communication skills 6 buk retno

7/26/2019 Communication Skills 6 Buk Retno

1/71

Retno Lestari

Communication

Skills


2/71

NURSES ARE HEALERS


3/71

CONTENTS

Concept of communication

Admitting patients to hospital

Introducing self to colleaguesGiving informationTreating grieving patient and

family


4/71

Concept ofCommunication


5/71

CONCEPT OF COMMUNICATION

What is communication?

What is good communication?

Why is good communicationimportant?Factors which inuence nurse-

patient communicationGuidelines for conducting an

interview


6/71

COMMUNICATION

Is the way weinteract

with fellow humans

Eyes

Face

Body

Voices

Words


7/71

WHAT IS COMMUNICATION?

Communication comes from the wordcommunicate

communicate! comes from the "atinto impart, to share

communication! is imparting,conveying or exchanging ideas,knowledge# etc$

Is the art of transferring or e%changinginformation ideas or thoughts easilyand correctly through ver&al or non-ver&al language


8/71

WHAT IS COMMUNICATION?

Methods of communication'teaching(lecturing# two friends tal)ing#telephone# writing a letter# radio(T*#reading# email(I+# nurse or doctor with

patient


9/71

THE COMMUNICATION

PROCESS:

The communication processcould &e de,ned as a

sending-receiving process $


10/71

WHAT IS GOOD COMMUNICATION?

Based on a study in Manchester,

patients preferred interviewers who'Were warm and sympathetic

Were easy to tal) to

Introduced themselvesAppeared self-con,dent

"istened to the patients and responded totheir ver&al cues

As)ed uestions that were easilyunderstood and were precise

.id not repeat themselves


11/71

WHY IS GOOD COMMUNICATION

IMPORTANT?

Good communication &etween nurse andpatient is more li)ely to'

+a)e an accurate, comprehensivediagnosis$ Good communication s)ills

ena&le one to collect information a&out apatient!s pro&lems that comprehensive#relevant and accurate$

Detect emotional distress in patientsand respond appropriately

/ave patients who are satisfed with thecare and less an%ious a&out their pro&lems


12/71

FACTORS WHICH INFLUENCE NURSE-

PATIENT COMMUNICATION

0atient-related factors

1urse(doctor-related factors

The interview setting'reuirements


13/71

PATIENT-RELATED FACTORS

0hysical symptoms

0sychological factors related to illnessor medical care 2e$g$ an%iety#

depression# anger# denial30revious e%perience of medical care

Current e%perience of medical care


14/71

NURSE/DOCTOR-RELATED FACTORS

Training in communication s)ills

4elf-con,dence in a&ility tocommunicate

0ersonality0hysical factors 2e$g$ tiredness3

0sychological factors 2e$g$ an%iety3


15/71

THE INTERVIEW SETTING:

REQUIREMENTS

0rivacy

Comforta&le surroundings

An appropriate seating arrangement


16/71

GUIDELINES FOR CONDUCTING

AN INTERVIEW

5eginning the interview

The main part of the interview

6nding the interview


17/71

BEGINNING THE INTERVIEW

Greet the patient &y name 27Good morning+r 8amirun93 and sha)e hands

As) the patient to sit down

Introduce your self 27I am 4iti 8amilah#student nurse93

6%plain the purpose of the interview 27I

would li)e to ,nd out a&out your presentpro&lem93

4ay how much time availa&le

6%plain the need to ta)e notes and as) if

this is accepta&le


18/71

THE MAIN PART OF THE INTERVIEW

+aintain a positive atmosphere# warm

manner# good eye contact:se open uestions at the &eginning

"isten carefully

5e alert and responsive to ver&al and non-ver&al cues

Facilitate the patient &oth ver&ally 27Tellme more93 and non-ver&ally 2posture3

:se speci,c 2closed3 uestions whenappropriate

Clarify what the patient has told you

6ncourage the patient to &e relevant


19/71

ENDING THE INTERVIEW

4ummari;e what the patient has toldyou and as) if your summary isaccurate

As) if they would li)e to add anythingThan) the patient


20/71

Admitting Patients

to Hospital


21/71

ADMITTING PATIENTS TO

HOSPITAL

5eginning an interview

Gathering information' ta)ing a medicalhistory

5asic information a&out the patient.escription of presenting pro&lem

/istory of presenting pro&lem


22/71

BEGINNING AN INTERVIEW

Providing comfortable setting

Explaining the purpose of the interview

Indicating the time available

E.g.:

Student: Hello Mr Jono, Im sorry to interrupt you but

Im Paijo, one of the students attached to the Dr Saiful

Anwar hospital. Ive been asked to come and talk to you

about the problem that brought you into hospital so that

I can tell Dr Samudra about you when he does his ward

around this afternoon. I can spend about 40 minutes

talking with you. Is that alright?Mr Jono: Yes sure go ahead.

Student: Well, I like to take some notes so that I can

write up your history later. How do you fell about that?

Mr Jono: Thats fine by me.


23/71

BASIC INFORMATION ABOUT THE

PATIENT

This include the patient!s name#address# age# occupation and maritalstatus$

=ou should try to ,nd out their name&efore the interview$

=ou may prefer to gather the rest ofthe information during interview' toavoid as)ing a list of uestions# whichmay not &e a good way to &egin aninterview


24/71

DESCRIPTION OF PRESENTING

PROBLEM

Find this out &y as)ing as an open uestion#e$g$'

7Could you please tell me what pro&lem

&rought you to hospital?97 Why have you come to see the doctor

today?9

4ometimes a patient will provide a diagnosis

rather than a symptom$ When this happens# itis important to as) the patient what they aree%periencing

1e%t# as) the patient if they have any other

pro&lems


25/71

HISTORY OF PRESENTING

PROBLEM

The aims are'

>&tain a detailed history that that iscomplete# accurate and relevant

Find out the patient!s perception ofwhat is wrong

6sta&lish their attitudes to thepro&lem

.etermine what eect the pro&lemhas on their day-to-day life andrelationship


26/71

HISTORY OF PRESENTING

PROBLEM

WHATWhat does it feel

like?

What brings it on?What else?

WHERE

Show me where it is

HOWHow bad is it?

How is it altered by

?

WHEN

When did it start?

When does it occur?

How often?How long for?

WHY

Why do you think

youve got it?

WHO

Who is affected by it?

HISTORYOFPRESENTINGPROBLEM


27/71

HISTORY OF PRESENTING PROBLEMA patient complaining pain:

Timing: when?

How long does the pain last?

Location: where?Ask to point the siteRadiation: where?Pain spreads to?

Quality: what is it like?Sharp, dull, tight, throbbing, constant,

comes and goes?

Severity: how bad is it?mild, moderate, severe? Would you say it is the worst pain you have ever had?

Associated signs and symptoms: what else? When you had your chest pain, did you have any other symptoms

at the same time?

Setting: when does it occur? Could you tell me now about what you are usually doing when

the pain comes on?

Modifying factors: how is it affected by ? (eating, exercise,

medicine, etc.)

When you have the pain, is there anything that makes it better?


28/71

REVIEW OF BODY SYSTEMS

Introduce this section &y saying something li)e'

7I!m now going to as) you a series of uestionsa&out common medical pro&lems$ This is toma)e sure we don!t miss anything that may &eimportant9

5ody systems'1ervous system

Cardiovascular(respiratory system

Gastrointestinal system

6ndocrine system

:rogenital system

+usculos)eletal system


29/71


1ervous system

/ead achesFaints# ,ts# loss of

consciousness

1um&ness(tingling

in lim&s0ro&lems with

eyesight(speech(hearing

+ood# memory#concentration

Wea)ness(wastingin lim&s

Cardiovascular(

respiratorysystem

Cough(sputum

4hortness of&reath(whee;e

Chest pain

0alpitations

An)le swelling


30/71


Gastrointestinal

systemAppetite

Weight change

.i@culty swelling/eart&urn

1ausea(vomiting

A&dominalpain(swelling

5owel freuency(consistency(

rectal &leeding

6ndocrine system

0olydipsia

0olyuria

/ot(coldtolerance

/air change


31/71


Urogenital systemDysuria

Frequency

Nocturia

Haematuria

Men: testicular pain,

swelling, problem

urinating

Women: menstrualdetails, obstetric

history, contraception

Musculoskeletal system

Joint pain/ stiffness/swelling

Back pain

Muscle pain

Skin problems


32/71

REVIEW OF BODY SYSTEMS 6%ample of the uestions'

Cardiovascular'

7Could you tell me if you have any trou&lewith your heart? What a&out chest pain orpalpitations? .o your an)les ever swell?9


33/71

PAST MEDICAL HISTORY

You should obtain information about the

patients:

Previous general health

Previous illnessAdmissions to hospital

Operations

Accidents and injuriesPregnancies


34/71

PAST MEDICAL HISTORY

E.g.:Youve told me a lot about the problems youve had

with your bowels, and Ive asked you a number of

questions. Now Id like to ask you about any illness

youve had in the past. Could you tell about this?Have you had any other operations?

Have you been in hospital at any other time?

Did you have any problems with your pregnancies?

Could you tell me if youve had any accidents or

injured yourself at any time?


35/71

FAMILY HISTORY

This is important, because:Patient may be suffering from a genetically

determined disease

Their concerns about their presenting problems my

be related to the experience of other members of thefamily

Ask about all first-degree relatives (parents,

siblings, children), if they are living, and if not,

the cause of deathE.g.:

Im sorry to hear your father died of cancer. How old

he when he died?


36/71

SOCIAL HISTORY

The aim is to build up a picture of the patient as

a person outside of the hospital:How do they spend an average day?

What is the structure of their family and how do the

members relate to each other?What is their lifestyle?

Do they have any worry about finance,

accommodation, etc.?


37/71

SOCIAL HISTORY

0atient pro,le

"ifestyle

4ources of stress


38/71

PATIENT PROFILE

This includes information a&out familylife# other close relationships# wor) anddaily activities

6$g$'7Could you tell me something a&out

yourself as a person? 0erhaps youcould start with your family and

other people you are close to$9

7Could you tell me what you do in anaverage day?9

LIFESTYLE


39/71

LIFESTYLE 0articularly for'

4mo)ing history'

7.o you smo)e?9# 7What do you smo)e?9#/ow much do you smo)e?9# 7/ow long haveyou smo)e li)e this?9

If the patient is a non-smo)er# as) if they

have smo)ed in the past$.rin)ing history'

7I!d li)e to as) you now a&out your drin)ingha&its$ Can you tell me if you drin) alcohol?9#

7Could you tell me what you drin)?9.rug history'

Include all current drugs prescri&ed &y adoctor# all drugs that the patient has &ought

over the counter# and if they misuse drugs


40/71

SOURCES OF STRESS

Health can be severely affected by stress related

to work, personal relationship finances,

accommodation, etc.

Could you tell me if you feel particularly

stressed?What sort of things cause you stress?


41/71

Introducing Self to

Colleagues

INTRODUCINGSELFTO


42/71

INTRODUCING SELF TO

COLLEAGUES


43/71

Giving

Information


44/71

GIVING INFORMATION

The aims

Guidelines for giving information to a patient


45/71

THE AIMS

To help the patient understand what is

happening

To reduce their anxiety and uncertainty as far as

possible

To gain their cooperation in the management of

their problem


46/71

GUIDELINES FOR GIVING

INFORMATION TO A PATIENT

.escri&e what information you plan to give

4ummari;e patient!s pro&lems

Find out the patient!s understanding of theirpro&lem

>utline structure of interview

:se appropriate language

:se drawings

Give important information ,rst 6%plore patient!s view

1egotiate management

Chec) understanding


47/71

DESCRIBE WHAT INFORMATION

YOU PLAN TO GIVE

Is it'


48/71

SUMMARIZE PATIENTS PROBLEMS

5egin the interview &y summari;ingthe patient!s pro&lems

7=ou!ve told me a&out the pain in your

stomach and the heart &urn you!ve&een having after meals and at night$

=ou also mentioned that you!ve had anulcer in the past$ Is that right?9


49/71

FIND OUT THE PATIENTS

UNDERSTANDING OF THEIR PROBLEM

Assess the patient!s understanding ofthe condition

7Could you tell me what you thin) is

causing your symptoms?97+ost people have some ideas or

worries a&out what is causing thepro&lem$ .o you have any idea?9


50/71

OUTLINE STRUCTURE OF

INTERVIEW

>utline how you plan to structure therest of the interview

71ow# I!m going to discuss several

things with you' ,rst# what I thin) iswrong with youB second# what furtherinvestigations you needB and lastly#the treatment we!re going to give

you$9


51/71

USE APPROPRIATE LANGUAGE

Give the most important information,rst

:se short words and short sentences

5e speci,cAvoid medical argon# when you used

them# as) if the patient understand

7Well# your &arium meal did notshow any ulcer$ 5ut it did show thatyou have something we call a hiatushernia$ .o you )now what that is?9


52/71

If appropriate, use

drawings to

supplement the

informationE.g. It will be more

easy to explain a

hiatus hernia by

drawing rather than

using words

Give the mostimportant first of

all

Use drawingsGive important

information first


53/71

EXPLORE PATIENTS VIEW

6%plore the patient!s views on theinformation they have received

6ncourage them to as) uestions

70erhaps you could say what you feela&out that$9


54/71

NEGOTIATE MANAGEMENT

1egotiate management with thepatient$ If appropriate# help them todecide &etween treatment options

7=es# I understand you might havesome pro&lems with the diet I!msuggesting# especially as road-sidecafes usually sell lots of greasy food$

/owever# perhaps you could )eep tothe ,sh and chic)en and avoid thechips and fried eggs$ =ou say you!renot )een on ta)ing ta&lets why not?9


55/71

CHECK UNDERSTANDING

Chec) the patient!s understanding ofwhat has &een said

7Well# +r 8ono# I seem to have given

you lots of information$ Would you li)eto ust go over what we have said?9


56/71

Treating Grieving

Patient and Family


57/71

TREATING GRIEVING

PATIENT AND FAMILY

How to give bad newsPersonal preparation

The physical setting

Talking to the patient and responding to their

concernsArranging follow-up or referral

Feedback and handover to professional colleagues

What to do if..

What if the patient cries?What if the patient becomes angry or violent?

What if patient threatens suicide?


58/71

PERSONAL PREPARATION

The following points should be considered:Is the patient expecting bad news?

Should anyone else be present (such as relative?)

What does the patient already know about the

illness, or what has happened?What personal resources does the patient have?

Have I got sufficient time to spend with the patient?

Can someone else look after my bleep for an hour?

Are there any what if questions I should preparemyself for?


59/71

THE PHYSICAL SETTING

The ideal setting is:A private room that is reasonably comfortable

Free from interruptions

Has a calm ambience

Obvious things you should NOT do:Dont give bad news at he end of physical

examination while the patient is still undressed

Dont give bad news in corridors and over the

telephoneDont pace around, keep looking out the window or

become distracted by activities nearby


60/71

TALKING TO THE PATIENT AND

RESPONDING TO THEIR CONCERNS

5rea)ing &ad news reuires'

6mpathy7I reali;e this pro&a&ly comes as a shoc) toyou9

4tarting with what the patient or relativealready )nows or understands7.id .r


61/71


RESPONDING TO THEIR CONCERNS5rea)ing &ad news reuires'

Finding out what they want to )now 7It is helpful to us to hear from you what you

want to &e told a&out your condition$ Is thereanything you would prefer not to &e told?9

7What would you li)e to &e told a&out thediagnosis?9

7.o you want to )now all the details a&out thediagnosis# tests and treatment# or do you ust

want to have an outline of what is going on?9Active listening and giving information

6liciting the patient!s own resources for coping 7/ow did you deal with it?9

7/ow might this e%perience help you in what we


62/71


RESPONDING TO THEIR CONCERNS

5rea)ing &ad news reuires'

Instilling realistic hope7=es# there are some unpleasant

side eects$ I!m not sure that weneed to consider that at this stage$We should ,rst see whether aseries of inections will help$9

7We hope that things will get&etter after this course oftreatment9


63/71

ARRANGING FOLLOW-UP OR

REFERRAL

A plan should &e made for follow-upcontact to contain some of theiran%iety and provide a further

opportunity to address concerns In some cases it may &e appropriate to

ma)e referral to another professional#such as psychologist or counselor


64/71

FEEDBACK AND HANDOVER TO

PROFESSIONAL COLLEAGUES

It is good to practice to informcolleagues a&out the meeting with thepatient# summari;e what the patient#

and others# have &een told andunderstand# and what possi&lepro&lems or reactions can &e e%pected

.iscussion and consultation with

colleagues can also ma)e the tas) ofgiving &ad news easier


65/71

WHAT IF THE PATIENT CRIES?

:sually# you should give them sometissues# or pause# or say 7I can see youare very upset9

Touching may also &e helpfulAfter a few moments# you should

continue tal)ing and remainssympathetic &y saying' 7I am sorry to

have to give you this news$ It!s noteasy for me$ Were you e%pecting tohear this?9


66/71

WHAT IF THE PATIENT BECOMES

ANGRY OR VIOLENT?

=ou should stand up and it is important to&e at their eye level and show yourpreparedness

=ou should &e polite and ,rm=ou might say'

7I!m sorry to have to give you this news$ Ireali;e that you weren!t e%pecting to hear

this$ /owever# you may also want tospea) to someone else and get theiropinion9

7I can see that you are upset and

A A A S


67/71

WHAT IF PATIENT THREATENS

SUICIDE?

If the patient hints at suicide# ma)e yourconcerns e%plicit

For e%ample'

7I was wondering where you!re goingfrom here?9

>pen discussion a&out suicidal feelingscan &e containing for the patient and

conveys that you are not afraid toconfront sensitive issue

The patient should not &e discharged or

left alone

i b i l d


68/71

Dierent between social and

proessional relationship:

Social relationship Proessional relationship

Interaction is primarily forreason of pleasure orcompanion-ship.

oncerned with helping thepatients !regardless their sex,religion, race"etc.#

$o person is in the position ofresponsi%ility of helping theother.

&e'uire the help of personwith scienti(c knowledge andspecial skills !the nurse#.

)here is no this intention. )here is intention of dealingwith other*s pro%lem.

)he goal is more or less social

)he relation ship is purposefuldirected toward a therapeutic.

It is up to the partners to sharetheir personal a+airs.

)he relationship should notentail the nurse*s personalmatters or pro%lems.

nlimited. )ime limited.


69/71

Be a Bridge, Not a Wall


70/71

Thanks!uestions""


71/71

omework

Make a group consist of 5 students maimum Make a scenario a!out communication in

nursing

Admitting patients to hospital Introducing self to colleagues Giving information Treating grieving patient and family

4end email to'retno$lestariDEgmail$com

communication skills 6 buk retno

Documents