COMMUNICATION IN NURSING

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This PPT discuss on Communication in Nursing of IV Unit of Nursing foundation, I Year B.Sc. nursing as per INC Syllabus

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UNIT IV: Communication and Nurse patient relationship:

UNIT IV: Communication and Nurse patient relationship Mrs. P. Vadivukkarasi Ramanadin, Professor, Dept. Of OBG (N), Shri Vinoba Bhave College of Nursing, Shri Vinoba Bhave Civil Hospital, Silvassa, DNH.

UNIT IV: Communication and Nurse patient relationship:

UNIT IV: Communication and Nurse patient relationship • Communication: Levels, Elements, Types, Modes,Process, Factors influencing Communication o Methods of effective Communication - Attending skills - Rapport building skills o Empathy skills o Barriers to effective communication • Helping Relationships (NPR): Dimensions of Helping Relationships, Phases of a helping relationship • Communication effectively with patient, families and team members and maintain effective human relations with special reference to communication with vulnerable group (children, women physically and mentally challenged and elderly) • Patient Teaching :Importance, Purposes, Process, role of nurse and Integrating teaching in Nursing process SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA 2

INTRODUCTION:

INTRODUCTION Communication is the integral part of Nursing administration. It is one of the most important functions of Management. Nurse Managers are required to be aware of the techniques that can help them to ensure effective management of educational/service unit. It is the foundation upon which the nurse manager achieves organizational objectives . 3 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

MEANING :

MEANING The word communication is derived from the Latin word “Communis” means Common. By Communication we try to establish a “commoness” with others. It means try to share ideas, information or an attitude. 4 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

DEFINITION:

DEFINITION Communication is the purposive exchange resulting in workable understanding and agreement between the sender & receiver of the message. George Verdman Communication is interchange of thoughts, opinions or information by speech, writing or signs. - Robert Anderson 5 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont. . :

Cont. . Communication is a process in which a message is transferred from one person to other person through a suitable media and the intended message is received and understood by the receiver. The exchange of thoughts, messages, or the like, as by speech, signals or writing. Communication is shared feelings/shared understanding. 6 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

CHARACTERISTICS:

CHARACTERISTICS It is a Co-operative process that involves two or more people It depends on the ability to listen as well as to speak Involves both information & understanding Includes all mean of by which meaning is conveyed from one person to another 7 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont. . . .:

Cont. . . . The end result of communication is understanding It is the basis for action & co-operation Its primary purpose is to motivate a response A further attribute of communication is its universality in the organisation It is an integral part of the process of exchange 8 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

purposes:

purposes To obtain information To influence others To collect assessment data To initiate intervention To evaluate outcome of intervention To initiate change which helps in promoting health To improve nurses client relationship To take measures for preventing legal problems associated with nursing practice To analyse factors affecting helath team 9 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

levels:

levels Level 1: Conventional Acquaintances (With stranger, to know each other) Level 2: Exploratory Associates (Conversation if fact & problem oriented & impersonal) Level 3: Participate friends (Participate in group activity) Level 4: Intimacy (Closest friends) 10 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Levels of Communication :

Levels of Communication Intrapersonal communication is a powerful form of communication that occurs within an individual. This level of communication is also called self-talk, self-verbalization, or inner thought. People’s thoughts strongly influence perceptions, feelings, behavior, and self-concept. 11 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide12:

Interpersonal communication is one-on-one interaction between a nurse and another person that often occurs face to face. It is the level most frequently used in nursing situations and lies at the heart of nursing practice. It takes place within a social context and includes all the symbols and cues used to give and receive meaning 12 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide13:

Transpersonal communication is interaction that occurs within a person’s spiritual domain. Study of the influence of religion and spirituality has increased dramatically in recent years, and ongoing research helps us understand the role of nurses in addressing a patient’s spiritual need 13 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide14:

Small-group communication is interaction that occurs when a small number of persons meet. This type of communication is usually goal directed and requires an understanding of group dynamics. When nurses work on committees, lead patient support groups, form research teams, or participate in patient care conferences, they use a small-group communication process. 14 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Public communication:

Public communication Public communication is interaction with an audience. Nurses have opportunities to speak with groups of consumers about health-related topics, present scholarly work to colleagues at conferences, or lead classroom discussions with peers or students. Public communication requires special adaptations in eye contact, gestures, voice inflection, and use of media materials to communicate messages effectively. Effective public communication increases audience knowledge about health-related topics, health issues, and other issues important to the nursing profession. 15 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

symbolic communication:

symbolic communication Good communication requires awareness of symbolic communication, the verbal and nonverbal symbolism used by others to convey meaning. Art and music are forms of symbolic communication used by nurses to enhance understanding and promote healing. Lane (2006) found that creative expressions such as art, music, and dance have a healing effect on patients. Patients reported decreased pain and a greater sense of joy and hope. 16 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

types:

types 17 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

TYPES OR CLASSIFICATION:

TYPES OR CLASSIFICATION 18 Horizontal / Lateral Vertical Diagonal Upward Downward Formal Informal Verbal Nonverbal Oral Written Receivers Interpersonal Group Mass Intra personal SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

PROCESS / ELEMENTS / COMPONENTS / STEPS:

PROCESS / ELEMENTS / COMPONENTS / STEPS 19 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Factors:

Factors Development Gender Sociocultural characteristics Values and perception Personal space Territoriality Roles and relationships Environment Congruence / Correspondence Attitudes 20 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide21:

Pacing 1. Intimate: Touching to 1 1/2 feet 2. Personal: 1 1/2 to 4 feet 3. Social: 4 to 12 feet 4. Public: 12 to 15 feet 21 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Methods / techniques:

Methods / techniques Verbal Speaking, Listening, Writing, Reading. Nonverbal Gestures, Facial Expressions, Smile Posture and Gait, Tone of Voice, Touch, Eye Contact, Body Position, Physical Appearance, Silence 22 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Skills for effective communication:

Skills for effective communication Confidence Critical thinking Analytical Open mindedness Active listener Empathetic (Perceiving clients feelings) Honest Confidentiality Knowledgeable Systematic Tactfulness 23 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

important aspects of verbal communication :

important aspects of verbal communication Denotative and connotative meaning Vocabulary Pacing Adaptability Intonation Clarity and brevity Credibility, Simplicity Time and relevance & Humour 24 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

important aspects of Non verbal communication:

important aspects of Non verbal communication Personal appearance Posture and gait Facial expression Eye contact Hand movements and gestures Observable autonomic physiologic response Voice related behavior 25 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

CHANNELS:

CHANNELS Formal Channels of Communication Within or outside the organization Unity of Command Demerits Single executive will retard the speedy flow of information Organization distance may make distortion of the facts 26 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont. .. . :

Cont. .. . Informal Channel / Grape wine / Bush telegraph Built around social relationship of the members of the organization 27 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

BARRIERS:

BARRIERS Physical Physiological Psychological Language Cultural Perceptual Interpersonal Stereotyping Muddled Message 28 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont. . .:

Cont. . . Emotional Wrong Channel Due to organization structure Due to status and position Semantic barriers Tendency to evaluate 29 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide30:

Agreeing and disagreeing Being defensive Challenging Probing Testing Rejecting Changing topics and subjects Unwarranted reassurance Passing judgment Giving common advice 30 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont. . . . .:

Cont. . . . . 31 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

GUIDELINES / strategies:

GUIDELINES / strategies Think before communicating Know your objective Know your audience Consult Determine your medium Tone & content 32 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont. . . . :

Cont. . . . Establish genuine two way communication Listening Questioning Using Discretion Directing Help the receiver 33 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont . . . :

Cont . . . Timing & timeliness Check the result Look for tomorrow Support with action Climate of trust & confidence Continuing process Feedback 34 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Con . . .:

Con . . . The line of communication should be direct and as short as possible Simple & meaningful language Develop skill of listening Good deal can be transferred to mutual relationship & Confidence Face to face conversation is better than written conversation 35 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Importance of communication in health care:

Importance of communication in health care Verbal Non - Verbal Information Education Motivation Persuasion Counselling Bring peace Reduce stress / Tension Health Promotion Express feelings Regulate Interactions Validate Verbal Messages Maintain Self Image Maintain Relationship 36 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Helping relationship:

Helping relationship Nurse–client relationships are referred as interpersonal relationships or t herapeutic relationships or helping relationships . Helping is a growth-facilitating process that strives to achieve two basic goals (Egan, 1998): 1. Help clients manage their problems in living more effectively and develop unused or underused opportunities more fully. 2. Help clients become better at helping themselves in their everyday lives . A helping relationship may develop over weeks of working with a client, or within minutes . The keys to the helping relationship are (a) the development of trust and acceptance between the nurse and the client. The personal and professional characteristics of the nurse and the client influence the helping relationship . Age, sex, appearance, diagnosis, education, values, ethnic and cultural background, personality, expectations, and setting can all affect the development of the nurse–client relationship . 37 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Types of relationship:

Types of relationship Social relationship (Socialization) Intimate relationship (Emotional commitment) Therapeutic relationship (Client welfare) 38 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Characteristics of a Helping Relationship:

Characteristics of a Helping Relationship A helping relationship ■ Is an intellectual and emotional bond between the nurse and the client and is focused on the client. ■ Respects the client as an individual • Maximizing the client’s abilitie s to participate in decision making and treatments. • Considering ethnic and cultural aspects. • Considering family relationships and values . ■ Respects client c onfidentiality . ■ Focuses on the client’s well-being . ■ Is based on mutual trust, respect, and acceptance . 39 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Phases of the Helping Relationship:

Phases of the Helping Relationship PreinteractionPhase: The preinteraction phase is similar to the planning stage before an interview . In most situations, the nurse has information about the client before the first face-to-face meeting. Such information may include the client’s name, address, age, medical history, and/or social history . 40 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide41:

Introductory Phase: The introductory phase, also referred to as the orientation phase or the prehelping phase, is important because it sets the tone for the rest of the relationship. During this initial encounter, the client and the nurse closely observe each other and form judgments about the other’s behavior . The goal of the nurse in this phase is to develop trust and security within the nurse–client relationship. Other important tasks of the introductory phase include getting to know each other and developing a degree of trust . 41 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Steps of introductory phase:

Steps of introductory phase Opening the relationship Clarifying the problem Structuring & Formulating the contract (Obligations to be met by both the nurse & the client ) 42 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide43:

Working Phase: During the working phase of a helping relationship, the nurse and the client begin to v iew each other as unique individuals. They begin to appreciate this uniqueness and care about each other. Caring is sharing deep and genuine concern about the welfare of another person. Once caring develops, the potential for empathy increases. 43 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Steps of WORKING PHASE:

Steps of WORKING PHASE Exploring and understanding thoughts and feelings. The nurse must have the following skills Empathetic listening and responding Genuineness Respect Confrontation: The nurse points out discrepancies between thoughts, feelings, and actions that inhibit the client’s self understanding or exploration of specific areas. This is done empathetically, not judgmentally Concreteness (Specific) Facilitating and taking action 44 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Termination Phase:

Termination Phase The termination phase of the relationship is often expected to be difficult and filled with ambivalence. However, if the previous phases have evolved effectively, the client generally has a positive outlook and feels able to handle problems independently. On the other hand, because caring attitudes have developed, it is natural to expect some feelings of loss, and each person needs to develop a way of saying good-bye. 45 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Dimensions Of Helping Relationship :

Dimensions Of Helping Relationship There are five dimensions and are foundational aspects of building healthy and productive relationships with clients in need of service. Empathy : Empathy is described as the ability to understand the clients condition in a way that you as the helper can relate the experience to your own life. Respect: Helping professionals should have an amount of respect for the client that affords them a feeling of being listened to and acknowledged. 46 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide47:

Genuineness: A certain amount of self-disclosure may be necessary to let the client know that you are approachable and available to discuss matters pertaining to the relationship. Concreteness : Being clear about the nature of the relationship you are entering into is one way to establish a sense of concreteness. In addition to defining the helping relationship, it is important to provide tangible ways the client can ascertain the effectiveness of the treatment or service. 47 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide48:

Warmth: Warmth is an important aspect of the helping relationship. Tone of voice and eye contact can greatly improve one's warmth factor. 48 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Principles of therapeutic communication:

Principles of therapeutic communication Plan to interview at an appropriate time Ensure privacy Establish guidelines for the therapeutic interactions Provide comfort during interaction Accept the client exactly as he is Encourage spontaneity Focus on the client & on the leads & clues presented Encourage the expression of feelings Be aware of your own feelings during interactions 49 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Techniques of Therapeutic communication:

Techniques of Therapeutic communication Offering self Broad openings Open ended comments Reflection Exploring Recognition Focusing Directing Making Observation Clarifying Confronting Limit setting 50 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide51:

Providing general leads Being specific and tentative Using open-ended questions Using touch Restating or paraphrasing Seeking clarification Perception checking or seeking consensual validation Offering self Giving information Acknowledging Clarifying time or sequence Presenting reality 51 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide52:

Summarizing and planning Active Listening. S — Sit facing the patient. his posture conveys the message that you are there to listen and are interested in what the patient is saying. O — Observe an open posture (i.e., keep arms and legs uncrossed). This posture suggests that you are “open” to what the patient says. L — Lean toward the patient. This posture conveys that you are involved and interested in the interaction. 52 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide53:

E — Establish and maintain intermittent eye contact. This behavior conveys your involvement in and willingness to listen to what the patient is saying. Absence of eye contact or shifting the eyes gives the message that you are not interested in what the patient is saying. R — Relax. It is important to communicate a sense of being relaxed and comfortable with the patient. Restlessness communicates a lack of interest and a feeling of discomfort to the patient. 53 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide54:

Sharing Hope Sharing Observations Sharing Humor Sharing Feelings Asking Relevant Questions Self-Disclosure 54 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Nontherapeutic Communication Techniques :

Nontherapeutic Communication Techniques Asking Personal Questions Giving Personal Opinions Changing the Subject Automatic Responses. False Reassurance Sympathy: Sympathy is concern, sorrow, or pity felt for a patient. The nurse takes on a patient’s problems as if they were his or her own. Sympathy is a subjective look at another person’s world that prevents a clear perspective of the issues confronting that person. If a nurse overidentifies with a patient, objectivity is lost, and the nurse is not able to help the patient work through the situation (Townsend, 2009). 55 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide56:

Asking for Explanations Approval or Disapproval Defensive Responses Passive or Aggressive Responses Arguing 56 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Ways to Develop Helping Relationships:

Ways to Develop Helping Relationships Listen actively Identify others feelings Be empathetic Be honest Be genuine Be credible Maintain confidentiality Know your role & limitations Behave professionally 57 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Various communication in health care field:

Various communication in health care field Nurse-Family Relationships Many nursing situations, especially those in community and home care settings, require nurse to form helping relationships with entire families. The same principles that guide one-on-one helping relationships also apply when the patient is a family unit, although communication within families requires additional understanding of the complexities of family dynamics, needs, and relationships 58 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Nurse–Health Care Team Relationships:

Nurse–Health Care Team Relationships Communication with other members of the health care team affects patient safety and the work environment. Breakdown in communication is a frequent cause of serious injuries in health care settings. When patients move from one nursing unit to another or from one provider to another, also known as hand-offs , there is a risk for miscommunication. Accurate communication is essential to prevent errors. 59 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Nurse-Community Relationships:

Nurse-Community Relationships Many nurses form relationships with community groups by participating in local organizations, volunteering for community service, or becoming politically active. Nurse need to establish relationships with the community to be an effective change agent. Effective health communication requires awareness of language, nonverbal communication and respect for contextual and cultural influences. Communication within the community occurs through channels such as neighborhood, newsletters, health fairs, public bulletin boards, newspapers, radio, television, and electronic information sites. Use these forms of communication to share information and discuss issues important to community health. 60 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

ELEMENTS OF PROFESSIONAL COMMUNICATION:

ELEMENTS OF PROFESSIONAL COMMUNICATION Professional appearance, demeanor, and behavior are important in establishing trustworthiness and competence. They communicate that the nurse the professional helping role, are clinically skilled, and are focused on the patients. Nothing harms the professional image of nursing like an individual nurse’s inappropriate appearance or behavior. 61 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Cont . .. . :

Cont . .. . A professional is expected to be clean, neat, well groomed, conservatively dressed, and odor free . Visible tattoos and piercings are not acceptable in the professional setting. Professional behavior reflects warmth, friendliness, confidence, and competence. Professionals speak in a clear, well-modulated voice; use good grammar; listen to others; help and support colleagues; and communicate effectively. Being on time, organized, well prepared, and equipped for the responsibilities of the nursing role also communicate professionalism. 62 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide63:

Courtesy Common courtesy is part of professional communication. To practice courtesy, say hello and goodbye to patients and knock on doors before entering. State your purpose, address people by name, and say “‘please” and “thank you” to team members. When a nurse is discourteous, others perceive him or her as rude or insensitive. It sets up barriers between nurse and patient and causes friction among team members. 63 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide64:

Use of Names: Always introduce yourself. Failure to give your name and status (e.g., nursing student, registered nurse, or licensed practical nurse) or acknowledge a patient creates uncertainty about the interaction and conveys an impersonal lack of commitment or caring. Making eye contact and smiling recognizes others. 64 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide65:

Trustworthiness Trust is relying on someone without doubt or question. Being trustworthy means helping others without hesitation. To foster trust, communicate warmth and demonstrate consistency, reliability, honesty, competence, and respect. Sometimes it isn’t easy for a patient to ask for help. Trusting another person involves risk and vulnerability; but it also fosters open, therapeutic communication and enhances the expression of feelings, thoughts, and needs. 65 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide66:

Autonomy and Responsibility: Autonomy is being self-directed and independent in accomplishing goals and advocating for others. Professional nurses make choices and accept responsibility for the outcomes of their actions (Townsend, 2009). They take initiative in problem solving and communicate in a way that reflects the importance and purpose of the therapeutic conversation (Arnold and Boggs, 2011). Professional nurses also recognize a patient’s autonomy. 66 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide67:

Assertiveness Assertiveness allows you to express feelings and ideas without judging or hurting others. Assertive behavior includes intermittent eye contact; nonverbal communication that reflects interest, honesty, and active listening; spontaneous verbal responses with a confident voice; and culturally sensitive use of touch and space. Assertive behavior increases self-esteem and self-confidence, increases the ability to develop satisfying interpersonal relationships, and increases goal attainment. Assertive individuals make decisions and control their lives more effectively than nonassertive individuals. 67 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Disruptive Behaviors: :

Disruptive Behaviors: Disruptive Behaviors: The Center for American Nurses (2008) defines disruptive behavior as “ behavior that interferes with effective communication among health-care providers and n egatively impacts performance and outcomes. The type of behavior is not supportive of a culture of safety” . Three common disruptive behaviors reported among nurses are incivility, lateral violence, and bullying. 68 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide69:

Incivility Incivility is usually described as rude, discourteous, or disrespectful behavior that reflects a lack of regard for others (Hutton & Gates, 2008; Olender-Russo, 2009b). Sutton (2007) lists 12 common everyday actions that characterize incivility: personal insults, invading personal territory, uninvited physical contact, threats and intimidation, sarcastic jokes and teasing, abusive e-mails, humiliation, public shaming, rude interruptions, twofaced attacks, dirty looks, and treating people as if they are invisible. 69 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Lateral Violence :

Lateral Violence Lateral violence, also known as horizontal violence and horizontal hostility, are terms that describe physical, verbal, or emotional abuse or aggression directed at RN coworkers at the same organizational level. It usually includes verbal or nonverbal (rather than physical) behaviors. Examples of these behaviors include undermining activities, withholding information, sabotage (The deliberate attempt to damage, destroy, or hinder a cause or activity), scape goating (One that is made to bear the blame of  others ), infighting, backstabbing, and broken confidences (Center for American Nurses, 2008, p 2). 70 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Bullying:

Bullying Bullying is an “offensive abusive, intimidating ( To make timid; fill with fear) insulting behavior or abuse of power . . . which makes the recipient feel upset, threatened, humiliated, or vulnerable, which undermines their self-confidence and may cause them to suffer stress” To be considered bullying behavior, it must occur repeatedly (e.g., twice a week or more) and for at least 6 months, and be targeted at an individual who is unable to defend herself or himself. Bullying causes health problems for the target, a hostile work environment that hinders effective communication, and nurse retention problems for the organization. 71 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

COMMUNICATING WITH PATIENTS WHO HAVE SPECIAL NEEDS :

COMMUNICATING WITH PATIENTS WHO HAVE SPECIAL NEEDS Patients Who Cannot Speak Clearly (Aphasia ( inability (or impaired ability) to understand or produce speech, as a result of brain damage ), Dysarthria ( difficult or unclear articulation of speech that is otherwise linguistically normal. ),Muteness ( or mutism m eans "silent") is an inability to speak often caused by a speech disorder, hearing loss, or surgery.  )) • Listen attentively, be patient, and do not interrupt. • Ask simple questions that require “yes” or “no” answers. • Allow time for understanding and response. • Use visual cues (e.g., words, pictures, and objects) when possible. • Allow only one person to speak at a time. • Encourage patient to converse. • Let patient know if you have not understood him or her. • Collaborate with speech therapist as needed. • Use communication aids: 72 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Slide73:

Patients Who Are Cognitively Impaired • Use simple sentences and avoid long explanations. • Ask one question at a time. • Allow time for patient to respond. • Be an attentive listener. • Include family and friends in conversations, especially in subjects known to patient. 73 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Obstacles to therapeutic communication :

Obstacles to therapeutic communication Resistance Transference Counter Transference Boundary Violations 74 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Ineffective responses that hinder therapeutic communication :

Ineffective responses that hinder therapeutic communication Offering false reassurance Not listening Minimising the problem Offering advice Giving literal response Changing the subject Belittling Disagreeing Judging Challenging Criticism of others 75 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Patient teaching :

Patient teaching Teaching is a system of activities intended to produce learning. Patient teaching / Client teaching involves teaching about reducing the health risk factors, increasing client’s level of wellness & taking specific protective health measures 76 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Purposes of patient / client teaching :

Purposes of patient / client teaching To promote health to protect health To maintain health To identify relevant health care needs of a client To provide emotional & cognitive support during teaching learning process To keep nurse knowledgeable To raise self-confidence of nurse in teaching 77 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Process of Patient Education::

Process of Patient Education: The process of patient teaching refers to the steps you follow to provide teaching and to measure learning. The steps involved in the teaching-learning process are: Assessing learning needs Developing learning objectives Planning and implementing patient teaching Evaluating patient learning Documenting patient teaching and learning 78 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Role of nurse in patient teaching:

Role of nurse in patient teaching Identify the needs of the client Motivate the client Encourage the client to learn at specific time Involve client actively Topic of client should match with client need Organize the content from simple to complex Provide conducive environment Observe the client emotional, psychological needs Analyse the various factors of client teaching Should be knowledgeable & confidence 79 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

Guideliense for effective patient teaching :

Guideliense for effective patient teaching Establish & maintain good rapport Assess the previous knowledge Consider the time factor Communication skill Language As per clients non – verbal cues Use of AV AIDS Involvement of client senses Repetition reinforces learning Active involvement of client 80 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

“Education is our passport to the future, for tomorrow belongs to those who prepare for it today.” —Malcolm X:

“Education is our passport to the future, for tomorrow belongs to those who prepare for it today.” —Malcolm X 81 SHRI VINOBA BHAVE COLLEGE OF NURSINGH, SILVASSA

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