Complex Communication 2 Flashcards

1
Q

What are the usual complex topics that are discussed with clients and/or their families during a health challenge:

A
  • Diagnosis
  • Prognosis (how we predict the recovery from surgery will be)
  • Treatments
  • Palliation & end of life
  • Loss
  • Purpose and meaning
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2
Q

What are Crucial Conversations?

A
  • Dialogue under stress
  • To be successful, requires effective communication skills
  • Controlling emotions is vital
    • Emotions (such as frustration and anxiety) can alter one’s thought process and listening abilities
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3
Q

What are the 3 characteristics of Crucial Conversations?

A

1) Opinion differentiation
○ The conversation starts when there is a difference in opinion

2) High stakes
○ Can cause stress and tension, which leads to strong emotions

3) Emotions
○ Emotions can take over and result in individuals becoming silent, withdrawn, aggressive, distressed out of control

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4
Q

How to Identify a Crucial Conversation

A

3 Main Reactions
1. Emotional- Scared, angry, hurt, anxious

  1. Physical - Stomach aches, sweaty palms., fidgeting, restlessness
  2. Behavioural - Raising their voice, slamming objects, pointing theory fingers
  • As a conversations moves from routine to crucial, nurses can recognize cues and try to prevent them from getting out of control
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5
Q

What is the result of failed crucial conversations?

A
  • Bad communication impacts the quality and safety of client care
  • 20% of HCPs have seen harm occur to their clients because of failed crucial conversations
  • Nurses play a role as advocates and leaders to facilitate dialogue between individuals even when strong emotions are involved
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6
Q

Preparing for Crucial

A
  • Nurses are responsible for fostering a safe and calm environment that enhance clients’ physical and emotional comfort
  • The environment can hinder effective communication and distract the sender/receiver, distorting the message
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7
Q

Steps to Respond to Crucial Conversations

A

1) Identify goal
○ What is the mutual goal to reach?

2) Determine issue
○ What is the problem?
○ Avoid triggers that break down the conversation

3) Explore options
○ Brainstorm options by actively listening

4) Discuss pros/cons of the options
○ Share facts and perspectives without letting emotions take over

5) Mutually plan next steps
○ Make decisions, determine follow-up, document

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8
Q

Challenges Nurses face during Crucial Conversations

A
  • discussing spirituality, grief and loss, and caring for crying clients and/or families
  • Based on the nurse’s comfort level, conversations may be avoided if they lack the necessary skills to engage in the dialogue
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9
Q

Health Challenges Include:

A
  • A time of spiritual renewal – the discovery of inner strengths and resources
  • A time of spiritual disconnectedness – feelings of distress and powerlessness
  • A time when people begin to question the meaning and purpose of their life
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10
Q

Definitions of Spirituality?

A
  • An inner knowing and source of strength reflected in one’s being, one’s knowing, and one’s doing
  • An energy that gives a person a reason to exist
  • A sense of harmonious interconnectedness between self and others, nature and an ultimate being
  • A power greater than yourself

Ones definition of spirituality changes through their life

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11
Q

What is Spirituality?

A
  • A coping mechanism
  • Frequently identified as a key element in hope
  • Important in maintaining health and well-being
  • Has evolved beyond religious considerations to include multidimensional and existential perspectives that are integral to maintaining well being and coping with illness.
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12
Q

Define Spiritual Distress

A
  • When life circumstances overwhelm our resources and ability to cope
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13
Q

Spirituality & Nursing Practice

A
  • Nurses struggle to conceptualize spirituality even though they recognize it as being important to their clients
  • 93% of nurses believed spiritual care should be addressed with clients
  • Only 5.3% felt able to meet spiritual needs of clients all the time
  • The nurse’s intentional, caring presence with clients makes possible the speaking and hearing of spiritual concerns
  • Nurses can assess for signs of hope or hopelessness, and promote resources (chaplain, minister)
  • Give clients the opportunity to discuss what their illness means to them: (“How has this illness affected you…your relationship, family, work, your activities?”
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14
Q

Importance of Having Hope

A
  • Hope gives clients the strength and determination to continue and alleviates despair
  • Hope changes along the illness trajectory
    - Can shift from hoping to be cured to hoping for symptom relief or having more time
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15
Q

How to Foster Hope

A
  • Encourage involvement in positive experiences
  • Help clients find meaning and explore their spirituality
  • Promote connections with others
  • Develop goals with clients
    (May need to focus on the short-term future close to the end of life)
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16
Q

HOPE Questionnaire

A

H: Sources of hope, strength, comfort, peace, meaning, love and connection
- What gives you internal support?
- What are your sources of hope, strength, comfort, and peace?
- What do you hold onto during difficult times?

O: Role of organized religion or spiritual community
- Are you part of a religious or spiritual community?

P: Personal spirituality and practice
- Do you have personal spiritual beliefs or practices? (Ie. Prayer, religious services, nature, yoga)

E: Effects on medical care and end of life
- Are you able to do things that hep you spiritually?
(Any specific practices for end of life?)

17
Q

Nursing responsibilities at End of Life (EOL) include:

A

1) Promoting advance care planning
○ Advance care planning: allows for clients to document their wishes and preferences for care during illness and end of life

2) Eliciting clients’ preferences for end of life
3) Supporting clients and families through loss, grief, and bereavement

18
Q

Grief and Loss

A

Loss: the absence of something or someone
- Loss can be in terms of person, relationship, situations, things, functional abilities, independence

Grief: emotional response to loss

Suffering: severe distress and anguish that threatens a person’s mind, body and/or spirit

19
Q

Nursing Considerations for Grief & Loss

A
  • Identifying how much information the client and/or wants
  • Asking open-ended questions and actively listening
    ○ Validation and normalizing: clients experience sadness or anger when they are diagnosed, ask “how are you feeling” OR ‘tell me how you are feeling”
  • Validating the uncertainty
  • Being present
  • Using silence
    ○ Give the client time to express their emotions, let them cry if they need to
  • Preserving hope
    ○ Be careful with false hope
    ○ Say: “ we are working hard to provide your loved one with the best possible care”
  • Demonstrating sensitivity
20
Q

What is Bereavement?

A
  • Occurs from the time of the loss as one adjusts to life until they reach acceptance
21
Q

Nursing considerations for Bereavement include:

A
  • Assessing grief symptoms and coping strategies
  • Promoting resources such as support groups, counselling, spiritual care, etc.
  • Assisting families in identifying their emotions and feelings regarding the loss
22
Q

Communication Strategies

A
  • Be yourself
  • Be honest
  • Be genuine
  • Show that you care
  • Follow through
  • Involve the family
23
Q

Crying

A
  • Crying is natural behaviour that communicates emotions (Can express grief, loss, anger, joy, sorrow, pain, etc.)
  • Allows for others to understand one’s emotional experiences
  • Can be cathartic and healing
  • Clients can experience shame with crying - depending on the client, culture, how others respond, and the environment
24
Q

Verbal Responses to Crying

A

1) Try to initiate communication either during or after crying

2) Demonstrate empathy, warmth, and sensitivity
○ Saying statements such as: “I am here for you, I’m listening”

3) Avoid giving a sense of false hope

25
Q

Non- Verbal Responses to Crying

A

1) Letting the client cry
- Encourage them to finish
- Offer a blanket, drink, tissues

2) Therapeutic touch and closeness
- Assess if touch appropriate
- Can stay in close physical proximity
- Silence is golden

3) Simply being there can be enough
- Try not to “fix” the problem
- Presence is therapeutic
- You do not need to talk to show presence

26
Q
A