What happened to the small pox vaccine? D/C 1971 – eradicated
Health “A state of complete physical, mental and social well-being, not merely the absence of disease or infirmity”
Health Promotion “Health care directed toward the goal of increasing one’s optimal level of wellness.”
Empowerment “A form of self- responsibility that encourages people to take charge of their own decision making”
Disease prevention Primary – Before there is any disease Secondary – Begins with diagnosis Tertiary – Begins when a permanent disability occurs and is stabilized – Rehabilitation – Restoring the person to an optimal level of functioning
Healthy Lifestyle Nutrition Exercise Mental health
Mental Health Adjust to new situations Handles personal problems Contributes to society See themselves and others realistically Fluctuates – Continuity – Consistency
Stress “Anything that upsets our psychological or physiological equilibrium”
Responses to stress Physiological Emotional Intellectual
Emotions “feeling state” Autonomic System Limbic System
Emotional Maturity When individuals are able to control their responses and can express their emotions in socially appropriate ways.
3 Stages of Stress Alarm stage State of resistance State of exhaustion
Chapter 4: Communication “An interaction between tow of more persons – an exchange of information, ideas, feelings or emotions.”
Communication Process 1.Message 2.Sender 3.Method 4.Receiver 5.Feedback
Types of communication Verbal Non-verbal
Modes of Non-verbal Communication Physical Appearance and dress
Modes of Non-verbal Communication Body movement and posture – Open – Closed
Modes of Non-verbal Communication Facial expressions
Modes of Non-verbal Communication Gestures
Modes of Non-verbal Communication Eye contact
Modes of Non-verbal Communication Tone and volume of voice
Modes of Non-verbal Communication Touch
Modes of Non-verbal Communication Silence
Personality Types Passive or Unassertive Allowing your own rights to be violated by failing to express honest feelings Goal: Avoid conflict no matter what Little risk involved – very safe Little eye contact, often defers to others opinions, usually quiet tone,
Examples of Passive communication “I don’t know.” “Whatever you think.” “you have more experience than I. You decide” “I’ll go with whatever the group decides.” “I don’t care. It doesn’t matter to me.”
Personality Types Aggressive Protecting ones own rights at the expense of other’s rights – no exceptions Goal: win at all costs Does not consider actions a risk because this person thinks they will always get their way. Eye contact is angry and intimidating; lots of energy; loud and belittling, never defers to others.
Examples of Aggressive communication “I don’t know why you can’t see that this is the right way to do it” “It’s going to be my way or not at all.” “You’re just stupid if you think that will work.” “That kid of logic will sink the company.” “Who cares what you feel. We’re talking about making things work here.”
Personality Types Passive - Aggressive Forfeiting your own rights initially, followed by manipulation and vengeance later. Goal: avoid conflict and then make the other party wish they had seen it your way Avoid risk initially, risks relationships later, then acts surprised when people are mad Behaves passively to people’s face, then aggressively when they are not around.
Examples of Passive-Aggressive communication “Sure doctor, I’d be happy to write that verbal order” but back on the unit the order is “forgotten” “I love your hair. Most people probably can’t even tell it’s a wig” “I hear what you’re saying, and I wouldn’t want to make waves, so I’ll do what you say even though someone will probably get sued.”
Personality Types Assertive Protecting your own rights without violating the rights of others Goal: communicate with respect and find a solution to the problem Eye contact maintained, listens and validates others, confident and strong yet also flexible, objective and unemotional, presents wishes clearly and respectfully
Examples of assertive Communication “So what you’re saying is…” I can see that this is important to you and it is also important to me. Perhaps we can talk and try to solve the problem “I think… I feel… I believe that…” “I would appreciate it is you…”
Assertiveness Skills 1.Persistence 2.Objectivity 3.Validation 4.Owning 5.Challenging False Information 6.Pumping the negatives 7.Humor
Okay in assertive Communication “I don’t know” “No” or “I cannot do that” It is OK to make mistakes as long as you take responsibility It is OK to disagree and to verbalize that It is OK to challenge others opinions or actions It is OK to not accept another opinion as fact It is OK to ask for a change in behavior
Therapeutic Communication Purposeful Goal oriented Promotes trust
Components of Therapeutic Communication Listening and observing
Components of Therapeutic Communication Warmth
Components of Therapeutic Communication Genuineness
Components of Therapeutic Communication Attentiveness
Components of Therapeutic Communication Empathy
Components of Therapeutic Communication Positive regard
3 phases of Therapeutic Communication Orientation phase – Build trust Working phase – Determine coping – Plan of care implemented Termination phase – End of relationship
Factors affecting communication Congruence
Factors affecting communication Time and setting
Factors affecting communication Proxemics
Factors affecting communication Biases
Factors affecting communication Physical Handicaps
Blocks to Communication Belittling
Blocks to Communication Disagreeing
Blocks to Communication Agreeing
Blocks to Communication Defending
Blocks to Communication Stereotyping
Blocks to Communication Giving false reassurances
Blocks to Communication Giving advice
Blocks to Communication Changing the subject
Blocks to Communication Asking closed-ended questions
Blocks to Communication Asking “Why” questions
Blocks to Communication Probing
Techniques used to enhance communication Giving information
Paraphrasing or restating
Asking broad questions
Using general leads
Stating or making an observation
Therapeutic Communication “Tell me about a time you struggled caring for your family member.” A.Appropriate B.Inappropriate
Therapeutic Communication “Describe the circumstance that led you to the crisis unit…” A.Appropriate B.Inappropriate
Therapeutic Communication “Tell me about a time you felt confused about a decision.” A.Appropriate B.Inappropriate
Therapeutic Communication “Tell me, what you do when you get upset.” A.Appropriate B.Inappropriate
Therapeutic Communication “Why do you think your family does not care.” A.Appropriate B.Inappropriate
Therapeutic Communication “Of all the concerns you mentioned which is the most troublesome?” A.Appropriate B.Inappropriate
Therapeutic Communication “Tell me when you feel anxious…” A.Appropriate B.Inappropriate
Therapeutic Communication “Tell me your family problems.” A.Appropriate B.Inappropriate
Therapeutic Communication “The decision your family made is for your own good.” A.Appropriate B.Inappropriate
Therapeutic Communication “Why do you feel like that. Your family seems to care.” A.Appropriate B.Inappropriate
Therapeutic Communication “I would not worry about that…..” A.Appropriate B.Inappropriate
Therapeutic Communication “What you really mean is…” A.Appropriate B.Inappropriate
Therapeutic Communication “This hospital has a fine reputation.” A.Appropriate B.Inappropriate
Therapeutic Communication “Everyone gets down in the dumps.” A.Appropriate B.Inappropriate
Therapeutic Communication “I am not sure that I follow what you are saying.” A.Appropriate B.Inappropriate
Clarifying Using broad opening statements Giving information Reflecting Validating Acknowledging the patient’s thoughts and feelings Using general leads Selective reflecting Requesting an explanation Belittling the patient’s feelings Making stereotyped comments giving approval Defending Using reassuring clichés Expressing disapproval Giving advice Agreeing with the patient Changing the subject Disagreeing with the patient
Patient: “I don’t know. I hate to have my boyfriend see me looking like this. Just thinking about him coming to visit makes me nervous.” Nurse: “You really should stop worrying. That may be what’s keeping you from getting the rest you need. And after all, no one expects you to look your best when you’re in the hospital.”
Patient: “You’d think my doctor would have prevented me from getting phlebitis, but he’s too busy to care about what’s happening to me.” Nurse: “You’re wrong, Mr. Iverson. Of course he cares.”
Nurse: “You seem to be kind of restless tonight.” Patient: “Nobody cares. My doctor wants me to go—just go on home. He doesn’t care?” Nurse: “Go home?”
Patient: “Maybe I should find a hobby or something. I try not to get discouraged; I know I shouldn’t let it get me down.” Nurse: “That’s the right attitude. It really doesn’t help to worry about it.”
Nurse: “How are you feeling this morning, Mr. Patterson?” Patient: “Oh, fine, thanks.” (unenthusiastic) Nurse: That’s good.
Patient: “I can’t go home with this…AIDS. If they want me out of here so bad, why don’t they just let me die?” Nurse: “You can’t go home because you have AIDS?”
Patient: “Well, I haven’t been able to work for quite a while now, and the doctor says I might not ever work as a carpenter again.” Nurse: “It must be difficult for you right now, but I’m sure everything will be all right.”
Patient: "I'm just jumpy-I get like this sometimes. I guess it's because I didn't get too much sleep last night." Nurse: "Yes, when you don't get a good night's sleep it does make you edgy."
Patient: "What's there to talk about? First they say they have to operate, and then when I'm beginning to feel better, I get this infection. I don't think I'm ever going to get out of here!" Nurse: "I know just how you feel. You know, everyone gets frustrated when things aren't going right."
Listening Exercise Pair up with another student. Person A will tell person B her/his most memorable recent experience. Person B should try to think about a problem they have or an assignment coming up while person A is speaking. Discuss how you felt about both roles and experiences, with person A speaking first.
Person A then tells the same story again, taking about the same amount of time. This time person B will concentrate as much as possible on person A and on what he/she is saying. Share the differences between these two experiences and discuss the relevance this may have when person A is a client and person B is a nurse.
Therapeutic Communication Techniques (6) Initial Communication “What should the nurse say initially?” Goal of initial communication is to open communication. Empathy Restatement Reflection
An elderly woman is admitted to the hospital with a subdural hematoma. There are also numerous ecchymotic areas and cigarette burns. Elder abuse is suspected. The nurse’s aide says to the nurse, “Every time I see her family, I get so angry. How could anyone deliberately hurt such a sweet old lady?” Which initial response by the nurse would be most helpful to the aide? “It is not appropriate for nursing personnel to make judgments about people.” “It is very upsetting isn’t it.” “There is no proof yet as to who abused her.” “You should try to understand how frustrating it is to care for the elderly 24 hours a day.”
Who is client? Nurse’s aide. What is the problem/behavior? Nurse’s aid is angry with family of client. What are the details? Suspects elder abuse. What does question ask? Initial response to aide Answer: 2. Initially should encourage aide to express feelings.
The nurse is caring for an 18 yo male who is comatose following a head injury. The parents ask whether they should visit their son since he is comatose. Which of the following is the best initial response for the nurse to make? Advise the parents thay should visit their son as often as possible. Suggest to the parents that their presence is important even though their son does not seem to be aware. Tell them that they should arrange for his teenage friends to visit in small groups. Explain that he is unaware of their presence and tell them
Who is client? Parents of 18 y/o What is the problem/behavior? Ask if they can visit son. What are the details? 18 y/0 comatose after head injury. What does question ask? Initial response Answer: 2. Look at the verbs. Suggest is only collaborative verb. Advise, tell and explain are authoritarian verbs.
Think about the most fulfilling relationship that you have experienced with a client, one in which you felt you made a difference. 1.What were some of the aspects of this relationship that made it fulfilling? 2.How did you make a difference? 3.What communication skills did you use?
Now think about a relationship with a client that was the least fulfilling; one in which you think that you did not help. 1.What are some of the aspects of this relationship? 2.What happened and why?