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1 Communication N001 Spring 2013 2 Student Learning Outcomes In addition to course SLO # 3 Please review lecture specific SLO's on Course objectives,

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Presentation on theme: "1 Communication N001 Spring 2013 2 Student Learning Outcomes In addition to course SLO # 3 Please review lecture specific SLO's on Course objectives,"— Presentation transcript:

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2 1 Communication N001 Spring 2013

3 2 Student Learning Outcomes In addition to course SLO # 3 Please review lecture specific SLO's on Course objectives, lecture & lab outlines

4 NCLEX ® Question 3

5 4 Overview  Introduction  Stress & Coping  Verbal communication  Nurse client relationship  Interviewing  Communication with other members of the health care team  Chain of command  Define collaboration

6 Introduction Part I “ Communication is an essential part of patient centered care. Patient safety also requires effective communication. (Potter 8 th ed. P. 309) 5

7 Introduction  Nurses need to know about stress so that they can recognize it in the clients, families, & themselves  Stress ….”Physical, emotional, or psychological demand that often leads to growth or overwhelms a person and leads to illness (Varcorlis & Halter 2010) Potter & Perry p

8 Caring & Empathy  Caring is a universal phenomenon influencing the ways is which people think, feel, and behave in relation to one another (Potter)  Empathy is the ability to understand and accept another person's reality …. (Potter) 7

9 Physiology of Stress 8  Fight or flight response due to the arousal of SNS  Increased heart rate, shift of blood from extremities to core  Engaging the Medulla oblongata, reticular formation, & pituitary gland

10 General Adaptation Syndrome  Alarm reaction  Hormones activated  Pupils dilate  Resistance stage  Stabilization and repair  Exhaustion stage  Body can no longer resist effects  Death may result 9

11 Coping  Individual’s effort to manage physiological stress  Coping strategies  Effectiveness impacted by age, experience & cultural background  Strategies differ according to the stressor 10

12 Coping  Individual’s effort to manage physiological stress  Coping strategies  Effectiveness impacted by age, experience & cultural background  Strategies differ according to the stressor 11

13 Coping Strategies  Effectiveness impacted by age, experience & cultural background  Strategies differ according to the stressor  Most individuals use a combination of problem focused and emotion focused coping strategies 12

14 Coping Strategies  An individual may seek info and takes action as way to deal with it (problem focused)  While others or at another time might avoid thinking about the situation (emotion focused coping) 13

15 Ego Defense Mechanisms  Help regulate emotional distress  Denial  Regression See (Potter & Perry) for a more complete list 14

16 Impact on Nursing  Nursing is responsible for developing interventions to prevent or reduce stress  Client must initiate the change  Accurate assessment critical  Effective communication vital 15

17 Critical Thinking Includes:  Curiosity  Motivated to learn more  Creativity & Perseverance  Attitudes that assist the nurse to communicate and identify innovative solutions 16

18 Critical Thinking  A self confident attitude  Attitude of fairness  Listens to both sides of the issue 17

19 Critical Thinking  Humility  Willingness to ask for help  Appropriate approach for each situation 18

20 19 II. Elements of Communication  The referent – motivation  The sender – encodes & sends message  Includes feelings  Ensures accuracy  The receiver – decodes & receives message  Sender’s message acts as referent  Must translate & respond to message

21 Elements  The message – verbal, nonverbal, & symbolic language  “Meaning comes from individuals and their unique perspective” (Schuster & Nykolyn 2010)  “ Exciting” – means …  The channels –means of conveying & receiving messages  Auditory, tactile, & visual  Written or non written  Feedback – message thru receiver receives and returns 20

22 Elements of Communication  Interpersonal variables- factors within both the sender & receiver  Impacts perception  Environment- where the communication process takes place  Example need for privacy 21

23 Verbal Communication: Overview  Vocabulary  Denotative meaning  Common meaning  Connotative meaning  Interpretation of the word based on thoughts or feelings people have about the word  Pacing  Intonation 22

24 Verbal Communication  Clarity  Brevity  Timing  Relevance 23

25 Nonverbal  Personal appearance / Presentation of self  Posture & Gait  Facial expression  Eye contact  Cultural ramifications  Gestures  Sounds 24

26 25 Presentation of Self  Breath and depth of knowledge  Flexibility  Enthusiasm  Sincerity  Self perception

27 26. Presentation of Self First impressions Communication enhanced by your credibility Good personal hygiene Good grooming Appropriate uniform

28 27 Types of Personal Space  Intimate – 0 to 18 inches  May produce discomfort, anxiety or fight or flight response  Explain to client what & why  Respect client’s space  Do not whisper but speak quietly & clearly  Avoid eye contact during intimate care

29 28 Personal Space  Personal zone to 4 feet  May produce discomfort, anxiety or fight or flight response  Usually maintained with friends  Able to read nonverbal communication  Conversation  One to one teaching

30 29 Personal Space  Social zone– extends 4 to 12 feet  Communication – formal  Conducting a group  Sensory involvement less intense  Increased eye contact

31 Personal Space  Public zone  12 feet and beyond  Lecturing in a classroom 30

32 Zones of Touch  Nurses use touch  Caring touch, Task touch, Protective touch (Schuster & Nykolyn )  Social –permission not needed ex. hands  Consent – permission is needed  Mouth, wrists, feet  Vulnerable – special care  Face neck / front of the body  Intimate – sensitivity important  Genitalia & rectum (Potter box 24 –3) 31

33 Forms of Communication  Symbolic  Art & Music  Metacommunication  All factors that influence communication  Written communication 32

34 IiI. Nurse Patient Helping Relationships 33 y_nurses_201.jpg

35 Nurse Patient Relationship  Nurse Client Relationship  Student/RN – professional relationship  Therapeutic climate that facilitates positive change  Goal  - clients to achieve optimal personal growth (Potter & Perry 8 th ed. ) 34

36 Nurse Patient Relationship  Includes  Specific time frame  Goal directed approach  Confidentiality  Nonjudgmental  Focus on client's needs 35

37 Phases of the helping relationship Pre interaction Before meeting the client Review data Anticipate concerns Plan time frame and location Orientation Client and nurse begin to know one another Nurse presents positive attitude Client may test RN Prioritize client’s needs identify problems Clarify roles Discuss termination (Potter) 36

38 Phases of the helping relationship  Working  RN & client work together to solve the issues  Assist the client with self exploration  Take action  Use therapeutic communication to achieve goals  Termination  Ending of relationship  Remind client end of relationship is near  Evaluate goal achievement (Potter) 37

39 Professional Relationships  Nurse family relationships  Process is similar to assisting individuals  Take into account family & group dynamics  Family roles & responsibly  Nurse Community relationships  Participation in local activities  Leadership 38

40 Health Care Team Relationships  Collegial relationships  Focused on the client safety and the role that the health professional s have in taking care of that client  Communication  Respectful  Clear  Concise  Collaboration 39

41 Strategies for Health Care Team Communication & Collaboration  Respectful  Active listening  Try to understand the other individual’s view point  Identify bottom line – client safety  Be direct  Use “I” statements  Learn to say I was wrong  Adaptability  Flexibility & Adaptability 40

42 Clinical Assignment  Interviewing members of the health care team 41

43 Institutional Relationships  Chain of command  Process for communication client status  Process of communicating concerns  Important to identify the sequence  Example - EVC Nursing students  Collaboration  “Different perspectives are synthesized for better understanding of complex problems 42

44 SBAR 43

45 IV. Application of the Nursing Process 44

46 Assessment*  Note the context(helps determine meaning) of the situation that influences the communication (Potter)  Psycho physiological context  Internal factors  State of health & age, attitudes, perceptions etc.  Rational Context  Relationship between participants  Trust & Caring 45

47 Assessment  Client interview  Situational context  Reason for the communication  Environmental context  Privacy  Noise level  Cultural Context  Socio cultural elements that impact the communication  Culture influences feelings, perceptions & behaviors  Language Spoken (use of interpreter)  Gender, education level, economic status 46

48 Nursing Diagnosis  1.  2.  3.  4. 47

49 Nursing Process (Goals & Planning)  Planning your interventions – to meet the needs of your specific clients  Motivation  Priority setting  Setting goal for interview or intervention  Insuring continuity of care  Communication with others caring for these clients  Will need to apply refine these concepts when education clients 48

50 Implementation Therapeutic communication techniques  Active listening  Attentive to client  Sit facing client  Observe open posture  Lean toward client  Establish and maintain intermittent eye contact  Relax (calmness) 49

51 Implementation  Sharing observations  Comment on how other person looks, sounds or acts  Sharing observations  “I see you have not eaten today.”  Sharing empathy  “Ability to understand and accept another person’s reality”  Reflect the importance of what the other person has said on a feeling level  “It must be very frustrating to know what you want and not be able to do it.” (Potter) 50

52 Implementation  Sharing hope  “  Sharing humor  ‘ 51

53 Implementation  Sharing feelings  Making observations  Acknowledging feelings  Give permission to express negative feelings  Sharing feelings of caring are appropriate  The focus should be on the client not on the nurse  Using touch  Most personal  Appropriate – example touching some one’s hand is ok  Gentle yet firm 52

54 Implementation Use of silence ‘ Providing information Relevant Sensitively Clarifying Check if the interviewer's understanding is accurate Ask the client to restate “I am not sure I understand what you mean when you use the phrase …” 53

55 Implementation  Focusing  Centering on key elements  Use to guide the discussion – so not interrupt the client  Paraphrasing  Briefly restating the other’s message  Requires practice  States “I have been overweight my whole life.”  RN responds “You are not convinced you need a diet” 54

56 Implementation Asking relevant questions Seeking information necessary for decision making Summarizing Concise review of key aspects of the interaction Self disclosure by the nurse ‘ 55

57 Implementation Confrontation Assist the individual to become aware of inconsistencies Improves client self awareness Only use after trust has been established 56

58 Implementation *  Open ended and closed ended questions  Open- ended questions  Ask for longer interpretative response  Phrased as a request  “Describe your symptoms  Closed questions  Call for specific, short, responses  Do you have pain 57

59 Clinical Skills Lab Assignment Posted on Moodle 58

60 Implementation: Focus older adults  Obtain the client’s attention before beginning  Assist client with glasses and hearing aides if necessary  Make sure your face is visible to the client  Well lit environment  No glare  Lower register of voice  Provide time for questions  Approach client as adult 59

61 Implementation: Cultural competence  Keep instructions simple & to the point  Incorporate member of community or family  Negotiate if necessary  Interpreter:  Professional  Working with  Written materials – can client read in their own language  Videos 60

62 Implementation  Be sure and review the chart in Potter & Perry  Page 357 – that focuses on clients with special needs. 61

63 Implementation  Documentation 62

64 Evaluation  Communication analysis  Are client able to state in their own words – what was discussed.  In lab exercise  Were the goals of the therapeutic communication met?  Were there any missed verbal and nonverbal cues? 63

65 Nontheraepeutic Communication Techniques 64  Asking personal questions  Giving personal opinions  Changing the subject  Autonomic responses  False reassurance  Sympathy  Asking for explanations  Approval or disapproval  Defensive responses  Passive or aggressive responses  Arguing  Use of idioms

66 V. Student responsibilities  Communication with team leaders  Check in – Report  Check out – Report to RN  Update client status – ex vital signs, care etc (SBAR)  Situation  Background  Assessment  Recommendation 65

67 66 Clinical applications  Address client formally –  “Introduce yourself  “Tell them what you are going to do and obtain their consent. (within reason)  Remember – do not whisper and avoid eye contact during intimate care

68 Demonstrating Caring by Expressing Empathy Adapted from Marilyn Tagatac’s Presentation Physiology of Compassion 8/5/2009 Slides

69 Empathy  Use of Therapeutic communication  Giving broad openings  Encouraging description of perceptions  Verbalize the implied  Inquiring about client’s decisions  Empathetic response can be learned  Sincere  Inquire about client’s feelings  Validate your observations with the client  Try to be in tune with client’s style 68

70 Empathy  Steps  Enquire/explore client’s feelings in order to accurately identify them  You feel __________________-?  Because _________________ the reason the client identifies the feeling 69

71 Class exercise #1 70

72 In class exercise Part II 71

73 72 Remember  “ I feel” statements  Reflection  Citing specific behaviors  Asking for feed back  Open ended questions

74 Final Words Communication Should Be  Complete  Clear  Concise  Cohesive  Courteous 73

75 74 Summary  All parties must participate in the communication process.  The verbal and nonverbal message must be congruent  How you present your self can impact the dialogue  Important to treat everyone in a respectful manner

76 75 References Doenges, M.E,, Moorhouse, M.F. & Murr, A., (2010) Nursing diagnosis manual (3 rd ed.) Philadelphia, PA: F.A. Davis. Potter, P.A., Perry, A. G. (2013) Fundamentals of nursing (8 th ed.) St. Louis, MO: Mosby. Schuster, P. M. & Nyklolyn, L. (2010) Communication for Nurses. Philadelphia, PA: F.A. Davis. Tagatac, M., Presentation Physiology of Compassion 8/5/2009

77 References  px px  rvices/ps_images/36.jpg (this link does not open) rvices/ps_images/36.jpg  jpg (this link does not open) jpg  fetyGeneral/Tools/SBARTechniqueforCommun icationASituationalBriefingModel.htm fetyGeneral/Tools/SBARTechniqueforCommun icationASituationalBriefingModel.htm 76

78 References  Google Images  Microsoft Word images 77


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