NURS 1660 Lecture 3: Week Three
10 Jun 2018
School
Department
Course
Professor
Week Three (Sept. 25-29, 2017)
Health Assessment I
Unit One
CHAPTER TWO: The Interview and Therapeutic Dialogue (Pgs. 20-34)
Communication Process
- This dynamic process is always subject to interpretation. It is a complex, interactive
process; building the nurse-patient relationship. It is a connection between sender and
receiver.
- The sender sends code (verbal, gestures, facial expression, body cues).
- The receiver decodes message (meaning of verbal and nonverbal and
understanding perception).
- Therapeutic communication is a basic tool that the nurses use in the caring relationship
with patients. The interaction focuses on the patient and the patient’s concerns. Takes
practice; listen for messages.
- Caring encompasses the nurses empathy for the connection with the patient. It includes
the ability to demonstrate emotional characteristics
such as compassion, sensitivity and patient-centred
care.
- Values patient unconditionally and
nonjudgmentally. Show warmth, interest, care
and respect.
- Empathy means the ability to perceive, reason, and
communicate understanding of another person‘s
feelings without criticism. See and feel situation from
the patient’s perspective, help patients express how they are feeling and thinking.
- Self-concept is when a nurse is aware of his or her own biases, values, personality,
cultural backgrounds and communication style. It allows nurses to work with patients of
different backgrounds/personalities/cultures/socioeconomic backgrounds. Self-reflection
increase ability to be genuine, connect with patients and meet their needs.
Nonverbal Communication Skills:
- People tend to believe nonverbal communication over verbal communication
when the two are inconsistent (ie. if nurse says they are interested by are
yawning and looking around the room).
- Facial expressions of nurses should be relaxed, caring, and interested.
- Maintain eye-level with the patient whenever possible.
Verbal Communication Skills:
Week Three (Sept. 25-29, 2017)
- Nurse’s speech should be at moderate pace and volume, with clear articulation.
Active Listening - The ability to focus on patients and their perspectives.
Restatement - Nurse makes a simple statement in the words of the patient to
encourage elaboration (ie. “you said it feels like there is a knot in your chest.”)
Reflection - Instead of simply restating comments, the nurse identifies the main
themes of communication and how the patient may be feeling. (ie. If patient
expresses a hate for needles, nurse may say “You sound a bit nervous about
getting an injection.”).
Encouraging Elaboration (Facilitation) - A technique that assists patients to
describe concerns more completely (Ie. nodding head and saying “Um hm”).
Silence - Used purposefully during interview to allow patients time to gather their
thoughts and provide accurate answers.
Focusing - Used when patients are straying from a topic and need redirection.
(Ie. “We were talking about the reaction that you had to the penicillin. Tell me
more about that reaction.”).
Clarification - Used when the patient’s word choice or ideas are unclear in order
to better understand the meaning. (Ie. the nurse states, “Tell me what you mean
by….”). → prompts patients to identify other symptoms or give more information
so that the nurse better understands.
Summarizing - Happens at the end of the interview. Nurse reviews/condenses
info. into two or three of the most important findings. → helps ensure nuse has
identified important information and lets clients know if they’ve been heard
accurately.
Non Therapeutic Responses:
False Reassurance - used to minimize uncomfortable situations(ie. “It won’t
hurt”). → Enhances anxiety and tells patient that their concerns are not worth
discussing.
Week Three (Sept. 25-29, 2017)
Sympathy - When a nurse is being sympathetic, they are not being therapeutic
as they are interpreting the situation as they perceive it. Needs to focus on
patient. “I feel sorry for you”. Sympathy is feeling what the patient feels from the
viewpoint of the nurse→ In contrast, empathy is feeling what the patient feels
from their perspective.
Unwanted Advice - It is advice based on the nurse’s perspectives, opinions and
experience; not the patient’s - thus is might not help patient.
Biased Questions - These questions carry judgement. May cause patients to feel
guilty or inferior of unhealthy behaviours (ie. “You don’t use drugs, do you?”).
Changes of Subject - May happen why a situation is uncomfortable for a nurse
because of personal experiences or coping mechanism. (ie. if the nurse just lost
a loved one, it may be challenging for them to talk to the family of a terminal
cancer patient).
Distractions - Distractions contribute to nontherapeutic communication. (ie.
overhead paging system).
Technical or Overwhelming Language - Using too many technical terms or
providing too much information. Important to conduct conversation at the
knowledge level of the patient.
Interrupting - Talking too much or interrupting is not a therapeutic way of
communicating. Better to listen more than talk and ask effective questions.
Professional Expectations
The nurse who becomes too involved with patients experiences burnout and decreased job
satisfaction.
- Nonprofessional Involvement: occurs when the nurse crosses the boundaries of
professional relationships and establishes social, personal or economic ties with
patients.
- Sexual Boundary Violation: Sexual contact is never acceptable within the therapeutic
nurse-patient relationship. The CNA has established professional guidelines about
behaviours such as dating or having outside contact with patients. Visiting patients
beyond the role of nursing also breaks professional boundaries.
→ The nurse must not confuse the privileged intimacy of the nursing role with the
intimacy involved in a social or personal relationship.
Phases of the Interview
Document Summary
Chapter two: the interview and therapeutic dialogue (pgs. This dynamic process is always subject to interpretation. It is a complex, interactive process; building the nurse-patient relationship. It is a connection between sender and receiver. The sender sends code (verbal, gestures, facial expression, body cues). The receiver decodes message (meaning of verbal and nonverbal and understanding perception). Therapeutic communication is a basic tool that the nurses use in the caring relationship with patients. The interaction focuses on the patient and the patient"s concerns. Caring encompasses the nurses empathy for the connection with the patient. It includes the ability to demonstrate emotional characteristics such as compassion, sensitivity and patient-centred care. Empathy means the ability to perceive, reason, and communicate understanding of another person s feelings without criticism. See and feel situation from the patient"s perspective, help patients express how they are feeling and thinking.
