Culture & Communication
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| Culture | A sacred system of beliefs, values and behavioral expectations that provide social structure for daily living
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| People's views of self, expectations and behaviors are influenced by | Culture
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| Culture is transmitted primarily by | Language
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| Culture is learned | through formal and informal experiences
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| 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
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| What are Cultural Concepts? | Ethnicity and Race
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| Ethnicity | A sense of identification that a cultural group collectively has
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| Race | A way of categorizing people into subgroups according to specific PHYSICAL characteristics
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| Cultural Concepts | Cultural Assimilation; Culture Shock; Stereotyping; Ethnocentrism; Cultural Imposition
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| 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
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| Culture Shock | Acute experience of not comprehending the culture in which one is situated
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| Cultural Conflict | Feeling threathened and uncomfortable by something you do not understand and so you ridicule and put down that group
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| Stereotyping | assuming all members of a culture, subculture or ethnic group act alike
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| Ethnocentrism | Judge other people based on the standards and practices of your own culture
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| Cultural Imposition | Belief that everyone should conform to the majority belief system
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| 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
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| Cultural Beliefs | Attitudes based on faith as opposed to fact
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| 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
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| Cultural Competence | Develop cultural self-awareness; Devlop Cultural knowledge, Accomodate cultural practices in healthcare
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| Develop cultural self-awareness | Understand your own culture and biases; Become sensitive to culture of others; Appreciate differences
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| Develop Cultural Knowledge | Values & Health Practices
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| Accommodate Cultural Practices in Healthcare | Cultural assessment, Communication, Respect culturally based family roles, Modify care, Avoid mandating change, Patient advocate
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| Spirituality | Anything that pertains to a person's relationship with a nonmaterial life force or higher power
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| Spiritual needs | Need for meaning and purpose; need for love and relatedness; need for forgiveness
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| Spirituality in Life Cycle: Children | ages 4-12 - may perceive God as frighteningly powerful, works through human interconnectedness, causes positive transformations
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| Spirituality in Life Cycle: Adolescents | may question values/practices in forming identity
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| Spirituality in Life Cycle: Young Adults or Later | individualize spirituality in line with own commitments, beliefs and attitudes
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| Spirituality in Life Cycle: Adulthood | expands concept of spirituality to include other faiths, focus on love...
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| Factors Affecting Spirituality | Developmental considerations, family, ethnic background, formal religion, life events
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| Spiritual Development | has different characteristics depending upon the stage of development that an individual has achieved.
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| 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
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| 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?)
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| 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
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| 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
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| 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;
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| 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
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| 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.
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| 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.
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| Spiritual Distress Problems | Spiritual pain, alienation, anxiety, guilt, anger, loss, despair
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| Cause of spiritual distress | the inability to resolve life situation with spiritual beliefs.
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| 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,
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| 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
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| Religious Beliefs Affecting patient Care | medications, dietary practices, prayers, Holy days, rituals, interventions or treatments, birth practices, death practices
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| What is Communication? | A means of exchanging information or feelings between two or more people
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| Forms of Communication | Verbal and Nonverbal
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| Verbal Communication | Exchange of information using words
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| Nonverbal Communication | Touch, Gestures, Posture, Eye Contact, Personal appearance, Facial expression, Sounds, Silence
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| Factors Influencing Communication | Developmental level, gender, sociocultural differences, role responsibilities, space and territoriality, physical, mental, and emotional state, values, environment
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| Therapeutic Relationship | Helping relationship established for the benefit of the client; social vs therapuetic relationship (professional)
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| Therapeutic Relationship is | Purposeful & goal directed; Client centered; Time-limited
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| Phases of Helping Relationship | Orientation, Working phase, Termination phase
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| 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
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| Working Phase | Provides care to meet needs/goals; thoughts, understanding, and feelings are explored; promotes problem-solving and coping skills; client teaching; longest phase
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| Termination Phase | examine progress and attainment of goals; prepare client for next phase of care; support emotional response
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| Promoting Effective Communication | Effective communication requires interpersonal skills
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| Interpersonal skills for effective communication are: | Rapport, warmth and friendliness, trust & honesty, genuineness, respect, empathy, caring
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| Communication Skills | Rapport and Trust
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| Rapport | Warmth and friendliness; convey acceptance and interest
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| Trust | Basis of therapeutic relationship; confidence in nurse's ability; responsible and competent
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| 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?
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| 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?
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| Empathy | Ability to see things from client's perspective; communicate understanding of their feelings
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| Sympathy | Nurse shares what the client is feeling; can decrease objectivity
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| Caring | Demonstrate behavior that is nurturing; provides a means of comfort & promote self-actualization; don't be "task oriented", be client focused!
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| Humor | Decreases stress; Increases positive feelings
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| Criteria for Humor: | Timing, receptivity, content
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| 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
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| 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
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| Communication Skills | Listening is the most important communication skill!
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| Active Listening (attending skills) | Giving the client your complete attention: Sit facing the client; open posture; lean forward; establish appropriate eye contact; relax
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| Interview Techniques | Purpose of the interview; what is an appropariate setting and seating arrangement? what should be included in the introduction?
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| Communication Skills | Therapeutic techniques and Non-therapeutic communication
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| Therapeutic techniques | verbal & non-verbal responses that facilitate nurse-client interactions; help client to express feelings, gain insight & clarify their thinking
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| Non-therapeutic communication | Hinder or block effective communication
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| Questioning | Purpose: Gather specific information; Assist clients in identifying & exploring ideas & feelings; Over use limits client ineraction & disrupt flow of ideas
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| Types of Questioning | Open, Closed, Indirect
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| Open ended questions | Require more than a one word or yes/no response; begin with what, how, could; indirect statements
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| 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
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| Communications Techniques | Paraphrasing, reflecting, offering general leads/minimal encouragers, summarizing, seeking clarification, restating, exploring/focusing, making observations, giving information, presenting reality, Silence
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| Paraphrasing | Restating in the content of the message to clarify your interpretation
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| 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
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| 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
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| Seeking Clarification | Further describe or explain what has been said. e.g. do I understand correctly that you siad...?
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| Restating | Repeat portion of what was said e.g. Pt: my doctor wants me to go home N: go home?
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| Exploring Focusing | examine topics in more details
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| Making Observations | verbalizing what you observe; encourages client to take note of behavior
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| Giving Information | Facts the client needs to know
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| Presenting Reality | Orient client to the environment e.g. Today is October 4th; I see no one else in the room
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| Silence | Causes: Time to think, embarrassment, resistance, exhausted topic; Helpful: Waiting for client to speak; Unhelpful: Respond too quickly or change the subject
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| Non-therapeutic Techniques | Advising, Giving False reassurance, Probing, defending or judgmental, asking why, requesting an explanation; changing the topic
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| Advising | Telling the client what the nurse thinks should be done; fosters dependency; giving advice is different than giving information
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| Giving false reassurance | indicates that the client's feelings are not important. e.g. Don't worry
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| Probing | questioning not related to problem
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| 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
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| Asking Why; Requesting an explanation | Client may become defensive or feel threatened; can imply criticism
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| Process Recording | Verbatim account of the verbal & non-verbal communication between nurse & client
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| Purpose of Process Recording | It is a learning tool
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| Five Components of Process Recording | Nurse verbal, nurse non-verbal, patient verbal, patient non-verbal, communication technique used
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| IPR Rules | Do not take notes, do not tape conversation, maintain confidentiality
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| Communication with the elderly | Presbycusis, presbyopia, dementia,
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| Presbycusis | Speak clearly in a low to normal tone, avoid shouting, face the person, use gestures
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| Presbyopia | Loss of peripheral & night vision: Front approach, exaggerate gestures, indirect lighting, speak before touching, large print items
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| Dementia Communication Techniques | Identify self, don't quiz; calm, low-pitch voice' decrease stimulation; short, simple sentences; one step commands; closed questions
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| Reminiscence Therapy (Patients with Dementia) | Review of life events; increases self-esteem & socialization; decreases depression; stimulates memory & recollection
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