Patient Centred Care Course - Day Two

Leasa Knechtel, RN, MN CNCC(C), APNCritical Care & Cardiovascular ICU

Ria Spée, RN, MSc. GNC(C),APNSunnybrook Veterans Centre

Dialogue ExpectationsPATIENT'S COMMENTS & NON-VERBAL

ACTIONS 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 What you felt or thought about the patient's statement

and the patient's non-verbal communication at the time of the interaction

Dialogue ExpectationsCOMMENTS TO PATIENT

What you said (verbatim) or did in response to each of the patient's remarks and/or behaviour

STAFF ANALYSIS OF STAFF COMMENTSA short discussion of what you believe the dialogue illustrates with respect to your interaction skills 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 Open–ended questions Identifying blocks

Remember to: Stay with the meaning Move with the rhythm Go with the flow Less is best

Blocks to CommunicationFound 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 Reassurance Pre-mature offering

of services Validating Fixing Giving answers Acting on your need

to “do” somethingBeitel, J. (1999)

Overt power Persuasion Controlling the agenda Terms of endearment

Hewison, A. (1993)

Blocks to Communication 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 CommunicationBelittling feelings is justifying yourself Changing the subject is distracting or

interruptingSummarizing may be inaccurateParaphrasing may emphasize what is

not important to the person

Whose Reality Is It? What aspects of the nurses’ approach made

a difference in “Dialogue with your patient”?

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? Reality Orientation Validation Parse theory

Patient-Centred Communication

Stop & think Ask open-ended questions Go with the flow

S. Shrivastava

How Am I Representingthe Person? How does your

documentation tell your patient’s story?

What is your experience with representing the person in inter-professional 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?

Share a practice that you can relate to from the “Struggling in Change” article

Creative Group ExerciseHow 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 Complete course evaluation forms

Dialogues #4 & #5 due March 12th - Required in order to receive certificate

Celebratory Tea for your Certificate of Completion on March 27th 1430-1530 in L101a

References Beitel, J. (1999). Illuminations File Newsletter of International

Consortium of Parse Scholars, 7(3), 3-5.

Hewison, A. (1993). Power of language in a ward for the care of older people. Nursing Times, 94(21).

Mattice, M. & Mitchell, G. J. (1990), Caring for confused elders. The Canadian Nurse, 16-18.

Mitchell, Gail J. (1990). Struggling in change: From the traditional approach to Parse’s theory-based practice. Nursing Science Quarterly, 3, 170-176.

Mitchell, Gail J. (1992). Parse’s theory and the multidisciplinary team: Clarifying scientific values. Nursing Science Quarterly, 5 (3) 104-106.

Spée, R., Chua, L., & Nosé, L. (2001). Patient focused care: dialogue with your patient. The Canadian Nurse, 97(5) 19-22.