communication- non therapeutic, NPR

nurse patient relationship

1. UNIT IV COMMUNICATION AND NURSE PATIENT RELATIONSHIP Non-therapeutic technique, NPR Anjana Thomas

2. NON THERAPEUTIC COMMUNICATION TECHNIQUES Overloading Value judgement Underloading False reassurance/ agreement Invalidation Changing the subject Giving advice Internal validation

3. Overloading Talking rapidly, changing subjects too often, and asking for more information than can be absorbed at one time. what is your name , where do you live?

4. Value judgement Giving one’s own opinion, evaluating, moralizing or implying one’s values by using words such as “nice”, “bad”, “right”, “wrong”, “should” and “ought”. “You shouldn’t do that, its wrong”.

5. Underloading Remaining silent and unresponsive, not picking up cues, and failing to give feedback. The patient ask the nurse, simply walks away.

6. False reassurance/ agreement Using cliché to reassure client. “It’s going to be alright”.

7. Invalidation Ignoring or denying another’s presence, thought’s or feelings. Client: How are you? Nurse responds: I can’t talk now. I’m too busy.

8. Changing the subject Introducing new topic Inappropriately, a pattern that may indicate anxiety. The client is crying, when the nurse asks “How many children do you have?”

9. Giving advice Telling the client what to do, giving opinions or making decisions for the client, implies client cannot handle his or her own life decisions and that the nurse is accepting responsibility. “If I were you… Or it would be better if you do it this way

10. Internal validation Making an assumption about the meaning of someone else’s behavior that is not validated by the other person (jumping into conclusion). The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood.

11. PROFESSIONAL COMMUNICATION Is the exchange of knowledge and skill for decision making about patient care Need to establishing professional communication with each other For quality of care – collective understanding of care plan, safe patient care

12. Service communication skill Attending skill Rapport building skill Empathy skill Observation skill

13. Attending skills Keep the communication as natural as possible and control tone of voice Be knowledgeable about the topic of conversation and have an accurate information. Be flexible, clear and concise Avoid words that may be interpreted differently Active listener Use therapeutic touch in the communication

14. Rapport building skills It is the relationship of mutual understanding between people Develop it with the patient through warmth and non-judgmental attitude Eg : technique to build rapport – Posture, eye contact, using appropriate facial expression and body gestures W ill help to reduce anxiety and patient feel comfortable for self disclosure

15. Empathy skills It an action of understanding, being aware of, sensitive to the patient’s feeling Recognize, perceive and directly experiencing feeling and emotions of another person

16. Observational skills Observe the patient by look, sound and action Focus on the patients minor changes , doubts of client Made skillfully to prevent unwanted or wrong judgement Eg ; As you look disturbed today, how I can help you

17. Nurse patient relationship

18. Definition Planned purposeful interaction between two human being, the nurse uses personal attributes and clinical techniques in working with patient to bring insight and behavior changes

19. Factors determining NPR Rapport Empathy Warmth Trust

20. Rapport Relationship or communication with the patient Acceptance and willingness to involve with the patient Mutual understanding and growth Ability to treat another as equal and sympathetic

21. Empathy Unconditional positive regard and acceptance are easier to achieve, if nurse develops empathetic understanding of people. The nurse senses patient’s anger, fear or confusion as if they were her own.

22. Warmth Ability to make the patient feel comfortable Acceptance of patient as unique individual Willingness to be involved with patient

23. Trust Frim belief in honesty

24. Goal of NPR To increase the patient’s self esteem and promoting a positive self-concept and sense of security To gain in depth assessment to provide individual care and identify health need To assisting the patient in improving communication skill and participating comfortably with other persons To decrease4 the patient’s anxiety to a minimum

25. Phases of NPR Pre-interaction phase Introductory or orientation phase Working phase Termination phase

26. Pre-interaction phase: This phase begins before the actual interaction with the patient. In this phase, a patient is assigned to nurse. The nurse feels fears and misconcept before interacting with patient.

27. Tasks of pre-interaction phase: Obtaining information about the patient from secondary sources like file, relatives of patient or from other health team members. Explore own feelings, fears and anxiety. After collecting the information, she plans the interaction with patient and objectives of the interaction phase. The nurse may experience anxiety in interacting with the new patient, feelings of inadequacy and fear of hurting from patient.

28. Introductory or orientation phase Phase begins when the nurse and the patient interact for the first time. The primary concern of nurse is nursing assessment and it helps the nurse to focus on patients problems.

29. Tasks of introductory or orientation phase Creating an environment for the establishment of trust and rapport. Establishment of the contact with the patient and develop rapport. Initiating a therapeutic contact by establishing time, place and duration of meeting as well as the length of time the relationship exist. Gather information from the patient and define the nursing needs, set priorities for intervention. Mutually set short and long term goals and develop a plan of action that is realistic for meeting the established goals.

30. Working phase This phase starts when the nurse and patient are able to overcome the barriers of orientation or introductory phase. They actively work in fulfilling the goals which they have established.

31. Tasks for working phase The nurse collects history from patient and identifies nursing needs of patient. She encourages the patient to communicate so that he is able to find an alternative to his/her problems. Provides information needed to understand and change behavior. Take actions to meet the goals set with the patient. Uses therapeutic communication skills to facilitate successful interaction with the patient.

32. Termination phase Termination of relationship may occur for a variety of reasons such as goals established may have been attained or patient may be discharged from the hospital.

33. Tasks of termination phase Summarizing the course of interaction Exploring the future plan and coping strategies Exploring feelings about termination of therapeutic relationship.

34. Communicating effectively with health team Encourage one to one problem solving Maintain a healthy and co operative environment Develop understanding Feedback and reinforcement result in effective communication A friendly and professional exchange can improve relationship

35. With patient and family Assure your availability and encourage him to ask questions Listen to what patient has to say about their condition and care Inform all procedure to the patient and family Involve patient and family in developing the care plan Use language that is understandable and simple Ask one question at a time Be gentile and soft while communicating Convey honesty and trustworthiness Do not make promises, accept and respect Getting and giving feed back

36. Communication with Children 1. Maintain rapport with the child. 2. While communication consider the developmental age of the child. 3. Use of toys and playful attitude will encourage child to express feelings and thoughts. 4. Speak softly, use simple words and direct statements. 5. Always communicate with child in comfortable environment and an environment free of distracting machines, or fear producing instruments. 6. Observe the non-verbal behavior that indicate anxiety - avoidance of eye contact or clenched fist. 7. Interact with the parents and involve them in teachings

37. Communication with Old Age People 1. Maintain eye to eye contact with the patient. 2. Focus on the topic. 3. Don't discuss about the extra topic. 4. Only discussion in their conversation, not arguing and questioning 5. Distracting area should be avoided. 6. If we ask about any point or any idea they are not directly involving because due to ageing they are very agitated and irritated easily. Only discussion is the best possible method to search your point in proper way.

38. Blind Patients Always speak to the patient when you enter the room so he will know who is there. Speak directly to the patient do not turn your back. Speak to the patient in a normal tone of voice. Speak to the patent before touching him. Offer to help with arrangements for patients who may enjoy hearing tapes or reading Braille literature.

39. Deaf Patients Look directly at the patient when speaking to him/her. Do not cover your mouth when speaking because the patient may be reading lips. If the patient does not lips-read, charts with pictures may be used or simply writing your questions or comments on a piece of paper may be helpful. Charts with hand signs are available at the local society for deafness and/or hearing preservation. Use communication aids: Pad and felt-tipped pen, magic slate, pictures denoting basic needs and call bells or alarm.

40. Patients who are Cognitively Impaired Reduce environmental distractions while conversation. Get patient's attention prior to speaking Use simple sentences and avoid lengthy explanations. Ask one question at a time. Allow time for patient to respond. Be an attentive listener. Include family and friends in conversations, especially in subjects known to the patient.

41. Patients who cannot Speak Clearly (Aphasia, Dysarthria, Muteness) Listen attentively, be patient and do not interrupt. Ask Simple questions that require "yes" and ‘no answers. Allow time for understanding and response. Allow only one person to speak at a time. Do not shout or speak too loudly. Alternative methods for communicating with the patient include: Lip reading Paper and pencil Picture cards Eye blinks Computer assisted communication

42. Communication with Handicapped Patients (Physically or Mentally Challenged) Listen to the patient and give enough time to communicate. Do not shout or speak loudly. Use simple and short questions. Use simple gestures to give additional clues. Speak slowly and divide task in small steps.

43. Patients who are Unresponsive Call the patient by name during interactions. Communicate both verbally and by touch Speak to the patient as though he or she could hear. Explain all the procedures and sensations. Provide orientation to person, place and time. Avoid talking about the patient to others in his or her presence. Avoid says things, the patient should not hear.

44. Confused Patients Maintain appropriate eye contact. Keep background noises to a minimum. Use simple, concrete words and sentences. Use pictures and symbols. Use closed rather than open-ended questions. Give the patient, time to respond.

45. Agitated Patients Use caution when communicating with a patient who has a history of violent behavior or poor impulse control. Do not turn your back towards the patient. Arrange the setting so that the patient is not between you and the door of the room. Focus on the patient's body language Be alert for physical indicators of impending aggression: narrowed eyes, clenched jaw, clenched fist or a loud tone of voice. Model the expected behavior by lowering your tone otvoice.6. Stay within the patient's line of vision and do not touch.

46. THANK YOU