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Identify the Functions of Interpersonal Communication in Nursing

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Communication is: The vehicle in establishing a therapeutic relationship The means by which people influence others The relationship itself Without it there would be no therapeutic nurse-client relationship

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What is assertive communication?

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Assertive Be clear about what you need Be respectful in your language and behavior Be confident and comfortable An "active" behavior

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What is nonassertive communication?

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Nonassertive Disregard own needs and rights May be interpreted as lack of interest/knowledge A "passive" behavior

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What is aggressive communication?

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Loud Forceful Confrontational way of trying to get what we want Rights are responded to out of proportion to those of others

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Identify Assertive Rights

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Be treated with respect A reasonable workload An equitable wage Determine your own priorities Ask for what you want

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Identify Assertive Rights

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Refuse without making excuses or feeling guilty Make mistakes and be responsible for them Give and receive information as a professional Act in the best interest of the patient Be human

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Irrational Beliefs that impede assertive Communication

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Arise when we are anxious about being assertive Focus on possible negative outcomes

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Explain the DESC Script for Developing an Assertive Response

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Anatomy of an assertive response Describe the situation Express what you think and feel Specify your request Consequences

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Basic Assertion

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Expresses an idea, belief, or opinion; stands up for your rights or the rights of others

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Empathic Assertion

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Conveys sensitivity to the situation while taking an assertive position

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Escalating

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Expresses more emphatically when a simple assertion did not accomplish your goals and your rights are still being violated

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Three Essential Criteria for presenting an Assertive response

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Timing Content Receptivity

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Behavior of an Assertive Nurse

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Appears self-confident and composed Maintains eye contact Uses clear, concise speech Speaks firmly and positively Speaks genuinely, without sarcasm Is nonapologetic Takes initiative to guide situations Gives the same message verbally and nonverbally

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Advantages of Assertive Communication

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You will likely get what you want when you ask for it clearly People respect clear, open, honest communication You stand up for your own rights and feel self-respect You avoid the invitation of aggression when the rights of others are violated You are more independent You become a decision maker You feel more peaceful and comfortable with yourself

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A nurse who communicates responsibly

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Focuses on the nursing process and problem-solving process Considers the world of the client and the client's family Is a client advocate

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A nurse who communicates responsibly

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Appreciates the sacred role of intimate care of the sick Maintains a sense of wonder at the human experience and treats each person as an individual Is open to learning to trust intuition as another way of knowing about the client

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Role of Caring in Nursing

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Ongoing commitment to sharpening knowledge and skills Identifying care needs and nursing actions that will bring about positive change Protecting and enhancing human dignity

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Who is known as the founder of transcultural nursing?

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Madeleine Leininger Mid 1960's

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What is the definition of transcultural nursing?

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Culturally competent practice Client centered Research focused

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What are the functions of communication?

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Discloses information or provides a specific message May include self disclosure Self awareness may be achieved, or awareness of personal feelings Conveying respect Giving or taking away of power

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Communication

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Effective Health care communication=better informed, more confident health seeking clients (Giorgianni, 2000) Healthy people 2010 and 2020 All behavior, verbal or nonverbal Written and oral language, gestures, facial expressions, body language, space

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Examples of Verbal Communication

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Vocabulary Names Grammatical structure Voice qualities Intonation Rhythm Speed Pronunciation silence

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Examples of nonverbal communication

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Touch Facial expression Eye movement Body posture

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Combination of verbal and nonverbal communication

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Warmth humor

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Communication implications for nursing care

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1. personal beliefs 2. communication variables 3. plan of care 4. modification of communication 5. respect

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Identify the Purpose of the Client-Nurse Relationship

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Established to help the client achieve and maintain optimal health Represents a different order of interaction than that which occurs in a friendship Entered into for the benefit of the client More effective if it is mutually satisfying Goals are directed toward the growth of clients May also be a mutual learning experience

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Client cognitive abilities for a therapeutic encounter

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Preferred ways of perceiving and judging Knowledge and beliefs about illness in general and their illness in particular Knowledge and beliefs about health promotion and maintenance in general and information about their own healthcare activities Ability to problem-solve Ability to learn

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Client affective abilities for a therapeutic encounter

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Cultural values Feelings about seeking help from a nurse Attitudes toward nurses in general Attitudes toward treatment regimen Values about preventing illness Willingness to take positive action about own health status at this time with this particular nurse

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Client psychomotor abilities for a therapeutic encounter

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Ability to relate and to communicate with others Ability to carry out own healthcare management Ability to learn new methods of self-care

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Nurse cogntive abilities for a therapeutic encounter

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Preferred ways of perceiving and judging Knowledge and beliefs about illness in general Knowledge about their clinical specialty and knowledge and beliefs about health behaviors that prevent illness and promote, regain, and maintain health Ability to problem-solve Knowledge about factors that increase client compliance with treatment regimen

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Nurse affective abilities for a therapeutic encounter

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Cultural values Feelings about being a nurse-helper Attitudes about clients in general Biases about nursing treatment regimen Value placed on being healthy Value placed on people's active prevention of illness or enhancement of well-being Willingness to help clients take positive action to improve their well-being

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Nurse psychomotor abilities for a therapeutic encounter

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Ability to relate to and communicate with others Proficiency in administering effective nursing interventions Ability to teach nursing interventions to client

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Clients' Rights as Consumers of Healthcare Service

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To expect a systematic and accurate investigation of their health concerns by thorough and well-organized nurses To be informed about their health status and have all their questions answered so that they clearly understand what nurses mean To receive healthcare from nurses who have current knowledge about their diagnosis and are capable of providing safe and efficient care To feel confident that they will be treated courteously and that their nurses show genuine interest in them

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Clients' Rights as Consumers of Healthcare Service

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To trust that the confidentiality of any personal information will be respected To be informed about any plans of action to be carried out for their benefit To refuse or consent to nursing treatments without jeopardizing their relationship with their nurses To secure help conveniently, without hassles or roadblocks To receive consistent quality of care from all nurses

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Characteristics of a Successful Client-Nurse Relationship

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Partnership between clients and nurses Philosophy about human nature and what motivates humans in health and illness Purposeful and productive objectives Preservation of the client's present level of health and protection from future health threats Palliation of clients' worries and fears through nurses' reassurances Easing of pain A psychic or morale boost

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Therapeutic Communication Techniques

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Listening/Remaining silent Establishing guidelines Making open-ended comments Reducing distance Acknowledging/Restating/Reflecting Seeking clarification Seeking consensual validation Focusing/Summarizing/Planning

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Nontherapeutic Communication Techniques

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Defending Getting advice Making stereotyped responses Changing topics Patronizing

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Nontherapeutic Communication Techniques

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Failing to listen Failing to probe Parroting Being judgmental Reassuring Rejecting

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Do's in the Client-Nurse Relationship

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Be prepared mentally, emotionally, and physically to assist your clients Be punctual and polite Promote clients' well-being and comfort Be philanthropic in your approach to clients Be plucky in planning and generating creative solutions Be proficient in the nursing skills required to safely and successfully care for your clients Praise and encourage clients Be patient and understanding Persevere in pursuing your pledge to help clients preserve their health

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Don'ts in the Client-Nurse Relationship

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Patronize clients Preach at them or pressure them to change Pigeonhole clients with labels such as "good," "lazy," or "uncooperative" Procrastinate following through on clients' reasonable requests Put down clients by using medical jargon Punish clients for acts of omission or commission that have negatively affected their health Reveal prejudices against the race, religion, or creed of clients Be pleasure seeking Pretend to have knowledge that you do not

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Client Behavioral Dimensions Indicative of Bonding in the Client-Nurse Relationship

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Anticipates nurse's arrival Initiates greeting Greets back the nurse in a verbal or nonverbal way Acknowledges nurse's statements by responding Manifests at-ease behaviors Volunteers information Elaborates on physical condition, past and present health status even when not prompted to do so Verbalizes feelings, psychosocial implication of disease in his/her life Talks about support persons and other resources Talks about other personal concerns

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Nurses Behavioral Dimensions Indicative of Bonding in the Client-Nurse Relationship

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Greets patient Pauses to visually check on patient Touches patient for further assessment Exchanges friendly/light comments or jokes Makes clarifications, asks follow-up questions for further assessment Asks patient what patient knows already Listens attentively to verbalization of patient's feelings, health condition, personal/family information Asks patient/family about other pertinent information that may not be in the record

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Client Examples of NOT Bonding

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Shows avoidance of the nurse as she approaches Interrupts nurse in midsentence Shows cold treatment toward nurse Demonstrates irritation through facial expression Converses in angry tone

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Nurse examples of NOT bonding

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Ignores patient's questions or comments Discourages inquiries from patient Has a stern or aloof facial expression Focuses on tasks, not maintaining eye contact with patient Projects irritable behavior Converses in angry tone Shows hurried behavior

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The Clients engaged relationship

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Accepts nursing care without reluctance "Prepares" for procedure by voluntarily assuming needed position Seeks clarification for proper implementation of care Demonstrates understanding/agreement with what nurse tells him/her and readily follows nurse's instructions Provides data asked by nurse Asks about other anticipated procedures or interventions Takes time to respond to questions or asks that questions or instructions be repeated

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Nurse engaged relationship

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Implements needed interventions/procedures promptly and competently Completes routine tasks with friendly comments or other manifestations of high regard/caring for patient Acknowledges and addresses inquiries of patient about care Volunteers needed information without being asked by patient or family Touches patient for reassurance when appropriate Provides verbal reassurance

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Client Unengaged Relationship

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Demonstrates verbal or nonverbal cues of reluctance/refusal to comply with what nurse says

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Nurse unengaged relationship

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Attends only to the IV and other routine procedures and ignores the patient Scorns patient's questions by laughing with sarcasm or getting irritated Sternly demands patient comply with instructions, demonstrating irritation

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F.O.C.U.S.E.D. Model of Presence

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New work based on model by Martin Buber, who distinguished between "I-It" and "I-Thou"

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I-It

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routine caring for patient Subject-object relationship Nurse focuses on being heard or understood

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I-Thou

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": nurse using self as "whole being" Connection exists by being present Focus on understanding people Nurse must disconnect from personal distraction

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F.O.C.U.S.E.D. Model of Presence

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F=Feel O=Observe C=Connect U=Understand S=Share E=Energize D=Disconnect

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Qualities of a Storycatcher

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is a practitioner of the heart of language creates context → context highlights relationships and leads to holistic and connected action → connected action becomes a force for restoring/restorying the world Have we lost the understanding of how essential ___ is to who we are?

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Qualities of a storycatcher

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Intrigued by human experience Inquisitive about meaning and insight Curious, not judgmental More in love with questions than answers

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Storycatchers

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Able to hold personal boundaries in relationships Present while others experience emotions and have insight Able to hold the sacred space for listening Able to invite forgiveness, release, and grace Aware of the power of story and use it consciously

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Listening Skills

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Body mechanics Arms open, eye contact, leaning in, focus on what is being said Relax Be present in the moment Be aware of verbal and nonverbal communication

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Mutuality

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Experience of real or symbolic commonalities of visions, goals, sentiments, or characteristics, including shared acceptance of difference that validates the person's worldview Sharing of collective knowledge

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Mutuality in Nurse-Client Relationships

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Responsive relationships between the nurse and client are based on Respect, trust, and mutuality that reflect both personal moral knowledge and ethical nursing knowledge An ongoing sharing of knowledge between healthcare professionals and shared decision making helps ensure patient satisfaction

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Face Work and Politeness Theory in Approaching Clients

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"Saving face" means the preservation of dignity so that each party continues to be willing to invest in the interaction without experiencing threat. Each party wants to maintain a sense of personal competency and control. Attacks on these or on the person's poise or sense of belonging or being liked are called face threats.

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Face Work and Politeness Theory in Approaching Clients

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Polite behavior Ways in which nurses ease the interaction to help decrease fear, embarrassment, and anger Lessens the threat of the intimate nature of nursing interventions Nurses need to understand the importance of tact in engaging the client's participation

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Validation

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Consciously seeking out our clients' opinions and feelings at each phase of the nursing process Unearthing any questions or concerns our clients have about plans for their healthcare and securing their understanding and willingness to proceed to the next step

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Validation

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Makes the difference between problem solving for clients and mutual problem solving with clients Keeps us focused on the rights and obligations of clients to make their own decisions about their health Must be incorporated at each step of the problem-solving process in nursing Stops us from moving too quickly and "doing" to our clients

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Validaation

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Ensures that we obtain complete agreement and commitment from our clients about the nursing care plans Gives clients a sense of control Clients clearly understand their nursing diagnoses and have a say Invites the collaboration that is essential for successful client change Enriches the foundation for the rest of the nursing process The trust developed from working together is likely to increase the accuracy and validity of the database

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Mutual problem-solving process

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Assessment Diagnosis Planning

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Assessment

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Collecting data regarding the client, client-family system, or community Identifying needs, problems, concerns, or human responses

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Diagnosis

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Analyzing data Validating interpretation of data with the client Identifying nursing diagnoses Validating the nursing diagnoses with the client

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Planning

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Setting priorities for resolution of identified problems with the client Determining expected and desired outcomes of nursing actions in collaboration with the client

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Planning

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Writing nursing interventions to achieve these outcomes in collaboration with the client

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Implementation

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Implementing nursing actions with assistance from the client Encouraging client participation in carrying out nursing actions to achieve the outcomes Continuing to collect data about the client's condition and interaction with the environment

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Evaluation

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Evaluating the outcomes of nursing care in consultation with the client Ongoing evaluation to revise the nursing care plan

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Incorporation of validation into the nursing process

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Validating interpretation of collected data Identifying actual or potential problems and validating the nursing diagnoses with the client Determining expected and desired outcomes of nursing actions in collaboration with the client Deciding on the nursing strategies to achieve these outcomes in collaboration with the client Implementing nursing actions with assistance from client and encouraging client participation in carrying out nursing actions Evaluating the outcomes of nursing care in consultation with the client

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Advantages of mutual problem solving

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Contributes to growth and development of clients and nurses Nurses and clients gain trust in each other Matheis-Kraft et al (1990) Clients who take more active roles in their treatments recover faster

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Advantages of mutual problem solving

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Spin-offs from working with this philosophy Opportunity to bring more nurturing and caring into their profession Enjoyment of expanded autonomy and authority Experience of a more equal relationship with physicians who listen to their recommendations and even seek their counsel Satisfaction of being client advocates as they were educated to be

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Contract

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An agreement between you and your client outlining activities and responsibilities for each party

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Contracts should be

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Be realistic Spell out measurable behaviors Have dates of expected completion Be worded positively Build in rewards for success Provide standards for evaluation

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Steps in making a contract

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Names of client and nurse Purpose of the client-nurse relationship Roles of client and nurse Responsibilities of client and nurse Expectations of client and nurse Specific details such as meeting times and structure for confidentiality Conditions for termination

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Inner Personal Space

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Inner spirit core Unacceptable thoughts/feelings Acceptable thoughts/feelings Superficial public image

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Outer Personal Space

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Area surrounding your body Space within the area Objects within the area

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COMFORT ZONE

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Inner and outer personal space

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DISCOMFORT ZONE

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Space invaded

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RECEPTOR SYSTEMS

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A response to sensory stimulation in the internal and external environment Sensory systems- sight, sound, touch, smell Proximity to others, objects, movement

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DISTANCE RECEPTORS

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Eyes Ears Nose

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IMMEDIATE RECEPTORS

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Touch Skin

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Sense of Touch

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basic to the maintenance of life

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Vision

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last and most specialized sense to develop in humans (when our ancestors left the ground and took to trees to search for food and safety)

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VISUAL SPACE

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Less ambiguous More focused Less subject to external manipulation

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AUDITORY SPACE

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Factor in performance i.e., reading

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CULTURAL PERCEPTUAL PATTERNS

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Remain stable throughout life Example: Japanese proceeding from "parts" to BIG PICTURE and paper walls or screens Japanese more perceptive visually and therefore comfortable with paper screens vs. thick walls, doors to control sound Layout of cities NY (grid) vs. Paris (radiating from center) India-spaces are divided by castes, secular and sacred activities, male and female segregation; inferior or superior housing

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OLFACTORY PERCEPTION

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Smell evokes deeper memories than vision or sound U.S.A. sanitize odor; underdeveloped olfactory perception Odor can define a space Odor as a determinant of disease

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TOUCH

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Most personal of all sensations Confirms the reality perceived through the other senses Factor in cardio protective health

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TACTILE vs VISUAL SPACE

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People do not see exactly the same thing There are perceptual differences Perceptual worlds of people of the same culture are closer Ex: art and architecture of different cultures

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PROXIMITY TO OTHERS

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Front, back, right or left regions Western Culture Intimate zone 0-18 inches Personal zone 18-36 inches Public zone 3-6 feet Childbearing practices Family group sleeping arrangements Sensory stimulation and space Cultural groups tend to act similarly

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benefits of warmth

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Makes us feel welcomed, relaxed, and joyful Fosters feelings of well-being Promotes healing Warmth from caregiver = more client dialogue and personal information Enhances closeness and makes us more approachable Work has a more pleasant environment Enhances the process of building an effective relationship

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behaviors of warmth

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is displayed primarily in a nonverbal manner Subtle facial expressions and body signs Gestures (small movements of hand, brow, or eyes) Indicators -Shift of posture toward the other person A smile Direct eye contact Motionless hands Verbal reinforcers "I see..."

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tools to analyze warmth

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Facial signals -Muscles relaxed, forehead smooth; no furrowing of the brow Eyes -Comfortable eye contact maintained; pupils are dilated; gaze is neither fixed nor shifting and darting Mouth Lips are loose and relaxed, not tight or pursed; gestures such as biting a lip or forcing a smile are absent; jaw is relaxed and mobile, not clenched; smile appropriate Expression -Features of the face move in a relaxed, fluid way; worried, distracted, or fretful looks are absent; face shows interest and attentiveness Postural signals of warmth Body position -Client is faced squarely, with shoulders parallel to client's shoulders

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Tools to analyze warmth

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Head position -Kept at same level as client's; periodic nodding shows interest and attentiveness Shoulders -Kept level and mobile, not hunched/tense Arms -Loose and able to move freely rather than stiffly Hands -Natural gestures; no clenching or grasping of a clipboard or chart; avoid distracting mannerisms like tapping a pen

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Tools to analyze warmth

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Chest -Breathing is at an even pace; the chest is kept open, neither slouched nor extended too far forward in feigned attentiveness; slight forward leaning shows interest Legs -Crossed or uncrossed, legs are kept in a comfortable and natural position; during standing, knees should be flexed and not locked Feet -Avoid fidgeting, tapping, and kicking

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Ways warmth is displayed

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Spacial distance or closeness we display Touching -The gentle, sincere touch of your hand can express warmth, caring, and comfort Volume of the voice Softer, modulated tones Comfortable pitch Pacing of words (nonpressured) Soft words Relaxed with genuine interest

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Benefits of respect

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Makes people feel important, cared for, and worthwhile Without respect people feel hurt and ignored Follows philosophy of holistic nursing -A person is body + mind + spirit

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Benefits of respect

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Warmth plus this = unconditional position regard Unconditional Positive Regard Maintains Patient Dignity When Body + Mind + Spirit are balanced Maximum Well-Being exists

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Ways to show respect

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Look at your client Offer your undivided attention Maintain eye contact Smile if appropriate Move toward the other person Determine how the other person likes to be addressed Call the client by name and introduce yourself Make contact with a handshake or by gently touching the individual Acknowledgment means demonstrating your awareness of your clients as individuals

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To respect a client

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To listen to what the person identifies as a need and work to incorporate meeting that need into nursing care To recognize the power of caring in nurse-client relationship (see Watson, 1979, and Erickson, 2007)

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Workplace Bullying

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Highly prevalent Defined: "repeated health-harming mistreatment of one or more persons (targets) by one or more perpetrators" Bullying is an abusive conduct Seen as -Threatening, humiliating, or intimidating workplace interference -Sabotage -Verbal abuse

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Bullying

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The Joint Commission mandated policies for addressing disruptive, disrespectful, behavior among colleagues -In schools and colleges student "incivility" shows lack of value for human dignity and altruism, which are ESSENTIAL to professional nursing Examples of student incivility: late to class, leaving early, inattentiveness, threatening language, physical violence

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Civility

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is an ethical principle of respect for people.

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Incivility

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"morally destructive patterns of self-absorption, callousness, manipulation, and materialism so ingrained in our routine behavior that we do not even recognize them"

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Genuineness

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Presentation of one's true thoughts and feelings, both verbally and nonverbally A real picture of you, not a distorted one Willingness to present ourselves as we are and courage to risk rejection -Honesty is reassuring and refreshing A "what you see is what you get" phenomenon -Results in increased trust

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Nurse genuineness

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-Speaks deep from within without apology -Expresses thoughts, feelings, and experiences in here and now -Shows spontaneity -Conveys openness

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Nurse incongruence

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-Puts up a façade or pretense -Withholds thoughts or experiences -Shows a mismatch between verbal and nonverbal messages -Communicates in a rigid and contrived way; sounds scripted

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Nongenuine

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Verbal messages don't correspond with facial expressions, posture, tone of voice, and body language Interpreted as two distinct and dissimilar messages Puts our credibility in question Meaningful relationships are unlikely to ensue Denial of awareness/defensiveness occurs when there is a mismatch between nurses' experiences of their thoughts and feelings and their awareness -Is perceptible by others, taking away credibility

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Why its important to be genuine

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-we give to our clients and colleagues the message "You are strong and worthy of my engaging fully with you." Takes a risk -Genuineness can involve expressing negative thoughts and confronting others with reactions We are our own best judge of our __ Being __ is being respectful of yourself

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Why its important to be genuine

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We are more relaxed and self-assured when true to our thoughts and feelings -Comfort that we feel derives from the freedom that comes from living in harmony with ourselves Others will react positively by wanting to communicate and trust you Benefits for clients and colleagues -Feel free to express their true thoughts and emotions -Develop a feeling of trust for the nurse -Are provided with information they can use in the relationship here and now -Can unwind in a relaxed atmosphere -Enjoy a climate of realness

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Negative effects of not being genuine

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Distrust nurse Suspicious of nurse Relate to nurse in a strained, tense way Omit valuable information from the interchange Decode message as two distinct and dissimilar ones

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Negative effects of not being genuine

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-Feel confusion -Question the nurse's credibility -Believe only the nonverbal message -Difficulty maintaining meaningful dialogue in the presence of mixed messages -Don't feel that they are talking to a real person -Feel that the nurse is trying to impress rather than connect with them

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Empathy

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-The act of communicating to our fellow human beings that we understand something about their world -Free of the judgment of condolence -Value-free message showing that you understand the other person's point of view -The warmth you express with ____ should convey genuine caring, not honeyed insincerity

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benefits of empathy

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Increases the feeling of being connected with another human Helps reduce negative feelings of loneliness and isolation -Empathy dissolves alienation -Positive feeling of belonging Provides comfort in times of challenging transitions Creates a human bond that adds to your clients' or colleagues' personal strength Contributes to feelings of increased self-esteem

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Benefits of empathy

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Helps clients/colleagues to trust that you genuinely accept them as they are Possibility of self-acceptance is gradually increased Frees your clients and colleagues from having to defend or rationalize their feelings -They are then able to experience alternative reactions

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Six Steps to Empathic Communication

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Clear your head of distracting agendas Remind yourself to focus on the speaker Attend to your clients' and colleagues' verbal and nonverbal messages Ask yourself, "What does this person want me to hear?" Convey an empathic response Check to see if your empathic response was effective

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Steps in breaking bad news

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Plan what is to be said ahead of time and organize your thoughts Establish rapport Control the environment as much as possible Find out what the client and family already know Find out how much given individuals want to know -Don't make assumptions about this

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Steps in breaking bad news

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Use language the client and family will understand -Be sensitive and respectful of cultural issues Respond to the reactions of the client and family using an empathic approach When appropriate, explain the treatment plan and prognosis, and summarize

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Centering excercise

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Honor the sacred nature of your work. Take time each day to connect with your own purpose in your work. -Before you interact with a client, family, or colleague, pause. -Let go of any distractions or worries just now. -Close your eyes briefly and take a deep breath. -Say silently to yourself, "I am here for the greater good of all people involved and will give my full attention to this moment." -Bring to mind someone or something that evokes love and compassion. -Hold that feeling of love and compassion, repeating to yourself, "I am present in this moment."

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Self-disclosure

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Open up the self to others Reveal our thoughts and feelings and make known to others some of our personal experiences

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Self-disclosure and nurses

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Nurses are moved to offer ___ where the need for connectedness "transcends theoretical connections. Sharing . . . for the sake of connection and to give the interaction life, meaning and depth" (Drew, 1997)

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Appropriate self-disclosure

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Anything you reveal about yourself—your thoughts, feelings, and experiences—should be revealed for the benefit of your clients The focus of the relationship is the client Consider the why, what, when, and how of self-disclosing with your clients (Stuart, 2009) -Maintains health boundaries --Characteristic of a professional relationship

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Appropriate Self-Discluser

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Use judgment about what to reveal to clients Two questions to answer before ___ are -Is what I am planning to reveal likely to demonstrate to my clients that I understand them? -Do I feel comfortable (safe from repercussions and embarrassment; legally and morally secure) about revealing this information to my clients? Both questions should receive a solid affirmative response before you self-disclose

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Appropriate Self-Disclosure

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-Let your client know that you are a normal human being -Lead the client into an exploration of deeper feelings Promote comfort, honesty, openness, and risk taking by the client but never burdens clients with your problems

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Helpful Self-Disclosure

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The purpose of a therapeutic self-disclosure is to let your clients know that they have been understood Self-disclosure augments an empathic reply and deepens the trust between you When you wish to increase your level of understanding and strengthen that trust, and you feel comfortable revealing the content of your self-disclosure, then self-disclosure is the right choice

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Specificity

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means being detailed and clear in the content of our speech - Communication is then focused and logical

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Vagueness

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-Opposite of specificity -Can be frustrating -Lack of clarity creates distance between people who are trying to communicate

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Specificity's usefullness

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Explaining our thoughts and feelings Reflecting others' thoughts and feelings Asking questions Giving information or feedback Evaluating

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Strategies to Communicate with Specificity

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Being specific when explaining your thoughts and feelings Being specific when reflecting others' thoughts and feelings Being specific when giving information or feedback Being specific when evaluating Providing specific documentation

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Placebo effect

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Language or expectations of a clinician that positively affect the course of the client's illness by suggestibility

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Nocebo effect

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Produces negative responses Effect occurs when a healthcare provider sends a negative message through choice of language, words, or voice tone

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Importance of the Skill of Asking Effective Questions

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Secure data that are essential to providing quality care to clients Saves time Collects more pertinent and useful information Enables a more effective interviewing experience Ensures that you collect the data you need to provide quality nursing care

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Six Points to Keep in Mind When Asking Questions

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Why What How Who When Where

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Why

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Why do you need info? If irrelevant, makes you look "unfocused"

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What

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Be clear in your intentions

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How

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Know how to phrase well so patient wants to respond

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Who

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If patient can speak, ask him or her; if not possible, determine significant other who is most relevant

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When

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Quiet time, unhurried part of day

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Where

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Secure, private, without interruptions or noise

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Long-winded buildup

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Avoid long, rambling introductions Keep it short! Common error

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Thunder stealer

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Listen to patient's point of view before giving opinions Common error

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Multiple choice mix-ups

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Too many questions fired in a row Ask one at a time Common error

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Incomprehensible and cryptic codes

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Do not use medical terms and jargon Word clearly in language they can understand common error

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Offensive misuse of "why"

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Frequent use of "___" can be threatening Use softer, more receivable words Common error

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Misuse of open and closed questions

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Closed approach asks for short yes or no answers Common error

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Misuse of open and closed questions

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How you ask can give you more data Open-ended questions can lead patients to answer in whatever way they want Not focused Common error

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Mystery interview

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Give feedback on how the data being provided will be processed Make it known the data and questions are going to help problem-solve common error

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Expressing opinions

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Assertive behavior Disclosing what you think or feel about healthcare situations Offered as additional information -Aids clients' problem solving and decision making Provides clients with a fuller picture to make choices about their health and treatment plans Giving people the benefit of your point of view -NOT telling people what to do

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Giving Advice

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Unilateral process of solving problems or making decisions for others Prevents clients from becoming independent Gives colleagues the idea that you might think they are incapable of self-direction

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Expressing Opinions

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Get the consent of your receiver before expressing your opinions Make allowances for the uniqueness of your client or colleague Include the rationale for your viewpoint

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Sharing Positive regard

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Notice a behavior that you find noteworthy and give feedback on it Compliment and commend people for their actions Set the stage for others to feel comfortable in sharing their ideas in a friendly, accepting environment Promote creativity and teamwork using a noninvasive, cost-effective tool

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Effects on Empowerment

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You can make a choice about when to share your disagreement even if you see no choice but to comply with the decision Being able to voice your disagreement makes you feel more authentic, more assertive

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Benefits of empowerment

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When you take appropriate risks to express your opinion, you will earn the respect of clients and colleagues You may find that your input is requested because you are viewed as an authentic person who is willing to take a stand

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ENCULTURATION/SOCIALIZATION

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-Acquiring knowledge -Internalizing values

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MODERN WESTERN HEALTH CARE

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"Scientific Method" vs Holistic Vs -Alternative health services -Folk medicine -Spiritual interventions -Zen meditation -Tai Chi to reduce chronic pain

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CULTURE-BOUND SYNDROMES

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Specific to a certain culture or group Amok-Phillipines -Causes one to become a killer Susto-Spanish -leaves body as result of frightening event

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ETHNOCENTRISM

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-One's own way is the best -Nurses need to be SELF AWARE -Relationship between illness and evil Puerto Rico- one's evil deeds Uganda- infant death is a neighbors curse South Africa- AIDS-curse Female genital cutting/circumcision 28 African countries 50% prevelance

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SOCIAL ORGANIZATIONS

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GROUPS Family Religion Ethnic Racial Tribal Kinship Clan

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FAMILY GROUPS

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-Basic unit in US society -Not being in family is common and accepted -Implications for health care delivery

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AMERICAN FAMILY

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-Diverse multicultural populations Defined by: -KINSHIP -FUNCTION -LOCATION Nuclear or Stem Husband-father/wife-mother/child-sibling FUNCTION-i.e. unit vs. independent, decision maker, companion, provider, meeting emotional needs, nurturer LOCATION-urban, rural, migration, kinship ties Nuclear-2 generations Stem-3 generations G'parents, parents, children

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WHITE AMERICAN

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-Defined by present generation -Fiscally independent -Husband-wife type partnership -Emphasizes happiness of individual -Feeling oriented

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ASIAN AMERICAN

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-Defined by past, present, future -Economic obligation to kin -Parent-child as core -Welfare of family emphasis -Task oriented --Illness as family obligation

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CHURCH TYPE

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Religious Groups -Normative spiritual values i.e., Hinduism in India, Catholicism in Spain, Major denominations in US

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WITHDRAWAL GROUP TYPE

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-The majority or normative is not for them -A separate choice i.e., Amish, Jehovah's Witness

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Religious groups

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-Catholic -Baptist -Methodist -Lutheran -UCC -Mormon

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JEHOVAH'S WITNESS/NURSING IMPLICATIONS

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-Blood represents life and thus sacred -No human should sustain life by taking blood -Hemo dilution at start of surgery and use of blood expanders -Legal battles, withholding treatment from minor child -Nutritional needs-sausage, lunchmeat -Don't observe national holidays or ceremonies

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SEVENTH-DAY ADVENTISTS

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Body is a temple of God; keep HEALTHY -Avoid meat, seafood, caffeine, alcohol, drugs, tobacco -No surgery Friday evening-Saturday evening -Iodine and protein deficiencies noted

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Positive humor

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Associated with love, hope, joy, creativity, or a gentle sense of playfulness Intent is to bring people closer together

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Negative humor

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Puts people on the defensive and makes them feel put down May be sarcastic, racist, sexist, or ageist

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Negative humor (Cont.)

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-Reinforces negative stereotypes about different cultures, age groups, or conditions -Relieves tension for the sender of the communication -Demeans others and undermines credibility -Isolates you and alienates people

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Timing

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Criteria for the Appropriate Use of Humor in Healthcare Humor may be inappropriate in some settings unless initiated by patients or family Distinguish banter among clients/family members to ease tension from the put-down humor or sarcasm that needs intervention In chronic illness, humor may be a much needed coping technique

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Receptivity

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-Some people have been raised to believe that humor is frivolous; thus a humorous intervention would not be appreciated -If you use humor and it offends, apologize and explain that your intentions were to be helpful Content -Avoid sexist, racist, or sarcastic humor

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Functions of Humor in Healthcare

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serves both social and psychological functions Social functions -Coping with disruptive acts of hospital custom -Consider the banter about "air-conditioned" hospital gowns

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Functions of Humor in Healthcare

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Establishing relationships Coping with social conflict Promoting group solidarity -Two teams of nurses with separate medication carts competed to dress a stuffed animal attached to their carts with a different costume for every holiday

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Psychological functions of humor

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Relief of tension -One supervisor of a telemetry unit puts on oversized clown sunglasses and strolls down the hall when staff members are irritable Release of hostility and anger -A Nerf basketball and hoop or a Koosh ball to toss in the staff lounge is helpful Denial of reality- -- in the OR that would seem offensive elsewhere helps staff diffuse tension --Coping with disability and death

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Implications for humor

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Try gentle banter -Provides comic relief from tension and worry Let humor take the lead -How to add a light touch? Try using the "good news, bad news" approach Look for the positive -Take the initiative to encourage a positive attitude Be creative -Use our talents Use toys and props -Use fun items to make light of situations and add humor

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Humor Kit

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is a colorful basket that can be useful to add a light touch Some hospitals have humor carts or humor rooms equipped with items to pass the time or get a good laugh Some items to consider for your basket -Whistles -Joke books -Bubbles -Koosh ball -Clown nose -Games such as cards, checkers, and chess

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Prevention

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Using humor before a crisis occurs makes staff more willing to work together when tension is great Promotes positive communication

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Perception

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Injecting humor into a situation changes the perception that the situation is so terrible that it cannot be handled Promotes positive communication

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Perspective

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-Humor helps us to keep the big picture in view and not to take ourselves too seriously -Make light of your own idiosyncrasies -Get people to laugh with you Promotes positive communication

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POSSIBLE HEALTH BENEFITS OF LAUGHTER

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Stimulation of the production of catecholamines and hormones, which enhance feelings of well-being and pain tolerance Decrease in anxiety Increase in cardiac and respiratory rates Enhancement of metabolism Improvement of muscle tone Perception of the relief of stress and tension with increased relaxation that may last up to 45 minutes following laughter

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health benefits of laughter

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Increased numbers of natural killer (NK) cells, which fight viral infections of cells and some cancer cells Increased T cells (T lymphocytes), which fight infection Increased antibody IgA (immunoglobulin A), which fights upper respiratory infections Increased gamma interferon, which helps activate the immune system (Riley, 2004)

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Social Support and Health

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-The ability to cope with stress, crisis, or serious illness -The experiencing of contentment or depression and loneliness -The functioning of the immune system (Hall, 2002) -Positive relationship exists between the presence of social support and health and coping with illness

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Support System Assessment

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Determine the support you need at work or school Cognitive support (supports your thinking) Affective support (acknowledgment of work we do) Physical support (materials, staff) Request the support you need at work or school Identify needs for support Decide if you wish to pursue acquiring support

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Assertive request for support

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-Outline the situation -Indicate what is the problem -Respectfully offer a possible solution

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Nonassertive

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-Unsure, undecided, and without confidence -Gives the message that we do not expect to receive what we are seeking -Puts doubts about our requests in the minds of potential providers -Conveys that we do not have much faith in ourselves or our ideas -Involves little advance preparation and little visualization of positive outcomes -Looks unsure and sounds hesitant

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Aggressive

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-Go after what we want in a way that is upsetting, disrespectful, or threatening to others -Attack other people in our endeavors to get what we want -Create bad feelings that take considerable energy and time to overcome -Out of control and do not present our arguments in a logical, clear way

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