Session 2 - communication skills 2016

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<p>Maryland State Hospital Breastfeeding Policy</p> <p>The Maryland Department of Health and Mental HygieneHospital Breastfeeding Policy Maternity Staff Training ProgramCommunication SkillsSession 2</p> <p>Larry Hogan, GovernorBoyd Rtherford, Lt. GovernorVan Mitchell, Secretary, DHMH</p> <p>Read title and subtitle1</p> <p>Demonstrate ability to communicate effectively about breastfeedingLearn effective communication techniquesStandards of effective communication</p> <p>Objectives</p> <p>During this session you will learn how to effectively communicate about breastfeeding. Standards of effective communication will also be highlighted.</p> <p>2</p> <p>Adults expect honestyMake them participants in learningEffective learning leaves a positive impressionIndividualize Levels of learningVerbalVisualParticipatoryAdult Learning</p> <p>Source: United States Breastfeeding Committee</p> <p>Adults expect honesty - you have a responsibility to give accurate, up-to-date, factual information so that the parent can make an informed decision. This empowers parents to be informed health care consumers and to make responsible choices. Providing accurate information will not induce guilt. Withholding information in order to protect a patient from experiencing guilt is paternalistic and unprofessional, and can compromise health outcomes. Trust parents to learn consequences of not breastfeeding and to make an informed decision.</p> <p>Make the parents participants in learning when the parent is involved in the learning plan, they are more likely to internalize the information and accept responsibility for outcomes. This also helps to develop problem-solving skills.</p> <p>Effective learning leaves a positive impression - when parents learn new skills, it improves their impression and satisfaction of the staff and their care. Humor can be an effective tool in learning, as it reduces anxiety and improves learning.</p> <p>Individualize - Assess mothers needs, abilities and skills, and make every interaction focused and appropriate.</p> <p>There are three levels of learning that take place:</p> <p>1. Tell me and I may remember - verbally sharing information is the lowest level of learning, useful in cases where visual or interactive reinforcement is not necessary (i.e., discussing contraception).</p> <p>Show me and I may understand - visual reinforcement of verbal instruction increases the level of learning and retention, and can be used when interactive reinforcement is not needed.</p> <p>3. Involve me and I may master - active participation in the learning process produces the highest level of learning. Return demonstrations reinforce the learning so the learner can master the element being taught (such as: use of a breast pump).</p> <p>3</p> <p>Delivery and receptionReception depends onThe message as it is spoken (7%)Tone of voice (38%)Body language (55%)</p> <p>Components of Communication</p> <p>Communication requires the delivery of the message and its reception by the intended target. The way the message is meant is not necessarily the way it is received.</p> <p>Many factors combine to account for the way a message is received, including spoken word, tone, and body language.</p> <p>Words account only for about 7% of the message that is received. It is important to be direct, specific, and to use positive language that implies success and confidence. Negative language could undermine confidence or imply the mother is wrong, so it should be avoided.</p> <p>Tone of voice, which accounts for 38% of the message that is received, should be even, warm, friendly, of moderate volume, and moderate rate of speed.</p> <p>Body language accounts for the strongest part of the message being received (55%). A relaxed and comfortable posture at the mothers eye level helps to create interest and engagement. Ensure meaningful eye contact. Touch, with permission, can be warm and encouraging, as well as instructive, as in the case of positioning. Remember to always ask permission to touch a mothers baby or breast.</p> <p>4</p> <p>Listen and learnBuild confidence, give supportArrange support specific to moms situationDemonstrate the ability to effectively communicate about breastfeedingCommunicating With Families About Breastfeeding</p> <p>Source: United States Breastfeeding Committee</p> <p>It is important when working with families that you focus on effective listening so that you can learn their needs and concerns. After doing that, you can provide them with help and information to build confidence. If mothers need additional support beyond what you are able to provide, you will want to arrange for that. Finally, youll need to be able to effectively communicate about breastfeeding to the families you work with.5</p> <p>Clear, easily understoodComplete Refrain from using unnecessary detailsGood timing Provide information for right nowAcknowledged and verifiedStandards of Effective Communication</p> <p>To be effective, when delivering information from the sender to the receiver, the information being communicated must be clear and easily understood. Some buzzwords and acronyms are confusing and might lead to misunderstanding, so they should be avoided, when possible. </p> <p>Effective communication must be complete , contain pertinent information, and should not include unnecessary details. Too much detail can confuse the receiver.Timeliness of giving the information is important, especially when communicating patient care related issues. Timeliness also gives a true sense of urgency. Any delays in patient-related communication will often lead to the patient being compromised. With regard to breastfeeding, being timely, such as assisting a mother while the has the baby latched on, can make the difference for breastfeeding success. Not being timely , on the other hand, could result in a mother no longer breastfeeding</p> <p>It is important that information communicated be acknowledged and verified by the receiver. By doing so, you guarantee that the message you intended was received, and therefore that the communication was effective..</p> <p>(Credit: adapted from Effective Communication and Patient Safety by Helen V. Calalang-Javier, MSN, RNC, IBCLC )</p> <p>6</p> <p>EducationYou spend a lot of time each day with your patientsMuch of this time includes communicating and educatingEducation is more effective when the learner is motivated or recognizes relevance</p> <p>Source: United States Breastfeeding Committee</p> <p>Effective communication will help the learner understand why the education provided is important, and as a result be more motivated.7</p> <p>RelevanceRespectKeep the content safe</p> <p>Communication</p> <p>Source: United States Breastfeeding Committee</p> <p>What is being communicated needs to apply to something that is important to your patient. If it is not, she will not listen, internalize, or respond to the communication, and ultimately she will not learn.</p> <p>Adults need to be shown respect they may not remember what you said, but they will always remember how you made them feel.</p> <p>The way in which the content of a conversation is presented can affect how it is heard.8</p> <p>Acknowledge Establish a sense of trustAffirm Make them feel heard and respectedMaintain esteem Articulate Motivate and educateShowing Respect</p> <p>Source: United States Department of Agriculture (USDA)</p> <p>You want to begin by acknowledging the patient youre instructing, as this establishes a sense of trust. Be sure also to affirm her feelings, as this helps her to feel heard and respected. The affirmation step also paves the way for your patient to want to listen to what you have to say, allowing you to articulate the information in a way which not only educates, but also motivates.9</p> <p>Ask open-ended questionsListenAllow the other to talkBe sincereCare more about the person than the issue</p> <p>Acknowledge</p> <p>Source: United States Breastfeeding Committee</p> <p>Trust can be gained by expressing interest, smiling, and knowing and using your patients name.Acknowledgement can be accomplished by listening, allowing the other person to do most of the talking, and talking in terms of your patients interests; sincerely make the person youre speaking with feel important.Demonstrate, through listening, that you really care about her, and not just the issue. Have a two-way conversation, ask open ended questions, such as Tell me what youve heard about breastfeeding? or How can I help you? and listen to what she has to say.</p> <p>10</p> <p>Open-ended question</p> <p>Nurse: Good morning! What are your concerns about breastfeeding?</p> <p>Patient: Oh, well I think the baby isnt getting enough milk.Example: Acknowledge</p> <p>For example, and open ended question might be the nurse saying, Good morning! What are your concerns about breastfeeding?</p> <p>The patients response then might be, Oh, wellI think the baby isnt getting enough milk.11</p> <p>Make them feel heard and respectedMaintain esteem do not be judgmentalAvoid criticizingValidates the patients concernIf you have had a similar experience, you may choose to relay that to your patient. This will focus a mistake or misconception on the nurse/counselor (you).</p> <p>Affirm</p> <p>Affirm your patient to help her maintain esteem. No matter what she says, make a statement acknowledging that you have heard the comment or concern and that the patient is safe sharing this information with you. Keep in mind that if you are relaying personal experience, limit your affirmation to the fact that you can relate to her because you had similar feelings. This is not a place for you to educate her with your own personal experience. On the other hand, if you did not experience what shes concerned about, do not pretend that you have. </p> <p>12</p> <p>MOST important stepReassures mother that her feelings are not unusualBuilds her confidence and self-respectAllows a mother to feel confident by drawing attention to what she is doing wellDoes not mean you have to agree with herBuilds trust in you</p> <p>Affirmation and Validation</p> <p>13Affirmation and validationthis is the most important step. A mother may feel uneasy after she shares with you her true feelings about breastfeeding. She may think shes the only person feeling this way.</p> <p>And, if a mothers comment is misinformation, realize that your affirming statement does not have to agree with what she said.</p> <p>Doing a good job is important to you.I can tell you are going to be such a good mother.Breastfeeding is not supposed to hurt.It is not uncommon for breastfeeding to be frustrating at first.This can be difficult.Many moms I work with feel the same way.I used to think the same thing.Affirming Statements</p> <p>14An affirming statement is a short, simple statement that lets the mother know she is okay, and not necessarily alone in feeling this way.</p> <p>Affirmation statements that acknowledge the patients comments and concerns might be:Doing a good job is important to you;I can tell you are going to be such a good mother;Breastfeeding is not supposed to hurt;It is not uncommon for breastfeeding to be frustrating at first;This can be difficult;Many moms I work with feel the same way.I used to think the same thing!</p> <p>Nurse: I can understand your concern. Many mothers wonder how much milk their babies are getting. Example: Affirm</p> <p>Source: Maryland WIC Program</p> <p>For example, the nurse might say, I can understand your concern. Many mothers wonder how much milk their babies are getting. </p> <p>Now that you have affirmed that youre listening to your patient, she is more open to listening to what you have to say. 15</p> <p>Motivate/EducateProvide information in a non-judgmental toneMove forwardMake it relevant to themAsk if you can assist with a feeding to demonstrate while you are teaching </p> <p>Articulate</p> <p>Articulate--This is the step where you will educate your patient. Since you have begun by asking an open ended question to determine her concern or issue, and have affirmed her feelings (not necessarily agreed with them but let her know that it is okay for her to feel this way), you have built rapport. You now can move on to providing her with the information and education that she needs.</p> <p>16</p> <p>Nurse: Counting the number of wet and dirty diapers that your baby has in a 24-hour period lets us know if your baby is getting enough to eat. In the first day of life, we only expect your baby to have at least one wet and one soiled diaper. We also want to be sure that your baby is feeding at least 8-12 times during these same 24 hours. Example: Articulate</p> <p>Source: Maryland WIC Program</p> <p>For example, the nurse might say, Counting the number of wet and dirty diapers that your baby has in a 24-hour period lets us know if your baby is getting enough to eat. In the first day of life, we only expect your baby to have at least one wet and one soiled diaper. We also want to be sure that your baby is feeding at least 8-12 times during these same 24 hours.17</p> <p>Nurse: Hi Mrs. Jones. I am nurse Nice and I will be caring for you and your baby tonight. How can I help you with breastfeeding?</p> <p>Patient: I had a lot of company today so I want to send my baby to the nursery so I can sleep. Acknowledge</p> <p>Now lets see how this might work when we put it all together. The nurse might say, Hi Mrs. Jones. I am nurse Nice and I will be caring for you and your baby tonight. How can I help with breastfeeding? Your patients response, I had a lot of company today so I want to send my baby to the nursery so I can sleep.18</p> <p>Nurse: Having a lot of company can be tiring.Affirm</p> <p>Source: Maryland WIC Program</p> <p>The nurses affirmation then might be, Having a lot of company can be tiring.19</p> <p>Nurse: Something that I learned not long ago really surprised me. Studies have shown that mothers actually sleep better and more restfully when their babies are in the room with them. I will check on you often to make sure that you are doing okay with the baby in the room if you will give it a try.Articulate</p> <p>The nurse might then say, Something that I learned not long ago really surprised me. Studies have shown that mothers actually sleep better and more restfully when their babies are in the room with them. I will check on you often to make sure that you are doing okay with the baby in the room if you will give it a try.</p> <p>At this point, providing relevance and an alternative is key.20</p> <p>Builds positive relationships with patientsAllows you to provide needed information so they can make informed choices</p> <p>Effective Communication</p> <p>Source: Maryland WIC Program</p> <p>Effective communication builds positive relationships with patients, and allows you to provide needed information so that they can make informed choices.</p> <p>(Adapted from: Communication Techniques That Work, Glenda Dickerson)21</p> <p>Use open-ended questions when talking to mothersAn open-ended question cannot be answered with a yes/no responseUsing open-ended questions will elicit more information, like the mothers feelings and thoughtsCounseling Techniques</p> <p>Source: United States Breastfeeding Com...</p>

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