Flashcards
module 3 communication across the lifespan
Cards in this deck (37)
- 1communication advocacyIn our professional roles as nurses, we are responsible to care for persons who are ill. When ill, patients may be unable to speak or advocate for themselves. Vulnerable patients need our voices to speak for them.
- 2benefits of good communication for nursesThere is a well-established link between team communication, worker morale, and patient safety. Poor team communication has been directly linked to preventable medical errors, high nurse turnover rates, and low morale (Brinkert, 2010; Institute of Medicine, 1999; Vessey, DeMarco, & DeFazio, 2010). Low morale contributes to high levels of stress, burnout, poor job satisfaction, and an overall poor quality of life.
- 3hierarchy of human needsIn 1943, Abraham Maslow developed a hierarchy of human needs wherein he described the basis of human behavior in terms of the priorities of survival (Figure 1). Oxygen, food, water, and shelter, our most basic needs, must be met first. Once these basic needs are met we can progress upward in the hierarchy toward fulfillment of needs for safety/security, love/belonging, and esteem. Finally, according to Maslow, the highest human needs revolve around finding one's purpose and realizing one's full potential, which culminate at the pinnacle of the hierarchy in self-actualization.
- 4hierarchy of human needs and communicationThe concept of communication can be most appropriately considered in the context of three levels of the hierarchy: safety, love/belonging, and esteem. Of these, safety has the most intimate involvement with basic, "primitive" needs. For example, it feels very personal when one's safety is threatened by loss of any kind, whether it is a perceived or actual loss. A loss can invoke anger, grief, or fear in response to feeling helpless, powerless, unsafe, and vulnerable. Likewise, effective or ineffective communication may impact our ability to satisfy the needs of love and belonging, and also esteem.
Many would agree that interpersonal communication is an intimate, human activity that can weigh heavily on our overall psychological health and wellness, and therefore, warrants much discussion and attention.
As each person seeks to meet his or her human needs, a number of variables, both internal (or personal factors) and external (or behavior of others) can combine to support effective or ineffective interpersonal communication. - 5predisposing factorsIn addition to our genetic makeup and gender, the variables (termed internal predisposing factors) consist of thoughts, feelings, and perceptions that are often learned early in life and shaped by childhood upbringing and experiences. In my clinical experience with patients, I have observed that early experiences can affect persons deeply, and perceptions of these experiences are not easily changed. Indeed, the impact of these experiences can cause a person to be rigid and inflexible. For example, a person who has been abused physically, verbally, or sexually by the opposite sex, and unhealed from this, can become unyielding in any future interactions with persons of that gender regardless of the situation or circumstances.
- 6Some consequences of ineffective interpersonal communicationSome consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Some consequences of ineffective interpersonal communication can be chaos, confusion, disorder, fear, conflict, inefficient systems, and wasted resources. Poor team communication has been cited as the number one cause of unnecessary patient deaths related to medical error since the 1990s (Institute of Medicine, 1999).
- 7how to coach demeanorPersonal life versus professional role calls us to develop and apply competent skills based on the specific situation, and adopt an appropriate demeanor and response. However, behavior based solely on role expectations may not always be appropriate. Here are some suggestions to begin to think differently. When applying what is discussed in this article to your personal and professional lives, think of yourself holistically. In other words, you cannot compartmentalize basic personality structure, or your personal way of relating to the world; you are who you are. Divorce yourself from antiquated acculturated role expectations of how women or men and nurses are supposed to behave.
- 8spontaneous human interactions that are meaningful.One way to do this is to think in terms of the use of "self" versus "skills." Effective interpersonal communication is much more than techniques, skills, or procedures to be mimicked or parroted. Parroting or mimicking is generally viewed as insincere; if one behaves as a robot, most people will sense this. To say one must perform a certain skill or competency, in my opinion, diminishes our ability to have spontaneous human interactions that are meaningful. Techniques and skills can become too automatic and thus may limit your options.
- 9conflict managementit is ok to disagree, and not all problems will be or can be solved. If you are not comfortable with conflict, chances are somewhere along the line you may have learned that conflict is "bad." Maybe you witnessed conflict that escalated into inappropriate aggression or violence, or you were not allowed to express negative feelings in order to solve conflict. The term "conflict management" that was coined years ago by the business world suggests that conflict must be managed or kept under control. This is not always true. Conflict often can provide the friction we need to discuss issues, consider alternative strategies and solve problems. Conflict in and of itself is not bad, but necessary. Opinions that differ from our own help us to learn and grow (Peck, 1978). Keep an open mind and discuss solutions respectfully when conflict arises.
- 10Poor Negotiation/Problem-Solving Skills. . . poor negotiation and/or problem-solving skills often happen when people are in a hurry to fix a problem. . . In my experience, poor negotiation and/or problem-solving skills often happen when people are in a hurry to fix a problem, whether at home or in the workplace. A person may not take time to thoroughly think about the problem and possible solutions because we live in what I have heard described as a hurry-up, fix it now, instant mashed potatoes, just put out the fire culture. This "hurry up and fix it/get it away from me" ideology is sometimes due to discomfort with problems. Why? Because problems can evoke negative feelings within us, and we do not want to feel negative feelings. In my opinion, this is a real shame because "problems call forth our courage and wisdom; indeed they create our courage and wisdom"
- 11emotion over or under involvementhowever, empathy requires a complex balance of well-developed boundaries, emotional stability, experience, and indeed, effective interpersonal communication. Helping professionals may find themselves on one end or the other of the emotional caring spectrum and err by being overinvested in or, conversely, detached from patients. Unfortunately, emotional detachment, a technique adopted by some providers, does not protect one from future or worsening burnout.
If you lack empathy, you may have become hardened to the world for some reason. Perhaps you have been hurt or are burned out. Compassion fatigue, a term coined in the mid 1990s, describes a phenomenon wherein professionals working with traumatized clients were actually at risk for secondary traumatization due to over identification with their clients' experiences (Sabo, 2006). This phenomenon occurs in all types of healthcare providers. Therefore, to maintain both physical and emotional health, it is important to strive to maintain the delicate balance between over and under caring. - 12if you are unsure of yourselfNever degrade yourself or allow others to denigrate or be disrespectful to you. Never refer to yourself or your personal characteristics in pejorative terms. Make a decision to view these behaviors as unacceptable. If you want respect, you must demonstrate this by respecting yourself.
Sometimes we have to teach people how to treat us. For example, if you are spoken to in a disrespectful or condescending manner, by anyone, especially a co-worker, first know that this is unacceptable. You do not have to take verbal abuse from anyone, especially in the workplace. The expectation is for nurses, physicians, and all members of the healthcare team to behave professionally at all times. Should inappropriate behavior occur, you must make the decision to stand up for yourself. Even if it is hard, try calmly stating words such as, "Excuse me, but I would like to be addressed with courtesy and respect at all times" or "Please refrain from making pejorative remarks and focus on a solution to this problem." - 13Lack of Boundaries/Inability to Set LimitsAssertiveness, or saying NO and setting limits appropriately is an ART that must be learned. The inability to set limits is generally related to fear of rejection, people pleasing, or emotional insecurity. You may think, "They won't like me." Accept that you will not like everyone, and everyone will not like you, and that is okay. Assertiveness, or saying NO and setting limits appropriately is an ART that must be learned. Setting limits requires one to make simple, short statements in a calm, respectful manner. Focus on the positive and describe the desired behavior, as opposed to one that is undesired. Following this, describe the consequences for continuation of the undesired behavior. Do not argue, threaten, and attempt to intimidate, or show fear. State only the consequences that you have power to enforce, and that you will follow through upon. Do not promise what you cannot deliver. In your role as a nurse, you will deal with upset patients at times; however, you have the right and responsibility to set limits on inappropriate behavior.
- 14Importance of Self Analysis and InsightSince we do not live in a vacuum or in isolation, understanding yourself and developing insight into YOU is paramount to effective communication. Refer back to the personal variables in Figure 2. How were you treated and addressed by your parents and teachers? Was your family patriarchal (led by father) or matriarchal (led by mother)? How has your race, culture, and/or religion possibly influenced you? As an adult, how has your education and real world experience impacted you? Have you been ill or lost someone close to you? It is important to understand how these factors have shaped and influenced you, and to what extent. These variables influence how you present, behave, and communicate in the world.
- 15layman's termsLack of clarity in speech and/or writing often contributes to ineffective communication. Avoid jargon, any kind of "isms," clichés, slogans and boring overused stories. If you have heard something before, it is likely that others have, too. Use others' work discriminately and give credit as appropriate. Be original. Shorthand, texting, hashtags, and social networking lingo should never be used in professional communication. Say what you mean and mean what you say. Use plain, straight-forward talk that addresses the issue at hand.
- 16Perception of suffering and organ donationSome families made decisions that were linked to a perception
that their loved one was suffering. This was despite the
interviewee’s ability to emphasise that they “knew they
weren’t suffering”; however, interviewees found it difficult
to reconcile that information with visual signs of what they
perceived through their senses (smell, sight, touch, sound) as
suffering. - 17Perception of suffering and organ donationFor example:
... and it was absolutely horrific … oh, God … I couldn’t
even look at him … the smells.
And for another family:
... and he looked, he looked uncomfortable, he looked
really, really uncomfortable, … even though I know he
wasn’t with it. He just looked really uncomfortable, oh,
… and he didn’t look peaceful at all, there was nothing
peaceful about the way he looked.
Some families made decisions based on their desire to limit
suffering. The perception that it would take a long time to
arrange the donation of their loved one’s organs contributed
to refusals because the families felt the responsibility to
protect their loved one from further suffering:
It’s pretty obvious that xxx has gone and he’s not going to
survive, but I don’t want to see him suffering …
All the families revealed an overriding need to protect and
care for their dying/deceased family member before and after
death. Hope1 - 18Perception of suffering and organ donationfor a positive donation outcome, a wish to help
others and to honour their relative was important to them,
but this concept was overridden when any perception of harm
to their loved one became evident. Their “deep hope”2
was
based on doing the best they could to care for their loved one.
Trust3
in the care that was given was essential for this to occur.
I am aware that there have been great steps forward in trying
to bridge the information and communication deficit that has
been present surrounding organ and tissue donation in the
Australian context. A continued focus on choosing words
carefully (for example, not harvest) is essential. I would
like to encourage new and innovative means to engage with
health care professionals and the community, to ensure
people understand the organ and tissue donation process as
a compassionately delivered standard part of end of life care. - 19Perception of suffering and organ donationStaff who are skilled and knowledgeable,
and who have the emotional intelligence to support the
families at this time, provide hope to these families that
someone who cares about them and their loved one will
guide them through the labyrinth of grief, fatigue, thirst, time
and desire to protect their loved one from further harm. In
Australia, we have some staff who do this extraordinarily
well; they predominantly tend to be experienced nurses and
some doctors who make the time to create a patient (person)-
centred relationship which recognises the families’ needs.
Sadly though, my findings suggest that the process of ‘tickbox’ governance means that some families who have agreed
to donation may be confronted with additional trauma
as staff struggle through a complex process, following a
regulation ‘check’ sheet. The ‘shopping list’ whereby donor
coordinators are required to gain consent from families by
individually naming and signing off each organ, tissue, blood - 20the transition from wellness to illnessThey may be adults moving from being independent to being permanently or temporarily dependent on others for their survival. It may be a family coming to grips with a catastrophic illness or a terminal diagnosis of one of its members. Others may be awaiting a medical diagnosis after experiencing symptoms of illness. For others, it will be dealing with the challenges of chronic illness, often exacerbated by bouts of acute illness and the continual need for readjustment. All of these circumstances involve transition— a movement from one way of being to another.
Transitions through health and illness are often transformative in the sense that lives are altered. A health transition is ‘a process of convoluted passage during which people redefine their sense of self and redevelop self-agency in response to disruptive life events’ (van Loon & Kralik 2005, cited in Kralik et al. 2006, p. 321). Distress, anxiety, loss and grief may also mark health transitions, as people cope with life alterations such as being unwell, getting well again, becoming disabled and approaching death. - 21difference between disease and illnessIllness is the experience of disease— that is, how disease affects a person’s life. Illness is also the whole personal experience of a disease— the ‘story’ of the patient. ‘Illness is the human experience of loss or dysfunction whereas disease is the manifestation of aberration at a cellular, tissue or organ level’ (Benner & Wrubel 1989, p. 8). Illness is the human response to disease; however, there can be illness in the absence of disease. Similarly, a person can have a disease, yet not experience illness.
- 22how to discuss the end of life with patientsdont lie or give them false hope. letting them know in advance that if they ask a question that you will answer it so if they are not ready to hear the answer best not to ask. also read the patients facial expressions to understand how much they want to know. in the case of a family member or patient who is very scared lead with observations will help them to come to terms with it while not directly bringing up the situation. and may give them time to accept the situation so they can come to you later and ask questions or feel better about discussing it at a later date. exaples of this might be do you notice how cold your dads hands are. don't say you understand their experience because you don't. prepare them for the impact "I'm afraid its not good news". are you the type of person who wants to know everything in detail or just key facts. active listening. explain about changes in breathing.
- 23define copingIllness is the experience of disease— that is, how disease affects a person’s life. Illness is also the whole personal experience of a disease— the ‘story’ of the patient. ‘Illness is the human experience of loss or dysfunction whereas disease is the manifestation of aberration at a cellular, tissue or organ level’ (Benner & Wrubel 1989, p. 8). Illness is the human response to disease; however, there can be illness in the absence of disease. Similarly, a person can have a disease, yet not experience illness.
- 24active and passive copingCoping is defined as ‘constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person’ (Lazarus & Folkman 1984, p. 141). Coping efforts include all attempts that are made in response to these demands. Attempts to cope range from denying the significance of an event to mastering new skills in order to meet the demands of the situation. Coping efforts may be focused on reducing the anxiety, mastering the situation, minimising its significance or simply tolerating it.
- 25active copingCoping is defined as ‘constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands that are appraised as taxing or exceeding the resources of the person’ (Lazarus & Folkman 1984, p. 141). Coping efforts include all attempts that are made in response to these demands. Attempts to cope range from denying the significance of an event to mastering new skills in order to meet the demands of the situation. Coping efforts may be focused on reducing the anxiety, mastering the situation, minimising its significance or simply tolerating it.
- 26passivePassive coping efforts are aimed at keeping uncomfortable feelings within manageable limits and thinking about the situation in a different way. Examples of these types of effort include avoiding the situation, minimising the significance of the event, distancing techniques, focusing on the bright side, maintaining an optimistic outlook, deriving positive value from negative events, meditating, turning to religion, laughing it off and using physical exercise to decrease tension. These efforts are aimed at attempts to avoid the situation and are often considered to be a form of denial.
- 27denialDenial is frequently used as a means of emotion-focused coping and is effective in containing anxiety within manageable limits. There is often an automatic tendency by nurses to confront and challenge denial because nurses often perceive denial as an ineffective way of handling an illness. Before challenging denial, nurses need to understand and appreciate the benefits of it. Denial serves as a buffer for a disturbing and disruptive reality by allowing a temporary respite from this reality. Because patients will let reality ( their reality) seep into their awareness at a rate that is manageable for them, the degree of denial is in keeping with this rate. This rate may be different from the nurse’s desired rate.
- 28Cognitive appraisalThe perception of the event, referred to as ‘cognitive appraisal’ (Lazarus & Folkman 1984), affects coping efforts that are made. Cognitive appraisal relates to how an event is evaluated in terms of its perceived outcome in relation to personal life goals and values, and an assessment of coping skills to achieve this outcome. The appraisal influences the person’s coping response. Coping efforts that are aimed at keeping anxiety under control (passive or emotion-focused coping) are effective in situations that are perceived as futile (i.e. when there is considered to be a lack of control over the outcome). These types of coping efforts are usually focused on maintaining emotional control. When the outcome is perceived as overwhelming or disruptive to major life goals and there is little that can be done to alter the outcome, then temporary denial or avoidance may be the most effective alternative.
- 29COPING EFFECTIVENESScoping methods are not inherently good or bad, and nurses need to view patients’ coping efforts within the overall context of the situation (e.g. the effects of coping on significant people in the patient’s life). An evaluation of the effectiveness of coping efforts relies on the use of a variety of criteria, expressed in the following questions: • Does the coping effort help to keep anxiety and distress within control? • What are the long-term effects of the coping efforts? • Does the coping effort help to maintain a sense of self-esteem? • Is the coping effort helping to maintain interpersonal connections? • Is there flexibility in the thinking about and the approach to the situation?
- 30coping resources: resiliencePeople who are resilient have the ability to ‘bounce back’ in the face of adversity and remain optimistic in the face of threats to their wellbeing.
Resilient people are capable of being injured and they do bend under stress, but they are equally capable of subsequent rebound and recovery. They demonstrate minor or transient disruptions in their functioning whenever they are under stress (Bonanno 2004). Resilience is characterised by a strong sense of self-esteem and self-reliance, high flexibility and adaptability, an optimistic outlook that includes a sense of humour about oneself and life in general, which is accompanied by positive, caring, strong social connections and support (Earvolino-Ramirez 2007; Lundman et al. 2010). Resilient people possess a strong sense of self and they are able to find meaning and purpose in life (Waaktaar et al. 2004). Once considered a personality characteristic that moderates the negative effects of stress, resilience is now recognised as a dynamic process that is learnt and therefore modifiable - 31coping resources: Sense of coherenceAaron Antonovsky (1987) developed a theory about how people stay healthy in order to counteract the tendency in healthcare to focus on why people get sick. In doing so, he emphasised the resources that people use to successfully cope with the stresses of life. These resources combine and converge to form what Antonovsky (1987) refers to as a sense of coherence, an orientation towards life’s challenges that averts tension and assists in managing life stress and transitions.
- 32coping resources: Sense of coherenceA sense of coherence (Antonovsky 1987, 1996) is marked by three attributes: an ability to understand and make sense of situations that happen in life (comprehensibility); an abiding trust that things will work out because there are resources available to meet the demands of life’s various situations ( manageability ); and the motivation to invest time and effort in life’s challenges ( meaningfulness ). People who have a strong sense of coherence perceive life’s challenges as having some structure and clarity as opposed to the perception that life is a series of random events. This is what is meant by comprehensibility. Manageability, the second attribute, is the extent to which a person perceives that resources to cope successfully are available and adequate. The final characteristic, meaningfulness, is the extent to which a person believes it is worth putting time and effort into coping with life stresses
- 33coping resources: Social supportSocial support involves connection with and mutual obligation to other people; people who experience social support feel cared for, loved and esteemed (Thoits 2011). Social support is based on the assumption that people need to have supportive relationships with other people in order to manage the demands of daily living and cope with life transitions. These relationships serve to fulfil social needs for affection, approval, belonging, security and identity.
Support from other people in the form of aid, assistance, personal affirmation and information is necessary when stressful events such as transitions in health and illness are experienced. While support from other people does not necessarily alter the demands of a situation, it does lessen its consequences. Social support helps people to: evaluate their situation realistically; challenge and alter their existing perspectives; - 34coping resources: Social supportThe concept of social support is sometimes presented as all positive, expressed through catch phrases such as ‘your friends are your best medicine’ . Nevertheless, this is a simplistic notion of social connections because people in a social network can place demands on each other as well as offer assistance. Friends and family can create stress as well as alleviate it. Also, support that is offered must match what is needed (Thoits 2011). There is no use in a friend offering help that actually hinders (e.g. offering advice that is neither wanted nor useful).
- 35ILLNESS REPRESENTATIONReferred to as the lay view, or commonsense model of illness, this representation is based on the sources of information that are available to people in order to make sense of and manage an illness event (Hagger & Orbell 2003). The sources include: previous experiences and cultural understandings; information from other people including authoritative sources such as healthcare professionals; and current perception of and previous experience with the illness. The illness representation includes five cognitive dimensions: cause, consequences, identity (of the symptoms), timeline and cure/controllability.
- 36uncertaintyUncertainty is experienced as confusion, ambiguity and fear of the unknown, and is often accompanied by lack of information (Neville 2003); it is the opposite of feeling confident of the way forward and in control. A high level of uncertainty results in emotional distress and anxiety (Hansen et al. 2012; McCormick 2002; Neville 2003), especially if coping resources are inadequate to resolve the ambiguity or manage emotions.
- 37how to help children thriveearly and often connecting, talking and playing as well as having a health home and community.
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- university Therapeutic Use of Self 2 Flashcards on module 3 communication across the lifespan, created by Avalon Frost on 04/03/2022.
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