Caring - The Art and Science of Caring and Communication

THE ART AND SCIENCE OF CARING AND COMMUNICATION NURS (201). SPRING 2020-2021 1 LEARNING OBJECTIVES After completion of this Lecture, the students should be able to: 1. Identify caring and caring outcomes. 2. Discuss self Care for Professional Nurse 3. Describe factors influencing the communication process. 4. Discuss nurse–client communication as a dynamic process. 5. Describe four phases of the helping relationship. 6. Identify features of effective groups. 7.Identify types of groups helpful in promoting health and comfort. 8. Discuss how nurses use communication skills in each phase of the nursing process. 2 CARING Care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. Is sharing deep and genuine concern about the welfare of another person The work or practice of looking after those unable to care for themselves, especially on account of age or illness 3 PROFESSIONALIZATION OF CARING  Care is central to all helping professions and enable persons to create meaning in their lives.  Caring practice involves connection, mutual, recognition and involvement  E . g. After administration of pain medication for a patient who is having surgery, the nurse holds patient’s hand and provide reassurance…she is caring 4 CARING OUTCOMES Promote self actualization Promote individual growth Preserve human dignity and worth Augment self healing Relieve distress 5 DESCRIPTION OF CARING PROCESS        knowing Humility Patience Honesty Trust Hope Courage 6  Compassion: awareness of one’s relationship to others  Competence: having a knowledge, judgement, skills, experience to respond to others  Confidence: quality of trusting relationship. comfort with self, client & family  Conscience: sense of right/wrong, ethics  Commitment: obligation  Comportment: manner, behavior 7 Caring for self: involves initiating and maintaining behavior that promote healthy living and well being Examples of Caring Activities:  A balanced diet  Regular exercise  Adequate rest and sleep  Recreational activities  Meditation (thought) and prayer. 8  Is any means of exchanging information, ideas or feelings between two or more people  Is a two way process involving the sending and the receiving of a message.  Basic component of human relationships in nursing.  Methods are: talking, listening, writing or reading . 9 THE COMMUNICATION PROCESS 10 TYPES OF COMMUNICATION Intrapersonal Communication. Interpersonal Communication. Group Communication. 11 INTRAPERSONAL COMMUNICATION (SELF-TALK) Is the internal thoughts of the communicator. Occurs within the self she/he carry out personal dialogue. Both the sender and the receiver of a message usually engage in self-talk. It involves thinking about the message: 1- before it is sent, 2- while it is being sent, 3- after it is sent, and it occurs constantly. Examples are day dreams, talking to yourself. 12 INTERPERSONAL COMMUNICATION Examples: Communication between the nurse and patient Communication among Health Professionals: Nurse and Physician Communication Effective communication is important among health professionals. communication Problems cause of most client errors  Nurse and Physician Communication Communication styles Nurses are taught to be descriptive both verbally and in writing. Physicians are taught to be brief, to the point, and focused. 13 GROUP COMMUNICATION Group  Two or more people with shared needs and goals  Exists to help people achieve goals that would be unattainable by individual effort alone Group dynamic  Communication between any members of a group, affecting the group process  Each member has effect on dynamics.  For a group to be effective, it must:  Maintain a degree of unity, cohesion  Develop, modify structure to improve effectiveness  Accomplish its goals 14 SENDER Person or group who whishes to communicate a message to another. There should be an idea, feeling or reason for communicating and must put the idea or feeling into a form that can be transmitted (encoding). Encoding: is the selection of specific signs, symbols (codes) to transmit the message. (like; which language or words use, how to arrange the words  & what tone of voices or gesture to use). 15 MESSAGE Method use to convey the message can target any of the receiver senses. » Methods of transmitting messages: talking face to face, telephoning, writing, recording,& the non verbal channel of touch. 16 RECEIVER • The listener who must listen, observe,& attend • The decoder, who perceive what the sender intended to Decode (relate) the message perceived to the receivers’ knowledge & experience & sort out meaning of message. 17 RESPONSE OR FEEDBACK The message that returns to sender, can be verbal, non verbal or both 18 MODES OF COMMUNICATION Verbal communication:  Is the use of sounds and words to express yourself, especially in contrast to using gestures or mannerisms (non-verbal communication).  An example of verbal communication is saying “No” when someone asks you to do something you don't want to do. Non verbal communication:  Is less conscious  It includes body language  Doesn’t use words, and tells others more about what a person is feeling. Electronic Communication:  e-mail by computer (most common) 19 Factors to be Considered When Choosing or Write Words. 1. Pace and intonation: Pace and Intonation. The manner of speech, as in the pace or rhythm and intonation, will modify the feeling and impact of the message. For example, speaking slowly and softly to an excited client may help calm the client. 2. Simplicity: using common/understood words 3. Clarity and brevity: direct and simple; Clarity-saying precise what is meant, Brevity-using the fewest words necessary. 4. Timing and relevance: involves sensitivity to the clients needs & concern 5. Adaptability: adjustment of spoken messages in accordance with behavioral cues from the patient. 6. Credibility: worthiness of beliefs, trustworthiness by being consistent, 7. dependable and honest. Humor: can be positive and powerful tool in the nurse-patient, can help patient adjust to difficult & painful situation. 20 Is controlled less consciously than verbal behavior. Called ”Body Language” includes: o gestures o Body movements o Use of touch o Physical appearance The Nonverbal Communication (Physical Appearance) o Personal appearance o Posture o Gait o Facial expression o Gestures 21 Development Gender Values and perceptions Personal space Territoriality Roles & relationship Environment Congruence Interpersonal attitudes Boundaries 22 1.Development: knowledge of the clients developmental stage will allow the nurse to modify the message accordingly. 2. Gender: females & males communicate differently. Girls: use language to seek confirmation, minimize differences & establish intimacy Boys: use language to establish independence & negotiate status within a group 23 3. Values and Perception: (individual differences). Values: are standard that influence behavior. Perception: are the personal view of an event. 4. Personal Space: distance people prefer in interactions with others. 24 DISTANCE OF COMMUNICATION Intimate: Touching to ½ feet (15Cm) Personal: 1 1/2 to 4 feet (.5 to 1.2 Meter) Social: 4 to 12 feet (1.2 to 3.7 Meter) Public: 12 to 15 feet (3.7 to 4.5 Meter) 25 5. Territoriality: Concept of the space and things that an individual considers as belonging to the self. 6. Roles and Relationship Choice of words, sentence structure & tone of voice vary from role to role, specific relationship between the communicator is significant 7. Environment: Communication may interfere by:  Excessive noise  Ventilation  Privacy  Extreme temperature 26 8. Congruence: verbal and non-verbal aspects of message match that help to prevent miscommunication 9. Interpersonal attitudes: conveys beliefs and feelings about people & events (caring, respect & acceptance) 10. Boundaries: limits in which a person may act or refrain from acting within a designated time or place .e.g. gift giving, spending more time than necessary with client 27 1. Therapeutic Communication 2. Attentive listening 3. Physical Attending 28  Therapeutic communication, in short, is an interaction between a nurse and a patient that helps advance the physical and emotional health of the patient.  Therapeutic communication is an active process.  Therapeutic communication relies on two types of communication: verbal and nonverbal  Promotes understanding and can help establish constructive relationship between the nurse and the client.  It is client and goal directed. 29 Nurses must: 1. Respond not only content of the client's verbal message But also to the feeling expressed. 2. Understand how the clients view the situation and feels about it before responding. 3. Know more about the client and his resources for coping with theses feelings. 4. Allow the clients to deal with their feeling , because the content of the client's communication is words or thoughts as distinct from the feelings 30 1. Is listening actively using all senses 2. Is an active process that require energy & concentration. 3. Involves paying attention to the total message, both verbal and nonverbal. 4. It is absorbing both the content and feeling of the person is conveying without selectively. 5. Attentive listening conveys an attitude of caring and interest thereby encourage the client to talk. 6. Nurses must NOT respond to the message quickly , must take time to think about the message before responding. 31 Silent pause: encourage the speaker to continue. Attentiveness is indicated by comments such as: Yes, go on Restatement: repeating what was said.. Clarifying: asking the speaker what was meant. Reflecting: responding to the feeling communicated. Summarizing: reviewing the major points made. 32 5 Actions of Physical Attending: 1. Face the other person squarely. (increase the (degree of involvement) 2. Adopt an open posture. 3. Non defensive position : arms or legs are crossed 4. Lean toward the person. 5. Closer to the patient 6. Maintain good eye contact. 7. Eye level denotes willingness to maintain communication 8. Try to be relatively relaxed. 9. Taking time in responding, allowing pauses as needed, natural gesture 33 1. Poorly expressed message 11. Challenging. 2. Lack of clarity and precision 12. Probing. 3. Lack of coherence 13. Testing. 4. Talking too fast or too slow 14. Rejecting. 5. Slurring words 15. Changing topics and subject. 6. Words means different things. 16. Unwarranted reassurance. 7. Flow control and information load. 17. Passing judgment 8. Stereotyping. 18. Giving common advice 9. Agreeing and disagreeing 10. Being defensive 34 Goals of helping relationship 1. Helps clients manage their problems in living more effectively and develop unused or underused opportunities more fully. 2. Helps clients become better at themselves in their everyday lives. helping 35 1. Is an intellectual & emotional bond between the nurse and the client focused on the client. 2. Respect the client as an individual , it includes:  Maximizing the client’s abilities to participate in decision making & treatments  Considering ethnic & cultural aspects  Considering family relationship & values 3. Respect client confidentiality 4. Focus on the client’s well being 5. Is based on mutual trust, respect & acceptance. 36 37 1. Pre interaction: Similar to the planning stage ; nurse has information about the client before the first face to face meeting. (name, address, age, medical history etc.) Planning to initial visit may generate clients’ anxious feeling in the nurse. 2. Introductory phase: Is an orientation or pre helping phase, (client &the nurse observe each other's behavior) 3. Working Phase: The nurse and the client begin to view each other as unique individuals. The nurse helps the client plan a program of action to meet pre established goals. 38 4. Termination Phase: Difficult and filled with ambivalence Sharing how things were & comparing them into how they are now Summarizing or reviewing the process can produce a sense of accomplishment. Need to start in advance of the interview, this allows time for the client to adjust to independence. Referral is needed to give support. Follow up phone calls or by E-mail 39 DEVELOPING HELPING RELATIONSHIP 1. Listen actively. 2. Help to identify what the person is feeling. 3. Put yourself in the other person's place. 4. Be honest. 5. Be genuine and credible 6. Use your ingenuity. 7. Be aware of cultural differences that may affect meaning and understanding. 8. Maintain client's confidentiality. 9. Know your role and your limitation. 40 GROUP COMMUNICATION Group: is two or more people who have shared needs and goals. Group Dynamics: is a communication that takes place between members of any group. Types of Health Care Groups: (Helpful in Promoting Heath & Comfort) 1. Task Groups: Is one of the most common types of work-related groups to which nurse belong. E.g. nursing care planning committee, hospital staff meetings. The focus of such group is completion of a specific task. Target date for termination of the group is usually set in advance. 41 GROUP COMMUNICATION 2. Teaching Groups: Major purpose is to impart information to the participants Continuing education Client health care group. 3. Self-help Groups:  Is a small, voluntary organization composed of individuals who share a similar health, social or daily living problem. Are available for range of problems: (stillbirth, drug abuse, cancer, menopause, divorce, alcoholic). 4. Self Awareness Group: The aim is to improve the person's functioning in the group to which they return weather job, family or community. The focus is interpersonal concern around current situation. 42 GROUP COMMUNICATION Therapy Groups: » Is related to self –understanding, more satisfying ways of relating or handling stress, and changing patterns behavior toward health. » Duration of therapy group is NOT usually set. » Termination date is usually mutually determined by the therapist and members. 6. Work- Related Social Support Groups. » Group members know about work with others can encourage and challenge members to be more creative and enthusiastic about their work and to achieve more. » Members can also share joy of success & the frustration of failure through active listening 43 COMMUNICATION AND NURSING PROCESS  Communication is an integral part of nursing process.  More important when the client has sensory, language or cognitive deficits. Communication Skills in the Phases of Nursing 1. Assessment Determine communication impairments or barriers and communication styles Impairments to Communication  Language deficits  Sensory deficits  Cognitive Impairment  Structural deficits  Paralysis Style of Communication:  Verbal  Non verbal 44 2. Diagnosing Communication problems may be: Receptive. e.g. Difficulty of hearing Expressive e.g. Difficulty of speaking (NANDA International, 2015) 1. Anxiety r/t impaired verbal communication 2. Powerlessness r/t impaired verbal communication 3. Situational Low self esteem r/t impaired verbal communication 4. Social isolation r/t impaired verbal communication 5. Impaired Social Interaction r/t impaired verbal communication 45 Planning » Plan ways to improve effective communication » Reduce or resolve the factors impairing communication the 46 4. Implementing To facilitate the intervention with client who have problems with speech or language, includes; » Manipulate environment (quiet environment, sufficient light) » Provide support (give non-verbal reassurance: touch) » Employ measures to enhance communication:  keep word simple and concrete  discuss topic of interest to client  use alternative communication strategies like; picture paper and pencil, word board. » Educate the client and support person(explain anticipated problems) 47 5. EVALUATING » Client Communication : the nurse must listen actively, observe verbal cues and therapeutic communication skills). » Nurse Communication: process recording are frequently used for effective communication. 48 PROCESS RECORDING » Is a verbatim (word for word) account of a conversation. » It can be taped & written. » It includes verbal and non-verbal interaction of both the client & nurse. 49 THANK YOU 50