Non-therapeutic techniques.Barriers to effective communication.

Communicating with the angry, demanding or manipulative patient.

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

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.

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.'

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).

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.

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? 

•  assist the family in dealing with the impending death of a loved one

•  facilitate their -

-  coping response,

-  readjustment

-  bereavement and

-  participation in care.

Modes of communication

• Verbal communication - spoken or written wordVerbal communication - spoken or written word• Be aware of:Be aware of:• vocabulary - various subculturesvocabulary - various subcultures• clarity and brevityclarity and brevity• use layman’s terms – denotative and use layman’s terms – denotative and

connotative meaningconnotative meaning• pacing when speakingpacing when speaking• IntonationIntonation

Verbal communication

• Timing and RelevanceTiming and Relevance

• HumorHumor

Nonverbal CommunicationNonverbal Communication

• Transmission of messages without the use Transmission of messages without the use of wordsof words

• FactorsFactors

• Personal appearancePersonal appearance

• Facial expressionFacial expression

• Posture / GaitPosture / Gait

• Eye ContactEye Contact

Nonverbal communication factors

• GesturesGestures

• TouchTouch

• Territoriality and SpaceTerritoriality and Space

Factors to influence communicationFactors to influence communication

• Perceptions - personal view of eventsPerceptions - personal view of events

• ValuesValues

• EmotionsEmotions

• GenderGender

• KnowledgeKnowledge

• Roles and relationshipsRoles and relationships

Factors to influence communicationFactors to influence communication

• Sociocultural backgroundSociocultural background

• European Americans more openEuropean Americans more open

• Native Americans comfortable with silenceNative Americans comfortable with silence

Zones of Personal Space

• Intimate (0-18 in)Intimate (0-18 in)

• Personal (18-4ft)Personal (18-4ft)

• Social (4- 12 ft)Social (4- 12 ft)

• Public (12 ft or greater)Public (12 ft or greater)

Forms of CommunicationForms of Communication

• Therapeutic- Communication that is Therapeutic- Communication that is beneficial in developing a nurse-client beneficial in developing a nurse-client helping relationshiphelping relationship

• Non-Therapeutic- Communication that is Non-Therapeutic- Communication that is not beneficial or helpful to people involvednot beneficial or helpful to people involved

Therapeutic CommunicationTherapeutic Communication

• Listening - nonverbal; conveys interest in Listening - nonverbal; conveys interest in the client; active listeningthe client; active listening

• Listening vs. HearingListening vs. Hearing

• Nod as client speaksNod as client speaks

• Appear attentiveAppear attentive

• Conveying Acceptance - listen without Conveying Acceptance - listen without judgingjudging

Therapeutic CommunicationTherapeutic Communication

• Paraphrasing Paraphrasing • Focusing - centering information on the key elements of Focusing - centering information on the key elements of

the messagethe message• Stating observations Stating observations • ClarifyingClarifying• FocusFocus• AssertivenessAssertiveness• standing up for one’s rights without violating those of standing up for one’s rights without violating those of

othersothers• Summarizing - concise review of main ideasSummarizing - concise review of main ideas• Appropriate self-disclosureAppropriate self-disclosure

Barriers to Effective Barriers to Effective CommunicationCommunication

• Inattentive listeningInattentive listening• Medical vocabularyMedical vocabulary• Giving personal opinionsGiving personal opinions• Being defensivenessBeing defensiveness• Showing disapprovalShowing disapproval• Cultural differencesCultural differences• PryingPrying• Offering false reassurance Offering false reassurance • Being defensiveBeing defensive• Asking whyAsking why• Stereotyping - generalized beliefs held about peopleStereotyping - generalized beliefs held about people• Changing the subject inappropriatelyChanging the subject inappropriately• Showing approval or disapprovalShowing approval or disapproval

Components of helping Components of helping relationshipsrelationships

• Trust Trust - Belief that other people will provide - Belief that other people will provide help in times of need and distresshelp in times of need and distress

• Empathy Empathy - Ability to try to understand and - Ability to try to understand and enter the patient’s frame of referenceenter the patient’s frame of reference

• SympathySympathy - expression of one’s own - expression of one’s own feelings about another’s predicamentfeelings about another’s predicament

Components of caring relationshipsComponents of caring relationships

• Caring - positive regard for another personCaring - positive regard for another person

• AvailabilityAvailability

• Courtesy/ConfidentialityCourtesy/Confidentiality

• “ “ A Professional”A Professional”

Communication with special Communication with special populationspopulations

• ChildrenChildren

• Nonverbal messages - avoid sudden Nonverbal messages - avoid sudden movements or gesturesmovements or gestures

• Calm and gentleCalm and gentle

• Be honestBe honest

• Short simple concrete sentences and Short simple concrete sentences and explanations explanations

Communication with the older adultCommunication with the older adult

• Changes in hearingChanges in hearing

• TinnitusTinnitus

• Decrease in visual acuityDecrease in visual acuity

The Nurse-Client Helping The Nurse-Client Helping RelationshipRelationship

Helping relationships are created through Helping relationships are created through the nurse’s:the nurse’s:

• Application of scientific knowledgeApplication of scientific knowledge

• Understanding of human behavior and Understanding of human behavior and communicationcommunication

• Commitment to caringCommitment to caring

• **TherapeuticTherapeutic communication doesn’t communication doesn’t happen. You have to work at it.happen. You have to work at it.

Phases of Nurse/ Client Phases of Nurse/ Client RelationshipsRelationships

• Pre-interaction PhasePre-interaction Phase

• Orientation PhaseOrientation Phase

• Working PhaseWorking Phase

• Termination PhaseTermination Phase

Pre-interaction PhasePre-interaction Phase

• Before meeting clientBefore meeting client

• Review data available ( diagnosis, medical Review data available ( diagnosis, medical history)history)

• Assign appropriate roomAssign appropriate room

• Anticipate concerns or needsAnticipate concerns or needs

Orientation PhaseOrientation Phase

• Introduce yourselfIntroduce yourself

• Set a positive tone with a warm Set a positive tone with a warm empathetic mannerempathetic manner

• Assess client health statusAssess client health status

• Prioritize needs and goals of your client Prioritize needs and goals of your client

• Clarify client’s and your rolesClarify client’s and your roles

• Let the client know when to expect the Let the client know when to expect the relationship to endrelationship to end

Working PhaseWorking Phase

• Encourage and help the client express Encourage and help the client express feelingsfeelings

• Encourage and help client set goalsEncourage and help client set goals

• Take action to meet the goals set the Take action to meet the goals set the clientclient

Termination PhaseTermination Phase

• Remind client that termination is nearRemind client that termination is near

• Evaluate goal achievementEvaluate goal achievement

• Help to achieve a smooth transition to Help to achieve a smooth transition to other caregiversother caregivers

Techniques for improved Techniques for improved therapeutic communicationtherapeutic communication

• ProfessionalismProfessionalism• CourtesyCourtesy• ConfidentialityConfidentiality• AvailabilityAvailability• TrustTrust• EmpathyEmpathy• SympathySympathy• AcceptanceAcceptance• RespectRespect• SilenceSilence• Hope Hope • EncouragementEncouragement• SocializingSocializing• Gender/Cultural sensitivityGender/Cultural sensitivity

Communication-Communication-Nursing ProcessNursing Process

• AssessmentAssessment

• Physical and Emotional FactorsPhysical and Emotional Factors

• Developmental FactorsDevelopmental Factors

• Sociocultural FactorsSociocultural Factors

• GenderGender

Communication-Communication-Nursing ProcessNursing Process

• Nursing DiagnosisNursing Diagnosis• Impaired verbal communicationImpaired verbal communication• AnxietyAnxiety• Social isolationSocial isolation• Ineffective copingIneffective coping• Impaired social interactionImpaired social interaction• PowerlessnessPowerlessness• PlanningPlanning• Goals and outcomes; priorities; continuity of Goals and outcomes; priorities; continuity of

care.care.

Therapeutic Communications

ImplementationImplementation• Attentive ListeningAttentive Listening• Sharing observationsSharing observations• Sharing empathySharing empathy• Sharing hopeSharing hope• Sharing humorSharing humor• Sharing feelingsSharing feelings• Using touchUsing touch• Using silenceUsing silence• Providing informationProviding information• ClarifyingClarifying

Therapeutic Communication -2Therapeutic Communication -2

• FocusingFocusing

• ParaphrasingParaphrasing

• Asking relevant questionsAsking relevant questions

• SummarizingSummarizing

• Self-disclosureSelf-disclosure

• ConfrontationConfrontation

Barriers to Effective Barriers to Effective Communication-2Communication-2

• ArguingArguing

• Passive or Aggressive ResponsesPassive or Aggressive Responses

• Defensive ResponsesDefensive Responses

• Asking personal questionsAsking personal questions

• Sympathy and not empathySympathy and not empathy

Communication-Communication-Nursing Process - EvaluationNursing Process - Evaluation

• Analysis of communication patternsAnalysis of communication patterns

• Process recordingsProcess recordings

• Evaluate goal of improving Evaluate goal of improving communication.communication.

• If goal unmet, utilize new and different If goal unmet, utilize new and different nursing interventions.nursing interventions.

CommunicationCommunicationSummarySummary

• Communication is important.Communication is important.

• Collect data and establish trusting Collect data and establish trusting relationship.relationship.

• Share information with other team Share information with other team members.members.

• Implement care and evaluate goals .Implement care and evaluate goals .

Critical Thinking ExerciseCritical Thinking Exercise

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

Thank you for your attention!