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Unformatted text preview: Communication in Health Care Settings Settings
N 310 310 Unit 1 Unit Lecture #2 By Veronica Garcia Walker
With special thanks to Jan Fox RNC, MSN And Stella Logan MSN, RN, PMHCNS-BC Barriers to Effective Communication Barriers
Role Stress Health Professional
Role uncertainty Responsibility conflicts Power differences Unshared meanings Lack of Interprofessional Understanding Autonomy Health Professional Limited Contact Information management Family role disruption Closed communication Patient Family Member The nurse is not sure what she is supposed to The do at the hospital. The patient is unsure of how to act as a patient. This is called… When we are trying to determine whose When responsibility it is for the patient being sick we call this…. call Which Model of Responsibility requires the Which patient to be responsible for their problems and changing their situation? and Which Responsibility Model requires that Which patient to be responsible for his care, but not for his situation?? for Which responsibility model says that the Which patient is not responsible for the problem or for solving the problem? for Which Responsibility model says that the Which patient is responsible for his/her illness, but not for the solution??? not When there is a question to who will be When submissive and who will be dominant in the relationship we call this… relationship A nurse tells the patient their diagnosis in nurse terms that the patient does not understand. This is called… This What are three barriers to effective What communication found in health professional/health professional communication? communication? Role Stress Insufficient Interdisciplinary Understanding Autonomy Struggles A new graduate nurse is out of nursing school new and does not feel that what she learned in nursing school is what it is like in reality. This nurse has…. nurse The social worker does not feel that the nurse The has authority to talk to the patient about discharge. This is called… discharge. There is some question about what the nurse is There allowed to do even though she has been trained in these particular skills. These may be called… called… When the family is not included in the When planning and the health care professionals may not be communicating with the family we call this… this… When a patient is bypassed and the When information goes to the family this is called… information When the roles of the family become loose and When undefined due to a hospitalization, we say that the roles are… the When the roles of the patient and family are When fixed in inappropriate patterns this may be called… called… A family may say, “We do not discuss that family because we do not want Daddy to get another heart attack.” This is an example of… heart Patients may not discuss their fatal Patients illness with their children because they are afraid that they may break down in front of their children or that they will have difficulty dealing with their children’s concerns. This is.. their HEALTH COMMUNICATION MODEL Health Professional Health Professional Communication Variables Health Health Care Contexts Transactions Communication Client Variables Significant Others Comparisons Between Social and Therapeutic Helping Relationships Therapeutic 1. 2. 3. 4. Helping as Social May be an intimate or personal act Helper uses a wide variety of resources Relationship does not always allow Relationship participants to realize personal goals participants Can result in continued interdependence or Can self dependence self Comparisons Between Social and Therapeutic Helping Relationships Therapeutic 1. 2. 3. 4. Helping as Therapeutic Is a personal but not intimate act. Helper uses specialized, professional skills. Relationship allows participants to realize Relationship personal goals (should foster constructive dependence). dependence). Should result in self dependence: dignity is Should maintained through professionalism. maintained The Health Care Interview The The health care interview is an intentional, The serious, focused conversation which involves questions and answers, with the goal of sharing information or facilitating therapeutic outcomes. outcomes. Types of Interviews Types Information Sharing: purpose is to request and provide information request content focused rather than relationship focused focused usually of short duration Intake interview, history taking, Intake Preliminary job interviews, performance Preliminary appraisals, Surveys Types of Interviews Types Intake interview, history taking Types of Interviews Types Preliminary job interviews Performance appraisals Performance Types of Interviews Types Surveys Types of Interviews Types Therapeutic Interviews: purpose is to develop Therapeutic supportive relationship and help clients identify and work through personal issues, concerns, and problems. concerns, Express personal thoughts and feelings Gain new insights Develop problem solving strategies Develop Two Basic Approaches to conducting a Therapeutic Interview: Therapeutic 1. Directive 2. Non-Directive Directive Interviewing Directive A form of therapeutic interview in which the form interviewer guides, leads or prescribes solutions for the client. solutions Advantages Makes full use of professionals knowledge Provides specific, concrete information about the Provides nature of the problem and possible solutions nature Time efficient Directive Interviewing Directive Disadvantages Doesn’t fully recognize the client’s ability to Doesn’t assess and resolve problems assess May not be helpful if advice is not compatible May with client view of the situation or client values. values. May create a power differential with the client May in a submissive role, and the professional in a dominant role. dominant Non-Directive Interviewing Non-Directive A form of therapeutic interview in which the form interviewer allows the client to control the content and to choose direction for the interaction. interaction. Based on the belief that the client is the person Based best able to identify and resolve his or her problems. problems. Advantages Advantages Encourages client involvement in the Encourages treatment process treatment Increases the chances that the client and health Increases professional will address the real problem Gives greater control to the client who is a Gives treated as an equal partner in the interaction treated May increase compliance (follow-through) Disadvantages Disadvantages Requires large amounts of time Considered by some to be inefficient, costly Some professionals may feel the need to direct Some clients away from ineffective strategies, and toward strategies known to be effective. toward Settings for Interviewing Settings Directive: Non-Directive ER Ambulatory/((Inpatient) Inpatient)
Care Care Abuse assessment
… … Psychiatric Unit Hospice Sexual concerns … … Most settings require a combination of directive and non-directive techniques in practice. Interview Process Interview Four Phases of the Interview Process: Four Preparation, reparation, Orientation, rientation, Exploration, xploration, Termination Interview Process Interview Movement through phases happens more Movement quickly when: quickly Goal is information sharing rather than therapeutic Goal change change Client’s personality is well integrated rather than Client’s disorganized disorganized There is a single problem being addressed Preparation Phase Preparation Involves anticipating and planning for the Involves actual meeting actual Self (caregiver) assessment: strengths, Self limitations, feelings, biases limitations, Client assessment: preview materials (eg: Client intake data, chart, change of shift report) intake Clients also gather information about the Clients caregiver caregiver Orientation (Initiation) Phase Orientation Begins with first contact Begins Sets the tone and creates the climate for the Sets relationship relationship 4 tasks for the professional Establish therapeutic climate Clarify purpose of the interview Formulate a contract with the client Establish mutual goals The Contract The Spells out what is expected by both the Health Care Provider Client Patient Goals Patient Should be measurable Should be time framed Should be directed toward the patient Should not what the “nurse will do” Exploration (Working) Phase Exploration Major task: help clients explore their personal Major problems problems Second task: help clients manage feelings Third task: help clients develop new coping Third skills skills Common 3rd Phase Errors Common Clinician unable to sustain focus on an Clinician important issue important Clinician offers inappropriate advice, approval Clinician or reassurances or Clinician responds in stereotyped ways to Clinician clients, or overuses the same communication techniques techniques
(Sayre in Northouse & Northouse) (Sayre Termination Phase Termination Major task is to plan for closure of the Major interview interview Second task; summarize issues and Second accomplishments accomplishments Third task; assist clients to express their Third feelings about termination feelings Common 4th Phase Errors Clinician terminates prematurely because Clinician client does not behave as expected client Clinician does not allow adequate time, and Clinician termination is superficial termination Clinician brings up emotional issues that Clinician should have been dealt with earlier should Clinician avoids termination Clinician ...
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This note was uploaded on 12/24/2009 for the course N 310 taught by Professor Fox during the Fall '08 term at University of Texas at Austin.
- Fall '08