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Patient Centred Care Course - Day Two

Patient Centred Care Course - Day Two. Leasa Knechtel, RN, MN CNCC(C), APN Critical Care & Cardiovascular ICU Ria Sp é e, RN, MSc. GNC(C),APN Sunnybrook Veterans Centre. Dialogue Expectations. PATIENT'S COMMENTS & NON-VERBAL ACTIONS

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Patient Centred Care Course - Day Two

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  1. Patient Centred Care Course - Day Two Leasa Knechtel, RN, MN CNCC(C), APN Critical Care & Cardiovascular ICU Ria Spée, RN, MSc. GNC(C),APN Sunnybrook Veterans Centre

  2. Dialogue Expectations PATIENT'S COMMENTS & NON-VERBAL ACTIONS • What the patient said verbatim (note this should be a word-for-word script and not a summary) • What the patient was doing while he/she said this STAFF THOUGHTS ABOUT PATIENT COMMENTS • What you felt or thought about the patient's statement and the patient's non-verbal communication at the time of the interaction

  3. Dialogue Expectations COMMENTS TO PATIENT • What you said (verbatim) or did in response to each of the patient's remarks and/or behaviour STAFF ANALYSIS OF STAFF COMMENTS A short discussion of what you believe the dialogue illustrates with respect to your interaction skills • A critical analysis of each of your statements with respect to whether it facilitated or blocked communication, changed or expanded the focus of the conversation • How statements reflected your own agenda, anxiety, strengths or areas for growth in interviewing skills • What you believe the dialogue illustrated about the patient's situation - how might you have handled the interaction differently?

  4. Dialogue Feedback • Open–ended questions • Identifying blocks • Remember to: • Stay with the meaning • Move with the rhythm • Go with the flow • Less is best

  5. Blocks to Communication Found in dialogues: • Yes/no questions • Who is leading? • Who is the expert? • Fixing &Telling • Interpreting, Assuming • How are you feeling? • Why? • What is your intent? • Whose agenda is it?

  6. Reassurance Pre-mature offering of services Validating Fixing Giving answers Acting on your need to “do” something Beitel, J. (1999) Overt power Persuasion Controlling the agenda Terms of endearment Hewison, A. (1993) Blocks to Communication

  7. Blocks to Communication • Giving advice is telling • Giving approval is giving permission • Giving reassurance is false cheerfulness • Interpreting/agreeing is making assumptions • Expressing disapproval is making judgments • Asking why? Is requesting an explanation

  8. Blocks to Communication • Belittling feelings is justifying yourself • Changing the subject is distracting or interrupting • Summarizing may be inaccurate • Paraphrasing may emphasize what is not important to the person

  9. Whose Reality Is It? • What aspects of the nurses’ approach made a difference in “Dialogue with your patient”? • What were the outcomes of the different approaches to the cognitively impaired person in the “Caring for Confused Elders” article?

  10. What is the difference? Reality Orientation Validation Parse theory Patient-Centred Communication Stop & think Ask open-ended questions Go with the flow S. Shrivastava Whose Reality Is It?

  11. How Am I Representingthe Person? • How does your documentation tell your patient’s story? • What is your experience with representing the person in inter-professional rounds?

  12. Documentation • Share sample documentations from your units • How did you convey the resident or patient’s perspective? • What was your response/action? • What would you like to change about your documentation?

  13. What Changes With Patient-Centred Care? • Share a practice that you can relate to from the “Struggling in Change” article

  14. Creative Group Exercise • How has learning about PCC impacted your practice? • What struggles have you encountered as you incorporate a PCC approach? • What else would help you to integrate PCC into your practice?

  15. Wrap Up • Complete course evaluation forms • Dialogues #4 & #5 due March 12th - Required in order to receive certificate • Celebratory Tea for your Certificate of Completion on March 27th 1430-1530 in L101a

  16. References • Beitel, J. (1999). Illuminations File Newsletter of International Consortium of Parse Scholars, 7(3), 3-5. • Hewison, A. (1993). Power of language in a ward for the care of older people. Nursing Times, 94(21). • Mattice, M. & Mitchell, G. J. (1990), Caring for confused elders. The Canadian Nurse, 16-18. • Mitchell, Gail J. (1990). Struggling in change: From the traditional approach to Parse’s theory-based practice. Nursing Science Quarterly, 3, 170-176. • Mitchell, Gail J. (1992). Parse’s theory and the multidisciplinary team: Clarifying scientific values. Nursing Science Quarterly, 5 (3) 104-106. • Spée, R., Chua, L., & Nosé, L. (2001). Patient focused care: dialogue with your patient. The Canadian Nurse, 97(5) 19-22.

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