Transcript Living Client Centred Care in Complex Care

Patient Centred Care
Course - Day Two
Leasa Knechtel, RN, MN CNCC(C), APN
Critical Care & Cardiovascular ICU
Ria Spée, RN, MSc. GNC(C),APN
Sunnybrook Veterans Centre
Dialogue Expectations
PATIENT'S COMMENTS & NON-VERBAL
ACTIONS
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What the patient said verbatim (note this should
be a word-for-word script and not a summary)
What the patient was doing while he/she said this
STAFF THOUGHTS ABOUT PATIENT
COMMENTS
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What you felt or thought about the patient's
statement and the patient's non-verbal
communication at the time of the interaction
Dialogue Expectations
COMMENTS TO PATIENT
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What you said (verbatim) or did in response to each of the
patient's remarks and/or behaviour
STAFF ANALYSIS OF STAFF COMMENTS
A short discussion of what you believe the dialogue
illustrates with respect to your interaction skills
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A critical analysis of each of your statements with respect
to whether it facilitated or blocked communication, changed
or expanded the focus of the conversation
How statements reflected your own agenda, anxiety,
strengths or areas for growth in interviewing skills
What you believe the dialogue illustrated about the
patient's situation - how might you have handled the
interaction differently?
Dialogue Feedback
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Open–ended questions
Identifying blocks
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Remember to:
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Stay with the meaning
Move with the rhythm
Go with the flow
Less is best
Blocks to Communication
Found in dialogues:
 Yes/no questions
 Who is leading?
 Who is the expert?
 Fixing &Telling
 Interpreting, Assuming
 How are you feeling?
 Why?
 What is your intent?
 Whose agenda is it?
Blocks to Communication
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Reassurance
 Pre-mature offering
of services
 Validating
 Fixing
 Giving answers
 Acting on your need
to “do” something
Beitel, J. (1999)
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Overt power
 Persuasion
 Controlling the agenda
 Terms of endearment
Hewison, A. (1993)
Blocks to Communication
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Giving advice is telling
 Giving approval is giving permission
 Giving reassurance is false cheerfulness
 Interpreting/agreeing is making assumptions
 Expressing disapproval is making judgments
 Asking why? Is requesting an explanation
Blocks to Communication
 Belittling
feelings is justifying yourself
 Changing the subject is distracting or
interrupting
 Summarizing may be inaccurate
 Paraphrasing may emphasize what is
not important to the person
Whose Reality Is It?
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What aspects of the nurses’ approach made
a difference in “Dialogue with your patient”?
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What were the outcomes of the different
approaches to the cognitively impaired
person in the “Caring for Confused Elders”
article?
Whose Reality Is It?
What is the difference? Patient-Centred
Communication
 Reality Orientation
 Stop & think
 Validation
 Ask open-ended
 Parse theory
questions
 Go with the flow
S. Shrivastava
How Am I Representing
the Person?
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How does your
documentation tell
your patient’s story?
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What is your
experience with
representing the
person in interprofessional rounds?
Documentation
 Share
sample documentations from
your units
 How
did you convey the resident or
patient’s perspective?
 What was your response/action?
 What would you like to change about your
documentation?
What Changes With
Patient-Centred Care?
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Share a practice that you can relate to from
the “Struggling in Change” article
Creative Group Exercise
 How
has learning about PCC impacted
your practice?
 What
struggles have you encountered
as you incorporate a PCC approach?
 What
else would help you to integrate
PCC into your practice?
Wrap Up
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Complete course evaluation forms
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Dialogues #4 & #5 due March 12th - Required
in order to receive certificate
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Celebratory Tea for your Certificate of
Completion on March 27th 1430-1530 in
L101a
References
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Beitel, J. (1999). Illuminations File Newsletter of International Consortium
of Parse Scholars, 7(3), 3-5.
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Hewison, A. (1993). Power of language in a ward for the care of older
people. Nursing Times, 94(21).
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Mattice, M. & Mitchell, G. J. (1990), Caring for confused elders. The
Canadian Nurse, 16-18.
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Mitchell, Gail J. (1990). Struggling in change: From the traditional
approach to Parse’s theory-based practice. Nursing Science Quarterly, 3, 170176.
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Mitchell, Gail J. (1992). Parse’s theory and the multidisciplinary team:
Clarifying scientific values. Nursing Science Quarterly, 5 (3) 104-106.
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Spée, R., Chua, L., & Nosé, L. (2001). Patient focused care: dialogue with
your patient. The Canadian Nurse, 97(5) 19-22.