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Culture & Communication

Question	Answer
Culture	A sacred system of beliefs, values and behavioral expectations that provide social structure for daily living
People's views of self, expectations and behaviors are influenced by	Culture
Culture is transmitted primarily by	Language
Culture is learned	through formal and informal experiences
What is transcultural Nursing?	Nursing care that is planned and implemented in a way that is sensitive to the needs of individuals, families and groups representing the diverse cultural populations within our society
What are Cultural Concepts?	Ethnicity and Race
Ethnicity	A sense of identification that a cultural group collectively has
Race	A way of categorizing people into subgroups according to specific PHYSICAL characteristics
Cultural Concepts	Cultural Assimilation; Culture Shock; Stereotyping; Ethnocentrism; Cultural Imposition
Cultural Assimilation	members of a minority group live within a dominant group, and lose the characteristics that made them different. (It takes 3 generations to assimilate); Children assimilate much easier to another culture and the elderly are the hardest to assimilate
Culture Shock	Acute experience of not comprehending the culture in which one is situated
Cultural Conflict	Feeling threathened and uncomfortable by something you do not understand and so you ridicule and put down that group
Stereotyping	assuming all members of a culture, subculture or ethnic group act alike
Ethnocentrism	Judge other people based on the standards and practices of your own culture
Cultural Imposition	Belief that everyone should conform to the majority belief system
Cultural Influences Affecting Healthcare	Physiologic & Psychological characteristics, Reactions to pain, Mental health norms, Gender roles, Health beliefs & practices, Language & Communication, Orientation to space & time, Food & nutrition, Family structure & roles, Socioeconomic Factors
Cultural Beliefs	Attitudes based on faith as opposed to fact
Cultural Competence	A process in which the nurse strives continuously to achieve the ability and availablity to effectively work within cultural context of the individual, family, or community; View the patient as an unique individual with own ethnic and cultural background
Cultural Competence	Develop cultural self-awareness; Devlop Cultural knowledge, Accomodate cultural practices in healthcare
Develop cultural self-awareness	Understand your own culture and biases; Become sensitive to culture of others; Appreciate differences
Develop Cultural Knowledge	Values & Health Practices
Accommodate Cultural Practices in Healthcare	Cultural assessment, Communication, Respect culturally based family roles, Modify care, Avoid mandating change, Patient advocate
Spirituality	Anything that pertains to a person's relationship with a nonmaterial life force or higher power
Spiritual needs	Need for meaning and purpose; need for love and relatedness; need for forgiveness
Spirituality in Life Cycle: Children	ages 4-12 - may perceive God as frighteningly powerful, works through human interconnectedness, causes positive transformations
Spirituality in Life Cycle: Adolescents	may question values/practices in forming identity
Spirituality in Life Cycle: Young Adults or Later	individualize spirituality in line with own commitments, beliefs and attitudes
Spirituality in Life Cycle: Adulthood	expands concept of spirituality to include other faiths, focus on love...
Factors Affecting Spirituality	Developmental considerations, family, ethnic background, formal religion, life events
Spiritual Development	has different characteristics depending upon the stage of development that an individual has achieved.
Infants and Toddlers (Spiritual Development)	Infants and Toddlers have no sense of right or wrong, spiritual beliefs, or convictions to guide activities; Toddlers may follow rituals in imitation of their parents and attend church or nursery school
Preschoolers (Spiritual Development)	Parental attitidues toward moral codes and religion convey to children what is good and bad; May copy what they see instead of what they are told; Often ask questions about morality and religion (e.g. what is heaven?)
Preschoolers also (Spiritual Development)	Follow religion not because they understand it, but because it is part of daily life; Five year olds may make up prayers themselves; Believe that God or humans are responsible for natural events as rain adn wind
School-age children and Adolescents -1. (Spiritual Development)	Young school-aged children expect that their prayers will be answered, good rewarded and bad punished; During pre-puberty, there is awareness of spiritual disappointments
School-age children and Adolescents -2.(Spiritual Development)	Some may drop or modify certain religious practices; Adolescents compare standards of their parents with others, and select the ones they wish to incorporate in their lives; By age 16 many adolescents have decided whether to accept the family religion;
School-age children and Adolescents -3.(Spiritual Development)	When parents have different faiths, adolescents may choose either or neither; for some adolesents, a firm faith provides strength in these turbulent years
Adults	Young adults who need to answer the religious questions of children may find that early teachings of childhood are more acceptable; during the middle eyars, adults often find that they have more time for religious activities.
Spritual Distress	Refers to a disturbance in or a challenge to a person's belief or value system that provides strength, hope and meaning to life.
Spiritual Distress Problems	Spiritual pain, alienation, anxiety, guilt, anger, loss, despair
Cause of spiritual distress	the inability to resolve life situation with spiritual beliefs.
Nursing Interventions to Promote Spiritual Health	Offer supportive presence; facilitate patient's practice of religion; pray with patient; nurture patient spirituality; promote love and relatedness, encourage patient verbalization, encourage visits of acceptable family and friends; promote forgiveness,
Determining whether spiritual needs have been met	Verbalizes satisfaction with relationship with God (if relevant); Moves toward a healthy acceptance of the current situation; Develops mutually satisfying relationships; Reconciles interpersonal differences causing patient anguish
Religious Beliefs Affecting patient Care	medications, dietary practices, prayers, Holy days, rituals, interventions or treatments, birth practices, death practices
What is Communication?	A means of exchanging information or feelings between two or more people
Forms of Communication	Verbal and Nonverbal
Verbal Communication	Exchange of information using words
Nonverbal Communication	Touch, Gestures, Posture, Eye Contact, Personal appearance, Facial expression, Sounds, Silence
Factors Influencing Communication	Developmental level, gender, sociocultural differences, role responsibilities, space and territoriality, physical, mental, and emotional state, values, environment
Therapeutic Relationship	Helping relationship established for the benefit of the client; social vs therapuetic relationship (professional)
Therapeutic Relationship is	Purposeful & goal directed; Client centered; Time-limited
Phases of Helping Relationship	Orientation, Working phase, Termination phase
Orientation	Sets the tone, introduce self, clarifies roles, establish agreement or contract, orient to facility, establish trust, discuss confidentiality, establish, locatin, and length of meeting
Working Phase	Provides care to meet needs/goals; thoughts, understanding, and feelings are explored; promotes problem-solving and coping skills; client teaching; longest phase
Termination Phase	examine progress and attainment of goals; prepare client for next phase of care; support emotional response
Promoting Effective Communication	Effective communication requires interpersonal skills
Interpersonal skills for effective communication are:	Rapport, warmth and friendliness, trust & honesty, genuineness, respect, empathy, caring
Communication Skills	Rapport and Trust
Rapport	Warmth and friendliness; convey acceptance and interest
Trust	Basis of therapeutic relationship; confidence in nurse's ability; responsible and competent
Genuineness	Open and honest; congruent communication with verbal matching nonverbal behavior; self disclosure - reveal own feelings, life events for the client's benefit; how should you respond to personal questions?
Respect	Belief in the dignity and worth of a person; non-judgmental of client's lifestyle, values, and behaviors; positive regard, how do we show respect?
Empathy	Ability to see things from client's perspective; communicate understanding of their feelings
Sympathy	Nurse shares what the client is feeling; can decrease objectivity
Caring	Demonstrate behavior that is nurturing; provides a means of comfort & promote self-actualization; don't be "task oriented", be client focused!
Humor	Decreases stress; Increases positive feelings
Criteria for Humor:	Timing, receptivity, content
Assertiveness Skills	Express thoughts in direct, positive manner; shows respect for self and others; Aggressive: abuses rights of others; non-assertive: does not stand up for own rights
Self-Awareness	Conscious of your own values and feelings and how these affect interactions with others; Thoughts influence behavior; sensitive to and accepting of client's values
Communication Skills	Listening is the most important communication skill!
Active Listening (attending skills)	Giving the client your complete attention: Sit facing the client; open posture; lean forward; establish appropriate eye contact; relax
Interview Techniques	Purpose of the interview; what is an appropariate setting and seating arrangement? what should be included in the introduction?
Communication Skills	Therapeutic techniques and Non-therapeutic communication
Therapeutic techniques	verbal & non-verbal responses that facilitate nurse-client interactions; help client to express feelings, gain insight & clarify their thinking
Non-therapeutic communication	Hinder or block effective communication
Questioning	Purpose: Gather specific information; Assist clients in identifying & exploring ideas & feelings; Over use limits client ineraction & disrupt flow of ideas
Types of Questioning	Open, Closed, Indirect
Open ended questions	Require more than a one word or yes/no response; begin with what, how, could; indirect statements
Closed questions	answered in yes-no or one word response; useful when immediate and specific information is needed; non-therapeutic when you want the patient to elaborate; begin with Do, Is, Are
Communications Techniques	Paraphrasing, reflecting, offering general leads/minimal encouragers, summarizing, seeking clarification, restating, exploring/focusing, making observations, giving information, presenting reality, Silence
Paraphrasing	Restating in the content of the message to clarify your interpretation
Reflecting	Encourages client to elaborate on their feelings; nurse describes feelings or emotions that are implied. ex. You feel scared about being pregnant at your age
Offering general leads/minimal encouragers	Encourages client to continue; allows client to determine direction of the interaction; Go on... and then?; Non-verbal: Nod Head
Seeking Clarification	Further describe or explain what has been said. e.g. do I understand correctly that you siad...?
Restating	Repeat portion of what was said e.g. Pt: my doctor wants me to go home N: go home?
Exploring Focusing	examine topics in more details
Making Observations	verbalizing what you observe; encourages client to take note of behavior
Giving Information	Facts the client needs to know
Presenting Reality	Orient client to the environment e.g. Today is October 4th; I see no one else in the room
Silence	Causes: Time to think, embarrassment, resistance, exhausted topic; Helpful: Waiting for client to speak; Unhelpful: Respond too quickly or change the subject
Non-therapeutic Techniques	Advising, Giving False reassurance, Probing, defending or judgmental, asking why, requesting an explanation; changing the topic
Advising	Telling the client what the nurse thinks should be done; fosters dependency; giving advice is different than giving information
Giving false reassurance	indicates that the client's feelings are not important. e.g. Don't worry
Probing	questioning not related to problem
Defending or Judgmental	Objections to client's remarks, feelings or opinions; imposing nurese's view on client; explore the client's perspective; complaints may be related to anxiety
Asking Why; Requesting an explanation	Client may become defensive or feel threatened; can imply criticism
Process Recording	Verbatim account of the verbal & non-verbal communication between nurse & client
Purpose of Process Recording	It is a learning tool
Five Components of Process Recording	Nurse verbal, nurse non-verbal, patient verbal, patient non-verbal, communication technique used
IPR Rules	Do not take notes, do not tape conversation, maintain confidentiality
Communication with the elderly	Presbycusis, presbyopia, dementia,
Presbycusis	Speak clearly in a low to normal tone, avoid shouting, face the person, use gestures
Presbyopia	Loss of peripheral & night vision: Front approach, exaggerate gestures, indirect lighting, speak before touching, large print items
Dementia Communication Techniques	Identify self, don't quiz; calm, low-pitch voice' decrease stimulation; short, simple sentences; one step commands; closed questions
Reminiscence Therapy (Patients with Dementia)	Review of life events; increases self-esteem & socialization; decreases depression; stimulates memory & recollection

Created by: howardccnurs

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