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Qsen
Quality and safety education for nurses
effect. communcation about hazards, and errors to patient , family and healthcare team
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communication
- sharing meaning and obtain response
- building effective working realtionships
- verbal and nonverbal
- used to meet physical, psychosocial, emotional and spiritual needs
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3 levels of communication
- intrapersonal communication:
- selftalk, can be positive or negative
- interpersonal communication:
- occurs between 2 or more people
- mostly 2 face to face
- to gather information during assessment
- to teach about health issues
- explain care, give comfort
- also communicate effectively with personnel
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group communication
- among several people
- small group meeting, 2 or more e.g. staff meeting
- needs effective working skills and understanding of group processes
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public speaking
- speaker addresses a dozen t a hundred people with varying degrees of interaction
- speech, talk directly, open discussion
- public speeking often used to educate, to lobby, to address colleagues
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content of communication
actually said words or gestures
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process of communication
- act of sending, receiving , interpreting and reacting to a message
- five elements:
- sender/source/encoder
- encoding-> selecting the words, gestures, tones
- consciously or unconsciously
- affected by situational stressors
- message:
- effective : complete, clear, organized, ...
- apppropriate for situation and developmental level,
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channel
- medium used to send message
- face to face, touch
- writing...
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receiver
- observer, listener, interpreter of the message
- interpretation is decoding
- relating message to past experience
- using the senses to receive
- if decoding matches-> effective communication
- sometimes not successful
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feedback
- validates what was received and sending back
- verifying message avoids confusion
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verbal communication
- education
- culture
- language
- age
- experiences
- -> goal: being understood
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vocabulary
- technical terms and jargons-> not to lay persons
- our responsibility to send a message the patient can understand
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denotative and connotative meaning of a word
denotation = dictionary meaning of a word
connotative= implied or emotional meaning of the word
e.g. the word "baby"
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pacing
- pace and rythm can alter meaning of the message
- rapid-> hard to follow
- better slow, so the receiver
- can follow
- can respond
- fast enough to maintain interest
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Intonation
- tone of voice
- pitch (high and low)
- cadence (rising and falling of the pitch)
- volume (soft or loud)
- here you can see emotions
- too monotone- loosing interest
- no intonations on electronic messaging
- -> sometimes smiley faces used to give clues
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clarity and brevity
- words should go conform with body language and intended meaning
- use fewest words possible
- if clear it holds interest and is effective
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timing an relevance
- timing is crucial
- assess before starting communication
- distracted by pain, hunger, coping with stressors, presence of others,
- effective when interesting and relevant for both
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credibility
- depends on honest and timely response to patient concerns
- congruence of verbal and nonverbal messages
- I'll find out better than wrong answer
- never lie
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humor
- can have a positive influence on healing
- use cautiously, highly subjective and personal
- depends on cultural norms
- misused can have effect on self esteem, confidence,...
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nonverbal communication
often not consciously done
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facial expression
- face and eyes are the most obvious forms of nonverbarl message
- everybody understands smiling
- other facial expressions can differ because of culture like eyecontact
- micmatch-> doubt, mistrust,
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posture and gait
offer clues regarding attitude, wmotion, well-being, self-concept
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personal appearance
- provide clues regarding feelings, status , culture, religion, values,
- think about own personal appearance
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gestures
- should clarify spoke words
- vary among individuals and cultures
- use them with caution
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touch
affection, caring, concern, encouragement
avoid if someone is angry or mentally disturbed-> misinterpretation possible
use with conscious and awareness of culture, situation,...
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environment
- best if quiet, private, pleasant,
- be sensitive how patient experiences environment
- provide most comfortable environment possible
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developmental variations
- physical and cognitive
- language skills
- education
- alter communication to fit patient's level
- with respect and effect with patients of all levels
- children with chronic diseases often more knowledgeable
- olders might be affectied by sensory alterations
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gender
- women:
- to form connections
- establish relationships
- be connected
- consensus
- men: maintaining independence
- positions in hierarchy
- be one
- win or loss
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personal space
- vary in amount of physical space needed
- influenced by relationship
- setting
- cultural influences
- intimate distance: immediatly surrounding people/ personal space
- western around 18 inches
- body contact can occur
- performance of assessment
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personal distance
- 18 inches to 4 feet
- formal interaction
- communication with group
- no range of touch
- answer might be more impersonal than when being closer
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public distance
- beyond 12 feet
- public speakers
- lack of individuality and focus on group
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territoriality
- space belonging to individual
- visible or unvisible bounding
- less at ease when away from territory
- ask for permission when e.g. moving furniture
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sociocultural factors
- culture and status strongly influence communication
- male nurse might be no go for female patient
- reaction with physician different than with nurse...
- social distance-> evtl. no questions, concerns ...mentioned
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roles and relationships
- affect communication
- choice of words, tone, gestures,...
- claify roles to patient
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communicating assertively
- passive approach: avoids conflict and allows others to lead
- helpless, indecisive, apologetic, whining
- aggressive approach:
- forces others to lose
- goal is to win and be under control
- bossy, arrogant, sarcastic, manipulative, intolerant
- nonassertive style:
- men-women
- defferent status
- unclear indirect communication leads to errors
- assertive communication
- expression of wide range of positive and negative thoughts
- direct, open, spontaneous, responsible, non judgemental
- responsible for own actions without blaming others
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therapeutic communication
- improving health of client
- to establish therapeutic relationship
- provide/obtain healthcare information
- express interest/concern
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pre-interaction phase
orientation phase
working phase
termination phase
- pre-interaction
- gathering information about client
- no diret communication yet
- prepare for clinical days
- can be anxious time for client
- orientation phase
- introduction
- establish trust
- exchange of initial information - reason for visit or concerns
- in emergency very brief
- working phase
- active part of relationship
- thought, feelings, respect exchange, honest
- -> clarify feelings and concerns
- confidental, active listening
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