) The nursing profession has RULES and NORMS for. Ex) being truthful during your conversations, being patient and encouraging the client to speak, demonstrating empathy, speaking clearly, making eye contact. The CONTEXT of communication situations will become important when we discuss conflict and challenging situations Ex) How soon after an angry outburst (psychological context) should we approach a patient? Esther is trying to figure out how to phrase a question for the patient. What term is used to describe this process? a) Decoding b) Interaction c) Encoding d) Channeling  Understanding Models of Communication (1.3) Models of communication: Help simplify the process by providing a VISUAL representation Allow you to see specific concepts and steps within the process of communicating Models give rise to ideas or nuances that you may not have considered. Message TRANSFER Model Message EXCHANGE (interaction model) Message CREATION (transaction model)  Communication as an Action: Message TRANSFER Model (fig 1.1)  This model sees communication as an ACTION: ONE DIRECTIONAL  THIS model focused on the Sender and the message.  Main elements: The Channel, The Sender and The Receiver  Communication as action, or a transferring of meaning from SOURCE to a RECIEVER  Communication takes place when a message is sent and received  RECIEVER is viewed as a target or end point rather than an ongoing process.  Mentions noise  Communication as an Interaction Message EXCHANGE Model (fig 1.2 )  Message exchange model describes communication as a PROCESS by sending and receiving feedback  Feedback loop is incorporated  Messages sent in a response to other messages.  Leads to a more complex understanding of the participants= alternate roles of sender and receiver  SO many messages being sent at one time that many may not be received.  Includes physical and psychological context  Communication as an Interaction Message EXCHANGE Model  Feedback loop and incorporation of context HELP make this model a more useful illustration of the communication process.  Feedback makes this model CIRCULAR vs LINEAR Examples of a feedback loop:  I respond to a point you made during a class discussion  You point to the remote on the coffee table when your roommate asks where it is Consider this scenario: Provide a handout on signs of infection and go over with your patient who asks a question related to ‘how red is bad’. = feedback loop (message exchange model)  Example: How physical and psychological contexts matter in health care. Breanna the nurse has worked 11 hours and is attending to a client recently admitted to the hospital. The 68-year-old client is waiting for a bed and is stationed on a stretcher in the emergency room hallway. The client sought emergency care after experiencing severe abdominal pain and passing substantial blood when having a bowel movement. The client was informed that it is likely they have end-stage bowel cancer but is still awaiting a formal diagnosis and referral to oncology (cancer specialist). The nurse asks the client if the nurse can take a set of vital signs. The client responds “yes.” The nurse also tries to make the client comfortable by adjusting the head of the stretcher and asks the client if they need anything. The client has many questions and concerns and has not had anything to eat or drink in several hours but responds “no.” The nurse says “OK, well let me know if you need anything.”  Why doesn’t the client ask more questions or Breanna the nurse prob a bit more? Consider the contexts…. Physical Context  Lack of privacy and overstimulation in waiting area  Nurse being physically tired after 11 hours may have led to them NOT asking further about clients needs Psychological Context  Burden of a looming terminal diagnosis  Undignified environment  Nurse may have also been emotionally drained after an 11-hour shift PROS- this model allows us to reflect on how physical and psychological contribute to GOOD communication  Communication as a Transaction: Message CREATION Model (figure 1.3)  This model recognizes that sender and receiver are acting simultaneously  In the middle of sending a verbal message, you can adapt your communication in response to the non-verbal message you are simultaneously receiving from your communication partner.  Senders and receivers are called COMMUNICATORS  The message of one communicator influences the message of the other.  More complex understanding of context- includes social, relational and cultural contexts This approach requires analysis and critical reflection. It requires a broader understanding of historical, political and social structures that affect communication. The specific factors affecting a communication encounter may or may not be possible to uncover  Summary of Communication Models Model Focus Message Transfer model Frames communication as a thing, like an information (Transmission) packet, that is sent from one place to another. Communication is defined as sending and receiving messages Message Exchange model Frames communication as an interaction in which a (Interaction) message is sent and then followed by a reaction (feedback) followed by more feedback. Communication is defined as producing conversations and interactions within a physical and psychological context Message Creation model Frames communication as integrated into social realities in (Transaction) such a way that it helps communicators not only to understand them but also to create and change social realities  Hey Nurse Regine….. Is one communication model better than the other?  No…it is about choosing the best model for the situation and type of message. Ex) Message TRANSFER Model  Videos for labs Ex) Message EXCHANGE Model  Emails, telephone conversations, letters (views feedback as slower process and have two participants consistently sending and receiving messages based on previous message) Ex) Message CREATION Model:  Face to face meeting or conversation  This lecture  Skype or ZOOM  Take home points  5 principles of interpersonal communication  5 principles of power within relationships  5 sources of power in relationships  3 models of communication  Elements of the nurse-client therapeutic relationship include: Trust Respect Professional Intimacy Empathy Power  Peplau’s Theory of Interpersonal Relationships a) Includes: orientation, working, termination b) Includes: therapeutic communication, client centered, development of boundaries and protecting the client from abuse  The End of Lecture One What Questions do you have for me??