Caring

Considered by many nurses to be essential aspect of nursing. Leninger states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. She states that there can be no cure without caring, but that there may be caring without curing. Watson describes caring as grounded in a set of universal human values. Caring is the anti thesis of simply using the other person to satisfy ones needs.

13 Carative Elements
1.

Humanistic altruistic value system

Refers to an individuals ability to be in touch with reality and to give self in service of others.

2.

Faith and Hope

Faith is the persons adherence to what is good and real, personified in our Creator. Hope is the propelling motor that keeps one going even through rough ways.

3.

Sensitivity to self and others

Ability of the individual to feel and realize ones needs, weaknesses and strengths in relation to others needs, weaknesses, and strengths.

4.

Helping trusting relationship

Anchors his/her beliefs in others capacity based on trust and confidence.

5.

Ability to accept positive and negative expression of feelings

The individual is reality based and does not live in fantasies.

13 Carative Elements
6.

Personality type
The carer is able to identify whichever personality type suits any particular situation and devices way to adapt.

7.

Interpersonal teaching and learning abilities

The individual is an educator and should be able to impart knowledge to modify ones behavior.

8.

Solid family background

The solidarity and the harmony within the family relationship that the background the individuals grown and development are the capital determinants in making one a caring person.

9.

Experience of having been loved and the ability to love

The quality of love the child receives at home and the role model he/she sees among the significant other around him/her influence to a great extent, is his/her very own way of giving or receiving love. The more spiritual the person is, the finer is the regard and relatedness with the other.

10. Spiritual life

13 Carative Elements
11. Sense of humor Humor relaxes tension and makes one feel at ease with oneself and others. 12. Relaxed attitude When one is comfortable, his vision is broader and accommodates more things in his heart and mind. 13. Open mindedness
The ability to choose between two sides is an important asset in learning to prioritize care and devotion.

COMFORTING

Comforting Is a complex process that includes discrete, transitory actions such as touching or broad, longer lasting interventions such as listening. The desired outcome or product of comforting is comfort. (from Latin word comfortare meaning to strengthen greatly

Comfort implies a renewal, an amplification of power or sense of control, an invigorating influence, a positive mind set, and a readiness for action.

Different Comfort Needs

Kolcaba identifies comfort needs within four contexts: 1. 2. 3. 4. Physical Comfort Psychospiritual Comfort Social Comfort Environmental Comfort

1. Physical Comfort - relates to the bodily sensations and the physiologic problems associated with the medical diagnosis. 2. Psychospiritual Comfort - relates to the internal awareness of self, including esteem, concept, sexuality, and meaning in ones life. They can also include the persons relationship to a higher order or being.

3. Social Comfort - relates to interpersonal, family, and social relationship. 4. Environmental Comfort - relates to the external background of human experience and can include light, noise, ambience, color, temperature, and natural versus synthetic elements. They may also include culturally specific foods and languages.

Intensity (Type) of Comfort (according to Kolcaba) 1. Relief 2. Ease 3. Transcendence

1. Relief
Relief from discomfort is the experience of having the specific need met. Relief may be incomplete, partial, temporary, lasting only a short time until discomfort arises again.

2. Ease
Refers to the state of calm or peaceful contentment. This state of comfort can exist without a prior state of discomforts that are lasting, rather than temporary relief from severe discomforts

3. Transcendence
Refers to the state in which the client rises above problems or pain. This state of comfort differs from the other two states in that the client is invigorated or inspired for extraordinarily performance as the end state, rather than ordinary performance, which is the end state for relief and ease.

COMMUNICATION

Communication
- The process of sharing information or the process of generating and transmitting meanings. - Foundation of our way of life - Requirement for a persons well being - communicare; to impart, share or make common

10 Commandments of Communication
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Clarify ideas before communicating Examine the true purpose of each communication Consider the total physical and human setting Consult with others when appropriate Be mindful of overtones Convey only something of value Follow up Communicate for the future as well as the present Support communication with action Seek to understand as well as to be understood

General Purpose of Communication

To gather information To validate information To share information To develop a trusting relationship

Elements of Communication
1. 2. 3. 4. 5. 6. Referent or Stimulus Sender or Encoder Message Channel or medium Receiver or decoder Feedback

Types of Communication
1. Social Communication usually for enjoyment. 2. Therapeutic communication nurse patient relationship/interaction; to improve the patients ability to function. 3. Formal Communication lectures, reports, charting in the patients records and public speaking.

Reasons for Ineffective Communication

The sender may not be able to send the message he thought he had already sent The receiver may not hear or receive the message intended Verbal and non verbal messages may conflict Many words have multiple meaning The message may be abstract and therefore confusing The receiver may not be prepared to hear or receive another message

THE COMMUNICATION PROCESS

FEEDBACK

thought

encoding

transmission

reception decoding understanding

NOISE

Channels of Communication
1. Auditory 1.1 Hearing receiving an auditory stimulus 1.2 Listening Interpreting what was heard and attaching meanings to them

2. Visual/Use of non verbal cues 2.1 Sight receiving a visual stimulus 2.2 Reading 2.3 Observation 2.4 Perception sense of understanding 3. Kinesthetic 3.1 Procedural touch 3.2 Caring touch

Modes of Communication
Verbal communication through words, and language, either spoken or written  When Choosing words to say or write, nurses need to consider: a. Pace and Intonation b. Simplicity c. Clarity and Brevity d. Timing and Relevance e. Adaptability f. Credibility g. Humor

Modes of Communication
Non Verbal Communication without the use of words.
 Facial expression e.g fear, interest, concern, sadness, dishonesty or honesty, shock, shyness, pleasure, excitement, and frustration  Postures anxiety, relaxation, negative or positive self image, confidence, depression, bodily condition, acceptance or interest, rejection or aversion, depression, exhaustion or boredom  Gestures movement of body parts such as shrugging the shoulders, waving the hand, and tapping the feet  Touch used cautiously for patients who are: confused (may misinterpret the intent to touch); aggressive (may see the touch as a threat and freak out; suspicious (may think touch is harmful; victims of the abuse (may frighten them)  Physical appearance and artifacts include clients environment, grooming or use of clothing and jewelry.

Factors Influencing the Communication Process

Development Gender Values and perception Personal space Territoriality Roles and relationship Environment Congruence Interpersonal attitudes

Phases of Communication
Orientation Phase tone and guidelines are established. Working Phase interaction is the essence of this phase. Termination Phase occurs when the conclusion of the initial agreement is acknowledged.

Therapeutic Communication Techniques that allows the client to set the pace
1. Offering Self nurse is available, physically, and emotionally. - indicates nurses willingness/intent to help. - nurses presence is reassuring; may prompt client to continue. - indicates nurses attention and interest. - ex. go on; head nodding

2. Broad Openings encourages client to choose topic for discussion Demonstrates respect for clients thoughts Emphasizes importance of clients needs Ex. what do you want to talk about? Can you tell me more about that? How have things been going? 3. Silence gives client time to reflect. Encourages client to express self. Indicates interest in what client has to say. Increases nurses understanding of clients message. Helps to structure and pace the interaction Conveys respect and acceptance. Ex. Sit quietly and observe clients behavior Use appropriate eye contact Employ attending behavior Control own discomfort during quiet periods or conversation

Therapeutic Communication Techniques that encourages expression of feelings

1. Verbalizing the implied An attempt to detect the true meaning of verbal messages. Ex. Client How much is the xray going to cost? Nurse Youre worried about your medical bills? 2. Making Observations Nurses calls attention to behavior indicative of feeling. Ex. You seem sad today. Youre limping as if your leg hurts

3. Clarifying Makes the meaning of clients message clear Prevents nurse from making assumptions about clients message. Ex. Client: Whenever I talk to my doctor, I feel upset. Nurse: Tell me what you mean by upset. Client: They said I could be discharged tomorrow Nurse: Who told you this? 4. Giving Information Providing in a simple and direct manner, specific, factual information the client may or may not request. When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it. Ex. Your surgery is schedules for 11 am tomorrow

5. Summarizing
Stating the main point of a discussion to clarify the relevant points discussed. Ex. During the past hour we have talked about Tomorrow afternoon we may explore this further

Therapeutic Communication Techniques that encourages the client to make some changes
1. Confronting / presenting reality
Nurses verbal response to incongruence between clients words and actions. Encourages client to recognize potential areas for change. Ex. Client: I am so angry at her (stated while smiling) Nurse: You say youre angry, yet youre smiling Client: I never know which of my symptoms to pay attention to. I think maybe Im just a hypochondriac Nurse: You say youre not sure which symptoms are important, yet you knew when to come to the clinic for help.

2. Limit setting
Stating expectations for appropriate behavior. Establishing behavioral parameters. Ex. Nurse: It seems that you are feeling unsure of how to behave right now. Client: What do you mean? Nurse: Well, youre asking me a lot of personal questions. The reason youre here is because you have some health problems. How can I help you tell me more clearly what brought you here to the clinic?

Therapeutic Communication Techniques that encourage spontaneity

1. Open ended comments/questions
Unfinished sentences that prompt client to continue Questions that cannot be answered with a one word answer Allows client to decide what content is relevant Ex. Tell me about your pain? instead of Are you in pain?

2. Reflection
Focuses on content of clients messages and feelings Repeating clients last words in order to prompt further expression Communicate nurses interest Lets clients know the nurse is actively listening Ex. Client: Do you think I should tell the doctor I stopped taking my medication? Nurse: What do you think about that? Client: I probably should. But the medicine makes me so tearful and agitated Nurse: You sound a bit agitated now

3. Restating
Repeating or paraphrasing client's main idea Indicates nurse is listening to the client. Encourages further dialogue Gives client an opportunity to explain or elaborate Ex. Client: I told the doctor that I had problems with this medicine, but he just didnt listen to me! Nurse: Sounds like youre pretty angry at him Client: I dont sleep well anymore Nurse: Youre having problems sleeping?

Therapeutic Communication Techniques thatfocus on the client by responding verbal, paraverbal, and non verbal cues
1. Exploring Attempts to develop in more detail or specific area of concern to client. Identifies patterns of themes Ex: Tell me more how you feel when you do not take your medication. Recognition Nurse points out observed cues to the client. Ex. I notice that you became embarrass when.. I can see that you have some pictures of the new baby

2.

3.

Focusing Questions or statements that help clients develop or expand an idea. Directs conversation towards key topics Ex. You mentioned that you are having a problem with You say you feel nauseous a lot Directing Comments that elicit specific information from the client Is used to collect assessment data, not to satisfy nurses curiosity Ex. Client: They told me I needed to see a specialist Nurse: What made them say to you? or When were you told this? or Where were you when they told you? or How do you feel abut seeing another doctor?

4.

Non Therapeutic Communization Techniques (Communication Blocks)

1. Challenging giving a response that makes clients prove their statement or point of view. These responses indicate that the nurse is failing to consider the clients feelings, making the client feel it necessary to defend a position. Ex. Client: I felt nauseated after that red pill. Nurse: Surely you dont think I gave you the wrong pill? Testing asking questions that make the client admit to something. These responses permit the client only limited answers and often meet the nurses nee rather than the clients. Ex. Who do you think you are?

2.

3.

Reassuring Comments that indicate to the client that concerns or fears unwarranted. Ex. Everything will be fine. You will feel better soon. Agreeing comments that indicate that the nurses views are those of the client. Ex. I think you are right. Approving comments that indicate that the clients views, actions, needs, or wishes are good rather than bad. Ex. Thats good. Using close ended questions questions or comments that can be answered by Yes or No. Ex. Would you like some water? Did you sleep well?

4.

5.

6.

7.

Defending comment that are aimed at protecting the nurse, someone else, or something from verbal attack. Ex. Dr. Reyes is a good doctor. Stereotyping Pat answers or clichs that indicate that the clients concerns are unimportant or insignificant. Ex. It will all come out in the wash. Changing focus switching to a topic that is more comfortable to discuss. Ex. Client: I wish I were dead. Nurse: Did your wife visit today?

8.

9.

10. Disapproving indicating displeasure about comments or behaviors and/or placing a value on them. Ex. Thats bad.

11. Judging comments or actions by the nurse that indicate pleasure or displeasure with what the client says. Ex. I do not like that 12. Blaming accusing the client of misconduct; undermines the clients needs to be loved and accepted. Ex. You should know better than to talk like that If you had not moved, I would have been able to complete this venipuncture 13. Belittling the clients feelings indicating to the client that feelings expressed are unwarranted or unimportant. Ex. Be a big boy and stop crying.

14. Advising giving the client opinion or direction about solving a problem. Ex. If I were you, I would talk to you husband about this 15. Rejecting indicating to the client that certain topics are not open to discussion. Ex. Lets not talk about that right now. 16. Probing pressuring the client to discuss something before she is ready. Ex. Why do you feel this way? Why did you come to the hospital?