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3738 Deliverable 4 - Apply Therapeutic Communication

Competency

Apply therapeutic communication to holistic nursing actions.

Scenario

While attending the National Holistic Nursing Conference, you participated in a workshop that introduced the therapeutic communication techniques listed below and discussed how to apply them in nursing practice.

· Setting an intention

· Centering

· Grounding

· Caring

· Healing

· Transcendent presence

· Intuition

When concluding the day's activities, the presenters asked you to reflect on the professional experiences you have had with patients and to document that reflection in a journal entry.

Instructions

Write a journal entry that addresses the following:

1. Using your own words, define therapeutic communication in relationship-centered, holistic nursing care.

2. Describe at least 1 nurse-patient encounter where you applied effective therapeutic communication skills in your role as a nurse. Identify which of the therapeutic communication techniques you used and explain how you employed them.

3. Describe at least 1 nurse-patient encounter where you could have communicated more effectively in your role as a nurse through the application of therapeutic communication techniques. Identify which of the therapeutic communication techniques you would use and explain how you would employ them.

Notes

Five Culturally Competent Communication Recommendations

Holistic nurses can promote a connected relationship with their patients by assessing for cultural differences, exploration of cultural variances, recognition of social context, and artful communication and negotiation with their patients. Holistic nurses should embrace these five culturally competent communication recommendations by the American Academy of Nursing (AAN) to guide their interactions (Dossey & Keegan, 2016).

An Example Employing the Five Recommendations

You recently started working in a clinic serving patients from the Navajo Nation. As a holistic nurse, you know that using the five culturally competent communication recommendations provides a guide for interactions with patients, so you want to apply them.

You decide to take a four-hour course on Navajo culture offered at the local library (education). Your manager is supportive of your education and decides to give you paid time to attend the course (practice). After attending the course, you are inspired to research additional therapies consistent with Navajo cultural preferences (research). After working in the clinic for a year, you are concerned with the health disparities your patients encounter related to their chronic conditions; you decide to write a letter to your local representative discussing your concerns and potential solutions (policy and advocacy).

Cultural Difference in Healthcare Communication

Practicing culturally competent communication with the staff in your facility provides a smoother transition as it can be difficult to ignore the current institutional culture and practice on communication practices. These practices are informal and formal and based on a traditional biomedical model of communication.

The traditional patient-provider conversation focuses on the patient being there for their “chief complaint” and is dependent on the clinician to provide guidance. However, this model is not the norm for all cultures. Holistic nurses have an opportunity to explore holistic purposes for the patient being present in a caring environment. The goal of the patient may be to be heard and unde rstood in their healing journey. Perhaps, they are not asking for all the answers in their health but instead searching for a guide in their healing journey.

Provider-patient roles and expectations may vary significantly from culture to culture. Understanding the rules in cultural expectations of healthcare relationships and the communication process can enhance the therapeutic relationship. Effective communication relies on you understanding your patient’s hopes and your patient understanding your expectations. With this in mind, in language barrier situations, consider using a translator to strengthen the connection.

Embracing Holistic Communication

Effective communication is a holistic caring process for nurses to embrace. The holistic nurse understands the cultural norms, and variances along with their personal experiences when integrating formal and informal methods of communication. Embracing cultural expectations for communication promotes a connected relationship between nurse and patient.

Optimal Healing Environments

An optimal healing environment encourages all aspects of the healing process. This type of setting supports the mind-body-spirit and promotes patient wholeness. According to Dossey and Keegan (2016), there are eight domains for an optimal healing space.

he Healing Environment has Internal and External Domains

There is a growing understanding that healing is not a silo response, based on one particular intervention. The healing process is influenced by internal and external factors. Holistic nurses can facilitate the establishment of optimal healing environments through interventions focused on the internal and external domains.

External Changes Supporting Optimal Healing

Sometimes holistic changes are phased-in incrementally. Consider the examples below, where small changes lead to big changes.

· Example 1: Paint Color

· Small Change: A medical-surgical unit decides to change the paint color in patient rooms to known healing colors.

· Big Change: The small change has a measurable, positive impact, which generates leadership support for repainting all patient spaces with colors that are more conducive to healing.

· Example 2: Aromatherapy Tabs

· Small Change: A mental health unit that decides to pilot aromatherapy to manage anxiety. The unit has been researching various studies regarding aromatherapy and anxiety. This unit pilots an aromatherapy tab that can be attached to the gown to help promote relaxation. The outcomes produced include a reduction in related behavioral incidents and PRN anxiety medication usage.

· Big Change: The positive outcome associated with the small change attracts the attention of the MRI department, and they decide to start using the aromatherapy tabs to help reduce the anxiety-related incidents 

·

· during procedures.

Internal Changes Supporting Optimal Healing

There are internal interventions —including relationship-based interventions— to help promote optimal healing environments. For example, patients want to be heard by their caregivers, so one of the most effective interventions a holistic nurse can use to strengthen the internal healing environment is to "be present" during interactions with patients. This approach may sound obvious, but it can prove to be challenging. Nurses are often rushed and feel torn between "being present" for their patient and completing their other tasks.

A useful strategy to combat this challenge is to establish a ritual for being present before each patient interaction. For example, before walking into the patient room, you may focus on being present while taking a two-minutes to wash your hands, meditate, and focus on the moment. This simple meditation may seem like an insignificant intervention, but it can have a dramatic impact on patients, especially when they feel your presence is one hundred percent focused on their care, healing, and wholeness.

Promoting an Optimal Healing Environment

Holistic nurses can promote internal and external optimal healing environments in various ways. Holistic nurses can choose to implement these changes in small incremental ways or focus on global changes. They can also choose to focus on internal and external healing environments. As a holistic nurse, it is essential to focus on the interpersonal relationship of healing as the guiding force in creating an optimal healing environment for patients. The deep trust created by this relationship provides the pathway to both internal and external optimal healing environments.

Reference(s)

Dossey, B., & Keegan, L. (2016). Holistic nursing: A handbook for practice. Burlington, MA: Jones & Bartlett Learning.

3561 Deliverable 1 - Strategies to Promote a Culture of Excellence in the Workplace

Competency

Describe a culture of excellence in nursing.

Scenario

You currently serve as a nursing member of a Practice Excellence Committee. The administration has proposed a new bar code system for medication retrieval by nurses at the bedside. The purpose of the new system is to decrease medication errors by providing nurses with an opportunity to retrieve medications at the bedside where clients and family members can ask questions and receive immediate feedback. At the beginning of the shift, each nurse will checkout a medication box based on assigned clients. Once medications are verified, scanned and removed nurses can send text messages from the bar code scanner to pharmacy should questions or concerns arise.

In the current medication retrieval system, the nurse must take a computer with client medication information to a central dispensing area and wait in line at the electronic medication dispensary for medications then return to the client’s bedside for administration. Hospital leaders are excited since the new beside bar code medication retrieval system is in response to a needs assessment of client and employee satisfaction survey data trended over three years and work by a consulting firm which identified the need after as six month observation period for employee behaviors related to medication administration.

Today is the launch of the new system. You presented the new, proposed innovation at a medical employee staff meeting attended by nurses, pharmacists, physicians, nurse practitioners, physician assistants, physical therapists, and respiratory therapists. Attendees received information including data summary supporting the change, a summary of the proposed change with equipment demonstration and proposed implementation plan including timeline and employee expectations for adoption.

During the implementation portion of the presentation, a few employees voiced concerns and disrupted the meeting. You lost focus and felt defeated

after the presentation; you thought the entire interprofessional team would be excited about the innovative medication administration system. Unfortunately, many nurses left the meeting before the entire implementation plan had been discussed expressing emotional outbursts with outward negativity toward the proposed innovative change.

To facilitate this change and address concerns you scheduled another meeting one month later in a town hall format with only nursing staff invited to attend. Before this meeting, you plan to create a Facts and Questions (FAQ) document based on three priority areas of concerns you noted from the first meeting. You plan to disperse the FAQ document in an email to invited nursing staff one week before the town hall as a way to “break the ice.”

Instructions

Create an FAQ document which provides a detailed and succinct response to each question below and promotes a culture of excellence.

· Why do we need this change?

· What we currently use works well, why change now?

· Honestly, as a nurse, how will this new piece of equipment help me better perform my professional role?

Resources

Birckhead, S. (2015). Three keys to creating a continuous improvement culture. Physician Leadership Journal, 2(4), 32–35.

Cesta, S., Douma, M., Evan, B., Neuman, A., & Vandall-Walker, V. (2018). Patient- and Family-Centred Care. Canadian Journal of Critical Care Nursing, 29(3), 6–7.

Clancy, G., & Graban, M. (2014). Engaging Staff as Problem Solvers Leads to Continuous Improvement at Allina Health. Global Business & Organizational Excellence, 33(6), 35–42. doi:10.1002/joe.21571

Clavelle, J. T., & Goodwin, M. (2016). The Center for Nursing Excellence. Journal of Nursing Administration, 46(11), 613–618. doi:10.1097/NNA.0000000000000413