Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Unit 2Nurse-Patient Communication:

Patient-Safe Communication in Professional Relationships

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Chapter 6Introduction to Nurse-Patient

Relationships

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Nurse-Patient Helping Relationships

Phase I: Preinteraction Phase II: Orientation Phase III: Working Phase IV: Termination

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Critical Thinking: Use the Patient-Safe Communication

Process when: Interpreting Analyzing Drawing conclusions Solving problems Making decisions

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

The Patient-Safe Communication

Process

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

The patient-safe communication process leads to: Recognition of patient needs Identification of conflicting nurse-patient goals Establishment of mutual goals Appropriate use of patient-safe responses Creation of common meaning Formation of trusting relationship Formation of collaborative relationship

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Flowchart of the Nurse-Patient

Relationship

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Stress and Conflict in Patients/Families

All patients/families have reactions of emotional anxiety, tension, and fear as they face challenges needed to understand and manage a patient care situation

Reactions are both physical and emotional Physical: Fight-or-flight response Emotional: Tears, anger, inability to focus

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Do you get angry or cry? Do you try to reason with the person upsetting you? Raise your voice? Remain silent and walk away? Remain in control of verbal and nonverbal behaviors?

When you are stressed and upset, what are your usual verbal and nonverbal behaviors?

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Universal Styles of Emotional Responses to Stress

BlamerPlacatorComputerDistractor

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Blamer: Aggressive bully, hostile “You” statements Putdowns Expressions of superiority Loaded words to start fights Interrupt, yell, call names, demand, give orders Tense, loud words or deadly quiet Cold, narrowed eyes Hands on hips, finger pointing

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Placator: Wants to please everyone Pleading looks, downcast eyes, soft voice Difficult time making a decision Stooped posture, nods head excessively Fidgets, flutters, wrings hands, picks fingernails Saying yes when really wants to say no Apologize for things they did not do Says cannot do something before even trying

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Computer: Nothing bothers me…. Quiet, aloof, reserved, withdrawn Does not want feelings known Does not discuss or show emotion (considered sign

of weakness) Difficulty responding when others express feelings Tries to remain calm, no matter what Face and eyes expressionless Closed posture, upright

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Distractor: Disruptive

Talks incessantly Talks nervously Inappropriate laughter Makes little sense Expends a lot of energy but does not focus on

problem or how to solve it

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Why do people act this way?

Aggressive, passive, nonemotional, and disruptive people have low self-

esteem

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

As a reaction to the stress and frustration in a situation, ineffective styles cover up:

Feeling isolated Feeling helpless Feeling incompetent Feeling unloved

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

“I am unlovable and nobody cares about me. I have to act this way

because it is how I am. I need to do this to survive.”

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Aggressive Blamer Believes By yelling and giving orders, the person is strong and

in control If the person didn’t act this way, no one would do a

thing The person is feeling unloved; nobody cares By getting others to obey, the person bolsters self-

esteem “I won’t let them put me down; I won’t be a

coward….” The person getting blamed feels fearful, helpless, and

resentful

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

The Super-Reasonable Computer Calm and collected on the outside, on the inside feels

vulnerable and weak Logic and ideas are all that count Emotions are a sign of weakness Rationalizes: “I’m not stupid; I’m too smart to make a

mistake.” Makes the other person feel inferior, stupid, bored,

frustrated

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

The Passive Person Wants to Keep Everyone Happy

Wants to feel liked or loved Wants to keep the other person from getting mad Experiences guilt, pity, and contempt for the person

who is being placated Wants to please to “get on another person’s good side” Rationalizes: “It is selfish not to do what is being asked”

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Disrupting Distractors:

Want attention “Nobody cares about me” Rationalizes: “It’s not good to be so serious;

we should live it up.”

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Communicators Are Assertive and Empathic

Honest statements—direct and to the point Controls temper Recognizes and responds to emotions (empathy) Posture open and relaxed Direct eye contact, hand gestures and body movements slow and

relaxed Asks questions to understand and analyze a situation Speaks up and asks for what he/she wants Can say no without feeling guilty

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

We all need to: Please others Criticize others Not get stepped on by others Use our intellect and explain to others Change the subject when appropriateHow does an assertive/empathic person do these

things?

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Assertive/Empathic Professionals Accept responsibility and apologize for something

done incorrectly or not done When criticizing, evaluate the act rather than blame

the other, and make suggestions for improvement Show feelings while giving explanations Clearly say the subject needs to be changed without

confusing the other person

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Personal & Professional Rights Build the Foundation of Assertive Behavior Right to be treated with respect Right to be listened to and taken seriously Right to change one’s mind Right to a reasonable workload Right to question and challenge Right to make mistakes

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Why Aren’t More People Assertive/Empathic?

Fear making mistakes—no one is perfect Fear not being liked— always someone who does not agree Fear criticism— everybody can use some; no one is perfect Fear imposing on someone—each time you speak & interrupt Fear retaliation—legal counselMost people admire others who have the courage to speak

their mind, even if they do not agree

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Can we be assertive and empathic all the time, in all

situations?

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Analyzing Situations That Are Stressful and Irritating

What upset you? How did you react? What did you want from yourself? What did you want from the other person? How can I manage this better in the future?

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Responding to Aggression:Hostility & Sarcasm

Assertiveness without regard for the rights of others is aggressive behavior—alienates others

People feel pushed to comply, even if it goes against their own feelings rights and needs

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Open Hostility Expecting you to fight or give in to

others Don’t do either: Let them blow off steam while you

count to 10 and get some oxygen flowing to your brain

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Hostility

Don’t aggravate them by attacking in return: “How dare you speak to me that way!”“You must be crazy!”

“How could you possibly think that?”

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Strategies for Hostility• First get their attention: In a rage, the patient is

not thinking or hearing; make a noise, drop a pen or chart….

When the patient hesitates: “I’d like to help you. Let’s go sit in the conference room and talk.”

Speak slowly, quietly; use calm gestures. If you slow down, so will the other person.

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Strategies for Hostility Have the patient sit down. Sitting is a less

aggressive position. If the patient refuses to sit, you remain standing. If you are sitting when approached by an angry

person, stand up slowly and calmly and quietly ask the person to sit down.

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Strategies for Hostility Listen attentively as the person explains Send back what the person is telling you, using

techniques such as empathy and restatement Ask questions, without antagonizing, to get to

the root of the problem Always validate what you think the problem is

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-safe Strategies for Passive Placators

As you talk about goals and objectives, be nonthreatening

Watch out for unrealistic commitments “If you have other things to do, I would appreciate if

you would tell me that you can’t do what I’m asking” “I know it is difficult to decide, no matter what you do.

Someone is not going to be happy about the decision.”

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Strategies for the Person Who Can’t Say No

The student nurse had given the home health patient a movie to view on balancing food, insulin, and exercise to discuss during the next visit in 2 days.

Patient: “I wanted to watch it, I’ll get to it today. I’m spread too thin, I think. I can’t get things done. I’m wasting your time here. But my family comes first, and I had to take care of them. There’s been games to attend, homework, laundry, cooking….”

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Complainer Complains to anyone who will listen but may not have

social skills to talk to the person who is the source of the problem

Extremely negative Keeps going over and over the same things Looks for someone to act on his/her behalf and to

solve the problem

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Strategies for Complainers

Complainers often speak in generalities; get them to be specific—who, what, when, where?

Then state the facts as you understand them

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Patient-Safe Strategies for Sarcasm Less obvious form of disguised aggression Insults, nasty remarks, cynical comments Expect you to be hurt by the comment or to blow up:

Don’t do either In a calm, quiet manner, ask: “Was there something in that

remark you just made?” “I don’t know what you meant by that comment; please explain

it to me.” If the person becomes angry and blows up, get the person to a

private area

Communication for Nurses:Communication for Nurses: How to Prevent Harmful Events How to Prevent Harmful Events and Promote Patient Safetyand Promote Patient Safety

Managing Stress in Patients and Families: Patient-Safe Professional Behaviors

Management of professional identity Manners

Professional conduct Appearance

Hairstyle, makeup, clothing, body adornment Setting

Creation of a safe and confidential environment