define the term communication explain why communication is an important concept in health care ...

Define the term communication Explain why communication is an important concept in health care Describe what is meant by the communication process Discuss four factors that affect communication List five examples of therapeutic communication

List five examples of blocks to communications Explain why multicultural health care is important List three components of a cultural sensitivity assessment List two questions that would elicit information about the clients spiritual issues.

Demonstrate the steps for beginning client interaction. Explain why it is therapeutic to encourage the client to express feelings and thoughts. Describe the phases of the health care provider-patient relationship List three components for maintaining a health care provider-patient relationship

Describe the rationale for discussing termination at the beginning of the relationship

Communication is the process of sending and receiving messages by means of symbols, words, signs, gestures, or other actions. Messages sent and received define the relationship between people. It is a vital element in health care and includes both verbal and non-verbal expresions.

A person cannot not communicate. People have an inherent need to communicate, whether it is verbal or non-verbal. Even silence is a form of communication. There is a content, or informational value to messages sent and received that explains what the message is about and expresses how the sender regards the receiver.

The message sent is not necessarily the meaning received. Messages contain overt and covert meanings. Communication becomes dysfunctional when a person does not assume responsibility for his or her communication. Dysfunctional communications results from failing to learn to communicate properly and leaving the responsibility for communicating to others.

Accept the patient as a valued and worthwhile individual, for this acceptance is a prerequisite for a health care provider-patient relationship. Be aware of the total patient, not just his or her physical needs. The clients social, emotional, and spiritual needs are also important.

Understand your own needs, feelings, and reactions so that they do not interfere with the therapeutic process with the client Be prepared to feel some degree of emotional involvement with your patient, evidencing caring and concern for his her welfare. At same time, however, it is necessary to remain objective.

Remember that the health care provider- patient interaction is a professional one. As such you as the health care provider possess the skills, abilities, and resources to relive the other persons pain and discomfort and your patient seeks comfort and assistance for alleviation of some existing problem.

A heath care provider-patient relationship does not require a long term agreement or formal meetings between health care provider and patient to be effective. Take an active role and guide the conversation if the client is overly hesitant. Give broad opening statements and ask open ended questions to help the patients describe what is happening to him or her.

Use body language to convey empathy, interest, and encouragement to facilitate communication. Use silence as a therapeutic tools, as it allows the patient to pace and direct his or her own communications. Long periods of silence, however, may increase the patients anxiety level, so use this technique wisely.

Therapeutic communication techniques assist the flow of communication and always focus on the client.

Acknowledge the client without inserting your own values or judgments. Acknowledgment may be simple and with or without understanding, verbal or non-verbal.

Clarifying the patients message. Check out or make clear either the intent or hidden meaning of what the message, or determine if the message sent was the message received.

Using feedback to relay to the patient the effect of his or her words. This method helps keep the client on course or alters the course. It involves acknowledging, validating, clarifying, extending, and altering.

Focusing or refocusing on the patients statement. Pick up on central topics or cues given by the patient.

Encourage the client to continue.

Consciously receiving the patients message.

Keeping your own verbalization minimal and letting the client lead the conversation.

Creating harmony of verbal and non- verbal messages.

Using body language to communicate interest, attention, understanding, support, caring, and listening to promote data gathering.

Asking questions that cannot be answered with a simple yes or no or maybe/ Generally ask questions requiring an answer of several words to broaden conversational opportunities and to help the client communicate.

Identifying and sending back a message acknowledging the feeling or repeating the last few words the patient said.

Repeating the patients statement as encouragement for him or her to continue.

Verifying the accuracy of the senders message.

Introducing new topics inappropriately, a pattern that may indicate anxiety.

Using clichs, cherry words, and advice, and comforting statements in an attempt to reassure the patient. Most of what is called reassurance is really false reassurance.

Telling the client what to do. Giving your opinion or making decisions for the patient implies that he or she cannot handle his or her own life decisions and that you are accepting responsibility for him or her.

Sending verbal and nonverbal messages that contradict one another; two or more messages, sent via different levels, seriously contradicting one another. The contradiction may be between the verbal/nonverbal content or time/space content.

Making an assumption about the meaning of someone elses behavior that is not validated by the other person.

Ignoring or denying another persons presence, thoughts or feelings.

Talking rapidly, changing subjects, and giving more information than can be absorbed at one time.

Responding in a way that focuses attention on the nurse instead of the patient.

Giving ones own opinion, moralizing or implying ones own values by using words such as nice, good, bad, right, wrong, should, and ought.

As we move into the 21 st Century thee are demographics shifts occurring that will change the direction of health care.

70.4%Caucasian 11.8%African American 0.7% American Indian or Alaskan native 3.8% Asian 0.1% Pacific Islander or native Hawaiian 10.5% Other race 37.6% Hispanic or Latino

72.4%Caucasian 12.6%African American 0.9% American Indian or Alaskan native 4.8% Asian 0.2% Pacific Islander or native Hawaiian 6.2% Other race 16.3% Hispanic or Latino

Because of the change in the US, and more specific Texas population demographics, there are emerging barriers to health care. The greatest barrier is language. Approximately 20% of the US population cannot speak English at all. It is estimated that over half a million people in the state of Texas do not speak English.

Living in urban, poor neighborhoods Poor health care prevention Poverty Beliefs that affect how certain cultural groups understand illness and respond to treatment Reduced access to health care

As more and more people are migrating to the US, health care providers will be faced with cultural diversity problems in administering health care. Cultural Diversity implies the range of differences in values, beliefs, customs, folklore, traditions, language, and patterns of behavior for the various culture groups.

The health provider needs to be aware that personal space is related to culture, gender, and group behavior. Because all of these aspects potentially affect how an individual experiences, copes with, and responds to illness, health care providers must be aware of these cultural differences.

Health care providers must become sensitive to people from cultures other than their own. People from different cultures may have different beliefs and values about illness and treatment, and different health practices and patterns of behavior. In order to treat the patient holistically, the health care provider should be aware of these differences and be able to incorporate them into the patients plan of care.

When completing a total assessment on a client, the individual cultural components that would be important to include are: Cultural background and orientation Communication patterns (based on culture) Nutritional practices

Family relationships Beliefs and perceptions relating to health, illness, and treatment modalities. Values relating to health practices Education Issues affecting the delivery of health care.

This need not be invasive or intrusive. The purpose of such an assessment is to open the channels of communication so that the patient will feel comfortable in discussing spiritual issues. If the patient does not experience an opening from the nurse, he or she may conclude that the health care provider does not wish to discuss spirituality.

Health care providers are given the unique opportunity to share part of who they are with others who have asked directly or indirectly for assistance. It is within this interpersonal relationship that the patient care relationship begins to develop and take on its individual characteristics.

Both individuals bring into the relationship their thoughts, feelings, sense of self or self- worth, behavior patterns, abilities to adapt and cope, belief systems, and points of view about life and how they interact with it. Characteristics of the relationship include acceptance, honesty, understanding, and empathy of the nurse towards the patient who is willing or unwillingly seeking help.

The goal of relationship therapy is to assist the patient to identify and meet his or her own needs. The health care provider may assist the patient in reaching the goals by demonstrating acceptance so that the client may experience the feeling of being accepted as an individual; by developing mutual trust through consistent, congruent nursing behaviors; by providing corrective emotional experiences to increase self- esteem; and finally by creating a safe, supportive environment.

Principles underlying a helping relationship include: Awareness of the total client, including emotional and physical needs, cultural and spiritual needs. Some degree of emotional involvement while maintaining objectivity. The setting of appropriate limits and consistency in behavior while caring for the client.

Open, honest, clear communication Encouragement of the expression of feelings Focus on the here and now

There are three phases in a traditional health care provider-patient relationship. 1. Initiation or Orientation phase 2. Continuation or Active Working phase 3. Termination Phase

In this phase, you introduce yourself to the client and establish boundaries of the relationship. Identify problems, expectations, and relevant issues that need to be addressed during the relationship. Identify any impairments such as hearing, speaking, developmental, or psychological that must be taken into account so that adjustments in the relationship may be made.

This is the phase in which you would develop a working relationship, and in conjunction with meeting the patients needs, begin resolving the patients problems.

At this final phase, when the patient is soon to be discharged; you would follow the plan that you began when the patient was admitted, that includes anticipating any problems or concerns the patient may have when they go home; complete discharge planning and teaching; deal with the patients fears about being on their own after leaving the hospital or clinic.

Obtain the patient assignment. Read the chart and review the patients chief complaint, past medical history, and history of present illness. Clarify any questions about patient assignment Proceed to patients room and check room number Introduce yourself to the patient.

Rationale: Blind clients become anxious when they hear someone enter the room who does not speak. If the patient is blind, introduce yourself as you come into the room: tell exactly what you are doing and when you are leaving. Rationale: Blind clients become anxious when they hear someone enter the room who does not speak. Begin to establish a health care provider-patient relationship using clear, open communication.

State your purpose. Following introduction, relate purpose of interaction. State your purpose. Tell the patient specifically what you will be doing in terms of his or her care. Ask if the patient understands or has any questions. Encourage the patient to describe how he or she is feeling at the time. Encourage the patient to participate in his or her care-both verbally and non-verbally.

Rationale: Often, your best information is drawn from observation. Pay attention to communication as well as the procedure you are administering. Rationale: Often, your best information is drawn from observation. Assess non-verbal behavior and determine if it fits with verbal communication, especially when you are evaluating pain level. Complete communication by asking patient for feedback.

Complete interaction by telling patient when you will return, and what you will be doing in relation to their care. Follow through on agreed upon meeting time to build patient trust.

Rationale: A complete history will detail cultural diversity patterns; a. Ethnic heritage and language; b. Family orientation and role of members; c. Dietary practices and knowledge about nutrition; d. Education, formal and informal; e. Health care practices and beliefs. Review patient medical history related to cultural orientation to determine if adequate information pertaining to cultural preferences is included. Rationale: A complete history will detail cultural diversity patterns; a. Ethnic heritage and language; b. Family orientation and role of members; c. Dietary practices and knowledge about nutrition; d. Education, formal and informal; e. Health care practices and beliefs.

Determine patients perception of illness based on cultural beliefs Rationale: When the patients cultural background is different from the health care providers, communication problems may occur. Validate verbal and non-verbal communication from patient based on cultural understanding. Rationale: When the patients cultural background is different from the health care providers, communication problems may occur.

Rationale: An interpreter will facilitate communication and reduce stress on the patient. Consider using an interpreter if communication seems unclear. Rationale: An interpreter will facilitate communication and reduce stress on the patient. Rationale: Health care should be congruent with the patients expectations or a positive outcome of treatment can be in jeopardy. Examine expectations of health care based on the patients cultural influences. Rationale: Health care should be congruent with the patients expectations or a positive outcome of treatment can be in jeopardy.

Rationale: If the health care provider never opens this subject, the patient will not feel free to discuss spiritual issues. Ask the patient relevant questions concerning spiritual issues. Rationale: If the health care provider never opens this subject, the patient will not feel free to discuss spiritual issues. Rationale: This approach will open communication and notify the client that you are willing to discuss these issues. Are there any spiritual issues that you would like to discuss? If so, lets arrange a time to talk about these issues. Rationale: This approach will open communication and notify the client that you are willing to discuss these issues.

Encourage the patient to describe his or her perceptions and feelings. Focus on communication as well as body reactions. Rationale: The less you, the more you encourage spontaneity and verbalization from the patient. DO NOT dominate the conversation. Rationale: The less you, the more you encourage spontaneity and verbalization from the patient.

Assist the patient to clarify feelings. Rationale: Making value judgments, even non-verbal ones, negatively affects the health care provider-patient relationship. Maintain an accepting, non-judgmental attitude. Rationale: Making value judgments, even non-verbal ones, negatively affects the health care provider-patient relationship. Rationale: This open approach enables the patient to describe what is happening. Give broad opening statements, and ask open-ended questions. Rationale: This open approach enables the patient to describe what is happening.

Focus on feelings rather than superficial topics during interactions. Assist patient to identify thoughts and feelings. Pick up on verbal cues, leads, and signals from the patient. Rationale: Being aware of your own feelings and attitudes and separating them from the patients contributes to acceptance. Convey attitude of acceptance and empathy toward the patient. Rationale: Being aware of your own feelings and attitudes and separating them from the patients contributes to acceptance.

Note what is said as well as what is not said. Assist the patient to become aware of differences between behavior, feelings, and thoughts. Give honest, non-judgmental feedback to the patient.

Rationale: Sitting down at the patients bedside or not acting as if you are in a hurry encourages communication. Use body language as well as verbal communication to convey empathy. Rationale: Sitting down at the patients bedside or not acting as if you are in a hurry encourages communication. Respect the patients need for emotional privacy, but be available to the patient. Encourage the patient to apply the problem solving approach to different situations.

Be non-judgmental. Mutually identify goals to meet the patients individual needs. Keep all agreements with the patient. Become the patients advocate. Give patient positive feedback when appropriate.

Assess the patients symptoms and problems, and communicate a willingness to help alleviate these discomforts. Rationale: Open, honest, congruent communication and consistent behavior help lay the groundwork for trust in a relationship. Establish a beginning relationship. Rationale: Open, honest, congruent communication and consistent behavior help lay the groundwork for trust in a relationship.

Rationale: Goals mutually set and agreed on are more easily accepted by both parties in the relationship. Establish mutual goals as a basis for the relationship. Rationale: Goals mutually set and agreed on are more easily accepted by both parties in the relationship. Rationale: The MOST IMPORTANT element is the beginning of trust. Without trust the health care provider-patient relationship is ineffective. Be consistent in your behavior; do what you say you will do, and only make promises that you are willing to keep. Rationale: The MOST IMPORTANT element is the beginning of trust. Without trust the health care provider-patient relationship is ineffective.

Rationale: This focus enhances compliance to treatment. Encourage the patients participation in his or her care. Rationale: This focus enhances compliance to treatment. Rationale: The patient may interpret a cool, aloof manner as a lack of interest. Approach the patient in a warm, accepting manner. Rationale: The patient may interpret a cool, aloof manner as a lack of interest.

Assume the role of facilitator in the relationship. Rationale: Basic acceptance is a fundamental prerequisite of a relationship. Accept the patient ass having value and worth as an individual. Rationale: Basic acceptance is a fundamental prerequisite of a relationship. Provide a safe environment conducive to patients willingness to share.

Rationale: Responding on a professional rather than a social level defines the relationship. Maintain the relationship on a professional level. Rationale: Responding on a professional rather than a social level defines the relationship. Rationale: Discussion of past or future experiences does not contribute to a change in behavior now. Keep interaction reality oriented, that is, in the here and now. Rationale: Discussion of past or future experiences does not contribute to a change in behavior now.

Listen actively, that is, responding to the patients cues. Use non-verbal communication to support and encourage patient. Recognize meaning and purpose of nonverbal communication, especially in assessing pain. Keep verbal and nonverbal communication congruent.

Focus on content and direction of conversation on patients cues, not on social or superficial topics. Interact on patients intellectual, developmental, and emotional level. Rationale: Asking why places the patient on the defensive because it requires justification of behavior. Focus on how, what, when, where, and who rather than why. Rationale: Asking why places the patient on the defensive because it requires justification of behavior.

Teach patient problem solving to correct maladaptive patterns. Assist patient to identify, express, and cope with feelings. Help patient develop alternative coping mechanisms that are more adaptive. Recognize a high level of anxiety, and assist patient to deal with it.

Rationale: This approach promotes the patients independence and increases his or her sense of self-esteem. Work closely with the patient in discharge planning and in planning the termination of the relationship from its beginning. Rationale: This approach promotes the patients independence and increases his or her sense of self-esteem. Rationale: Saying goodbye is often uncomfortable and difficult for both the patient and the health care provider. Anticipate problems of termination and plan for their resolution. Rationale: Saying goodbye is often uncomfortable and difficult for both the patient and the health care provider.

Rationale: Allowing this behavior to be expressed helps the patient to work through it. Be aware that the patients behavior may reflect fear that he or she cant cope at home, overdependence, depression and withdrawal. Rationale: Allowing this behavior to be expressed helps the patient to work through it. Do not terminate the relationship too abruptly or allow it to persist beyond the patients needs.

Rationale: This enables the patient to move on. Complete a satisfactory termination of the relationship. Rationale: This enables the patient to move on.

Primary goals of health care provider- patient relationship and identified patient needs. Ongoing process of relationship therapy, including patients expressed feelings, thoughts, and so forth. Patients behavior and changes in behavior, both positive and negative. Cues to other team members on how best to relate to this particular patient. Elements of discharge planning.

A 25-year old male comes to the emergency department. He has a bleeding wound on his arm and he refuses surgical intervention when told he must remove his clothes and jewelry.

1. What effect would this patient response have on the initial health care provider plan of care? 2. What is your understanding of this patient response? What are some questions you might ask the patient? 3. Describe the strategies and goals you would devise to solve this problem. 4. Describe the measures you would implement to resolve this situation.

A client has just been admitted with a diagnosis of rectal cancer. He is scheduled for surgery the next day. When you are completing an assessment and you ask about spiritual beliefs, the patient says, Im a washed out Catholic and I dont think Im going to live, so whats the sense in talking about it?

What would be the consequence of not responding to the patients comments about spiritual beliefs? How would the goals of establishing a health care provider-patient relationship and assessing spiritual beliefs overlap in this situation? Describe the actions you would take to engage this patient in a discussion about these issues.

define the term communication explain why communication is an important concept in health care ...

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