Health and Wellness_Week 5edapt

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Chamberlain College of Nursing *

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NR222

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Communications

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Jan 9, 2024

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Communication Basic Introduction to Communication Basics Learning effective communication takes time and effort. It is a lifelong learning process. As a nurse, you will communicate daily with clients in an attempt to form meaningful relationships. Through communication, we collect assessment data, provide education, and interact during nursing interventions. Communication is essential to establishing a nurse-client relationship and delivering client-centered care. In this lesson, you will learn how communication affects interpersonal relationships, how to develop communication skills, elements of the communication process, and forms of communication. Why Communicate? Ensuring our clients are safe and our care is effective requires excellent communication. This includes communication not only with our clients but also with members of the interprofessional healthcare team. Effective communication skills reduce errors, improve outcomes, and increase client satisfaction. Finally, through competent communication, we meet legal, ethical, and clinical standards of care. View the activity below to see more reasons for communication. Why Communicate?  Develop relationships  Collect relevant data  Provide education  Interact during intervention  Improve patient safety  Reduce errors  Increase satisfaction Why Communicate?  Develop relationships  Collect relevant data  Provide education  Interact during intervention  Improve patient safety  Reduce errors  Increase satisfaction Both nurse and client must be equal participants in the communication partnership.  Example: The nurse teaches about medications while the client actively listens then asks questions. Client responses are not always what we expect.

 Example: The nurse collects assessment data and is surprised to learn that the client is unhappy with the care received. Each client has specific communication needs. Some clients have specific learning and teaching needs, while others may have sensory perception impairments that need to be considered.  Example: The nurse assists the client to insert a hearing aid before a teaching session. More is communicated than meets the eye (and the ear). We must pay attention to the client’s verbal and nonverbal communication.  Example: The client is softly crying while listening to the nurse. When talking to clients at the bedside, provide for privacy by closing the door to the room and inquiring about any visitors who may be present.  Example: The nurse is discussing healthcare concerns with the client and has asked visitors to wait in the waiting room. Developing Communication Skills Becoming an expert communicator requires an understanding of the communication process and reflection on past communication experiences. Using critical thinking skills aids in this process. As nurses, we use communication in each step of the nursing process to:  gather comprehensive data from clients  integrate what we have previously learned in clinical experiences  interpret messages received from others  correct misinformation and promote client understanding  plan client-centered care Select each tab for detailed information. Attitudes and Ethical Standards Attitudes that aid communication are curiosity, perseverance, self-confidence, and creativity. Each attitude motivates the nurse to learn more about the client and communicate effectively. Ethical standards, such as integrity, autonomy, responsibility, and humility, are important in communication. Integrity allows the nurse to recognize and resolve conflicts. Autonomy encourages the nurse to share ideas with colleagues. Responsibility reminds the nurse to ask for help when needed. Humility helps the nurse recognize when better communication is needed.

For example, the nurse recognizes that the client does not understand the instructions and provides education in a different format. Perception of Communication Every time we receive communication, we process it using all five senses – sight, hearing, taste, touch, and smell. Our culture and education also influence our perception. Nurses must set aside biases and stereotypes that interfere with receiving, perceiving, and interpreting communication from others. For example, the client receives information by hearing, seeing, and feeling the nurse’s caring and compassionate behavior. Therapeutic Relationship Clients often experience stress and anxiety when sick. The nurse must use self- awareness, motivation, empathy, and social skills to build a therapeutic relationship. A therapeutic relationship is defined as one that helps and promotes trust and respect while nurturing faith and hope. It is sensitive to the needs of others and meets the clients' physical, emotional, and spiritual needs (Pullen & Mathias, 2010). For example, by developing a trusting relationship, the nurse is able to help the client recover from illness. What, When, Where, Why, and How The nurse must continually decide what, when, where, why, and how to deliver information. Understanding effective communication may not be difficult, but the application of essential communication skills is challenging. The nurse must decide which techniques best apply to each situation and may experience fatigue and frustration. For example, teaching about breastfeeding to a client who has just found out her baby has a congenital heart defect may not be appropriate. Whereas, teaching a mother who has recently given birth how to breastfeed is timely. Reference Pullen, R., & Mathias, T. (2010, May). Fostering therapeutic nurse-patient relationships. Nursing Made Incredibly Easy! 8 (3), 4. https://doi.org/01.NME.0000371036.87494.11 Therapeutic Communication Establishing a therapeutic nurse-client relationship is based on effective communication. Nurses are accountable for maintaining this relationship through trust, respect, and empathy.

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In professional health and wellness settings, therapeutic communication not only focuses on the individual and their current needs but also creates an open environment in which honesty and trust can be established between the health professional and the individual or group. Watch a video in each tab below and reflect on the questions as you watch them. Standard 10 Throughout this course, you will explore all 18 of the American Nurses Association’s scope and standards (ANA, 2021). Let’s review Standard 10. Standard 10. Communication The registered nurse communicates effectively in all areas of professional practice. This includes:  Assesses one’s own communication skills and effectiveness  Demonstrates cultural humility, professionalism and respect when communicating  Assesses communication ability, health literacy, resources, and preferences of the client  Uses language translation resources appropriately  Incorporates alternative strategies to communicate effectively with clients who have visual, speech, language, or communication difficulties  Uses communication styles and methods that demonstrate caring, respect, active listening, authenticity and trust  Conveys accurate information  Maintains communication with the interprofessional team to facilitate safe transitions and continuity in care delivery  Confirms the recipient of the communication heard and understands the message  Promotes safety in the practice environment by disclosing and reporting concerns related to potential or actual hazards or deviations from standards of care  Demonstrates continuous improvement of communication skills  Levels of Communication  Nurses communicate at different levels in their professional role.  Self-Talk  Self-talk refers to your thoughts and inner communications that strongly influence your perceptions, feelings, behaviors, and self-esteem. It is important to be aware of the nature and content of your own thinking. Positive self-talk increases confidence and helps with difficult tasks.  One-On-One  One-on-one interactions occur between a nurse and another person in a face-to- face manner. This is the most frequent way that nurses use to communicate. Everyone has different opinions, experiences, values, and beliefs, which impact communication. The most valuable interactions exchange ideas, problem-solve,

express feelings, make decisions, accomplish goals, build teams, and encourage personal growth.  Small-Group  Small-group communication occurs when a small group collaborates. This type of communication is usually goal-oriented and requires an understanding of group dynamics. Some examples may include working on a small committee to change a policy or practice, or teaching a small group of community members about heart- healthy eating. Regardless of the topic, communication should be organized, concise, and complete.  Public  Public communication is the interaction with a large audience. Nurses often speak to groups of clients 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 the use of media materials for communication to be effective.  Electronic  Electronic communication is the use of technology to create ongoing relationships with clients or the interprofessional team. Secure messaging may provide timely communication with a healthcare provider. Using a client portal may be an easy way to communicate appointment scheduling or information to a client.  Verbal Communication  Messages are conveyed both verbally and nonverbally. Verbal communication uses spoken or written words to convey meaning.  Important!  The most important aspects of verbal communication are vocabulary, meaning, pacing, intonation, clarity and brevity, and timing and relevance.  Select each aspect in this interactive to learn more. Meaning  Some words have different meanings depending on the context of their use. For example, the word sandwich has the same meaning for everyone who speaks English, but the word code has a special meaning for healthcare professionals. Select your words carefully to avoid misinterpretation. Pacing  Conversation should move at a comfortable pace and appropriate speed based on the information. Speak slowly and enunciate clearly. Avoid awkward pauses and rapid shifts in topic. Think before you speak and develop an awareness of your speech rhythm. Timing and Relevance  Timing is critical in communication. If your message is poorly timed or irrelevant, communication is ineffective. For example, teaching a client who is in pain or sleepy will likely be ineffective. Teaching a client who has five children how to give a newborn bath may be unnecessary. Clarity and Brevity

 Effective communication is simple, brief, and direct. Often, fewer words are less confusing. Repeating important aspects of teaching will reinforce understanding. Intonation  Tone of voice can dramatically alter the meaning and perception of a message. Is your tone conveying enthusiasm, anger, concern, or indifference? Is this your intention? Avoid sending unintended messages with your tone of voice. Pay attention to the client’s tone of voice as well. This can provide insight into their emotional state. Vocabulary  Communication is ineffective if senders and receivers cannot translate each other's words or phrases. When caring for a client who speaks a different language, use an interpreter. Even those who speak the same language may have cultural variations for certain words. For example, the word dinner may mean a noon meal to some and an evening meal to others. As healthcare professionals, we must avoid using medical jargon when communicating with clients. When communicating with children, vocabulary must be further simplified. Nonverbal Communication Messages are conveyed both verbally and nonverbally. Nonverbal communication includes our five senses and does not involve written or spoken words. Select each item below for details on the most important aspects of nonverbal communication. Eye Contact Posture and Gait Personal Space Appearance Facial Expression Gestures Sounds Barriers to Communication Some interactions are more challenging than others, requiring better communication. Let’s consider some situations in which communication with clients may be challenging.  Clients who are sad or suffering from depression.  Clients who are withdrawn or have difficulty expressing feelings or needs.  Clients with sensory perception deficits, such as vision, hearing, or speech difficulties.  Clients who are angry or confrontational.

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 Clients who are uncooperative.  Clients who are talkative or lonely.  Clients who are demanding.  Clients who are frightened, anxious, or having difficulty coping.  Clients who are confused or disoriented.  Clients who are flirtatious or sexually inappropriate. Reflect: Think about communication with your friends, family, or classmates. Can you think of a time when you had difficulty communicating? How did you resolve the problem? Your response is correct! The most appropriate level of communication to meet Ms. Simpson’s specific communication needs and prepare her for discharge is one-on-one communication. One-on-one interactions occur between a nurse and another person in a face-to-face manner. Small group communication occurs when a small group collaborates. This is best for teaching client health promotion strategies. Electronic communication is the use of technology to create ongoing relationships with clients or an interprofessional team. This is best for keeping a client informed of upcoming appointments or diagnostic results. Public communication occurs with large audiences. This is best for classroom lectures or speaking at conferences. Your response is correct! Timing is critical in communication. If your message is poorly timed or irrelevant, communication is ineffective. A client may be unable to focus and retain information when unpleasant physical symptoms are present, such as pain and nausea. The nurse should delay teaching until Ms. Simpson’s physical needs are met. Your response is correct! The best way to meet the communication needs of this client is to secure an authorized translator who can also perform sign language . Family members and unauthorized translators should not provide translation services. Since Ms. Simpson’s preferred language is Polish and her understanding of English is limited, education should be delivered in Polish. Your response is correct! Rachel is evaluating the client’s understanding of discharge teaching. Assessment occurs to collect data before interventions (teaching) are implemented. Planning happens after assessment to determine the client outcomes expected from interventions. Implementation is the act of teaching the client. Your response is incorrect! Personal space is invisible and individual. During one-on-one communication, maintain a reasonable distance (18 to 40 inches) and respect personal space. Examples include client teaching or communication.

There are times when an intimate distance (0-18 inches) is appropriate, such as assisting with toileting or feeding. Social distance (4-12 feet) is used with colleagues or visitors, such as when giving reports or communicating with family members. Zone of Personal Space Example Intimate Distance The nurse is assisting the client with toileting. The nurse is feeding the client who has had a stroke. Personal Distance The nurse is sitting in a chair at the client’s bedside. The nurse is teaching a client how to choose low-sodium foods from a menu. Social Distance The nurse is giving report to the oncoming shift. The nurse is talking to the client’s daughter about the diagnosis. Your response is correct! Clarity is breached when ending every sentence with “Okay?” and providing lengthy explanations. Effective communication is simple, brief, and direct. Often, fewer words are less confusing. Repeating important aspects of teaching will reinforce understanding. Intonation: Tone of voice can dramatically alter the meaning and perception of a message. Is your tone conveying enthusiasm, anger, concern, or indifference? Is this your intention? Vocabulary: Communication is ineffective if senders and receivers cannot translate each other's words or phrases. When caring for a client who speaks a different language, use an interpreter. Even those who speak our language may have cultural variations for certain words. As healthcare professionals, we must avoid using medical jargon when communicating with clients. Timing and relevance: Timing is critical in communication. If your message is poorly timed or irrelevant, communication is ineffective.

The Therapeutic Relationship Introduction to the Therapeutic Relationship You can create professional relationships with clients by applying what you have learned about communication and your commitment to ethical behavior. Caring is the hallmark of a professional nurse-client relationship. By responding to a client’s unique health needs with an individualized plan, you can develop a therapeutic relationship. In this lesson, you will learn how to establish and maintain a therapeutic relationship. Therapeutic relationships are goal-directed, purposeful, and contain boundaries. Communication is delivered with trust, empathy, and professionalism. Sympathy, giving advice, and asking personal questions are examples of non- therapeutic communication and should not be part of the therapeutic relationship. The stages of the therapeutic relationship in order are: 1. Preinteraction: planning and starting the process before the purposeful interaction with the client begins 2. Orientation: meeting, creating rapport, and establishing trust through honesty and empathy 3. Working: mutual problem solving to accomplish therapeutic goals 4. Termination: separating from the formal therapeutic relationship In the working phase of the therapeutic relationship, the nurse encourages the client through self-exploration and uses therapeutic communication to facilitate successful interactions. In the preinteraction phase, the nurse is preparing to meet with the client by reviewing data and talking with other care providers. In the orientation phase, the nurse begins communication that is casual and friendly to build trust. In the termination phase, the nurse is preparing the client to end the interaction and transitioning care to other professionals. Nurse-Client Caring Relationships Therapeutic relationships promote purposeful and positive client change and growth. Through a professional therapeutic relationship with a nurse, the client:  achieves optimal personal growth  forms positive relationships with others  satisfies health needs  achieves personal goals The nurse maintains specific commitments to the client, such as using a goal-directed approach, following an explicit time frame, and maintaining confidentiality.

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Additionally, the nurse establishes, directs, and takes responsibility for all interactions with the client and prioritizes the client’s needs over their own. The therapeutic relationship has established boundaries and is not social or even personal; rather, it is one in which professional assistance is rendered with empathy, care, trust, and rapport. Important! Nonjudgmental acceptance of the client is essential. This does not mean the nurse always agrees with or approves of the client’s decisions or actions but is willing to listen and acknowledge feelings. Characteristics of a Therapeutic Relationship Communication is the exchange of information, thoughts, and feelings and requires therapeutic communication. There are three essential characteristics of a therapeutic relationship. Rapport is harmony and mutual fondness between people in a relationship. Empathy is the ability to understand another’s feelings without losing personal identity and perspective. Purpose means that the nurse focuses on communication toward a specific client- centered goal. https://www.youtube.com/watch?v=cDDWvj_q-o8 Empathy is the ability to understand another’s feelings without losing personal identity and perspective. Client-Nurse Interaction Empathy Not Empathy The nurse is caring for a client who is hospitalized on Thanksgiving Day. The client is tearful and missing their family on the holiday. The nurse responds, “Why are you crying? It’s Thanksgiving Day!” X At the end of the shift, the nurse is caring for a client who has experienced stool incontinence. The nurse frowns when they realize this will delay leaving on time. X The nurse is caring for a client who recently experienced the loss of a newborn baby. The nurse sits at the bedside and holds the client’s hand while the client quietly cries. X The nurse is caring for an injured client who is far from home with no support system. The nurse arranges for transportation home and grocery delivery to relieve the client’s anxiety. X

Phases of the Therapeutic Relationship There are four distinct phases of the nurse-client therapeutic relationship: preinteraction, orientation, working, and termination. Even brief interactions use an abbreviated version of this process. Select each phase in the interactive to learn more. Phases of the Therapeutic Relationship Preinteraction : Begins when the nurse starts preparation for the initial interaction with a client and occurs before the initial contact with the client.  Example: The nurse gathers information about the client before entering the room for a teaching session. Orientation : Begins when the nurse and client meet for the first time. This is also called the introductory phase. A friendly, informal, warm communication style is beneficial. Factors such as values, culture, beliefs, past experiences, and expectations can influence this phase and should be assessed.  Example: The nurse meets the client and establishes trust. Working : Begins as the nurse and client collaborate as partners in promoting the client’s health.  Example: The nurse accomplishes teaching goals and verifies the client’s understanding of the lesson. Termination : Marks the end of the relationship as it exists for the predefined purpose.  Example: The nurse says goodbye at the end of the shift. The Nurse Role During Each Phase The nurse has a specific role during each phase of the therapeutic relationship. Select each image to learn more. Phase 1: Preinteraction Phase Before meeting a client:  Review available data, including the medical and nursing history.  Talk to other caregivers who have information about the patient.  Anticipate health concerns or issues that arise.  Identify a location and setting that fosters comfortable, private interaction.  Plan enough time for the initial interaction. Phase 2: Orientation Phase When the healthcare professional and patient meet and get to know one another:

 Set the tone for the relationship by adopting a warm, empathetic, and caring manner.  Recognize that the initial relationship is often superficial, uncertain, and tentative.  Expect the patient to test your competence and commitment.  Closely observe the patient and expect to be closely observed by the patient.  Begin to make inferences and form judgments about the patient’s messages and behaviors.  Assess the patient's health status.  Prioritize the patient's problems and identify their goals.  Clarify the patient's and the healthcare professional’s roles.  Form contracts with the patient, which specify who will do what.  Let the patient know when to expect the relationship to be terminated. Phase 3: Working Phase When the healthcare professional and patient work together to solve problems and accomplish goals:  Encourage and help the patient express feelings about their health.  Encourage and help the patient with self-exploration.  Provide information needed for the patient to understand and change their behavior.  Encourage and help the patient set goals.  Take action to meet the goals set for the patient.  Use therapeutic communication skills to facilitate successful interactions.  Use appropriate self-disclosure and confrontation. Phase 4: Termination Phase During the ending of the relationship:  Remind the patient that termination is near.  Evaluate goal achievement with the patient.  Reminisce about the relationship with the patient.  Separate from the patient by relinquishing responsibility for their care.  Achieve a smooth transition for the patient to other caregivers as needed. Example: A social worker is finishing a meeting with a family. Here is the dialogue: I will be meeting with you one more time next week. [ REMIND ] Fortunately, we've been able to get some community services for you and your children [ GOAL ACHIEVEMENT ]. It has been great working with you, and I've enjoyed our meetings [ REMINISCE ]. Be sure to follow up with these services so you can continue to benefit from them [ SEPARATE ]. Here is a card of one of my colleagues to call going forward as things come up or if you have follow-up questions [ TRANSITION ]. Motivational Interviewing Motivational interviewing (MI) is a communication technique that encourages clients to share their thoughts, beliefs, fears, and concerns in an effort to change behavior. This

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style of communication works well with clients who do not seem ready to make changes that are considered necessary for health promotion. https://www.youtube.com/watch?v=bTRRNWrwRCo Motivational interviewing focuses on exploring and resolving ambivalence related to decreased motivation toward changing unhealthy behaviors. Nurse-Family Relationships In addition to nurse-client relationships, the nurse may need to form caring relationships with the client’s entire family to best facilitate client care. This is most common in the community and home care setting. The same principles for one-to-one client relationships also apply to the family unit. Remember, communication with a family requires an understanding of the complexities of family dynamics, needs, and relationships Your response is correct! The nurse is performing assessment during the preinteraction phase (chart review) and the orientation phase (learning more about the client). The nurse is performing planning during the preinteraction (determining client needs) and orientation (learning about the client’s needs and desires for care) phases. The nurse is performing implementation during the working phase The nurse is performing evaluation during the termination phase. Your response is incorrect! The orientation phase begins when the nurse and client meet for the first time. This is also called the introductory phase. A friendly , informal , warm communication style is beneficial to establish rapport. Formal, professional communication will begin during the working phase of the therapeutic relationship. Your response is correct! Prisha is displaying empathy for Mr. Lang’s partner. Empathy is the ability to understand another’s feelings without losing personal identity and perspective. Purpose means that the nurse focuses on communication toward a specific client- centered goal. Confidentiality is keeping a client’s secrets or health information private. Boundaries are invisible limits that inform the client about what behavior is normal and acceptable. Your response is correct! By thanking the client and making an appointment for a future visit, Prisha terminated the therapeutic relationship.

The education session does not guarantee that Mr. Lang will be compliant with medication use in the future. The working phase of the therapeutic relationship has not been extended. Prisha has ended her time with Mr. Lang. Rapport was established during the orientation phase and Prisha accomplished the goal of medication compliance education. Therefore, the interaction was successful. Your response is correct! The family who is showing a lack of motivation or engagement for behavior change is the family of the child recently diagnosed with diabetes mellitus. The family’s eating habits will need to change to accommodate the child’s new dietary needs. The other families are showing motivation or have already worked to resolve issues that have led to health decline. Your response is correct! Clara’s actions demonstrate the preinteraction phase. In the preinteraction phase, the nurse is preparing to meet with the client by reviewing data and talking with other care providers. In the working phase of the therapeutic relationship, the nurse encourages the client through self-exploration and uses therapeutic communication to facilitate successful interactions. In the orientation phase, the nurse begins communication that is casual and friendly to build trust. In the termination phase, the nurse is preparing the client to end the interaction and transitioning care to other professionals. Therapeutic Communication Introduction to Therapeutic Communication Therapeutic communication techniques are specific responses made by the nurse, which encourage clients to express their feelings. These responses or statements convey acceptance and respect and can be applied in a variety of clinical situations. Each technique may not feel natural at first. However, the more you practice using these responses, the more comfortable you will become. In this lesson, you will learn about numerous therapeutic communication techniques, as well as when and how to appropriately use each response. The goal of therapeutic communication is to meet the expressed and unexpressed needs of the client in a timely manner and with respect to age, culture, and socioeconomic status. All healthcare professionals use therapeutic communication, which involves both verbal and nonverbal communication. Active listening means being attentive to what the client is saying, both verbally and nonverbally. It may feel uncomfortable at first to be quiet and listen, but active listening promotes trust and conveys respect.

As a nurse, it is appropriate to share humor, empathy, hope, observations, and information with clients. Active Listening Active listening means being attentive to what the client is saying, both verbally and nonverbally. It may feel uncomfortable at first to be quiet and listen, but active listening promotes trust and conveys respect. Use the acronym SURETY to help you remember how to actively listen. Select each letter of the acronym below for more information. SURETY S: Sit at an angle facing the client. U: Uncross your arms and legs to suggest that you are “open” to what the client has to say. Crossing your arms is a defensive position that may evoke a similar response from the client. R: Make your voice and posture communicate to the client that you are relaxed and comfortable. E: Establish and maintain intermittent eye contact with the client to convey your willingness to listen. Absence of eye contact may indicate that you are not interested. T: Use respectful and appropriate touch to convey empathy and compassion. Y: Trust your intuition! As you grow more confident in your communication abilities, learn to individualize, adapt, and apply communication techniques. Sharing As nurses, we share observations, empathy, hope, humor, feelings, and information with our clients. Select each tab to learn more about each type of therapeutic communication. Sharing Observations As a nurse, you will continually observe your clients. You may comment verbally on the client’s appearance, any sounds that you hear, or significant client behavior. Statements of observations may help a client communicate without the need for extensive questioning and may help jump-start communication with a quiet or withdrawn client. Example : “You seem tired today.” “I’ve noticed that you haven’t eaten much today.” Sharing Empathy Empathy is the ability to understand and accept another person’s reality and communicate this understanding. This communication technique allows the nurse to understand a client’s situation, feelings, and concerns. To reflect empathy, the nurse conveys understanding and feeling of the importance of the client’s situation. Empathy is important in every situation. Example : ”It must be very frustrating to want to walk independently but be unable to do so at this time.”

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Sharing Hope Hope is essential for healing. Nurses must learn to communicate a sense of possibility to the client. This can be accomplished through encouragement, positive feedback, and reinforcement. Sharing a vision for the future and reminding the client of their strengths is important. Example : “You are very courageous and strong. I believe you will find a way to cope with your current situation.” Sharing Humor Humor, when used appropriately, is a coping strategy that can reduce anxiety and promote positivity. It humanizes the illness experience, enhances teamwork, and relieves tension. As a nurse, you can bring hope and joy to a situation through humor, which makes you seem more approachable and warm. Humor is most appropriately placed in the orientation phase of the therapeutic relationship. Note: Be aware that humor has a cultural context and may be misunderstood or misinterpreted. Never joke about sexual orientation, race, economic status, disability, or cultural attributes. Sharing Feelings Feelings are neither right, wrong, good, nor bad, though they may be pleasant or unpleasant. Expression of feelings is very important to emotional health. Whether the client is expressing negative or positive feelings, it is important to acknowledge that you are listening. Note: Sharing your own emotions with clients can be appropriate in a variety of situations; however, be careful not to burden the client or break confidentiality. Sharing Information Sharing relevant information provides the client with what they need or want to know to make informed decisions and experience less anxiety. Sharing information is an essential part of health teaching. No matter the seriousness of the subject, information should not be withheld from clients. Example : ”Today you will have a chest x-ray, which takes a picture of your lungs to see if they are healing.” Using Touch and Silence When communicating with clients, the use of touch and silence can be valuable. Select each tab to learn more. Touch brings a sense of connection to the client. In today’s age of modern technology, this human connection can be valuable. Touch conveys affection, emotional support, encouragement, tenderness, and personal attention. However, be aware of a client’s nonverbal cues and ask permission before touching them. Silence is a valuable communication technique. It allows the client to think, gain insight, and share feelings. Most people have a natural tendency to fill empty spaces with words. However, sometimes the nurse needs time to observe the client, think of something to say, and consider what has already been communicated. Silence provides time for these actions. Silence is especially beneficial when the client is experiencing grief or sadness.

Other Communication Strategies Several other therapeutic communication strategies are used by nurses to convey messages to clients. These include:  clarifying  focusing  paraphrasing  validation  asking relevant questions  summarizing  confrontation Review the presentation to learn more about each type of communication and its most effective use. Clarifying Sometimes we need to clarify that we understand a message accurately. This includes restating an unclear message, asking the client to rephrase it, to explain further, or to provide an example. Without clarification, you may make an incorrect assumption and miss important information.  Example: “I’m not sure I understand where you are experiencing the pain. Can you explain further?” Focusing Sometimes the conversation must be refocused to convey a message or receive important information. If conversation is vague or rambling, focusing is a useful technique. Do not interrupt the client but guide the client back to the important topics of discussion.  Example: “You’ve told me when your pain started and what you’ve done to manage it; now, please rate your pain on a scale of 1 to 10.” Paraphrasing This communication technique involves repeating what a client has previously said in your own words. Paraphrasing is used to let the client know that you are listening and actively involved in the search for understanding. Be careful not to alter or change the message.  Example: The client states, “I’ve smoked tobacco my entire life. I don’t think I need to quit at this point.” The nurse paraphrases by stating, “You’re not sure you need to quit smoking because you’ve not experienced any damaging health effects.” Validation

The nurse uses validation to acknowledge a client’s thoughts, feelings, and needs. Through this communication technique, the client feels they are heard and taken seriously.  Example: “You’re concerned that you will not be able to ride your bike after your knee replacement.” Asking Relevant Questions Nurses need to ask relevant questions to seek information needed for decision making. Only ask one question at a time and explore one concept at a time. Ask questions in a logical manner, moving from general questions to more specific. Open-ended questions allow the client to lead the conversation. For example, “Can you describe your pain?” Focused (closed-ended) questions are used when more specific information is needed. For example, “When did your pain start?” Summarizing This is a concise way to review essential information during an interaction. Summarizing is very helpful during the termination phase of the therapeutic relationship.  Example: “You’ve told me a lot of things about your relationship with your daughter. We’ve developed some strategies for improving this relationship, and you’ve agreed to try some of them. You will let me know how things are going next week.” Confrontation Confrontation can be therapeutic when done appropriately. It may help the client become more aware of inconsistencies in their feelings, attitudes, beliefs, and behaviors. It aids self-awareness. Be sure to use confrontation only after you have established trust with a client. Be gentle and sensitive.  Example: You’ve already decided to stop smoking, but you are still debating whether you can or not. Self-Disclosure Self-disclosure occurs when the nurse shares personal experiences with a client. This is not meant to burden the client but to show the client that the nurse understands their feelings. Self-disclosure is most effective once a close, trusting relationship has been established. It demonstrates empathy but should be used sparingly so the client remains the center of the interaction. Example : A client has just been told that her baby has died in utero. The nurse shares her personal experience of losing a baby shortly after birth. Your response is correct!

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The nurse in this situation is focusing the conversation. Sometimes the conversation must be refocused to convey a message or receive important information. Self-disclosure occurs when the nurse shares personal experiences with a client. Confrontation may help the client become more aware of inconsistencies in their feelings, attitudes, beliefs, and behaviors. The nurse uses validation to acknowledge a client’s thoughts, feelings, and needs. Through this communication technique, the client feels they are heard and taken seriously. Your response is correct! The nurse in this situation is validating what the client has previously stated. The nurse uses validation to acknowledge a client’s thoughts, feelings, and needs. Through this communication technique, the client feels they are heard and taken seriously. Focusing is when the conversation must be refocused to convey a message or receive important information. Self-disclosure occurs when the nurse shares personal experiences with a client. Confrontation may help the client become more aware of inconsistencies in their feelings, attitudes, beliefs, and behaviors. Your response is correct! The nurse in this situation is using clarification. Sometimes we need to clarify that we understand a message accurately. This includes restating an unclear message and asking the client to rephrase it, explain further, or provide an example. Without clarification, you may make an incorrect assumption and miss important information. The nurse uses validation to acknowledge a client’s thoughts, feelings, and needs. Through this communication technique, the client feels they are heard and taken seriously. Focusing is when a conversation must be refocused to convey a message or receive important information. Self-disclosure occurs when the nurse shares personal experiences with a client. ackClose & Continue Your response is correct! The nurse in this situation is using the touch technique. Touch conveys affection, emotional support, encouragement, tenderness, and personal attention. Focusing is when the conversation must be refocused to convey a message or receive important information. Clarification is used to clarify that we understand a message accurately. This includes restating an unclear message and asking the client to rephrase it, explain further, or provide an example.

Nurses must learn to communicate a sense of possibility to the client. This can be accomplished through encouragement, positive feedback, and reinforcement (sharing hope). Your response is correct! "What would you like to talk about?” is an open-ended question. Open-ended questions allow the client to lead the conversation. Clarification is used to clarify that we understand a message accurately. This includes restating an unclear message and asking the client to rephrase it, explain further, or provide an example. Focused (closed-ended) questions are used when more specific information is needed. Summarizing is a concise way to review essential information during an interaction and is very helpful during the termination phase of the therapeutic relationship. Non-Therapeutic Communication Introduction to Non-Therapeutic Communication Certain communication techniques hinder or damage effective client or professional relationships. These techniques are referred to as non-therapeutic and often cause others to act defensively or negatively. Non-therapeutic communication techniques discourage conversation and expression of feelings and cause negative responses or behaviors in others. Non-therapeutic communication techniques discourage conversation and expression of feelings and causes negative responses or behaviors in others. Disapproving and false reassurance are two of several non-therapeutic communication techniques you will learn about in this lesson. Summarizing, clarifying, and active listening are therapeutic communication techniques. Parroting is a type of automatic response that involves repeating the client’s exact statements word for word. Paraphrasing should be used instead of parroting. Passive responses are used to avoid conflict. They reflect depression, sadness, or anxiety. Changing the subject when someone is talking is considered rude and demonstrates a lack of empathy. It blocks communication by sending the message that what the client is saying lacks importance. Asking and Giving Offering personal opinions, asking personal questions, and asking for explanations can impede communication. Let’s learn more about these non-therapeutic communication techniques. Select each item below for details.

Asking personal questions that are not relevant just to satisfy your curiosity is inappropriate in a professional setting. If clients wish to share private information, allow them to do so in their own time and in their own way. Non-therapeutic : “Why are you not married?” Therapeutic : “How would you describe your relationship with your partner?” When nurses offer personal opinions, it impedes the client’s decision-making ability. Now, personal opinions differ from professional advice. Often, clients need professional suggestions to help them make healthy choices. Suggestions are options for the client to accept or reject. Personal opinions can sway a client in one direction or another. Non-therapeutic : ”If I were you, I would put my son in daycare so I could return to work.” Therapeutic : “Let’s talk about which options are available to help you care for your son and continue to work.” Nurses are often tempted to ask clients why they believe, feel, or act a certain way. However, this is non-therapeutic. Clients often interpret a “why” question as an accusation or test of competence. Asking “why” questions causes resentment, insecurity, and mistrust. Non-therapeutic : “Why are you afraid to have surgery?” Therapeutic : “You seem scared. Tell me more about how you are feeling.” Negative Responses Automatic responses, defensive responses, passive or aggressive responses, and arguing can damage the nurse-client relationship. Select each item below to learn more about non-therapeutic responses. Automatic Responses Automatic responses tend to result from stereotypes, which reflect poor nursing judgment. For example, “Older adults are always confused.” Some stereotypes belittle and minimize others' feelings. For example, “You win some, you lose some.” Automatic responses indicate that you are not invested in the conversation or taking the client seriously. Parroting is another type of automatic response that involves repeating the client’s exact statements word for word. Paraphrasing should be used instead of parroting. Defensive Responses Nurses who become defensive when criticized imply that no one else’s opinion matters. When clients express criticism, listen to what they have to say. Listening does not imply agreement but allows the nurse to discover why the client is dissatisfied. Non-therapeutic : “Nurses on this unit would never intentionally withhold your medication.”

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Therapeutic : ”You believe that someone has deceived you. It must be hard to trust anyone.” Passive or Aggressive Responses Passive responses are used to avoid conflict. They reflect depression, sadness, or anxiety. For example, the client may state, “This diagnosis is so bad. There is nothing I can do about it.” Aggressive responses provoke confrontation. There is a difference between assertiveness and aggression. Assertive communication is necessary and professional. Non-therapeutic : A nurse who is angry about the shift schedule complains to the nurse manager. Therapeutic : A nurse who is angry about the shift schedule discusses dissatisfaction with the nurse who created the schedule. Arguing Challenging or arguing with a client is nonproductive and damaging to the relationship. A professional nurse provides information in a way that avoids arguments. Non-therapeutic : “How can you say that you are in pain? You are playing games on your cell phone.” Therapeutic : “You are experiencing discomfort and using your cell phone as a distraction.” Other Non-Therapeutic Communication Strategies Several other non-therapeutic communication strategies can impact the nurse-client relationship, such as changing the subject, false reassurance, sympathy, and offering approval or disapproval. Let’s explore each strategy. Changing the Subject Changing the subject when someone is talking is considered rude and demonstrates a lack of empathy. It blocks communication by sending the message that what the client is saying lacks importance. If changing the subject is necessary to meet the client’s immediate healthcare needs, reassure the client that you will return to their concerns as soon as possible. Non-therapeutic : “I know you are concerned about paying for your hospital stay, but it is time for your procedure.” Therapeutic : “After your procedure, let’s talk some more about your financial concerns.” False Reassurance False reassurance discourages open communication. When reassurance is not supported by facts, it does more harm than good. Often the nurse is trying to be kind, but offering reassurances that are not realistic blocks conversation and discourages expression of feelings. Non-therapeutic : “Many people are diagnosed with breast cancer each year. I’m sure you will be fine.”

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Therapeutic : “This diagnosis must be difficult for you. What information can I provide that may be helpful?” Sympathy Sympathy is concern, pity, or sorrow felt for another person. By expressing sympathy, the nurse takes on the client’s problems as if they were their own. It prevents a clear perspective of the issues the client is facing. Though sympathy is compassionate, it is not therapeutic. Empathy is the therapeutic response. Non-therapeutic : “I’m so sorry about the loss of your partner. I feel devastated for you.” Therapeutic : “Losing a partner is a major life event. Would you like to talk about how this may affect your life?” Offering Approval or Disapproval Offering approval or disapproval is not therapeutic. Nurses should not impose their own attitudes, values, beliefs, or moral standards on clients. Each client must make their own informed decisions. Agreeing or disagreeing sends the message that you have the right to make a value judgment about a decision. Non-therapeutic : “You should not even think about having an abortion. That is not moral.” Therapeutic : “You are considering having an abortion. Would you like to talk more about this?” Reflection Learning to avoid non-therapeutic communication techniques can be challenging. They are often part of everyday conversation, while therapeutic responses can often feel unnatural or uncomfortable. Think about a recent conversation you had. Which non-therapeutic responses did you use? What therapeutic responses could you have used instead? Your response is correct! Statement Non-Therapeutic Technique “If I were you, I would take a leave of absence from work.” Giving advice “It's time for your medications. We can talk about your concerns about discharge later.” Changing the subject “I'm sure your test results will be normal.” False reassurance

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Statement Non-Therapeutic Technique “I'm so sorry for the loss of your father. You must be devastated.” Sympathy “You should not stop your cancer treatments.” Disapproval “We would never intentionally withhold your medication.” Defensive response “How can you say that you are in pain? You are texting on your phone.” Arguing Your response is correct! The loss of a limb is a major change. Would you like to talk about how you are feeling? ( therapeutic ) – empathy You have been very courageous while fighting cancer. I believe you will find a way to face the surgery. ( therapeutic ) – sharing hope Why have you never had a child? ( non-therapeutic ) – asking personal questions You've told me that you are ready for discharge, but you still seem hesitant. ( therapeutic ) – confrontation Tell me more about the pain you are feeling. ( therapeutic ) – open-ended questions You can't win them all. ( non-therapeutic ) – automatic response Nursing Application: Professional Communication Introduction to Professional Communication Appearance, demeanor, behavior, and communication style are essential to establishing trustworthiness and competence. Sometimes, communication techniques must be adapted to accommodate a client’s special needs. In this lesson, you will learn the nursing application of professional communication to client interactions. A professional nurse is expected to be clean, neat, well-groomed, and odor-free, which includes strong-smelling soaps and perfumes. Many facilities have specific uniform requirements that must be followed. Visible tattoos and piercings may not be allowed in some facilities.

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Hair length is not part of professionalism. However, hair should not cover the face or touch clean surfaces when bending over. The nurse should appear warm, friendly, confident, and competent in all professional interactions. Nurses must speak in a clear voice, use grammatically correct language, and use good listening skills to help support clients and colleagues. Finally, the nurse should be on time for all interactions, appear organized, well-prepared, and equipped to manage professional communication. Element Description Courtesy Nurses say hello and goodbye to clients and knock on doors before entering. Trustworthy Nurses display consistency, reliability, honesty, competence, and respect. Autonomy Nurses are self-directed and independent in accomplishing goals and advocating for others. Appearance and Demeanor Two elements that convey professionalism are appearance and demeanor. Select each tab below to learn more. Professional Appearance A professional nurse is expected to be clean, neat, well-groomed, and odor-free, which includes strong-smelling soaps and perfumes. Many facilities have specific uniform requirements that must be followed. Visible tattoos and piercings may not be allowed in some facilities. However, as a student at Chamberlain University, you must follow the professional dress code standards as described in the student handbook.

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Appropriate appearance of a professional nurse Appropriate appearance of a nurse student Professional Demeanor Think back to what you have learned about the American Nurses Association’s Scope and Standards of Practice, which addressed standards of professional behavior. The nurse should appear warm, friendly, confident, and competent in all professional interactions. Nurses must speak in a clear voice, use grammatically correct language, and use good listening skills to help and support clients and colleagues. Finally, the nurse should be on time for all interactions, appear organized, be well- prepared, and equipped to manage professional communication.

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Elements of Professional Communication In addition to professional appearance and demeanor, the nurse must be courteous, trustworthy, and autonomous. Select each item below to learn how to exhibit these traits in your professional communication. Courteous Practicing courtesy during professional communication means that you say hello and goodbye to clients and knock on doors before entering. We address people by their preferred names, pronouns, and titles and say please and thank you as appropriate. When nurses are discourteous or rude, they are perceived as insensitive to the needs of others. Without courtesy, the development of professional relationships is difficult and friction occurs between colleagues. Trustworthy To be trustworthy means helping others without hesitation. For you to be trusted as a nurse, you must display consistency, reliability, honesty, competence, and respect. When the client trusts you, they are more open with their feelings, thoughts, and needs. Avoid dishonesty at all costs. Withholding information, lying, or distorting the truth violates our ethical principles. Do not betray someone’s confidence or gossip about clients or colleagues. This behavior sends the message that you cannot be trusted.

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Autonomous Autonomy means being self-directed and independent in accomplishing goals and advocating for others. As a professional, you make choices and accept responsibility for the outcomes of those actions. Additionally, we respect our client’s autonomy. Use of Names When communicating with clients or new colleagues, always introduce yourself. When you fail to provide your name and status (e.g., RN or nursing student), it conveys an impersonal lack of caring. Be sure to greet and acknowledge your clients by name as well. Select each tab for details. First or Last Name Typically, nurses first greet a client by using their preferred pronoun or title and last name. Once a relationship has been established, you may use the client's first name, if approved by the client. For both clients and colleagues, always ask how they prefer to be addressed and respect their preferences. When working with young children, addressing the child by their first name is appropriate. Endearment Terms Avoid the use of endearment terms, such as “honey,” “dear,” “sweetheart,” or “sweetie.” The nurse-client relationship does not progress beyond the use of first names. Endearment terms are too personal for use in a professional environment. In this image, the nurse has developed a close, professional relationship with the client from admission through discharge and is comfortable using the client’s first name. Using a Name Not a Diagnosis Never refer to a client by their diagnosis, room number, or other characteristic or physical attribute. To do so is demeaning and impersonal. Do not use: The appendectomy in room 107 needs pain medication. Try this instead: The client in room 107, who just returned from surgery, has requested pain medication. In this image, during the shift report, Tammy refers to Mrs. Jones as the fractured leg down the hall. Thomas quickly corrects her, stating “Let’s call her Mrs. Jones who suffered a fractured leg in room 109.” Your response is correct!

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Statement or Action Professional Unprofessional Rationale “Good morning, John. We have not met before, but I am one of the nurses here." X Calling a client by their first name when first meeting is inappropriate. “Justine, can you help me take care of the heart attack in room 126?” X Calling a client by a diagnosis instead of using their name is inappropriate. Jacob got into a fight with his partner this morning before work. When asked to take the first admission, he snapped at the charge nurse. X Jacob is not displaying professional demeanor. “Oh sweetie, we will get your pain under control.” X Do not use endearment terms. ”Alex, can you check Mr. Wong’s blood sugar? He is in room 212.” X This is the correct use of names. “Good evening, Mr. Lopez. My name is Susie. I will be your registered nurse tonight.” X This displays courtesy and the correct use of names. Will brushes out his hair and pulls it back from his face before leaving for work. X This displays professional appearance.

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Statement or Action Professional Unprofessional Rationale Lola prepares for work and realizes she does not have any clean scrubs, so she pulls out a dirty pair and sprays some perfume. X Nurses should be clean and neat in appearance without the use of strong odors. Assertiveness Being assertive means that you express your feelings and ideas without judging or hurting others. Being assertive does not mean being rude or unkind. An assertive nurse is respectful of others' feelings, ideas, and choices. When you learn to be assertive, you deal better with criticism and manipulation by others. You learn to set limits and resist guilt imposed by others. Assertive responses contain the word “I.” For example, you might say, “I want….” or ”I think…” or “I feel….” There are problems with both aggressive and passive responses. Aggressive responses may come off as too harsh or rude, whereas passive responses are weak and agreeable. For example, in this image, a client receives a confusing medical bill. They contact the healthcare facility stating, “I feel this bill is confusing and may be incorrect.” This represents assertive behavior. Your response is incorrect! Being assertive means that you express your feelings and ideas without judging or hurting others. Being assertive does not mean being rude or unkind. An assertive nurse is respectful of others' feelings, ideas, and choices. Aggressive responses may come off as too harsh or rude, whereas passive responses are weak and agreeable. Statement Assertive Aggressive Passive “As much as I would love to help, unfortunately, I have a lot of work to get through today.” X ”I am pretty busy today, but I can do the project for you.” X “I cannot help you today. You always ask for favors at the last minute.” X

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Statement Assertive Aggressive Passive “I disagree with you. This is how I see the situation.” X “I feel offended by your statement.” X ”Next time, I would appreciate it if you were on time for the report.” X “You are always late. What is the problem?” X “It is OK that you were late. I cared for clients until you got here.” Accurate and Timely Communication AIDET ® is a communication framework for healthcare professionals to better communicate with clients to decrease anxiety, increase compliance, and improve clinical outcomes. This technique helps the nurse provide accurate and timely communication to clients while focusing on excellent customer service. View the interactive and select each letter for an explanation. ACKNOWLEDGE. Greet the client by name. Make eye contact, smile, and acknowledge family or friends in the room. INTRODUCE. Introduce yourself with your name, skill set, professional certification, and experience. DURATION. Give an accurate time expectation for procedures, medications, and discharge. When this is not possible, give a time in which you will update the client on progress. EXPLANATION. Explain step-by-step what to expect next, answer questions, and let the client know how to contact you, such as a nurse call button. THANK YOU. Thank the client for choosing your hospital or for their communication and cooperation. Adapting Communication Techniques Some clients have special communication needs and the nurse must adapt to meet these needs.

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Hearing Loss Approximately 30 million people in the United States aged 12 years or older have hearing loss in both ears (National Institute on Deafness and Other Communication Disorders, 2021).  Disabling hearing loss is found in 2% of adults aged 45 to 54 and in 8.5% of adults aged 55 to 64.  Nearly 25% of adults aged 65 to 74 and 50% of those aged 75 and older have disabling hearing loss. About 29 million U.S. adults could benefit from using hearing aids, but fewer than one in three older adults have ever used them (National Institute on Deafness and Other Communication Disorders, 2021). When communicating with a client experiencing hearing impairment, the nurse should:  Assess the use of hearing aids.  Reduce environmental noise.  Get the client’s attention before speaking.  Face the client with mouth visible.  Speak at a normal volume.  Rephrase rather than repeat if misunderstood.  Provide a sign language interpreter if indicated. Vision Loss More than 3.4 million Americans aged 40 years and older are blind or visually impaired (CDC, 2020). When communicating with a client experiencing visual impairment, the nurse should:  Assess the use of glasses or contact lenses.  Identify when you are entering and exiting the room.  Speak in a normal tone of voice.  Do not use gestures or nonverbal communication.  Use indirect lighting.  Use at least 14-point print on written materials. Braille may be necessary. Speaking Difficulty Aphasia is the loss of the ability to understand or express speech, caused by brain damage. Dysarthria occurs when the muscles used for speech are weak and results in slurred or slow speech that can be difficult to understand. Both conditions can make communication challenging. When communicating with a client experiencing speech difficulties, the nurse should:  Listen attentively, be patient, and do not interrupt.  Ask simple yes or no questions.

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 Allow time for understanding and response.  Use visual cues when possible.  Let the client know that you understand them.  Use communication aids, such as letter boards, flashcards, or technology. Cognitive Impairment Cognitive impairment is when a person has trouble remembering, learning new things, concentrating, or making decisions that affect everyday life. Many medical conditions may result in cognitive impairment. When communicating with these clients, the nurse should:  Use simple sentences and avoid long explanations.  Ask one question at a time.  Allow time for the client to respond.  Listen attentively.  Use pictures or gestures that mimic the action desired. Cultural Diversity Differences in language may impede communication. Even among native speakers, variability in word usage, vocabulary, and literacy may affect client understanding. Decision-making authority may be deferred to others in certain cultures. To ensure effective communication, the nurse should:  Provide a professional interpreter if indicated.  Provide all written materials in the client’s preferred language.  Your response is correct! Action Client The nurse turns off the TV and faces the client when speaking. Client with hearing impairment The nurse announces entrance into the room and avoids the use of hand gestures when speaking. Client with vision impairment The nurse asks simple yes or no questions and uses visual aids when teaching. Client with aphasia The nurse uses simple sentences and avoids long explanations. Client with cognitive impairment

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Action Client The nurse provides a qualified interpreter when teaching. Client who only speaks Portuguese Your response is correct! Julian’s responses are passive while the charge nurse is being aggressive. Being assertive means that you express your feelings and ideas without judging or hurting others. Being assertive does not mean being rude or unkind. An assertive nurse is respectful of others' feelings, ideas, and choices. Aggressive responses may come off as too harsh or rude, whereas passive responses are weak and agreeable. Interprofessional Collaboration Introduction to Interprofessional Collaboration Communication within the healthcare team affects client safety and the work environment. When the healthcare team effectively communicates, client outcomes are optimized. When communication breaks down, client safety is compromised. Particularly when clients move from one department or nursing unit to another, the risk for miscommunication is high. Detailed hand-off reports are necessary when clients transfer care units and at the end of nursing shifts to ensure a safe transition in care. Interprofessional collaboration leverages knowledge from multiple disciplines to improve the care of an individual. Interprofessional collaboration reduces (not increases) the number of medical errors. It reduces costs (not increases) and increases (not reduces) the efficiency of the healthcare environment. Regardless of whether interprofessional collaboration increases or decreases the amount of documentation required, it is in the best interests of the client. ISBAR stands for Identify, Situation, Background, Assessment, and Recommendation . Each word describes specific information that a healthcare professional would communicate to another team member about a client for the purpose of collaborating, forming or updating a plan, or acting on cues. What is Interprofessional Communication? When the healthcare team works together and communicates effectively, client care is always improved. Interprofessional collaboration is defined as a partnership between healthcare professionals that includes the client. Through participatory collaboration and communication, shared decision making occurs. Advantages of interprofessional collaboration include:  reduced medical errors  reduced inefficiencies and healthcare costs  improved relationships and job satisfaction  improved client care and outcomes

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Members of the Interprofessional Team The interprofessional team, working together to care for the client, is essential to providing holistic care. The registered nurse is usually the manager of care and must understand the roles and responsibilities of each team member so that collaboration is effective. Let’s review some of the team members you may work with as a registered nurse (U.S. Bureau of Labor Statistics, 2021). Review the presentation using the arrows at the bottom. Registered Dietitian Registered dietitians are the experts on good nutrition and the food choices that contribute to health, whether the client is eating to prevent or manage the symptoms of an acute or chronic condition. Registered dietitians design nutrition programs to protect health, prevent allergic reactions, and alleviate the symptoms of many types of diseases. Speech Therapist Speech therapists are educated in the study of human communication, its development, and related disorders. They assess speech, language, cognitive-communication, and oral/feeding/swallowing skills. Occupational Therapist Occupational therapists assist clients who are weak or injured with everyday activities. They help clients develop, recover, improve, as well as maintain the skills needed for daily living and working activities, such as dressing, bathing, and feeding. Physical Therapist Physical therapists help clients who are weak or injured improve movement and manage pain. They are often an important part of preventive care, rehabilitation, and treatment for patients with chronic conditions, illnesses, or injuries. Respiratory Therapist Respiratory therapists care for clients who have trouble breathing due to an acute or chronic respiratory disorder. Social Worker Social workers help clients solve and cope with problems in their everyday lives. They also diagnose and treat mental, behavioral, and emotional issues. Medical Provider Healthcare providers (HCP), such as medical doctors (MD), doctors of osteopathy (DO), advanced practice registered nurses (APRN), and physician’s assistants (PA), diagnose and treat injuries or illnesses and address health maintenance. They prescribe medications, treatments, and diagnostic procedures. Case Manager

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A case manager, usually a registered nurse or social worker, organizes, facilitates, and evaluates care options to best meet a client’s mental, physical, and emotional health. The case manager strives to achieve holistic client care by advocating for needs, identifying resources, and ensuring services are cost-effective Standard 5A Throughout this course, you will explore all 18 of the American Nurses Association’s scope and standards (ANA, 2021). Let’s review Standard 5A. Standard 5A. Coordination of Care The registered nurse coordinates care delivery. This includes:  Collaborating with the client and the interdisciplinary team to help manage healthcare based on mutually agreed-upon goals.  Organizing the plan of care with input from the client and other professional team members.  Managing the client’s care to reach goals.  Engaging clients in self-care to achieve goals for quality of life.  Assisting the client to identify options for care and navigate the healthcare system.  Communicating with clients, the professional team, and community-based resources to ensure safe transition and continuity of care.  Advocating for the delivery of dignified and client-centered care.  Documenting the coordination of care. Standard 11 Throughout this course, you will explore all 18 of the American Nurses Association’s scope and standards (ANA, 2021). Let’s review Standard 11. Standard 11. Collaboration The registered nurse collaborates with the client and other members of the professional care team. This includes:  Partnering with the client and the professional team to advocate for change leading to positive outcomes and quality care.  Treating others with dignity and respect in all interactions.  Valuing the expertise and contribution of other professionals.  Using the unique and complementary abilities of all members of the team to achieve goals.  Articulating the nurse's role and responsibilities within the professional team.  Using appropriate tools and techniques to facilitate communication in a manner that protects dignity, respect, privacy, and confidentiality.  Promoting engagement through consensus building and conflict management.  Using effective group dynamics and strategies to enhance performance of the team.  Partnering with the client and the professional team to create, implement, and evaluate plans of care.

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 Role modeling the development of shared goals, clear roles, mutual trust, effective communication, efficient processes, and measurable outcomes within the professional team. Hand-Off Communication Client transition, or hand-off, represents a high risk for errors. The majority of the problems involve communication. Too often there is a misalignment of expectations between the sender of information and the receiver of information, which results in decreased client safety (The Joint Commission [TJC], 2017). Important! A hand-off is a transfer and acceptance of patient care responsibility achieved through effective communication. This is a real-time process of passing information from one healthcare professional to another for the purpose of ensuring the continuity of client care (TJC, 2017). There are some simple, yet effective ways to improve client safety during hand-off.  Standardize the content to be communicated using standard tools and methods of communication.  Communication should preferably be face-to-face and information should also be provided in written form.  Perform hand-off communication in a location free from interruptions and distractions.  Include all healthcare professionals involved in the client’s care in the hand-off process.  When possible, involve the client and supporting family members in the hand-off communication process (TJC, 2017 Using ISBAR When communicating in healthcare, using a common language is important. ISBAR is an acronym for a communication technique often used to deliver critical client information between members of the interprofessional team. ISBAR stands for Identify, Situation, Background, Assessment, and Recommendation. This tool is used to improve client care by creating a template to help the healthcare professional formulate thoughts and effectively communicate with others. It is used any time client needs must be communicated, during transitions in care, and when “hand- off” occurs between healthcare professionals.

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ISBAR in Use Here is an example of a healthcare professional using ISBAR to collaborate about the changes in a patient that may be concerning and that need attention. Lateral Violence Lateral Violence A common cause of disrupted team effectiveness is lateral violence, also called workplace bullying. When this occurs between colleagues, it adversely affects the work environment. Some examples of lateral violence include withholding information, making snide remarks, and nonverbal expressions of disapproval. Lateral violence leads to decreased job satisfaction, decreased sense of value and self- worth, poor teamwork, poor retention of qualified nurses, and nurses leaving the profession altogether. It also affects the client by reducing team communication and jeopardizes client safety. ANA Position Statement on Incivility Stopping Lateral Violence When interprofessional collaboration is effective, the team builds morale, accomplishes goals, and working relationships are strengthened. As we have already learned in Provision 6 of the American Nurses Association’s Code of Ethics for Nurses, “The nurse, through individual and collective effort, establishes, maintains, and improves the ethical environment of the work setting and conditions of employment that are conducive to safe, quality health care” (Fowler, 2015, p. 95). All registered nurses in all settings must collaborate to create a culture of respect, free of bullying and workplace violence, that promotes the health, safety, and wellness of registered nurses and ensures optimal outcomes across the healthcare continuum (ANA, 2015).

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When experiencing lateral violence, the nurse can use the following strategies.  Remain calm and address the behavior in an assertive manner.  Describe how the behavior is affecting your ability to function professionally.  Ask for the behavior to stop.  Notify the supervisor for support. Conflict and Resolution Strategies Conflict results from opposing thoughts, ideas, feelings, perceptions, behaviors, values, opinions, or actions between individuals or teams. Although it is inevitable, conflict may affect productivity, contribute to career burnout and anxiety, and impact client safety. There are three categories of conflict, including intrapersonal conflict, intergroup conflict, and interpersonal conflict. Intrapersonal Conflict Intrapersonal conflict occurs within a person and involves an internal struggle related to values. Example : A nurse wants to advance their career but is finding that time with family is compromised in the pursuit of advancement. Intergroup Conflict Intergroup conflict occurs between two or more groups of people and can be caused by changes in policy, leadership, or organizational structure. Example: There is confusion as to whether it is the responsibility of the nursing unit or the dietary department to deliver meal trays to clients. Interpersonal Conflict Interpersonal conflict occurs between two or more people with differing values, goals, or beliefs. Example: A new nurse is given a client assignment that is more challenging than those of other nurses. When the new nurse asks for help, it is denied. Provision 8 Throughout this course, we are exploring all nine provisions of the Nursing Code of Ethics. Let’s learn more about Provision 8. Provision 8 of the American Nurses Association’s Code of Ethics focuses on nursing’s commitment beyond individual client encounters (Fowler, 2015). “The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities” (Fowler, 2015, p. 129). Select each tab to learn more about Provision 8 of the code of ethics.

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Health is a Universal Right Nurses must participate in the radical declaration that health is a universal human right. We have an obligation to advance health and advocate for human rights. For example, all clients have a right to experience health and wellness. Collaboration for Health, Human Rights, and Health Diplomacy The nurse works together with other health professionals to advocate for human rights and reduce health disparities. Basic human rights include health, access to healthcare services, access to food and safe drinking water, adequate housing, freedom from discrimination, education, and a safe environment that promotes physical and mental well-being. For example, in a meeting, healthcare professionals are working together to reduce health disparities in the community. Obligation to Advance Health and Human Rights and Reduce Disparities Nurses must work together to address social determinants of health. Inequality, poverty, and discrimination erode health. For example, extreme poverty and homelessness experiences significantly impact the health and wellness of a client. Collaboration for Human Rights in Complex, Extreme or Extraordinary Practice Settings Nurses advocate for basic human rights in extraordinary settings, such as disasters where people are circumstantially, temporarily, or permanently vulnerable. For example, basic human needs must be met to maintain health and wellness during a natural disaster. Your response is correct! When possible, hand-off communication should involve the client and supporting family members. The best location for hand-off reporting is in the client’s room. Hand-off communication should be performed in a location free from interruptions and distractions. Therefore, the nurses’ station would not be a good location. Hand-off reports in the hallway outside the client’s room could result in a violation of confidentiality. The break room would most likely be private and distraction-free, but would not involve the client. Therefore, this is not the best location to perform hand-off reporting. Your response is correct! Healthcare Professional Primary Responsibility Speech Therapist Specializes in improving swallowing after a stroke.

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Healthcare Professional Primary Responsibility Physical Therapist Assists the client with a broken leg to use crutches properly. Registered Dietitian Teaches about a heart-healthy diet following a heart attack . Case Manager Coordinates discharge to home with home health services. Social Worker Provides community referrals to a support group. Healthcare Provider Prescribes medication to treat an infection. Registered Nurse Delivers bedside care to the client based on identified needs.

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Health and Wellness_Week 5edapt

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