Objectives Define the concept of Caring Communication Caring Communication Julia Rouse MN RN OCN Clinical Educator Swedish/Edmonds Identify the role of the nurse Examine barriers to caring communication Provide some necessary tools for caring communication Communication is The process of sharing information Components: Sender, Receiver, Message Means: Verbal, Body Language Influences: Perception, Environment Goal in Healthcare: Positive Clinical Outcomes 1
Real World Communication Definitions of Caring 1. Someone who is kind and gives emotional support to others (Cambridge Dictionaries On line, 2006) 2. Painstaking or watchful attention (From Creative Healthcare Management, www.chcm.com, 2003) (Merriam Webster On line, 2006) Definitions of Caring cont. Caring is the essence of nursing and caring is the unique and unifying focus of the profession. What defines caring for you? (International Association for Human Caring (IAHC) Inc. www.humancaring.org, 2006) 2
Caring involves Caring Nursing Theory Caring Themes Swanson (1991, 1993) Nyberg (1989, 1998) Watson (1985-2002) Compassion Love Honesty Heart Respect Empathy Time Intuition Professional skill Competence Trusting Maintaining belief Doing for Self worth Commitment Knowing Knowing Self understanding/ self care Establishing helping/trusting relationship Providing supportive, protective, corrective environment Being sensitive to self and others Trust Calm Bringing out potential Acknowledging existential/spiritual Understanding Courage Presence Good listener Patience Engaged Presence Being there/with Sharing feelings Being with Openness Assisting with needs Inspiring faith/hope Trusting Knowing Maintaining clinical competence Advocating for the patient: providing protection, promoting comfort, preserving dignity Conveying commitment, empathy, respect Your Patient: Avoiding assumptions Assessing thoroughly, including spiritual Anticipating needs Yourself: Maintaining self worth, self confidence, self understanding, self care 3
Presence Presence Being There: physically, emotionally, spiritually Therapeutic Presence: The deliberate use of interactional techniques specifically designed to achieve positive outcomes within the context of the patient s illness experience. (Engelking, 2001) Caring Communication is Tools of Therapeutic Communication The process of sharing information within the context of trusting, knowing, and presence. Paraphrasing Reflecting feeling Summarizing Self disclosure Confrontation Encouraging verbal interaction Attending behaviors (listening, eye contact, posture) Touch Humor Silence 4
Spirituality & Religion Spirituality The expression of meaning, purpose and connectedness to self, others, and the sacred Religion The expression of faith, rites, and rituals (Burkhart & Hogan, 2008; Puchalski et al., 2009) Addressing the Spiritual The Four Things Please forgive me I forgive you I love you Thank you from The Four Things That Matter Most, Dr. Ira Byock, 2004 The Role of the Nurse Minimize fears Facilitate informed decision making Interpret complex medical information Provide instruction Navigate pt/family through the system Counsel, coach, and guide Barriers to Caring Communication Setting (privacy) Timing (readiness) States of being (anxiety, anger, depression) Promote family functioning 5
More Barriers Internal Factors: Personal beliefs, values, fears, attitudes, motivations External Factor: Time Guidelines for Difficult Moments Gather data before responding Do reflective work; analyze your discomfort Make no assumptions; validate the uncertain Think helpful or unhelpful vs. right or wrong Share feelings (if patient-focused) Remember: no recipes, no pat answers Break-out Discussion Time Improving Caring Communication: The 3 R s Your 68 year old AML patient, Mr. Weary has been hospitalized for 5 weeks, from diagnosis through induction chemotherapy, extreme side effects, slow bone marrow recovery, and septicemia. The doctor has just discussed the next step: consolidation chemotherapy. As you greet Mr. Weary on your busy schedule, he announces to you that he will not be taking any more chemo. Death would be a better alternative than all that misery. You recognize that you have just been engaged in a difficult conversation. What is your response? Be willing to Risk Take time to Reflect and learn Repea the process 6
Video Presentation Conclusion From an ethic of care, maintaining ties, The Art and Science of Caring: Our Commitment to Our Patients Oncology Nursing Society, 2001 human connectedness, and human concerns are not just a means, but the very essence of being human. (Benner & Gordon,1996) References Benner, P., and Gordon, S. (1996). Chapter 3. Caring Practice. In Caregiving: Readings in knowledge, practice ethics and politics. Philadelphia, PA: University of Pennsylvania Press. Pages 40-55. Engelking, C. (2001). Chapter 58. Communication in Cancer Care: Making Every Word Count. In Oncology nursing secrets. Philadelphia, PA. Hanley & Belfus, Inc. Pages 490-501. Nyberg, J. (1998). Chapter 3: The Element of Care in Nursing Administration. In Caring approach in nursing administration. Boulder, CO: University of Colorado Press. Pages 28-37. Swanson, K.M. (1993). Nursing as informed caring for the well being of others. Image: The Journal of Nursing Scholarship, 25(4), 381-386. Watson, J. (2002). Chapter 2. Caring and Nursing Science: Contemporary discourse. In Assessing and measuring care in nursing and health science. New York, NY: Press. Pages 11-19. Springer 7