Did You BATHE?Did You BATHE?

Tools for Effective CommunicationTools for Effective Communicationbyby

Robyn L. Mendoza RN, MSN, FNPsRobyn L. Mendoza RN, MSN, FNPs

"The most important practical "The most important practical lesson that can be given to lesson that can be given to nurses is to teach them: nurses is to teach them:

what to observe-what to observe-how to observe-how to observe-what symptoms indicate what symptoms indicate

improvement-improvement-what the reverse-what the reverse-which are of importance-which are of importance-which are of none-which are of none-which are the evidence of which are the evidence of

neglect-neglect-and of what kind of neglect.... and of what kind of neglect....

But if you can not But if you can not get the habit of get the habit of observation one observation one way or other, you way or other, you had better give up had better give up being a nurse, for it being a nurse, for it is not your calling, is not your calling, however kind and however kind and anxious you may anxious you may be."   F.N.be."   F.N.

Nightingale believed nursing is Nightingale believed nursing is about:about:

Environmental Environmental ManipulationManipulation NutritionNutrition Conservation of Conservation of Patient Energy.Patient Energy.

    http://www.http://www.valdostavaldosta..eduedu/nursing/history_theory//nursing/history_theory/florenceflorence.html.html

Florence also tells us Florence also tells us what nursing is what nursing is notnot: :

Nursing is not limited Nursing is not limited to, nor defined by to, nor defined by medical acts. medical acts. 

Make sure the patient’s environment is clean, comfortable and safe

Make sure they are “manipulated”: get up, turn, cough, sit up, etc…

Make sure they have adequate nutrition

Help them conserve their energy through supportive interventions

Nurse’s Additional Role

Listening to Patients Is Part of Listening to Patients Is Part of AssessmentAssessment

Important skillImportant skill

Allows understandingAllows understanding

Shows interestShows interest

Helps to pick up clues as to what the Helps to pick up clues as to what the concerns of the patient areconcerns of the patient are

Establishes trustEstablishes trust

Common Listening ProblemsCommon Listening Problems

Attention wanders

Miss the real point of what is being said

Let personal emotions interfere with judgment

Interrupt or “step on” statements

Think ahead to what we want to say next and miss what is being said now

Non-Verbal CommunicationNon-Verbal Communication

Facial expressions:Facial expressions:Frown: displeasure, Frown: displeasure, unhappinessunhappinessSmile: friendliness, Smile: friendliness, happinesshappinessRaised eyebrows: Raised eyebrows: disbelief, amazementdisbelief, amazementNarrowed eyes: angerNarrowed eyes: angerBlushing: Blushing: embarrassmentembarrassment

Eye ContactEye Contact

Glancing: lack of Glancing: lack of interestinterest

Steady: active Steady: active listening, interest or listening, interest or seductionseduction

Hand and Arm GesturesHand and Arm Gestures

Pointing finger: authority, Pointing finger: authority, displeasure, lecturingdispleasure, lecturing

Folded arms: not open to Folded arms: not open to change, preparing to change, preparing to speakspeak

Arms at side: open to Arms at side: open to suggestions, relaxedsuggestions, relaxed

Hands uplifted: disbelief, Hands uplifted: disbelief, puzzlement, uncertaintypuzzlement, uncertainty

BATHE-ING the Patient

Case StudyCase Study

DW is a 38 year old female who you DW is a 38 year old female who you noticed looks very tense lately. She noticed looks very tense lately. She nervously laughs, talks rapidly and does nervously laughs, talks rapidly and does not hold eye contact. She also looks not hold eye contact. She also looks fatigued and has been gaining weight. fatigued and has been gaining weight.

How do you start the conversation?How do you start the conversation?

BB

B = BackgroundB = Background

What is What is going ongoing on in your life? in your life?

Reveals what is going on with the patientReveals what is going on with the patient

Do not ask “what is new” or stressful. If they Do not ask “what is new” or stressful. If they respond “the same old thing” or “nothing” go on respond “the same old thing” or “nothing” go on to “A”.to “A”.

AA

A = Affect (the feeling state)A = Affect (the feeling state)

““How do you How do you feelfeel about that?” about that?”““How does that make you feel?”How does that make you feel?”““What is your mood?”What is your mood?”

Allows the patient to report their current state of Allows the patient to report their current state of feeling as they are often not in touch with their feeling as they are often not in touch with their emotional responses. Expression is highly emotional responses. Expression is highly therapeutic.therapeutic.

TT

T = TroubleT = Trouble

““What about the situation What about the situation troublestroubles you the you the most?”most?”

Most important question! Helps you and the Most important question! Helps you and the patient to focus on the subjective meaning patient to focus on the subjective meaning of the situation. May be an “aha” moment of the situation. May be an “aha” moment for patient.for patient.

HH

H = HandlingH = Handling

““How are you How are you handlinghandling that?” that?”

Gives an assessment of functioning:Gives an assessment of functioning:destructive behavior destructive behavior helps patients to get in touch with answers they helps patients to get in touch with answers they already have, but are not aware ofalready have, but are not aware of

EE

E = EmpathyE = Empathy

““That must be very difficult That must be very difficult forfor you” you”

Legitimizes the patient’s reactionLegitimizes the patient’s reaction

Provides acceptance that their response is Provides acceptance that their response is reasonable under the circumstances.reasonable under the circumstances.

Benefits of BATHEBenefits of BATHE

Patient feels supportedPatient feels supported

Enables you to identify:Enables you to identify: DepressionDepression AnxietyAnxiety Other disturbing Other disturbing

symptomssymptoms

Best time to BATHEBest time to BATHE

Early in your contact with patientEarly in your contact with patient

Provides time for interventions: Provides time for interventions:

referralreferral

social workersocial worker

classesclasses

medicationsmedications

other therapyother therapy

Three Step Problem SolvingThree Step Problem Solving

What are you feeling? What are you feeling? (label the actual (label the actual feeling)feeling)

What do you want? What do you want? (specifically state your (specifically state your goal)goal)

What can you do What can you do about it? (focus on about it? (focus on what you can control)what you can control)

Patient in the Driver Seat

Sends the message you care

Sends message they are capable of handling their situation

Help engage patient in problem solving: they will become aware they have some control over the circumstances of their lives

Patient’s AbilityPatient’s AbilityThey have demonstrated the They have demonstrated the

ability to surviveability to survive

They are responsibleThey are responsible

They can leave a bad situationThey can leave a bad situation

They can change a bad They can change a bad situationsituation

They can accept it as it isThey can accept it as it is

They can interpret it differentlyThey can interpret it differently

Resist Giving Advice!!!

Less effective and

does not empower them

Nurses continue to light the way to Nurses continue to light the way to patient health and wellness.patient health and wellness.

Case StudyCase Study

DW states: “I’m working full time, and in school DW states: “I’m working full time, and in school part-time. I can’t sleep, in fact, I take Lunesta…part-time. I can’t sleep, in fact, I take Lunesta…two pills every night and it doesn’t work two pills every night and it doesn’t work anymore. I get maybe 2 hours of sleep every anymore. I get maybe 2 hours of sleep every night. My sister calls me all the time and my night. My sister calls me all the time and my brother is not taking care of my dad, who has brother is not taking care of my dad, who has Alzheimer’s. He is his live in care taker and I find Alzheimer’s. He is his live in care taker and I find dad dirty, hasn’t eaten, he (dad) sometimes dad dirty, hasn’t eaten, he (dad) sometimes shows up at my work disoriented and I probably shows up at my work disoriented and I probably need to report my brother for neglect.need to report my brother for neglect.