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Communication
Human interaction
Verbal and nonverbal Written and unwritten Planned and unplanned
Conveys thoughts and ideas Transmits feelings Exchanges information Means various things
Communication, continued
Effective communication Intrapersonal level self-talk Clear communication essential
Client safety Collaboration with diverse team challenged by
Current health care environment Professional communication and collaboration Cultural gaps Available resources and technology
Message
What is actually said/written, body language How words are transmitted channel
Receiver
Listener decoder perception of intention
Response Feedback
Verbal Communication
Pace and intonation Simplicity Clarity and brevity
Congruence
Nonverbal Communication
Body language
Gestures, movements, use of touch
Gestures
Cultural component
Electronic Communication
Advantages
Fast Efficient Legible Improves communication, continuity of care
Disadvantages
Client confidentiality risk HIPPA Socioeconomics
Electronic Communication,
continued Do not use e-mail
Urgent information
Jeopardy to clients health
Other guidelines
Agency-specific standards and guidelines Part of medical record Consent, identify as confidential
Development
Language and communication skills develop through stages Communication techniques for children
Play Draw, paint, sculpt Storytelling, word games Read books; watch movies, videos Write
Gender
Females and males communicate differently from early age Boys establish independence, negotiate status Girls seek confirmation, intimacy
Sociocultural Characteristics
Culture Education Economic level
Personal Space
Defined as distance people prefer in interactions with others Proxemics
Intimate distance frequently used by nurses Personal distance less overwhelming Social distance increased eye contact
Out of reach for touch
Public distance
Figure 36-5 Personal space influences communication in social and professional interactions. Encroachment into another individuals personal space creates tension.
Territoriality
Space and things
Individual considers as belonging to self Knock before entering space
May be visible
Curtains around bed unit Walls of private room Removing chair to use at another bed
Environment
Can facilitate effective communication Key factors
Comfort Privacy
Congruence
Congruence
Verbal and nonverbal aspects match Seen by nurse and clients
Incongruence
Senders true meaning in body language
Attitudes
Interpersonal attitudes
Attitudes convey beliefs, thoughts, feelings Caring, warmth, respect, acceptance
Facilitate communication
Respect
Barriers to Communication
Stereotyping Agreeing and disagreeing Being defensive Challenging Probing Testing
Rejecting Changing topics Unwarranted reassurance Passing judgment Giving common advice
Therapeutic Communication
Interactive process between nurse, client Helps client overcome temporary stress
To get along with other people Adjust to the unalterable Overcome psychological blocks
NOT synonymous with sympathy Interprets clients feelings without inserting own
Empathy
Empathy
Four phases of therapeutic empathizing
Identification Incorporation Reverberation Detachment
Listening
Attentive listening
Mindful listening Paying attention to verbal, nonverbal Noting congruence Absorbing content and feeling Listening for key themes Be aware of own biases Highly developed skill
Attending
Physical attending
Face the person squarely Adopt an open posture Lean toward the person Maintain good eye contact Try to be relatively relaxed
Silence
Using silence
Encouraging the client to communicate Allowing client time to ponder what has been said Allow client time to collect thoughts Allow client time to consider alternatives Look interested Uncomfortable silence should be broken
Analyzed
Reflection
Reflecting
Repeating the clients message
Verbal or nonverbal
Reflecting feelings
Verbalizing implied feelings in clients comment
Deflection
Avoiding self-disclosure
Deflect a request for self-disclosure
Honesty Benign curiosity Refocusing Interpretation Clarification Feedback and limit setting
Clarification
Clarifying
Attempt to understand clients statement Ask client to give an example
Paraphrasing
Nurse assimilates or restates in own words Fives nurse opportunity to test understanding
Checking perceptions
Sharing how one person perceives another
Structuring
Attempt to create order, establish guidelines Define parameters of nurse-client relationship
Linking
Nurse responds to client
Ties together two events, experiences, feelings Connect past experiences with current behaviors
Giving Feedback
Nurse share reaction to what client said Give in a way that does not threaten client Risk of client experiencing feedback
Personal rejection
Focus Feedback
On behavior, observations, description On more-or-less, rather than either/or On here-and-now: what is said, not why Sharing of information, ideas Exploration of alternatives Value to client Amount of information client able to use Appropriate time and place
Confronting
Deliberate invitation to examine some aspect of personal behavior that indicates discrepancy between actions and words Informational confrontation
Describes visible behavior
Interpretive confrontation
Draws inferences about the meaning of behavior
Processing
Direct attention to interpersonal dynamics
Barriers to Communication
Failure to listen Improperly decoding intended message Placing the nurses needs above clients
May develop over weeks or within minutes Influenced by nurse and client
Personal and professional characteristics
Relationship Characteristics
Characteristics of therapeutic relationship
Intellectual and emotional bond
Focused on client
Respects client as individual Respects client confidentiality Focuses on clients well-being Based on mutual trust, respect, acceptance
Introductory Phase
Preinteraction phase Introductory phase
Orientation, pretherapeutic phase Nurse and client observe each other Open relationship Clarify problem Structure and formulate contract Client may display resistive behaviors
Termination Phase
Difficult, ambivalent Summarizing Termination discussions Allow time for client adjustment to independence
Developmental Considerations
Establish rapport with children Sit or lower self to childs eye level Note what child is playing with or reading If appropriate, agree with child/share feelings Compliment a physical features, activity Use calm tone of voice, appropriate language Pace discussion, procedure in nonhurried manner Preschoolers have limited concept of time
Establish Trust
Establishing rapport
Include adolescent in discussion Listen more than you talk Avoid distractions Be truthful with the child
Establishing trust
Follow through with promises Respect confidentiality Be truthful, even if it isnt what they want
Conclusion
Nurses role requires communication skills Effective communication large role
Ability to deliver highest quality of care
Nurse needs to be understood Nurse needs to understand messages Strong verbal, written communication skills Monitor own nonverbal communication
Documentation
Effective communication vital to care Discussion Report Record Recording Charting Documenting Legal document
Purposes of Client Records Communication Planning care Auditing health agencies Research Education Reimbursement Legal documentation Health care analysis
Documentation Systems
Source-oriented record Problem-oriented medical record Problems, interventions, evaluation (PIE) Focus charting Charting by exception Computerized documentation Case management
Source-Oriented Record
Notations for each discipline in separate sections of chart Narrative charting Being replaced or augmented Organize information in clear, coherent manner Convenient Scattered
Figure 36-8
Problem-Oriented Record
Problem-oriented medical record (POMR) Arranged according to client problems Advantages Encourages collaboration Problem list alerts caregivers to clients needs Disadvantages Caregivers differ in ability to use format Vigilance to maintain up-to-date problem list Inefficient
POMR Components
Database Problem list Derived from database Listed in order identified Updated Plan of care Progress notes Same sheet for all notes
PIE System
Groups information Problems Interventions Evaluation of nursing care Flow sheets, incorporates ongoing care plan Assessment establishes, records problem NANDA Dx or develop problem statement
Focus Charting
Three columns usually used Date and time Focus: condition, nursing diagnosis, behavior, sign/symptom Progress note Data Action Response Holistic perspective
Charting by Exception
Charting by exception (CBE) Flow sheets Standards of nursing care Bedside access to chart forms Advantages Elimination of lengthy, repetitive notes Presumption that nurse did assess client
Computerized Documentation
Manage huge volume of information Information easily retrieved, format variety Can generate work list for shift Relatively easy Standardized lists, add narrative information Speech recognition technology Transmit information between settings MDS
Case Management
Emphasizes quality, cost-effective care Multidisciplinary approach Planning and documenting client care Critical pathway Incorporated graphics and flow sheets Goal not met is variance Unexpected outcome Document unexpected event
Figure 36-17
Traditional care plan written for each client Standardized care plans save time
Kardexes
Concise method for organizing, recording May/may not be part of permanent record May be in pencil May be organized into sections
Pertinent information, allergies Medications, IV fluids List of treatments, procedures Procedures orders
Kardexes, continued
Specific data on how physical needs to be met
Diet, assistance needed with feeding Elimination devices Activity Hygienic needs, safety precautions
Problem list with stated goals, nursing approaches Quick visual guide
Progress notes
Progress, interventions, re/assessment data
Nursing Discharge
Completion on discharge/transfer
If given to client, family understandable terms
Usually includes:
Clients status description, resolved problems
Referral Summaries
Usually include:
Unresolved continuing health problems Treatments to be continued Current medications Restrictions related to activity, diet, bathing Activities of daily living (ADL) abilities Comfort level Support networks
Requirements based on
Professional standards Federal, state regulations
HCFA OBRA law Medicare and Medicaid requirements
Encourage client, caregiver to record data Write discharge summary for physician
Notify reimbursers services discontinued
Accuracy
Clients name, identifying information Observations and facts Recording a mistake
Draw line through it and write mistaken entry Name or initials
Conciseness
Legal Prudence
Legal protection to nurse, caregivers, facility
And client
Admissible in court as legal document Adhere to professional standards Follow agency policy and procedures
Dont
Leave blank spaces Chart in advance Use vague terms Chart for others Use patient or client Alter record Record assumptions