Professional and Therapeutic communication notes for Exam 1 PDF

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Exam study guide for Professional and Therapeutic communication exam 1...

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Professional and Therapeutic Communication

Chapter one: The meaning of interpersonal communication: Communication involves the reciprocal process in which messages are sent an received between two or more people. -can create barriers or facilitate the development of relationships - the vehicle in establishing a therapeutic relationship There are two parts to face- to- face communication 1. The verbal expression of the sender’s thoughts and feelings 2. The nonverbal expression  

Verbally, Cognitive and affective messages are sent through words, voice inflections, and rate of speech Nonverbally, messages are conveyed by eye movements, facial expressions, and body language, smiling

Senders determine what message they want to transmit to the receiver and encode their thoughts and feelings into words or gestures  Sent through sound, sight, touch, and occasionally smell or taste Receivers of the messages have to decode the verbal and nonverbal transmission to make sense of the thoughts and feelings communicated by senders In interaction between two people (a nurse and a client), each person is both a sender and a receiver, and each person alternates between these two roles  When senders are speaking, they are also receiving messages from the person who is listening

Variety of factors that can affect the exchange of messages between people….  Environmental factors: formality, warmth, privacy, familiarity, freedom or constraint, physical distance between people, climate, mood, architecture, arrangement of furniture  Territory and personal space: crowding, seating arrangements, roles, status, position, physical characteristics (size, height)  Physical appearance and dress: body shape, race, body smell, hair, gender, body movements, body adornments, posture, age  Nonverbal cues: facial expressions, eye movements, vocal cues

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Intrapersonal factors: development stage, language mastery, differences in perception, differences in decision- making processes, differences in values self-concept The use of “I” messages to own one’s responses, such as “I don’t agree with you” instead of “you”” messages, which sound blaming, such as “you are wrong”

An important function of communication is to transmit messages from one person to another. *The real purpose of communication is to create meaning*  Senders chose certain words and gestures in a manner that they believe is congruent with their intended messages  The sender’s objective is to transmit a message to receivers that is clear and understandable. The real purpose of creating understanding in another person is to influence the other person to effect some change. The senders attempt to persuade the receiver to respond to the sender’s requests.  Requests from clients and colleague may be for the following… o Understanding o Action o Information o Comfort  Requests may be stated in a direct or indirect way -direct request is info ab time of last meal -indirect request is info about when he can have more of that painkiller Important Functions of Interpersonal Communications  Communication is the vehicle for establishing a therapeutic relationship  Communication is the means by which people influence the behavior of others, thus it is critical to the successful outcome of nursing intervention  Communication is the relationship itself because without it, a therapeutic nurse- client relationship is impossible

Assertiveness: is the ability to express your thoughts, ideas, and feelings without undue anxiety and without any expense to others. “Being clear about what you need, and respectful in your language and behavior”  Assertiveness, a key to successful relationships for the client, the family, the nurse, and other colleagues, reduces interpersonal stress, builds team relationships, improves nursing care, and promotes patient safety Assertive behavior: which is an active behavior, is contrasted with nonassertive or passive behavior, in which individuals disregard their own needs and rights; must be confident and comfortable -assertiveness helps you give or receive immediate feedback about a behavior that might have serious consequences – this positive pushback is lifesaving Aggressive behavior: when individuals disregard the needs and rights of others When you decide to use an assertive response, remember to consider 3 essential criteria for success  Timing  Content  Receptivity Assertive Rights: 1. You have the right to be treated with respect 2. You have the right to a reasonable workload 3. You have the right to an equitable wage 4. You have the right to determine your own priorities 5. You have the right to ask for what you want 6. You have the right to refuse without making excuses or feeling guilty 7. You have the right to give and receive information as a professional 8. You have the right to act in the best interest of the patient 9. You have the right to be human

Irrational Beliefs Irrational beliefs arise when we are anxious about being assertive and focus on possible negative outcomes. The rational counterparts focus on possible positive outcomes.  Irrational belief o If I am assertive, other people will be upset, hurt by it, or angry with me o If someone gets angry with me, I will be devastated o Assertive people are seen as cold and self-serving o It is wrong for me to turn down legitimate requests

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Rational counterpart o The other person may not be hurt or angry. This person might prefer being open and honest. This person might feel closer to me and help me solve the problem. o I will not fall apart in the face of anger. The anger is not my responsibility. An angry response is a chouse o Assertive responses are honest and demonstrate respect for the other person’s point of view. Assertiveness builds healthy relationships o It is acceptable for me to turn down even reasonable requests. I can consider my own needs first, and it is not possible to please all of the people all of the time

Anatomy of an Assertive Response A framework for developing assertive responses known as the DESC script. Although not all steps are used in every situation, it is a useful tool:  Describe the situation  Express what you think and feel  Specify your request  Consequences Types of Assertions: 1. Basic: simply expresses an idea, belief, or opinion; stands up for your rights or the rights of others, for example… “I want too…” “I don’t want you too….” “Would you….?” “I liked it when you….” a. To buy time to consider: “I can give you an answer tomorrow after o have had time to think about it” b. To deal with an interruption: “Excuse me, I am almost through. I’d like to finish my thought.” c. To return merchandise: “I am not satisfied with this product, I would like a refund” d. To say no: “I cannot loan you any money” 2. Empathic: conveys sensitivity to the situation while taking an assertive position a. “I know the unit is short staffed, but I have a pressing personal commitment and cannot work a second shift” b. “I know you cannot tell me the exact time the computer technician will arrive, but I have a full day and would appreciate knowing if it will be the morning or afternoon” 3. Escalating: Expresses your needs more empathetically when a simple assertion did not accomplish your goals, and your rights are being violated a. “I told you that as a nurse I cannot have a social relationship with you. I must insist you refrain from asking me personal questions”

b. “I asked you not to use my computer without permission. You have turned it off improperly and some files have been damaged. Please do not use it again.” An Assertive Nurse  Appears self-confident and composed  Maintains eye contact  Uses clear, concise speech  Speaks firmly and positively  Speaks genuinely, without sarcasm  Is nonapologetic  Takes the initiative to guide situations  Gives the same message verbally and nonverbally Advantages of Assertive Behavior  It is more likely you will get what you want when you ask for it clearly  People respect clear, open, honest communication  You stand up for your own rights and feel self-respect  You avoid the invitation of aggression when they right of others are violated  You are more independent  You become a decision maker  You feel more peaceful and comfortable with yourself Assertive communication skills make interaction more equal -healthy attitude of mutual respect -helps build trust between people -trust is built when healthcare professional acknowledge their wrongs and work to find ways to avoid future mistakes -90% of healthcare errors involve communication Responsible – “liable to be called on to answer” -can be a simple statement of caring -to communicate in a logical way based on your nursing knowledge and on facts presented in the situation The nursing process is a systematic means for nurses to demonstrate accountability and responsibility to clients… It is organized into 5 phases  Assess o Collect information about the client, family, and community to identify the clients needs, problems, concerns and responses  Diagnose

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o Critically analyze and interrupt the data collected and draw conclusions to identify nursing diagnoses that provide a focus for the rest of the process Outcomes/Planning o Establish priorities in the problems identified in the nursing diagnosis. Include the client and at times the family to create a plan of care that prescribes interventions to attain expected outcomes. Organize our communication strategy such as what the care plan will contain and when, how, and where you will present it Implement o Implement the interventions identified in the plan of care Evaluate o Conduct an ongoing evaluation of the client’s progress toward attainment of outcomes. This is the phase in which you check whether your response was assertive and responsible, and where your objectives were attained.

A problem solving process becomes a way of examining every client-nurse interaction A Nurse who communicates Responsibly…  Is naturally focused on the nursing process and problem- solving process  Considers the world of the client and the client’s family  Performs the role of client advocate  Appreciates the sacred role of intimate care of the sick  Maintains a sense of wonder at the human experience and treats each person as an individual  Is open to learning to trust intuition as another way of knowing about the client Building communication skills supports your contribution to delivery of safe care The Meaning of Caring  You need to be caring to facilitate a change in behavior  Basis of the nursing profession Swanson’s Five Caring Processes 1. Maintaining belief: sustaining faith in the capacity of others to transition and have meaningful lives 2. Knowing: Striving to understand events as the have meaning in the life of the other 3. Being with: being emotionally present to the other 4. Doing for: doing for the other what they would do for you

5. Enabling: facilitating the capacity of others to care for themselves and family members -this model of caring based on the belief in person’s capability to manage their own lives combines nursing compassion and competence to support a patient’s healing Caring communication is holistic, focusing on the entire person and demonstrating respect We must find out what is perceived as important to our clients and adjust our actions in keeping with their needs Learning involves three domains- cognitive aspects (understanding and meaning), affective aspects (feelings, values, attitudes) and psychomotor aspects (physical capability) Cognitive Domain: Basic Communication Competencies  The ability to demonstrate knowledge of the appropriate communicative behavior in ANY situation  Demonstrated by the identification of behaviors that would be appropriate or inappropriate in an observed interpersonal situation Affective Domain: Belief in the Value and Impact of Positive Communication  A belief in the value and effect of positive communication motivates the nurse to seek feedback and practice self-care strategies that build confidence

Psychomotor Domain: Putting it all together / using skills in the real world  To be a skilled nurse communicator you must be able to successfully implement communication strategies that are assertive and responsible  Consider the word “self-less” o It is a word we associate with altruism (doing good or others)  Self-care is also crucial o To be a successful nurse you have to take care of yourself before you can take care of patients o You cannot give what you don’t have

Chapter 2: The Client-Nurse Relationship: A Helping Relationship Nurses practice anticipatory compassion when we prevent suffering and we take steps to prevent it Nature of the Helping Relationship  A helping relationship is established for the benefit of the client- help client achieve optimal health  A successful helping relationship between nurse and client represents an order of interaction that is different from what occurs in friendship  Mutual benefit of client and nurse o Clients are satisfied when their healthcare needs have been met while nurses feel satisfied and accomplishment when their client’s needs are met o Nurses must educate patients so they can make informed decisions about their healthcare o Nurses are responsible for encouraging the interchange of ideas, values and skills Cognitive, Affective, and Psychomotor Abilities in the Therapeutic Encounter What CLIENTS bring to the Client- Nurse Relationship:  Cognitive o Preferred ways of perceiving and judging o Knowledge and beliefs about illness in general and their illness in particular o Knowledge and beliefs about health promotion and maintenance in general and information about their own healthcare activities o Ability to problem solve o Ability to learn  Affective o Cultural values o Feelings about seeking help from a nurse o Attitudes toward nurses in general o Attitudes toward treatment regimen o Values about preventing illness o Willingness to take positive action about own health status at this time with this particular nurse  Psychomotor o Ability to relate to and communicate with others o Ability to perform own healthcare management o Ability to learn new methods of self-care What NURSES bring to the Client- Nurse Relationship:

Cognitive o Preferred ways of perceiving and judging o Knowledge and beliefs about illness in general o Knowledge about their clinical specialty and knowledge and beliefs about health behaviors that prevent illness and promote, regain and maintain health o Ability to problem solve o Knowledge about factors that increase client compliance with the treatment regimen 2 perceiving processes:  Concrete details- sensing  patterns in data, explanations, working backward-intuitive  Judging – the process of making decisions about the information collected through perception is a mental process in which nurses and clients may differ-fit experiences into logical mental systems -objective  Vs. Subjective- make decisions by analyzing how they will affect people 

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Affective People view health from four different models: -the clinical model- absence of disease -role performance model- person is able to perform his/her role in life -adaptive model-health determined by persons ability to cope with stress -eudemonistic model- health is perceived as a quality of life and have meaningful relationships Cultural patterns -people adapt to recurrent change in their environment Cultural values Feelings about being a nurse helper Attitudes toward clients in general Biases about nursing treatment regimen Value placed on being healthy Value placed on people’s active prevention of illness or enhancement of well-being o Willingness to help clients take positive action to improve their well-being Psychomotor o Ability to relate to and communicate with others o Proficiency in administering effective nursing intervention o Ability to teach nursing interventions to the client o o o o o o

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Clients Rights in the Helping Relationship

Clients have the following rights…  To expect a systematic and accurate investigation of their health concerts by thorough and well-organized nurses  To be informed about their health status and have their questions answered so that they clearly understand what nurses mean  To receive healthcare from nurses who have current knowledge about their diagnosis and are capable of providing safe care  To feel confident that they will be treated courtesy and nurses show genuine interest  To trust that the confidentiality of a patient will be respected  To be informed about plans of action to be performed in their benefit  To refuse or consent to nursing treatments without jeopardizing relationship with nurse  To secure help without a hassle  To receive consistent quality of care from all Characteristics of Client- Nurse Helping Relationships 1. Mindful presence and genuine concern based on an understanding that nurses have an ethical imperative for self-care 2. A purposeful and productive objective 3. Competence, creativity, practicality and safe practice in handling concerns 4. Maintenance of the client’s present level of health and protection from future health threats 5. Easing of clients worries and dears 6. Consistency 7. A series of phases, with a beginning (initiation), middle(maintenance), and end(termination) 8. Individualized care 9. Safe space and privacy 10. Professional boundaries

Pointers to guide you in your client-nurse helping relationship DO  Be punctual and polite  Praise and encourage clients in their efforts  Be patient and understanding DON’T  Patronize clients  Use labels such as “good”, “lazy” or “uncooperative”  Procrastinate  Make a promise you cannot keep  Judge or criticize  Seek to meet your own needs

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Odder information you are uncertain of

*mindful listening* LISTEN - Look at the other person -

Show Interest

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Stop talking… listen Think about what the other person is saying Use Empathy Never assume you know what the other means

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True presence – bear witness to the client’s experience, understand the clients perspective and respect the clients dignity Two relationships established by Buber I-It and I-thou The I-It relationship is experienced as nurses do work of patient care -experiencing and using The It-thou is characterized by intensity and directness – experienced with the entire being FOCUSED on moments of connection… being present 1. Feel a. Disconnect from personal distractions. Stay in the moment. Anticipate needs of client, families, staff and community. Be FULLY present, one thing at a time 2. Observe a. Look for opportunities to connect. Watch for signs of fear, anxiety, grief or confusion. Pay attention to verbal and nonverbal cues. 3.

Connect

a. Take the initiative to approach. Listen, speak, touch, share, recommend resources, offer a private place, offer a drink 4. Understand a. Seek first to understand before to be understood. Share meaning in the illness experience. Consider the lessons you learn. 5.

Share

a. Share stories of moments of connection. Celebrate the connections. 6. NOW … to stay FOCUSD …. we… 7. Energize a. Find ways to restore energy

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Disconnect a. Take time to be alone, use inner resources

Caring nurse observation tool- measure verbal and nonverbal caring actions 6 values in nursing worth striving for -trust -nearness -sympathy -support -knowledge -responsibility Power of pause in healthcare- mindful breaks that build resilience to stress and make it possible for healthcare staff to be fully present The nurse implements the nursing process based on the client’s experience and clarifies the clients and nurses responsibilities Prescence is the art of nursing Technological Competence is a component of care -another way of knowing about the patient -follow critical pathways to deliver nursing care Baldwin- “a storycatcher is a practitioner of th...