Therapeutic Communication Test 3

Front 1

What is communication?

Back 1

• Figure out a way to communicate and get the care to the patient that they need.
• It is the way that we influence our patients. It is essential to the nurse-patient relationship.
• IT IS A LIFELONG PROCESS! We are constantly finding new ways to communicate with our patients.
• A vehicle for establishing a therapeutic relationship.
• Means by which an individual influences the behavior of another. The communication is the intimate contact with the patient and is what makes the difference between a good and bad experience.

Front 2

Importance of communication to nursing

Back 2

• Nurses who develop good critical thinking skills make the best communicators. It isn't the Dr's! They aren't there all they time, they aren't the ones patients complain to etc. The nurses are the ones relied to provide the care they need. The nurses are responsible for initiating and maintaining that communication with the patient and the families.

Front 3

How to express caring through communication

Back 3

• Being sensitive - be sensitive to surroundings and what is going on with your patient.
• Promote and accept both positive and negative feelings.
• Important that we give our patients hope. (Not false hope) However, reassure them we are doing everything possible that we can. (Not that everything will be great!) Try to keep positive attitude and getting them to be positive too. Instilling hope.
• Promote interpersonal teaching and learning. What their role is in the plan of care
• Provide a supportive environment
• Assist with gratification of human needs. Whatever it takes to make them happy within reason. (Dog brought to patient, books, clowns etc.)
• Allow spiritual expression. Pray 5 x a day, etc.
(list on page 342)

Front 4

Intrapersonal

Back 4

Within the individual. Self talk, self verbalization, inner though. Thinking things through in your head. "I can do this!" Used to try to improve self image and self awareness.

Front 5

Interpersonal

Back 5

1 on 1 interactions. IS THE HEART OF NURSING. Face to face communication with patients. • Remember that meaning resides within the person and not in words so: You may mean it one way and the person understands something completely different. It is different for different people, adjust your thinking. Typically takes place in a social context.

Front 6

Transpersonal

Back 6

Occurs within the spiritual domain. Prayers, meditation, guided imagery, anything that makes the person more "at peace". A lot of times nurses who really respect a persons spirituality will use this kind of communication to assist in plan of care, especially if they are a very difficult patient or in a very difficult situation. Use this to assist with fears.

Front 7

Small-group

Back 7

- 2 or 3 people meeting together. This type of communication is typically GOAL DIRECTED. A specific reason you are meeting etc. Have to understand group dynamics. Usually a leader and someone who directs the group. For it to be successful every person in the group HAS to feel accepted, they can open communicate, be involved in what's happening in the group and that their opinion matters. For this to happen it has to be 5-6 people, has to have enough seating, appropriate meeting place and have to have commitment.

Front 8

Public-Interaction with audience

Back 8

Rotary group, fetal monitoring, etc. Teaching sessions, REQUIRES SPECIAL ADAPTATIONS I.E. EYE CONTACT, GESTURES, WHEN TO DO VOICE INFLECTION. Effective public communication increases public knowledge.

Front 9

The referent

Back 9

What motivates one person to communicate with another. (Pain, fear, sights, odors, schedules, emotions, sensation, perceptions, ideas) Better able to organize and develop messages, if you are aware of what stimulus initiated the communication).

Front 10

Sender

Back 10

generates the message. Puts the message in a format that it can be transmitted. Selects encoding for sending the message

Front 11

Receiver

Back 11

Person who intercepts the message (decode what is said), is the listener or reader, the decoder of the message. Is what the patient said accurate or did they mean something else? (i.e. Patient saying I really just don't want to go home. Receiver: decode what is being said. Why don't they want to go home? Is something else going on?

Front 12

The message

Back 12

Can include both verbal and nonverbal techniques. Involves what is ACTUALLY SAID, WRITTEN OR SYMBOLIZED. Can also be said with body language. DO NOT LIE TO PATIENTS. Try to turn it back and get more information if possible. Content of the communication, is the message itself. Nurses decide the what, where, when, why and how message is conveyed. Basically, it is up to us to decide how the info is relayed.

Front 13

The channels

Back 13

This is how the message is transmitted.
Channels include:
• Visual
• Auditory
• Kinesthetic/tactile - Teaching the patient. Show the info, talk about how it is done, allow them to do it. For the most part, patients understand info more if it comes through more than one channel. Different ways of coming across.

Front 14

Feedback

Back 14

• Information sender receives about the receivers reaction to the message. How did the other person interpret it? It can be both positive and negative depending on how it was presented.
• Submitted verbally or nonverbally
• Repeating back, clarifying what is said allows sender a chance to make corrections and makes sure info is accurate.

Front 15

Perception

Back 15

A person's sensing and understanding of the world; unique; varies from person to person

Front 16

Sociocultural

Back 16

Nonverbal communication varies from culture to culture; examples are use of touch and eye contact.

Front 17

Intimate space

Back 17

0-18 inches around the person. When you are bathing them, changing dressings etc. Important to explain what is going on so they know why you are in their space.

Front 18

Personal space

Back 18

18 inches-4ft. Used when teaching, doing history, sitting next to their bed, giving report to the next shift.

Front 19

Social space

Back 19

4-12 feet. This would be if you were making rounds with physician. Stand out door while he goes in etc. Standing back further than he would be. Teaching a class.

Front 20

Public

Back 20

12 feet plus. Speaking at communication forum, large group etc

Front 21

Zones of personal touch

Back 21

Social zone - permission not needed
Consent zone - permission needed : opening mouth, dealing with feet, wrists
Vulnerable zone - special care needed. Face, neck, torso etc.
Intimate zone - great sensitivity needed. Genital or rectal areas. Make sure they understand what is going on and what you are going to be doing.

Front 22

Social zone

Back 22

permission not needed

Front 23

Consent zone

Back 23

permission needed : opening mouth, dealing with feet, wrists

Front 24

Vulnerable zone

Back 24

special care needed. Face, neck, torso etc.

Front 25

Intimate zone

Back 25

great sensitivity needed. Genital or rectal areas. Make sure they understand what is going on and what you are going to be doing

Front 26

therapeutic relationship

Back 26

• Relationship that benefits clients health status
• Nurse-client relationship focuses on the client, is goal -directed (with specific purposes) and has parameters
• Well planned; "helping relationship"

Front 27

preinteraction

Back 27

BEFORE meeting client, review data, talk to caregivers, plan timeframe

Front 28

orientation

Back 28

- introduction, data gathering, finding common ground, develop trust, finding role in relationship/clarification of role, identify purpose, test it.

Front 29

working

Back 29

identified problems and established goals. Develop plan of care with input of client and the nurse, problem-solving methods are selected, discussion centers on clients resolution of questions/problems and expression of feelings (not physical), HAVE TO HAVE INPUT FROM PATIENT - THEY HAVE TO THINK IT IS IMPORTANT TO THEM TO MAKE IT WORK!

Front 30

termination

Back 30

client needs preparation for this! Evaluation of goal achievement and effectiveness of treatment. Summarizing and reviewing the relationship, client needs preparation for this phase, both people may experience a sense of loss, can see behavior changes and emotions, was the relationship meaningful?

Front 31

active listening

Back 31

S - SIT FACING CLIENT
O - OBSERVE OPEN POSTURE
L - LEAN TOWARD CLIENT
E - ESTABLISH EYE CONTACT
R - RELAX

Front 32

infants - communication

Back 32

touch and soft voice. "cooing, talking, holding etc."

Front 33

todders/preschool communication

Back 33

Get to their level! Allow touch of objects (steth to get used to it etc.) simple words, used of dolls/puppets as vehicles. Do mock assessment on dolls.

Front 34

children - communication

Back 34

avoid sudden movements. Allow them time to talk to you w/out parent. Quiet, unhurried voice, allow time for fears/questions; use drawings or play.

Front 35

adolescents

Back 35

listen to them. Give them your attention. Remain calm, open-minded and respect their privacy. Praise good points and encourage them to express their ideas and feelings.

Front 36

older adults

Back 36

Provide quiet setting, make sure client can hear you, give them time to respond and don't talk to them like they are children

Front 37

Summary of therapeutic communication

Back 37

Create comfortable environment
Establish rapport using concepts of trust etc
Active listening skills. Avoid three hot topics, sex politics and religion
Ask open ended questions
Avoid yes, no, why
Have purpose to conversation
Aim to discuss client feelings not your own
Client should be doing the talking by doing the 90/10 rule. 90 from them, 10 from you
Be aware of verbal and non verbal cues from both client and yourself.
Aim to enter working phase and explore possible solutions with clients
Recognize dangerous situations that will direct you to break confidentiality - discussing things that make you break confidence. Danger to self; danger to others; plans for "elopement"