Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Therapeutic Listening Ms. Rica A. Santos, RN Objectives • Describe how the nurse as communicator assesses to understand the client’s met and unmet needs. • Intervene to assist the client toward mutual goal setting. • Practice active listening using therapeutic skills deliberately monitoring for non therapeutic interventions. Objectives • Relate how the self-aware nurse as communicator can holistically facilitate the client’s health. • Relate how the nurse in communicator and caregiver roles manifests caring and valuing. Activity Note taking by Tony Buzan Mind Map • Try the following words – Compass – Port MMUNICATION What is communication ? Definition • Process of sending a message to one or more persons (Varcarolis) • Process by which information is exchanged between individuals through a common system of symbols, signs, or behavior (Merriam-Webster) • Process of exchanging information and the process of generating and transmitting meanings between two or more individuals (Taylor) Definition • Process by which humans meet their survival needs, build relationships, and experience emotions (Kozier) • In nursing, communication is a dynamic process used to gather assessment data, to teach and persuade and to express caring and comfort. (Kozier) MMUNICATION Why do we need to communicate? Purpose (Stimulus) • To influence others • To obtain information • To give comfort or advice *Nurses who are able to communicate effectively are better able to collect assessment data, initiate interventions, evaluate outcomes of interventions, initiate change that promotes health, and prevent legal problems associated with nursing practice. MMUNICATION Levels of communication • Intrapersonal “self-talk” • Interpersonal • Group Communication – Small group communication – Organizational Communication MMUNICATION How do we communicate? Process of Communication • Stimulus • Sender • Message • Channel – auditory, visual, kinesthetic • Receiver • Response Communication Process Model MMUNICATION Modes of Communication • Content of the message • Considerations • Pace and Intonation • Simplicity • Clarity and Brevity • Timing and Relevance • Adaptability • Credibility • Humor • Process of the message • Considerations • Personal Appearance • Posture and Gait • Facial Expression • Gestures • Eye contact • Tone of voice • Mode of dress and grooming Non verbal • Electronic MMUNICATION Factors Influencing the Communication Process • Personal Factors • Emotional factors • Physical state • Roles and responsibilities • Values and Perceptions • Developmental Level • Gender • Cognitive factors • Congruence Factors Influencing the Communication Process • Environmental factors • Territoriality • Background noise, uncomfortable accommodations Factors Influencing the Communication Process • Relationship factors • Interpersonal Attitudes – Symmetrical relationship – Complimentary relationship • Personal Space – Proxemics - study of distance between people and interactions » Intimate – Touching to 1 ½ feet » Personal – 1 ½ to 4 feet » Social – 4 to 12 feet » Public – 12 to 15 feet MMUNICATION • Two main principles that can guide the communication process (Peplau) • Clarity • Continuity Therapeutic Communication Purpose • Promotes understanding and can help establish a constructive relationship between the nurse and the client • Client and goal directed • Nurses need to respond not only on the content of the client’s verbal message but also to the feelings expressed Clinical Interview Attentive Listening Physical Attending • Manner of being present to another or being with another • Listening in what a person does while attending • Body language – Consider kinesics and proxemics • Paralinguistics – “It’s not what you say, but how you say it.” – “I will see you tonight” Physical Attending • Verbal tracking • Five actions of physical attending (Egan, 1998) – Face the other person squarely – Adopt an open posture – Lean toward the person – Maintain good eye contact – Be relatively relaxed Cultural Communication Barriers • Communication style • Use of eye contact • Perception of touch • Cultural filters Degree of Openness • Open-ended questions • Closed-ended questions • Indirect or implied questions Communication Techniques Using silence • There is no universal rule as to how much silence is too much, it is said to be worthwhile as long as it is serving its purpose and not frightening the client. • Knowing when to speak during an interview is largely dependent on the nurse’s perception about what is being conveyed through the silence. • Silence may indicate an expression of anger and hostility, being ignored and insulted, or it may provide meaningful moments of reflection Accepting “Yes” “Uh-huh” “I follow what you say.” Providing general leads “Can you tell me how it is for you?” “Perhaps you would like to talk about….” “And then…” Being specific and tentative “Rate your pain scale from 1-10” (specific) “You seem unconcerned about your diabetes.” (tentative) Giving Broad Openings “How have you been feeling lately?” “What brought you to the hospital?” Using touch Putting an arm over the client’s shoulder Placing your hands over the client’s hand Restating or paraphrasing Client: “I couldn’t manage to eat any dinner last night – not even dessert.” Nurse: “You had difficulty eating yesterday?” Seeking Clarification “I’m not sure I understand that.” “Would you please say that again?” Perception checking or seeking consensual validation Client: “My husband never gives me any presents. Nurse: “You mean he has never given you any present for your birthday or Christmas?” Client: “Well-not never. He does get me something for my birthday and Christmas, but he never thinks of giving me anything at any other time.” “Tell me whether my understanding agrees with you.” Offering self “I’ll stay with you until your daughter arrives.” “We can sit here quietly for a while; we don’t need to talk unless you would like to.” Giving information “Your surgery is scheduled for 11am tomorrow.” “You will feel a pulling sensation when the tube is removed from your abdomen.” Acknowledging/ Giving Recognition “You walked twice as far today with your walker.” “You trimmed your beard and mustache and washed your hair.” Clarifying time or sequence Client: “I vomited this morning.” Nurse: “Was that after breakfast?” Making observations “You seem tense.” “I notice you biting your lips.” Presenting reality “Your magazine is here in the drawer. It has not been stolen.” “The telephone ring came from the television program.” Exploring “Tell me more about that…” “Would you describe it more fully?” Encouraging comparisons “Has this ever happened before?” “Is this how you felt when?” Restating Client: “I can’t sleep. I stay awake all night.” Nurse: “You have difficulty sleeping?” Focusing Client: “My wife says she will look after me but I don’t think she can, what with the children to take care of, and they’re always after her about something – clothes, homework, what’s for dinner not night.” Nurse: “Sounds like you are worried about how well she can manage Reflecting Client: “What can I do?” Nurse: “What do you think would be helpful?” Summarizing and Planning “During the past hour we have talked about…” “Tomorrow afternoon we may explore this further.” Barriers to Communication • • • • • • • • Stereotyping Agreeing and Disagreeing Minimizing feelings Being defensive Challenging Probing Testing Rejecting • • • • • • • Changing topics and subjects Unwarranted reassurance Passing judgment Asking why questions Giving common or premature advice Asking excessive questions Showing nonverbal signs of boredom and resentment Dimensions • Empathy • Respect • Therapeutic genuineness • Concreteness Facilitative skills checklist (Myrick & Erney) Indicate whether you strongly agree (SA), Agree (A), not sure (NS), Disagree (D), strongly disagree (SD) • I maintain good eye contact. • Most of my verbal comments follow the lead of the other person. • I encourage others to talk about feelings. • I am able to ask open-ended questions. • I can restate and clarify a person’s ideas • I can summarize in a few words the basic ideas of a long statement made by a person • I can make statements that reflect the person’s feelings Facilitative skills checklist (Myrick & Erney) • I can share my feelings relevant to the discussion when appropriate to do so • I am able to give feedback • At least 75% or more of my responses help enhance and facilitate communication • I can assist the person to list some alternatives available • I can assist the person to identify some goals that are specific and observable • I can assist the person to specify at least one next step that might b taken toward the goal MMUNICATION It is not enough that we have the knowledge of skills and techniques to communicate effectively but we as nurse also need to have genuine respect and the ability to listen and to understand the client’s concern and a desire to work with the individual to help in his or her situation. References communication. (2009). In Merriam-Webster Online Dictionary. Retrieved June 6, 2009, from http://www.merriamwebster.com/dictionary/communication Kozier B., Berman A., Synder S., &Erb, G. (2008). Fundamentals of Nursing Concepts, Process, and Practice (8th edition). Jurong, Singapore: Pearson Education Inc. Taylor C., Lillis C., LeMone P. (2005). Fundamentals of Nursing The Art and Science of Nursing Care (5th edition) Philadelphia: Lippincott Williams and Wilkins. Varcarolis, E., Carson V., & Shoemaker N. (2006). Foundations of Psychiatric Mental Health Nursing A Clinical Approach(5th edition)St. Louis Missouri: Elsevier Inc. Lab Activity In each of the following, identify the types of responses which block the client’s attempts to express himself. Correct the nurse’s response so that it is therapeutic. Patient: “Well, I haven’t been able to work for quite a while now, and the doctor says I might not even work as a carpenter again.” Nurse: “It must be difficult for you right now, but I’m sure everything will be all right.” Patient: “I don’t know. I hate to have him see me looking like this. Just thinking about him coming makes me nervous.” Nurse: “You really should stop worrying. That may be what’s keeping you from getting the rest you need. And, after all, no one expects you to look your best when you’re in the hospital.” Nurse: “How are you feeling this morning, Mr. Patterson?” Patient: Oh, fine, thanks.”(unenthusiastic) Nurse: “That’s good.” Patient: “But it’s kind of hard having to watch what I eat, and trying to be careful about what I do. I just sit around the house most of the time, watching TV.” Nurse: “You should take up a good hobby - something you can do without much physical strain. If you keep busy, it might take your mind off your troubles.” Patient: “You’d think a doctor could have prevented some of this, but he’s too busy to care about what’s happening to me.” Nurse: “You have a fine doctor. We have lots of his patients. He always takes every precaution.” Patient: “What’s there to talk about? First they say they have to operate, and then when I’m beginning to feel better, I get this infection. I don’t think I’m ever going to get out of here.” Nurse: “I know just how you feel. You know, everyone gets frustrated when things aren’t going right.” Patient: “Maybe I should find a hobby or something. I try not to get discouraged. I know I shouldn’t let it get me down.” Nurse: “That’s the right attitude. It really doesn’t help to worry about it.” • Look at activities in the syllabus to review QUIZ 1. Which of the following best describes therapeutic communication? A. Communication that facilitates cooperative, effective patient interaction B. Communication that helps to avoid or ameliorate violent patient encounters C. Communication that helps reduce the chance of a lawsuit D. All except C E. All of the above 2. In regards to feedback, if the message was not properly received the sender should: A. Restate the original message B. Modify the content of the original message to clarify C. Rethink the message and get back to the receiver at a later date D. All except C E. All of the above 3. Reflection allows the health care provider to facilitate an effective patient interview. Which of the following describes reflection? A. Allows the patient to restate something that confuses the healthcare worker B. Allows patient more time for their thought process C. Technique that involves paraphrasing what the patient says to clarify D. All of the above E. All except C 4. When faced with a patient who has a hearing disorder, which of the following techniques would facilitate better communications? A. Gaining the patient’s attention by shaking the patient B. Speaking more monotone C. Speak normally to facilitate lip reading D. All of the above E. None of the above 5. A nurse is teaching a home care patient how to administer a topical medication. The patient is watching television while the nurse is talking. What might be the result of this interaction? A. The message will likely be misunderstood. B. The stimulus for communication is unclear. C. The receiver will accurately interpret the message. D. The communication will be reciprocal. E. All of the above 6. Open-ended questions encourage the patient to: A. Answer “yes” or “no” B. Allows the nurse to manipulate the response C. Restrict the response D. Freely provide a more objective response E. All of the above 7. Which of the following is NOT an effective communication technique? A. Avoiding ambiguous phrases and excessive medical jargon B. Using analogies to everyday situations so that the patient can understand C. Using more versus fewer words to avoid confusing the patient D. Repeating the key elements during history taking E. None of the above