Communicatio PROFESSION

AL NURSING:
n ETHICAL
ASPECTS
 1. ANALYZE THE IMPACT OF
EMPATHY ON DEVELOPING
THERAPEUTIC RELATIONSHIPS.
2. INTRODUCTION TO
MOTIVATIONAL
INTERVIEWING TECHNIQUES
Objective IN THERAPEUTIC
s CONVERSATIONS.
3. FORMULATE THERAPEUTIC
COMMUNICATION STRATEGIES
TO ASSIST IN CRISIS
INTERVENTION.
4. EXAMINE ASPECTS OF
DIFFERENT NEGOTIATION
SKILLS.
Review

Any questions?
Empathy
THE ABILITY TO PERCEIVE THE
MEANING AND FEELINGS OF
ANOTHER AND TO COMMUNICATE
THOSE TO THE OTHER PERSON

STATE OF PERCEIVING THE

INTERNAL FRAME OF REFERENCE OF
ANOTHER PERSON, WITH
ACCURACY, EMOTION & MEANING,
AS IF ONE WERE THE OTHER PERSON
 Empathy
Temporarily entering another’s world
Organizes data into meaningful understanding
Responds to underlying messages/feelings
Adds significantly to the message conveyed
Caregiver remains objective
Facilitates awareness
Can be verbal or nonverbal
 Sympathy
Emphasizes sharing distressing feelings
Involves agreeing with patient’s feelings
Share own experiences
Loss of objectivity
Overemphasis on self rather than the patient
Pity, condolence
Empathy vs. Sympathy
Empathy
-active listening Sympathy
-maintains a sense of self
-non-judgemental -non-active listening
-professional and objective -not present in the moment
-empowers/moves forward -judging, evaluating
-own opinions and
subjective
-emphasizes negative
 Empathy
Dimensions of Empathy:
Perceptiveness
Know-How
Assertiveness
 Empathy
Active listening (listening for core message)

Response (emphasize understanding)

Validation (attending and encouraging)

Active communication (stay engaged)

 Levels of Empathy
Level 1
Nurse/Helper:
-no awareness of most obvious feelings
Kinds of Responses:
-insensitive, changes topic, criticizes, judges, confronts, challenges the accuracy
of perceptions, dominating
Effects:
-no trust, no partnership or damage to the existing partnership
*This is essentially a non-level*
 Levels of Empathy
Level 2
Nurse/Helper:
-recognizes feelings but responds in a way to distort their meaning
Kinds of responses:
-denies the right to feel, disallows feelings, gives advice, and questions uses
cliches, offers a rationale for not helping, reflects the content
Effects:
-impedes partnership, incomplete understanding
 Levels of Empathy
Level 3
Nurse/Helper:
-responds accurately to feelings expressed on the surface
Kinds of responses:
-responds to the content of patient statements and attends to surface feelings
Effects:
-communicates that the patient has been heard, starts building partnership,
only minimally effective
 Levels of Empathy
Level 4
Nurse/Helper:
-communicates understanding on a deeper level than expressed
Kinds of Responses:
-Level 3 and discloses deeper feelings
Effect:
-communicates deeper message being sent, builds partnerships
 Levels of Empathy
Level 5
Nurse/Helper:
-responds accurately to deeper and surface feelings
Effects:
-helps the client explore issues within self
 Levels of Empathy
Patient (in a hostile voice): “I’m sick of being poked and stuck with
needles! Go away and leave me alone!
Nurse Response:
“You’re fed up with needles and wish to be left alone.”
“Getting needles is part of being in the hospital.”
“You’re angry about having all these intrusive procedures and wish
you didn’t need them.”
“Just remember to fill out your menu for tomorrow.”
“With all these intrusive procedures, you feel vulnerable and
defenseless, ready to go hide to get away from it all.”
 Empathetic Responses
You feel…
From your point of view…
So, as you see it…
Kind of makes you feel…
I’m picking up that…
If I’m hearing you correctly…
To me, it’s like you’re saying…
I sense that maybe you feel…
I wonder if your concern is that…
From where you stand…
It seems to you…
You believe…
You mean…
Could it be that…
Are you trying to say…
Let me see if I’m with you…
From where I stand…
I imagine that makes you feel…
 Motivational
Interviewing
 Patient-centred communication
technique
 Can inspire change
 Communicates genuine interest and
gentle guidance
 Uses:
-empathy -reflective listening

-empowerment -affirmation of patient strengths

-accepts resistance -summaries of patient viewpoints

-open-ended questions -resist the need to be “right”

-ask questions, provide information
Spirit of Motivational
Interviewing
Collaboration and Respect
Therapist as the facilitator
Accepts ambivalence
What is a CRISIS?
A P E R C E P T I O N O F A S I T U AT I O N A S A N
I N T O L E R A B L E D I F F I C U LT Y T H AT E X C E E D S
CURRENT RESOURCES AND COPING MECHANISMS

A P E R I O D O F P S YC H O L O G I C A L D I S E Q U I L I B R I U M
T H AT R E S U LT S F R O M E X P E R I E N C I N G A
S I G N I F I C A N T T R A U M AT I C E V E N T T H AT C A N N O T
B E R E M E D I E D U S I N G AVA I L A B L E C O P I N G
S T R AT E G I E S

SUBJECTIVE RESPONSE TO A STRESSFUL LIFE

E X P E R I E N C E T H AT C O M P R O M I S E S A N
I N D I V I D U A L’ S S TA B I L I T Y A N D A B I L I T Y T O C O P E
OR FUNCTION
 ● EXTERNAL
R E S U LT F R O M A C T UA L
E V E N T S / C I R C U M S TA N C E S I N T H E
ENVIRONMENT
● INTERNAL

Types S U B J E C T I V E LY P E R C E I V E D A N D
EXPERIENCED

of ● M AT U R AT I O N A L
OCCUR DURING NORMAL GROWTH AND
DEVELOPMENT

Crises ● ADVENTITIOUS
O C C U R A S A R E S U LT O F E X T R A O R D I N A RY
EVENTS
● M E N TA L H E A LT H E M E R G E N C I E S
S U D D E N O R S E R I O U S P SYC H O L O G I C A L
DISTURBANCE
1. CRISES INVOLVE SPECIFIC, UNEXPECTED, AND
NON-ROUTINE EVENTS.
2. CRISIS CREATES UNCERTAINTY.
3. CRISES CREATE PERCEPTIONS OF THREAT.
4. CRISES ARE PROCESSES OF TRANSFORMATION
DURING WHICH THE OLD SYSTEM CAN NO
LONGER BE MAINTAINED AND THE NEED FOR
CHANGE IS IDENTIFIED.

Characteristics of a Crisis
1. T HE I N DI V I DUA L I S EX P O S ED TO A ST R ES S O R .
2. P R EV I O U S CO P I N G A N D P RO B L EM - S O LV I N G
ST R AT EGI ES FA I L TO R EL I EV E T H E ST R ES S O R .
3. R ES O U RCES F RO M I N S I DE A N D O U TS I DE O F T H E
I N DI V I DUAL AR E M O B I L I Z ED TO R ES O LV E T HE
P RO B L EM A N D TO A L L EV I AT E T H E D I S CO M FO RT
CAU S ED BY T HE ST R ES S O R .
4. T HE AB S EN CE O F CR I S I S R ES O LU T I O N L EA DS TO
M A JO R DI S O RGA N I ZAT I O N .

Phases of a Crisis
 FE AT URE S O F T H E
F E AT URE S O F T HE INDIVIDUAL :
CRISIS: -RISK FACTO RS
-P RE DICTAB IL IT Y -SE L F-CONCE PT
-DURAT IO N -FAIL URE TO L E ARN
-INT E NSIT Y FROM E XPE RIE NCE
-CO NT RO L -E XIST ING M E NTAL
DISORDE RS
-SE CONDARY G AIN
-T HE RAPIST-PAT IE NT
B OUNDARY P RO B L E MS
-SOCIOCULT URAL
CONSIDE RAT IONS

Crisis Response
 PRINCIPLES OF CRISIS
INTERVENTION

1. INTERVENE IMMEDIATELY.
2. STABILIZE THE INDIVIDUAL BY
Crisis RESTORING ORDER/ROUTINE.
Intervention 3. FACILITATE UNDERSTANDING
OF THE EVENT BY GATHERING
FACTS, LISTENING AND
TEACHING.
4. FOCUS ON PROBLEM-SOLVING.
5. ENCOURAGE SELF-RELIANCE.
Steps in Crisis
Intervention

1. DEFINE THE PROBLEM

2. ENSURE INDIVIDUAL’S SAFETY
3. PROVIDE SUPPORT
4. EXPLORE ALTERNATIVES
5. MAKE PLANS
6. OBTAIN COMMITMENT
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References