Important to consider:

1. Non-therapeutic techniques.Barriers to effective communication.Communicating with the angry, demanding or manipulative patient.

2. Important to consider: • psychological and emotional state of the patient • spiritual elements • financial state • educational background • mental state • social well being • familial aspects • physical state

3. It is important working with patient to think differently of:  • partnership • consumer rights • consultation • not forcing my views upon others • checking out with people what they want • giving people options.

4. Subjective data • Client—'I feel really awful, hot and dizzy all the time.' • Client—'They told me it was really bad, much worse than they thought.' • Husband—'She went through a really bad patch after her dad died.' • Nurse—'He looks depressed to me.' • Client—'Fit as a fiddle all my life nurse, can't understand what all the fuss  is about.'

5. Objective data • measurements (like a client's temperature) • examination (like listening to the client's chest sounds with a stetho-scope) • laboratory tests (like blood or urine) • past records (previous admission notes etc).

6. Loss, bereavement and grief • abbreviated grief • actual loss • anticipatory loss • bereavement • death • dysfunctional grief • grief • inhibited grief • loss • mourning • pathologic grief • perceived loss • physical loss • psychological loss • terminal illness • unresolved grief.

7. Care of the dying • construct a list of common psychological and physical problems associated with dying • Suggest how these problems could be rephrased into a possible nursing diagnosis •  What would the nursing goal be for each of these problems? • Outline nursing interventions for each of these problems •  What would the desired outcome-criteria be for clients with grief and loss and the physical symptoms related to dying?

8. assist the family in dealing with the impending death of a loved one • facilitate their - -  coping response, -  readjustment -  bereavement and -  participation in care.

9. Modes of communication • Verbal communication - spoken or written word • Be aware of: • vocabulary - various subcultures • clarity and brevity • use layman’s terms – denotative and connotative meaning • pacing when speaking • Intonation

10. Verbal communication • Timing and Relevance • Humor

11. Nonverbal Communication • Transmission of messages without the use of words • Factors • Personal appearance • Facial expression • Posture / Gait • Eye Contact

12. Nonverbal communication factors • Gestures • Touch • Territoriality and Space

13. Factors to influence communication • Perceptions - personal view of events • Values • Emotions • Gender • Knowledge • Roles and relationships

14. Factors to influence communication • Sociocultural background • European Americans more open • Native Americans comfortable with silence

15. Zones of Personal Space • Intimate (0-18 in) • Personal (18-4ft) • Social (4- 12 ft) • Public (12 ft or greater)

16. Forms of Communication • Therapeutic- Communication that is beneficial in developing a nurse-client helping relationship • Non-Therapeutic- Communication that is not beneficial or helpful to people involved

17. Therapeutic Communication • Listening - nonverbal; conveys interest in the client; active listening • Listening vs. Hearing • Nod as client speaks • Appear attentive • Conveying Acceptance - listen without judging

18. Therapeutic Communication • Paraphrasing • Focusing - centering information on the key elements of the message • Stating observations • Clarifying • Focus • Assertiveness • standing up for one’s rights without violating those of others • Summarizing - concise review of main ideas • Appropriate self-disclosure

19. Barriers to Effective Communication • Inattentive listening • Medical vocabulary • Giving personal opinions • Being defensiveness • Showing disapproval • Cultural differences • Prying • Offering false reassurance • Being defensive • Asking why • Stereotyping - generalized beliefs held about people • Changing the subject inappropriately • Showing approval or disapproval

20. Components of helping relationships • Trust - Belief that other people will provide help in times of need and distress • Empathy - Ability to try to understand and enter the patient’s frame of reference • Sympathy - expression of one’s own feelings about another’s predicament

21. Components of caring relationships • Caring - positive regard for another person • Availability • Courtesy/Confidentiality • “ A Professional”

22. Communication with special populations • Children • Nonverbal messages - avoid sudden movements or gestures • Calm and gentle • Be honest • Short simple concrete sentences and explanations

23. Communication with the older adult • Changes in hearing • Tinnitus • Decrease in visual acuity

24. The Nurse-Client Helping Relationship Helping relationships are created through the nurse’s: • Application of scientific knowledge • Understanding of human behavior and communication • Commitment to caring • *Therapeutic communication doesn’t happen. You have to work at it.

25. Phases of Nurse/ Client Relationships • Pre-interaction Phase • Orientation Phase • Working Phase • Termination Phase

26. Pre-interaction Phase • Before meeting client • Review data available ( diagnosis, medical history) • Assign appropriate room • Anticipate concerns or needs

27. Orientation Phase • Introduce yourself • Set a positive tone with a warm empathetic manner • Assess client health status • Prioritize needs and goals of your client • Clarify client’s and your roles • Let the client know when to expect the relationship to end

28. Working Phase • Encourage and help the client express feelings • Encourage and help client set goals • Take action to meet the goals set the client

29. Termination Phase • Remind client that termination is near • Evaluate goal achievement • Help to achieve a smooth transition to other caregivers

30. Techniques for improved therapeutic communication • Professionalism • Courtesy • Confidentiality • Availability • Trust • Empathy • Sympathy • Acceptance • Respect • Silence • Hope • Encouragement • Socializing • Gender/Cultural sensitivity

31. Communication-Nursing Process • Assessment • Physical and Emotional Factors • Developmental Factors • Sociocultural Factors • Gender

32. Communication-Nursing Process • Nursing Diagnosis • Impaired verbal communication • Anxiety • Social isolation • Ineffective coping • Impaired social interaction • Powerlessness • Planning • Goals and outcomes; priorities; continuity of care.

33. Therapeutic Communications Implementation • Attentive Listening • Sharing observations • Sharing empathy • Sharing hope • Sharing humor • Sharing feelings • Using touch • Using silence • Providing information • Clarifying

34. Therapeutic Communication -2 • Focusing • Paraphrasing • Asking relevant questions • Summarizing • Self-disclosure • Confrontation

35. Barriers to Effective Communication-2 • Arguing • Passive or Aggressive Responses • Defensive Responses • Asking personal questions • Sympathy and not empathy

36. Communication-Nursing Process - Evaluation • Analysis of communication patterns • Process recordings • Evaluate goal of improving communication. • If goal unmet, utilize new and different nursing interventions.

37. CommunicationSummary • Communication is important. • Collect data and establish trusting relationship. • Share information with other team members. • Implement care and evaluate goals .

38. Critical Thinking Exercise • Mr. Phillips is a 70 year old resident of the long term facility, who has begun making inappropriate sexual comments to the staff. He asks staff members for a “little hug” ( and worse ) and tries to pull young female members of the staff into empty rooms. The Nursing Assistant have asked you to help them create a plan to “deal with this”. What will you do then?”

39. Thank you for your attention!