Rachel Natividad, RN, MSN, NP

1. Rachel Natividad, RN, MSN, NP

2. Have you ever been nailed by nasty remarks from a hostile friend, family member, or stranger? Ever been bashed by comments and criticisms from colleagues? How did you react? Did you gracefully defuse the situation? Communication

3. Communication defined… • “The exchange of information which involves both sending and receiving messages between two or more people…”.(Timby, 2005) • “The process of sending and receiving messages by means of symbols, words, signs, gestures, or other actions”. (Smith, Duell, & Martin, 2004)

4. Describe a situation in which you did not communicate effectively and the result. • What could you have done differently?

5. Effective Communication in Nursing Increases patient satisfaction and health outcomes Decreases risk of complaints and litigation Increases level of job satisfaction

6. Elements of Communication • Sender • Message • Receiver • Feedback • Meaning (sender/receiver)

7. Language is inherently ambiguous… Communication can be confusing!!! Ambiguous Picture

8. Communication Patterns • Verbal • Tone • Nonverbal • Facial expressions • Gestures • Eye contact • Body language Verbal 7% Tone 38% Nonverbal 55%

9. Face talks…

10. Communication in Nursing • Nurse-client relationship - Therapeutic Relationship- • Client-centered

11. Case Study: The First Encounter

12. Phases of Therapeutic Relationship • Introductory phase - initiation or orientation phase • Working phase– facilitating the relationship • Termination phase– relationship comes to an end

13. Case Study Resolution: The First Encounter • Attempt to identify the source of hostility • Allow client to verbalize feelings, fears, concerns • Offer explanations and explain the purpose of the procedures/medications.

14. Case Study Resolution: The First Encounter Acceptable responses: • “You sound upset this morning.” • “Mrs. T, it is difficult to be a patient. You haven’t had much time to yourself.” • “When would you like me to bring your medicine?”

15. Listen… A poem by…. Anonymous

16. Changing the subject False reassurance Giving advice Incongruence Assumptions Invalidation Overloading Social Response Underloading Value judgements Blocks to Therapeutic Communication SDM

17. Acknowledgement Clarification Feedback Focus Incomplete sentences Listening Mutual fit or congruence Minimum verbal activity Nonverbal encouragement Open-ended questions Reflection Restatement Validation Therapeutic Communication Techniques

18. Case Study: Cultural Diversity (2)

19. Cultural Diversity • Slang terms and colloquialisms • Stress of illness – different meanings in various cultures • Eye contact, touch personal space – meanings vary among cultures

20. Assess language needs Approach patient slowly and greet her/him respectfully Do not raise your voice to be heard Allow sufficient time and a quiet setting Pay attention to nonverbals Try to mirror pt’s style of communicating Provide written material in patient’s language if available Let’s Communicate Transculturally!

21. Are you culturally competent? • “…learn the language that a majority of your clients speak – this will give you insight into the culture…”(Gaskill, 2002) • Greet or say words and phrases in the client’s language

22. Case Study Resolution: Cultural Diversity • Recognize impact of the client’s culture to communication style, health care and practices/beliefs • Consider cultural roots when continuing with the plan of care

23. Anxiety and Communication • How can stress/anxiety affect your communication with your clients? • How can stress affect client’s communication with you? • What techniques do you use to decrease your stress routinely? During exams?

24. Mild Moderate Severe Passive Assertive Aggressive Levels of Anxiety Communication Styles

25. A confrontation with Ms. Madd • You have just finished the change of shift report when Mrs. K confronts you at the nurses station. Due to a serious fall, Mrs. K’s sister M.L has sustained a cervical fracture that, in spite of numerous efforts, has not yet been stabilized. During the past few days…….(retrieved from www.nurseweek.com 1/20/05)

26. Be alert to s/s of anxiety Assist pt to verbalize feelings and concerns and try to ID source of anxiety Be understanding of pt’s feelings Avoid becoming tense or defensive Speak slowly and briefly, avoid empty phrases that does not help the situation Offer explanations of info if pt has misconceptions about the situation Assess the patient’s support system ID previously useful coping mechanisms Help the anxious client

27. Rather than just defend yourself and face the same problems over and over like Wiley Coyote, say what you are really feeling! Ask for help when you need it!

28. References • Timby, B. K. (2005). Fundamentals Nursing Skills and Concepts. 8th Ed. Lippincott Williams & Wilkins: Philadelphia, PA • Smith, S.F., Duell, D.J., & Martin, B. C., (2004). Clinical Nursing Skills: Basic to Advanced Skills. 6th Ed. Pearson Education Inc.: Upper Saddle River, NJ. • Sheldon, L.K. (2004). Communication for Nurses: Talking with Patients. Slack Inc: Thorofare, NJ. • www.nurseweek.com