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Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Unit 2 Nurse-Patient Communication: Patient-Safe Communication in Professional.

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Presentation on theme: "Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Unit 2 Nurse-Patient Communication: Patient-Safe Communication in Professional."— Presentation transcript:

1 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Unit 2 Nurse-Patient Communication: Patient-Safe Communication in Professional Relationships

2 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Chapter 6 Introduction to Nurse-Patient Relationships

3 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Nurse-Patient Helping Relationships  Phase I: Preinteraction  Phase II: Orientation  Phase III: Working  Phase IV: Termination

4 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Critical Thinking: Use the Patient-Safe Communication Process when:  Interpreting  Analyzing  Drawing conclusions  Solving problems  Making decisions

5 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety The Patient-Safe Communication Process

6 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety The patient-safe communication process leads to:  Recognition of patient needs  Identification of conflicting nurse-patient goals  Establishment of mutual goals  Appropriate use of patient-safe responses  Creation of common meaning  Formation of trusting relationship  Formation of collaborative relationship

7 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Flowchart of the Nurse-Patient Relationship

8 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Stress and Conflict in Patients/Families  All patients/families have reactions of emotional anxiety, tension, and fear as they face challenges needed to understand and manage a patient care situation  Reactions are both physical and emotional  Physical: Fight-or-flight response  Emotional: Tears, anger, inability to focus

9 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety  Do you get angry or cry?  Do you try to reason with the person upsetting you?  Raise your voice?  Remain silent and walk away?  Remain in control of verbal and nonverbal behaviors? When you are stressed and upset, what are your usual verbal and nonverbal behaviors?

10 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Universal Styles of Emotional Responses to Stress  Blamer  Placator  Computer  Distractor

11 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Blamer: Aggressive bully, hostile  “You” statements  Putdowns  Expressions of superiority  Loaded words to start fights  Interrupt, yell, call names, demand, give orders  Tense, loud words or deadly quiet  Cold, narrowed eyes  Hands on hips, finger pointing

12 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Placator: Wants to please everyone  Pleading looks, downcast eyes, soft voice  Difficult time making a decision  Stooped posture, nods head excessively  Fidgets, flutters, wrings hands, picks fingernails  Saying yes when really wants to say no  Apologize for things they did not do  Says cannot do something before even trying

13 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Computer: Nothing bothers me….  Quiet, aloof, reserved, withdrawn  Does not want feelings known  Does not discuss or show emotion (considered sign of weakness)  Difficulty responding when others express feelings  Tries to remain calm, no matter what  Face and eyes expressionless  Closed posture, upright

14 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Distractor: Disruptive  Talks incessantly  Talks nervously  Inappropriate laughter  Makes little sense  Expends a lot of energy but does not focus on problem or how to solve it

15 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Why do people act this way? Aggressive, passive, nonemotional, and disruptive people have low self- esteem

16 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety As a reaction to the stress and frustration in a situation, ineffective styles cover up:  Feeling isolated  Feeling helpless  Feeling incompetent  Feeling unloved

17 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety “I am unlovable and nobody cares about me. I have to act this way because it is how I am. I need to do this to survive.”

18 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Aggressive Blamer Believes  By yelling and giving orders, the person is strong and in control  If the person didn’t act this way, no one would do a thing  The person is feeling unloved; nobody cares  By getting others to obey, the person bolsters self- esteem  “I won’t let them put me down; I won’t be a coward….”  The person getting blamed feels fearful, helpless, and resentful

19 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety The Super-Reasonable Computer  Calm and collected on the outside, on the inside feels vulnerable and weak  Logic and ideas are all that count  Emotions are a sign of weakness  Rationalizes: “I’m not stupid; I’m too smart to make a mistake.”  Makes the other person feel inferior, stupid, bored, frustrated

20 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety The Passive Person Wants to Keep Everyone Happy  Wants to feel liked or loved  Wants to keep the other person from getting mad  Experiences guilt, pity, and contempt for the person who is being placated  Wants to please to “get on another person’s good side”  Rationalizes: “It is selfish not to do what is being asked”

21 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Disrupting Distractors:  Want attention  “Nobody cares about me”  Rationalizes: “It’s not good to be so serious; we should live it up.”

22 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Communicators Are Assertive and Empathic  Honest statements—direct and to the point  Controls temper  Recognizes and responds to emotions (empathy)  Posture open and relaxed  Direct eye contact, hand gestures and body movements slow and relaxed  Asks questions to understand and analyze a situation  Speaks up and asks for what he/she wants  Can say no without feeling guilty

23 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety We all need to:  Please others  Criticize others  Not get stepped on by others  Use our intellect and explain to others  Change the subject when appropriate How does an assertive/empathic person do these things?

24 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Assertive/Empathic Professionals  Accept responsibility and apologize for something done incorrectly or not done  When criticizing, evaluate the act rather than blame the other, and make suggestions for improvement  Show feelings while giving explanations  Clearly say the subject needs to be changed without confusing the other person

25 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Personal & Professional Rights Build the Foundation of Assertive Behavior  Right to be treated with respect  Right to be listened to and taken seriously  Right to change one’s mind  Right to a reasonable workload  Right to question and challenge  Right to make mistakes

26 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Why Aren’t More People Assertive/Empathic?  Fear making mistakes—no one is perfect  Fear not being liked— always someone who does not agree  Fear criticism— everybody can use some; no one is perfect  Fear imposing on someone—each time you speak & interrupt  Fear retaliation—legal counsel Most people admire others who have the courage to speak their mind, even if they do not agree

27 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Can we be assertive and empathic all the time, in all situations?

28 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Analyzing Situations That Are Stressful and Irritating  What upset you?  How did you react?  What did you want from yourself?  What did you want from the other person?  How can I manage this better in the future?

29 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Responding to Aggression: Hostility & Sarcasm  Assertiveness without regard for the rights of others is aggressive behavior—alienates others  People feel pushed to comply, even if it goes against their own feelings rights and needs

30 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Open Hostility  Expecting you to fight or give in to others  Don’t do either:  Let them blow off steam while you count to 10 and get some oxygen flowing to your brain

31 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Hostility  Don’t aggravate them by attacking in return: “How dare you speak to me that way!” “You must be crazy!” “How could you possibly think that?”

32 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for Hostility First get their attention: In a rage, the patient is not thinking or hearing; make a noise, drop a pen or chart….  When the patient hesitates: “I’d like to help you. Let’s go sit in the conference room and talk.”  Speak slowly, quietly; use calm gestures. If you slow down, so will the other person.

33 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for Hostility  Have the patient sit down. Sitting is a less aggressive position.  If the patient refuses to sit, you remain standing.  If you are sitting when approached by an angry person, stand up slowly and calmly and quietly ask the person to sit down.

34 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for Hostility  Listen attentively as the person explains  Send back what the person is telling you, using techniques such as empathy and restatement  Ask questions, without antagonizing, to get to the root of the problem  Always validate what you think the problem is

35 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-safe Strategies for Passive Placators  As you talk about goals and objectives, be nonthreatening  Watch out for unrealistic commitments  “If you have other things to do, I would appreciate if you would tell me that you can’t do what I’m asking”  “I know it is difficult to decide, no matter what you do. Someone is not going to be happy about the decision.”

36 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for the Person Who Can’t Say No The student nurse had given the home health patient a movie to view on balancing food, insulin, and exercise to discuss during the next visit in 2 days. Patient: “I wanted to watch it, I’ll get to it today. I’m spread too thin, I think. I can’t get things done. I’m wasting your time here. But my family comes first, and I had to take care of them. There’s been games to attend, homework, laundry, cooking….”

37 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Complainer  Complains to anyone who will listen but may not have social skills to talk to the person who is the source of the problem  Extremely negative  Keeps going over and over the same things  Looks for someone to act on his/her behalf and to solve the problem

38 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for Complainers  Complainers often speak in generalities; get them to be specific—who, what, when, where?  Then state the facts as you understand them

39 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Patient-Safe Strategies for Sarcasm  Less obvious form of disguised aggression  Insults, nasty remarks, cynical comments  Expect you to be hurt by the comment or to blow up:  Don’t do either  In a calm, quiet manner, ask: “Was there something in that remark you just made?”  “I don’t know what you meant by that comment; please explain it to me.”  If the person becomes angry and blows up, get the person to a private area

40 Communication for Nurses: How to Prevent Harmful Events and Promote Patient Safety Managing Stress in Patients and Families: Patient-Safe Professional Behaviors  Management of professional identity  Manners  Professional conduct  Appearance  Hairstyle, makeup, clothing, body adornment  Setting  Creation of a safe and confidential environment


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