Dialogue between a nurse and relatives is an example. Tips for the nurse to communicate with the patient
Hello! Diseases, their symptoms and treatment, medical care - this topic, unfortunately, is very relevant even in our progressive times. There is hardly a person in the world who can claim that he is absolutely healthy and has never consulted a doctor. And no matter what country you are in, the most important words that you strive to learn first, one way or another, relate to your health, and their knowledge is sometimes simply vital. So, our topic today is diseases in English. Knowledge of English vocabulary on medical topics
Let's imagine several situations and possible dialogues with doctors. Your task is to isolate and remember useful words and word combinations in English from the following dialogues.
First dialogue
Mike came for a medical examination to his old friend and attending physician Tom.
- Hello, Mike! How are you?
Hello, Mike! How are you?
- Hello, Tom! I'm fine, thanks.
Hi Tom! I'm fine thanks.
- Glad to hear it! Take a seat, I must examine you.
Glad to hear it! Sit down, I need to examine you.
- Open your mouth. Good. Now take a breath. Don't breathe. Breath out. Oh, it seems to me, there is a small problem.
Open your mouth. Fine. Now take a breath. Hold your breath. Take the day off. Oh, I think there's a little problem.
- Really?!
Really?!
— Don't worry. There is nothing to worry about so much. I’m going to prescribe you some pills. Be careful, take three of these pills two times a day.
Don't worry. There is nothing worth worrying about so much. I'm going to prescribe you some pills. Be careful, take three tablets twice a day.
— Write me on the paper, please. I can forget.
Write to me please. I can forget.
— Give this prescription to the chemist. I'll wait for you in 5 days.
Give the prescription to the pharmacist. I'll be waiting for you in 5 days.
- Thank you, Tom!
Thanks Tom!
- Take care!
Take care of yourself!
Second dialogue
Dialogue at the reception between Mary and the charge nurse. Mary, feeling unwell, decided to drop everything and devote time to her health.
- Good morning! Can I help you?
Good morning! Can I help you?
- Good morning! I would like to see Dr. Smite.
Good morning! I would like to consult Dr. Smith.
— What's your name? Do you have an appointment?
Your name? Have you made an appointment?
— My name is Mary Robinson. Unfortunately, I haven’t, but I am feeling unwell.
My name is Mary Robinson. Unfortunately, I'm not registered, but I'm not feeling very well.
— What are your symptoms?
What are your symptoms?
— I've got a pain in my back.
My back hurts.
- Take a seat. Wait a minute, please.
Sit down. Wait one minute.
- Okay.
Fine.
—Dr. Smite is ready to see you now.
Dr. Smith is ready to see you now.
- Thank you a lot!
Thanks a lot!
Third dialogue
The dialogue that takes place between the doctor and the patient directly during the examination. 
Dialogue taking place between doctor and patient— What's the problem, Mrs. Nelson?
What's the problem, Mrs. Nelson?
- I am in a lot of pain!
I have unbearable pain!
- Lay down over here. Where does it hurt?
Lie down here. Where does it hurt?
- Oh, my foot.
Oh my foot.
— Does it hurt when I press here?
Does it hurt when I press here?
- Yes!
Yes!
-What happened?
What's happened?
— I fell down the stairs. Doctor, I’ve been feeling sick and having headaches.
I fell down the stairs. I felt nauseous and had a headache.
— I hope you’ve pulled only a muscle in your leg. I want to send you for an x-ray.
I hope you only pulled a muscle in your leg. I want to send you for an x-ray.
The word "disease" in English
In English there are several terms that are translated into Russian as “disease”. However, these words are not complete synonyms - each of these words has its own semantic features. That is, depending on the type of disease, we choose the term that corresponds to it.
- Disease
This term refers to the most severe diseases - incurable and lifelong. - Illness
This word in English means not a disease, but a person’s poor health, which is temporary and can be gotten rid of
Illness- this is something like a symptom or the first manifestation of a disease
It means feeling unwell, but as a reaction of the body to something unacceptable or unusual. Poisoning, a sharp drop, an unpleasant odor cause a similar condition
It makes me sick. — This makes me sick. / I don't accept this.
Can also be used to indicate moral weakness.
Useful vocabulary on the topic “Diseases”
Medical professionals in English:
- Head physician - chief physician
- Doctor; doc - doctor
- Nurse - nurse
- Midwife - midwife
- Cardiologist - cardiologist
- Stomatologist - dentist
- Surgeon - surgeon
- Radiologist - radiologist
The most common diseases in English:
| Disease | Translation | Transcription |
| allergy | allergy | [ˈælədʒɪ] |
| asthma | asthma | [ˈæsmə] |
| AIDS | AIDS | |
| boil | abscess | |
| bronchitis | bronchitis | |
| сholera | cholera | [ˈkɔlərə] |
| quinsy | angina | [ˈkwɪnzɪ] |
| varicosity | varicose veins | |
| gastritis | gastritis | [ɡæsˈtraɪtɪs] |
| hepatitis C | hepatitis C | [ˌhepəˈtaɪtɪs] |
| influenza | flu | [ˌɪnfluˈenzə] |
| insomnia | insomnia | [ɪnˈsɔmnɪə] |
| jaundice | jaundice | [ˈdʒɔ:ndɪs] |
| meats | measles | [ˈmi:zlz] |
| meningitis | meningitis | [ˌmenɪnˈdʒaɪtɪs] |
| migraine | migraine | [ˈmi:ɡreɪn] |
| mumps | piggy | |
| smallpox | smallpox | [ˈsmɔ:lpɔks] |
| malaria | malaria | |
| tetanus | tetanus | [ˈtetənəs] |
| tuberculosis | tuberculosis | |
| typhus | typhus | [ˈtaɪfəs] |
| scarlet fever | scarlet fever | [ˈskɑ:lɪt ˈfi:və] |
| sty | barley | |
| ulcer/ sore | ulcer | [ˈʌlsə]/ |
Symptoms of diseases in English
| Symptom | Translation | Transcription |
| discharge | discharge | ["dɪskɑːd] |
| chest pains | chest pain | |
| chill | chills | |
| cough | cough | |
| fever | heat | [ˈfi:və] |
| headache | headache | [ˈhedeɪk] |
| phlegm | sputum | |
| pressure | pressure | [ˈpreʃə] |
| pimple | acne | [ˈpɪmpl] |
| vomiting | vomit | [ˈvɔmɪt] |
| shiver | shiver | [ˈʃɪvə] |
| rash | rash |
You can learn about English idioms on medical topics from this video.
Communication with the patient.
| Parameter name | Meaning |
| Article topic: | Communication with the patient. |
| Rubric (thematic category) | Psychology |
Topic No. 3.
- Specifics of communication between health worker and patient.
Any work with people is inextricably linked with the process and problems of communication; it permeates the professional activities of health workers at any level. The individual characteristics of the patient’s psyche in the conditions of therapeutic relationships and interactions come into contact with the psychological properties of the medical worker. The purpose of such contact is to provide assistance to the patient. Both the patient and the health worker have their own motives for interaction, and the medical staff has a role in ensuring conflict-free interaction.
Mid-level medical staff are in direct contact with the patient for a long time, and therefore can have both a positive and negative impact on the patient. The task of the medical staff is to avoid unnecessary negative psychological influences as much as possible and to contribute to the creation of a psychological climate that has a beneficial effect on the recovery process.
The prerequisites for interaction between the patient and the health worker are formed based on a number of factors that determine the patient’s expectations:
1. preliminary information about the health worker
2. reputation of the medical institution
3. “roads” to honey. institution
For effective and conflict-free interaction with patients, the presence of such a psychological parameter as communicative competence is extremely important.
Communicative competence – the ability to establish and maintain the necessary contacts with people, which implies achieving mutual understanding between communication partners, awareness of the situation and the subject of communication. It is also considered as a system of internal resources aimed at building effective communication in situations of interpersonal interaction. Incompetence in communication can disrupt the diagnostic and treatment process.
Characteristics of a healthcare worker that predispose them to successful communication with a patient:
Empathy
Acceptance (unconditional acceptance of the patient)
Authenticity or self-congruity (naturalness of behavior, consistency of feelings and their expression, sincerity).
The state of empathy is, along with an objective feeling of psychological contact between the health worker and the patient, one of the indicators that understanding communication has taken place.
Empathy (from the English empathy - feeling) is the ability to feel the emotional state of another person, accurately perceive the semantic shades of his inner world, the ability to look at circumstances through the eyes of the interlocutor. Empathy does not necessarily imply active intervention in order to provide effective help to another. It only implies entering the personal world of another, delicately staying in it without evaluating it. Empathy should be distinguished from emotional identification (likening, identifying oneself with another, with his emotional state) and from sympathy (concerns about the feelings of another). If a state of identification with the patient’s emotional state occurs, the health worker loses the ability to work professionally and needs psychological help.
The process of communicating with a patient begins with choosing the interaction distance; it should be such that the patient feels comfortable and safe. When changing the distance, especially when shortening it, it is advisable to explain your actions in order to avoid an increase in psychological tension and aggression. The patient, being in a situation of stress caused by the disease, needs a fixed territory that belongs only to him. Positive interaction depends not only on the territory, but also on the social status of patients and their age homogeneity.
Models of interaction between health care worker and patient.
Partnership- cooperation in matters of treatment, sharing of responsibility for the results of examination and treatment between the health worker and the patient.
Contract– cooperation based on mutual obligations, identified tasks, expected results. Used in paid healthcare settings.
In communication between a nurse and a patient, in the process of establishing a relationship with him, I. Hardy identifies three stages characteristic of inpatient treatment:
1. orientation - the patient and the nurse get to know each other.
2. expanded stage – cooperation with each other can take place.
3. the final stage - the stage of discharge, is associated with the loss of a sense of security in the patient.
General rules of communication with the patient.
1. Showing genuine interest in the patient.
2. understanding the patient’s merits and maximum approval - praise, emphasizing importance.
3. Understanding the meaning of his actions instead of sweeping criticism.
4. Friendliness, friendliness.
5. Addressing patients by name and patronymic, introducing yourself first, using a badger.
6. The ability to conduct a conversation in the circle of interests of the interlocutor.
7. The ability to listen carefully and give the patient the opportunity to “speak out”.
8. The ability to respect the opinion of the interlocutor, without persistently imposing one’s opinion.
9. The ability to point out to the patient his mistakes without causing offense.
10. The ability to correctly formulate questions and help the patient verbalize his condition.
11. Communicate with the patient as a healthcare professional would want to be treated if he was ill.
12. Use optimal non-verbal methods of communication - calm timbre of voice, smooth gestures, correct distance, signs of approval (patting, affectionate touching), etc.
- Communication with patients of different age groups, patients in the hospital.
The main conditions for the effectiveness of professional communication of a health worker are: demonstration of goodwill, tact, attention, interest, and professional competence.
It is necessary to know the peculiarities of the psychological reflection of their condition by patients of different ages and implement deontological communication tactics towards them accordingly.
For children preschool age typical :
Lack of awareness of the disease in general;
Inability to formulate complaints;
Strong emotional reactions to individual symptoms of the disease;
Perception of treatment and diagnostic procedures as intimidating events;
Strengthening character defects, raising a child during illness;
Feelings of fear, melancholy, loneliness within the walls of a medical institution, away from parents.
Deontological tactics - emotional warm attitude, distraction from illness, organization of quiet games, reading, carrying out procedures with persuasion., professional treatment of relatives of a sick child.
For teenagers characteristic:
The predominance of the psychological dominant of age is the “claim to adulthood”;
Bravado as a form of self-defense with internal psychological vulnerability;
Disregard for the disease and risk factors.
Deontological tactics - communication taking into account age-related psychological characteristics, reliance on independence, and adulthood of a teenager.
When working with patients working age.
It is necessary, first of all, to know the patient’s personality and her individuality. Find out the attitude towards the disease, the medical staff, the position on the interaction of the patient with the medical staff.
Deontological tactics- orientation towards labor and social rehabilitation, selection of communication tactics based on VKB, correction of inadequate attitudes, psychotherapy for anxious and suspicious patients.
For patients elderly and senile age characteristic:
The psychological dominant of age is “departing life”, “approaching death”;
Feelings of melancholy, loneliness, increasing helplessness;
Age-related changes: decreased hearing, vision, memory, narrowing of interests, increased sensitivity, vulnerability, decreased ability to self-care;
Interpretation of the disease only through age, lack of motivation for treatment and recovery.
Deontological tactics - maintaining the patient’s sense of self-worth; an emphatically respectful, tactical, delicate attitude, without familiarity, commanding tone, or moralizing; orientation to physical activity; motivation for recovery.
Features of communication with a patient in a hospital
Illness or hospitalization unsettle a person in life, and he may feel offended by fate and unhappy. He is worried about illness, possible complications, prognosis, being forced to leave work, parting with home, unfamiliar or unfamiliar surroundings, on which he also becomes dependent. In severe cases, in cases of paralysis, severe pain, and strict bed rest, the dependence must be absolute.
The routine of a patient’s life in a hospital is determined by medical workers; the patient’s life in a hospital itself is based on their knowledge, skills, responsibility, and kindness. At the same time, the relationships that he develops with paramedical workers, primarily with nurses, who communicate with patients constantly, are especially significant for the patient.
Relationships with patients should be built on the basis of age, profession, general cultural level, character, mood, severity and characteristics of the disease. All measures for treating patients and caring for them should be carried out calmly, accurately, carefully, trying not to irritate them, without causing them pain, and in no way humiliating their human dignity. It is necessary to take into account the usually characteristic feeling of embarrassment and frustration in patients due to their helplessness and dependence.
The average health care worker must know what diagnosis has been made to the patient, why the doctor has prescribed certain medications, procedures, and laboratory tests. At the same time, you need to be careful when talking with the patient; the conversation should be soothing.
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Under no circumstances should you tell him anything that could upset or frighten him. It is unacceptable in the process of communicating with him to say that he looks bad today, that his eyes are “sunken in,” or that his tests are bad.
It must be remembered that with many diseases, patients experience certain characteristics of mental activity. Thus, with atherosclerosis of the cerebral vessels, a significant decrease in memory, absent-mindedness, faint-heartedness, tearfulness, touchiness, and egocentrism are possible. Patients with heart pathology often feel a sense of fear for their lives, are wary, and are highly emotional. With diseases of the liver and gall bladder, irritability, causticity, and anger are often noted. In acute infectious diseases and intrathecal hemorrhage, euphoria and underestimation of the severity of one’s condition are possible. With high internal pressure, the patient is usually lethargic, inactive, passive, apathetic, answers questions with delay, laconically, as if reluctantly, and often remains in some fixed position. Certain features of the mental state and behavioral reactions are characteristic of many endocrinological, oncological and other diseases, various forms of endogenous intoxication, poisoning.
The work of a nurse in children's departments has significant features, because... Staying in a hospital without a mother is a significant psychologically traumatic circumstance for children. Relationships between medical workers and relatives of sick children can be difficult. Brief communication with parents can sometimes only agitate a sick child who has partially adapted to hospital conditions.
When communicating with patients’ relatives, it is extremely important to be tactful, polite, and do everything possible to reassure them and convince them that everything necessary is being done for the patient. At the same time, sufficient firmness is necessary to prevent relatives from violating the regime established in the hospital.
A genuine culture of communication is also necessary within the healthcare team itself. Kindness in relationships with colleagues and mutual assistance are required to create an optimal psychological climate in a medical institution and to provide comprehensive medical care. At the same time, the discipline of team members and their observance of subordination are very important.
- Communication in complex conflict situations.
It is believed that complex interpersonal and conflict situations, incl. arising between health workers and patients are primarily due to difficulties in communication. Human communication can become a source of problems, failures, worries, a wall separating people. What people's relationships will be like depends on their psychological literacy.
Conflicts of interests (needs) are the source of conflicts, but the factors that provoke conflict are extremely diverse. These include the characterological characteristics of a person: reduced self-criticism, prejudice and envy, self-interest, selfishness, the desire to subordinate others to oneself; his mood, well-being, intelligence, knowledge and ignorance of human psychology, psychology of communication, etc.
As a result, everything that constitutes an interpersonal communication situation can act as a conflict factor, a barrier in communication, and create a difficult psychological situation.
The likelihood of conflicts increases when:
Incompatibility of characters and psychological types;
The presence of a choleric temperament;
The absence of three qualities: the ability to be critical of oneself, tolerance of others and trust in others.
Often the cause of conflict is the incorrect behavior of the participants in communication. In a conflict situation you cannot:
Critically evaluate your partner;
Attribute bad intentions to him;
Show signs of superiority;
Blame and attribute responsibility for the conflict only to the partner;
Ignore his interests;
See everything only from your position;
Exaggerate your merits;
Annoy, shout, attack;
Touch your partner’s “pain points”;
Blast your partner with a lot of complaints.
Conflicts between a health worker and a patient can be divided into realistic and unrealistic.
Realistic (subject) - caused by dissatisfaction with the requirements or expectations of communication participants, unfair distribution of responsibilities, advantages; such conflicts are aimed at achieving specific results, etc.
Often associated with a discrepancy between the patient's expectations and reality.
Unrealistic (pointless) - have the goal of openly expressing accumulated pointless emotions, grievances, hostility, when the conflict itself is the goal. For example, a biased attitude towards the medical service or towards an individual health worker.
Daniel Dena identified three levels of conflict; skirmishes, clashes and crises.
Under skirmishes refers to minor conflicts that resolve or disappear on their own and do not affect the relationship's ability to meet the needs of the participants. Example - after a remark was made, the patient was again late for the procedure.
Collision. A sign of conflict at this level is the prolonged repetition of the same arguments on the same issue; expanding the range of reasons causing quarrels; a decrease in the desire to cooperate with another, a decrease in faith in the good attitude of another person; irritation for several hours, days; the emergence of doubts about the correctness of one’s understanding of these relationships. An example is a situation in which you have to repeatedly correct a colleague’s mistakes, but he does not respond to comments and perceives them as the result of pickiness.
A crisis- a level of conflict that threatens the further continuation of the relationship. A sign of a conflict at this level is the decision to finally break off the relationship; fears that the other will break off the relationship unilaterally; feeling that the relationship is unhealthy, fear of an emotional breakdown if it continues; fear of physical violence.
Psychologists call the inability to find a way out of conflict situations a barrier to interpersonal communication.
Communication barriers - These are the many factors that cause or contribute to conflicts. Barriers to interpersonal communication include: barriers to communication skills, divergence of interests, goals, needs, methods of activity, semantic, linguistic barters, prejudices, prejudices, social cliches, attribution of alien intentions to the interlocutor, etc.
- Means of communication and their use for psychotherapeutic purposes.
The practical activities of a health worker are characterized by their own specific verbal communication.
A message that is simple, clear, credible, relevant, and delivered at the right time, taking into account the individual characteristics of the patient, is considered effective. Simplicity is understood as brevity, completeness of phrases, and clarity of words. The clarity criteria assume that after receiving a message, the patient can unambiguously answer the question regarding his further actions (what, how, how much, where, when, why). The criterion “trustworthy” is very important for effective communication; trust in a health worker is influenced by the attitude of other health workers towards him, the health worker’s knowledge of the issue being discussed, and respect for confidentiality. The criteria of “appropriateness of the message” and “good timing” can be combined into one - “appropriateness”, which involves paying attention to the patient while he is waiting for a medical visit, performing manipulations, procedures, etc. Taking into account the individual characteristics of the patient during his stay in a health care facility is extremely important as a criterion for the verbal adequacy of the transfer of information. It is this measure of simplicity, clarity, appropriateness, and trustworthiness for a particular patient. Verbal communication skills should also include the ability to listen, which requires discipline and requires effort.
S.V. Krivtsova and E.A. Mukhamatulin distinguishes between active, passive and empathic listening. By active they understand listening, in which the reflection of information comes to the fore, and by empathic listening, the reflection of feelings.
The health worker mainly comes into contact with weakened people who sometimes find it difficult to communicate using words, ᴛ.ᴇ. verbally. For this reason, they must have the skills to encode and decode nonverbal signals, which have their own specifics when organizing communication with the patient. At the same time, it is important to master professional body language. The importance of body language is due to the fact that patients not only experience pain or illness, but also may be anxious about their chances of recovery, worried about leaving home and household members, etc. In a word, patients need psychological support and a caring attitude towards themselves.
The use of non-verbal means of communication for psychotherapeutic purposes on the part of the health worker presupposes a readiness for eye contact, a smile and other positive forms of facial expressions, nodding when listening to the patient’s complaints, open gestures, tilting the body towards the patient, a short distance and direct orientation, as well as the active use of touch, expressing support (holding hands, hugging shoulders, gently pressing oneself, etc.), neat appearance, careful synchronization of the process of communication with the patient and the use of encouraging interjections.
specialty "Nursing"
Communication with the patient. - concept and types. Classification and features of the category "Communication with the patient." 2017, 2018.
Kazan Medical College
On the topic: “Communication with the patient”
Plan.
I. Introduction. Communication and its importance in therapeutic activities.
II. Main part.1. Features of relationships in therapeutic activities
2. Types of communication
u "Mask contact"
u Primitive communication
u Formal-role communication
u Business communication
u Spiritual interpersonal communication
u Manipulative communication
3. Tactics of the medical worker.
4. Personality characteristics of a medical worker
5. Nurse and patient, principles of communication with the patient
6. Types of nurses and their characteristics
u Sister-routineer
u Sister “playing a learned role.”
u Type of "nervous" sister
u Sister type with a masculine, strong personality
u Maternal type sister
u Type of specialist
III. Conclusion. The role of the nurse in communication with the patient
IV. List of used literature
Introduction. Communication and its importance in therapeutic activities.
Nurse
and the patient, principles of communication with the patient.
The position and role of the nurse is becoming more important nowadays. She spends much more time with the patient than a doctor. The patient seeks her understanding and support. The work of a nurse is associated not only with great physical activity, but also with great emotional stress. The latter occurs when communicating with patients who are characterized by increased irritability, painful demands, touchiness, etc. It is very important to establish contact with the patient. The nurse is constantly among the patients, so her clear actions and professional implementation of the doctor’s instructions, her friendly, warm attitude towards the patient have a psychotherapeutic effect on him. The nurse should be able to show understanding of the patient's difficulties and problems, but should not strive to solve these problems.
I. Hardy recommends using the following methods of talking between a nurse and a patient in order to comply with the above principles:
1.
Repeat the patient’s last sentence in the form of a question, for example: “So, your wife offended you?”
2.
Ask a question summarizing everything said to the patient: “If I’m not mistaken, do you want to return home as soon as possible?”
3.
The nurse does not speak out about the patient’s unexplained problems without consulting the doctor.
4.
Ask an abstract question, for example, in case of family problems during illness: “Who takes care of the children?”
5.
Say an unfinished phrase: “And if you return home now, so...?
In the contact between a nurse and a patient, the personality of the nurse is of great importance. A nurse may love her profession, have excellent technical data and skills, however, if, due to her personal characteristics, she often conflicts with patients, her professional qualities do not give the desired effect. The path to true mastery is always long and difficult. Therefore, it is necessary to develop the desired style of work and master the art of having a beneficial effect on patients.
Types of nurses and their characteristics:
I. Hardy describes 6 types of sisters according to the characteristics of their activities.
u Sister-rutiner. Its most characteristic feature is the mechanical performance of its duties. Such nurses perform the assigned tasks with extraordinary care, scrupulousness, showing dexterity and skill. Everything that is needed to care for the patient is done, but there is no care itself, because it works automatically, indifferently, without worrying about the sick, without sympathizing with them. Such a nurse is capable of waking up a sleeping patient just to give him sleeping pills prescribed by the doctor.
u Sister “playing a learned role.” Such sisters, in the process of work, strive to play some role, striving to realize a certain ideal. If their behavior crosses acceptable boundaries, spontaneity disappears and insincerity appears. They play the role of an altruist, a benefactor, showing “artistic” abilities. Their behavior is artificial.
u Type of "nervous" sister. These are emotionally labile individuals prone to neurotic reactions. As a result, they are often irritable, quick-tempered, and can be rude. Such a sister can be seen gloomy, with resentment on her face, among innocent patients. They are very hypochondriacal, afraid of contracting an infectious disease or getting a “serious illness.” They often refuse to perform various tasks, allegedly because they cannot lift weights, their legs hurt, etc. Such nurses interfere with their work and often have a harmful influence on the sick.
u Sister type with a masculine, strong personality. Such people can be recognized from a distance by their gait. They are distinguished by persistence, determination and intolerance to the slightest disturbances. They are often not flexible enough, rude and even aggressive with patients; in favorable cases, such nurses can be good organizers.
u Maternal type sister. Such nurses perform their work with maximum care and compassion for the sick. Work is an integral condition of life for them. They can do everything and succeed everywhere. Caring for the sick is a life calling. Their personal lives are often imbued with concern for others and love for people.
u Type of specialist. These are sisters who, due to some special personality trait or special interest, receive a special assignment. They dedicate their lives to performing complex tasks, for example in special laboratories. They are fanatically devoted to their narrow activities.
Conclusion. The role of the nurse in communication with the patient.
The topic I covered in this essay is of great importance for health workers, especially for me, a future nurse. Therefore, this topic is interesting to me, and when writing the essay, I made certain conclusions for myself that will help me in my future professional activities.
As in everyday life, so in healing activities, there is communication. In both cases it has a certain meaning and psychological characteristics. In medical activities, there are several types of communication between a health worker and a patient. And it depends only on the health worker what type of communication he will have with the patient. But in any case, the doctor or nurse must follow certain tactics in relation to the patient and, most importantly, the health worker, as an individual, must have certain characteristics in all respects in order to earn the patient’s trust in him. After all, without trust, normal relationships between a health worker and a patient are impossible. Because The nurse spends more time in direct contact with the patient; her role in communicating with the patient becomes important. Consequently, the personality of the nurse, the style and methods of her work, the ability to influence and treat patients is an important element not only of the treatment process, but also of the psychological communication between the medical worker and the patient.
Bibliography:
1. Grando. A.A. Medical ethics and medical deontology. Kyiv, Head Publishing House “Vishcha School”, 1982, 168 pp.
2. Matveev. V.F. Fundamentals of medical psychology, ethics and deontology. Moscow, “Medicine”, 1989, 178 pp.
etc.................
Collaboration is the interaction between the nurse, patient, and family to promote patient learning and development. A positive relationship between nurse and patient largely determines the outcome of care.
The nurse's tasks in establishing a supportive relationship with the patient:
1. Creating an atmosphere of trust.
2. Promoting the preservation and development of the patient’s abilities.
3. Promoting personal growth and development of the patient in the process of joint problem solving.
4. Formation in the patient of the ability to act as a physically and emotionally healthy person should.
The psychology of dealing with sick people is a general discipline that extends to the activities of both doctors and nurses, the essence of which is: knowledge in the field of communication and the center: the ability to approach the patient, find the key to his personality, the path to creating contact with him.
There are two main rules of communication:
1. The best conversationalist is not the one who knows how to speak well, but the one who knows how to listen well.
2. People tend to listen to others only after they have listened to them.
A nurse may be a poor listener not only because she is not interested or does not have enough time, but also because she may be absorbed in her thoughts and experiences. Therefore, it is important to learn to listen, “pushing” your problems aside for a while.
During the listening process, the nurse is also attentive to nonverbal communication signals that come from the patient.
The function of listening skills is quite important not only for collecting information about the patient. The opportunity to speak out in a situation of safety, which the nurse creates, in itself has a psychotherapeutic effect on the patient (i.e., acts as a unique way of nursing intervention).
During the conversation, an atmosphere of trust is formed between the nurse and the patient, which is very important for subsequent work with him. In the process of communication, not only does the nurse get to know the patient, but he also gets to know her better. American psychologist K. Rogers found that if a person in 40% of cases demonstrates the same reaction style in communication, a certain fixed set of communication techniques, then his interlocutor has the right to think that this person always behaves this way. This is how myths about medical workers and nurses are born among patients, which leads to labeling them as “good-natured”, “strict”, “knowing about everything”, “understanding”, etc.
In order for a patient to listen to his sister, he himself must be listened to by her.
The nurse's speech culture presupposes the ability to:
1. Formulate your thoughts precisely
2. Formatting it grammatically correct
3. Present it in language accessible to the patient
4. Focus on the patient's reaction
When communicating with patients, the nurse should not overuse medical terminology, which is often incomprehensible to the patient and frightens him.
The nurse's speech should serve as an indicator of her interest in the fate of the patient, an indicator of her professional competence and culture.
In communication, not only words as such are important, but also thoughts and feelings conveyed by words.
American psychologists have calculated that verbal information in our communication makes up 1/6, and the language of postures, intonations, breathing and rhythm, i.e. non-verbal information - about 5/6. The verbal part usually takes up from 5% to 20% of the message, the rest is non-verbal communication.
In general, people are less able to consciously control nonverbal communication. Researchers have proven that oral speech is easier to control than facial and body language.
Information about the patient is transmitted by the nurse to the doctor in the form of a nursing primary psychological diagnosis, it should be considered as a component of the nursing diagnosis.
A psychological diagnosis is a comprehensive assessment of the patient’s personality and his place in his immediate environment. This diagnosis indicates those needs that are significant for the patient, which for one reason or another are not satisfied, and indicates those areas of the patient’s life that cause increased emotional tension in him.
Image of a nurse.
A prerequisite for a patient's trust in a nurse is her qualifications. But it is only a tool, the effect of which depends on other personal qualities of the nurse. The patient should have the impression that the nurse wants to help him. The patient can attribute the indifferent voice, the unfriendly, gloomy expression on the nurse’s face personally.
A nurse is trustworthy if she is calm, confident, optimistic, conscientious, patient, but not arrogant or rude.
Image is a set of qualities that people associate with a certain personality. A nurse's image is a set of qualities that patients associate with a particular nurse. The image begins to work from the first moments of acquaintance.
An attractive image can only be built on the basis of the natural self-disclosure of one’s individuality. The art of imagery does not consist in falsehood, but in emphasizing one’s true advantages and not emphasizing shortcomings.
Stages of image building:
Stage 1 - awareness of your Self, your strengths and weaknesses (the image of the Self - for yourself);
Stage 2 - building your public identity (the image of I - for others, how I want to appear in the eyes of others), which should not be strikingly different from personal identity, otherwise you will not be able to hide the falsity in your behavior;
Stage 3 - self-presentation (broadcasting one’s public identity, “self-presentation”).
Appearance significantly influences the attribution of positive qualities. The formation of the image is also influenced by speech characteristics. The nonverbal component of communication (eye contact; proxemics - organization of space and time of communication; extra and paralinguistics - voice timbre, rate of speech, pauses; optical-kinetic sphere - facial expressions, pantomime) also carries a large information load.
Lack of attention from a physician to his appearance is unacceptable. The unity of content and form is a harmony worthy of admiration. A favorable or unfavorable effect on the treatment process is exerted not only by the impression made on the patient by the staff, but by the medical institution itself.
Establishing psychological contact with the patient, increasing his trust in medical personnel and in the medical institution are necessary so that the patient:
· began to do everything in his power to get better;
· Resign from the role of the patient as soon as possible;
· collaborated with the treating staff and followed the doctor’s orders.
The reason for the unfavorable development of the relationship between the nurse and the patient may be her failure to maintain the necessary psychological distance (for example, flirting or emotional identification with him, helpless sympathy).
A nurse's talkativeness can introduce elements of conflict not only into her relationship with the patient, but also into the relationships between patients.
Accepting gifts from a patient often leads to conscious or unconscious discrimination against those who have not received this, which reduces trust in it on the part of all patients.
However, sometimes, when dealing with a vulnerable patient, refusing a gift can cause a strong blow to his pride, demonstrating that he means nothing to you. It is believed that gratitude can be accepted if it is expressed in a civilized form and does not contradict the principles of humanism and spirituality, or current legislation.
Nurses need to be sensitive to their patients' cultural differences and be prepared to care for people from different races, cultures, and ethnicities.
Emotional identification. Empathy(from the English empathy - sympathy, empathy, the ability to put oneself in the place of another, penetration into the subjective world of another) - the ability of an individual to perceive the inner world of another accurately, while maintaining emotional and semantic shades. Empathy does not imply mandatory active intervention in order to provide effective help to another, nor does it imply an evaluative response. It brings people together in communication, bringing it to the level of trust and intimacy.
Empathy should be distinguished from emotional identification (likening, identifying oneself with another, with his emotional state) and from sympathy (concerns about the feelings of another).
A sympathetic interlocutor is always ready to express his compassion to the speaker and quickly agree with him. Techniques used: praise, verbal agreement, reassurance, sympathy, consolation. When using this type of listening, there is a danger in the emotional identification of the health worker; in this case, the health worker himself may need professional psychological help.
Empathic listening is the highest level of listening skill and involves empathy (the ability to understand the interlocutor not with the mind, but with the heart). In this case, there are no attempts to reveal the speaker’s unconscious feelings, since they can be traumatic. This is a type of unreflective listening that can be learned.
Non-reflective listening is listening without analysis, giving the interlocutor the opportunity to speak out. This is an active process on the part of the listener and requires the ability to remain silent attentively. Its purpose is to support the flow of the interlocutor's speech, trying to get him to speak out completely.
Rules for such a hearing:
1. Minimum responses (non-interference)
2. Be a kind of “sponge”, absorbing everything that the interlocutor says, without any selection or sorting
3. Constantly give signals to the interlocutor that he is being listened to and focused on what he is saying (replicas: yes, yes, head nods)
The costs of this type of listening: the patient may regard the nurse’s attention as complete agreement with the content of his story; for a long time he has to listen to sometimes empty chatter.
The nurse has to balance in communication with the patient between open and businesslike communication. Being an understanding listener is a good way to maintain this balance. The ability to listen creates an atmosphere of trust.
The ability to listen to your interlocutor is an important component of the psychological preparation of a nurse.
Transfer is the transfer to the medical worker of the patient’s emotional attitude towards people significant to him (father, mother, etc.).
The term first began to be used in psychoanalysis. Transfer varies:
· positive - transferring feelings of love, respect, trust, affection, etc.
· negative - transference of feelings of fear, hatred, disgust, etc.
In the process of nursing care, these feelings can spontaneously arise in the patient in the absence of objective reasons for this in her behavior. The patient himself does not understand why he “falls in love” with the nurse or begins to hate her without any external reason. So, a person who has suffered all his life from a lack of love and care may expect exactly these feelings from a nurse. He may begin to admire her, but if his expectations are not met, he may suddenly hate her. Novice nurses are at a loss when faced with strong manifestations on the part of patients of such emotions as love, sexual desire, or hatred, insatiable demands, aggression.
For example, a “disobedient” patient may behave towards the nurse as a stubborn, disobedient child towards his mother.
Strengthening transfer reactions is facilitated by:
1. Maintaining external passivity and neutrality by the nurse
2. She shows interest in the patient’s personal life
3. Her active listening to the patient
This is exactly how a nurse usually behaves, so there is a high probability that in her professional life she will encounter transference reactions from patients.
Countertransference is the transfer by a health worker of his emotions to the patient, a response to the patient’s transference. Countertransference destroys the nurse's usually benevolent-neutral position, causing internal imbalance in her, manifested in the form of anger towards the patient, irritation, fear of the patient, or special love for him. Countertransference intensifies when the nurse experiences stressful events and unresolved conflicts.
Communication with the patient in and out of the hospital. Patient care is based on a holistic approach to the person, taking into account the physiological, personal, social and spiritual needs of the patient and his family.
When a person encounters certain obstacles on the way to achieving life goals, he experiences a crisis. The nurse strives to reduce the patient's level of tension associated with the stressful situation in which he is, helps the patient adapt to his situation, and helps him find the strength to improve this situation. The patient has to be taught to cope with a crisis situation, because all life is accompanied by one or another challenge and one must be able to respond to them. In the process of overcoming a problem or a crisis situation, personality development occurs, a person becomes wiser.
Upon admission to the hospital, the patient often suffers from a change in environment. He can express his dissatisfaction openly or keep it to himself. The first type of patients creates special difficulties for other patients. There are patients who do not want to adapt to the demands of the hospital environment.
The patient's first reaction to the diagnosis may be as follows:
1. Real peace of mind
2. Apparent calm
5. Suicidal tendencies and even attempts
A person’s attitude towards illness is influenced by the level of education, culture, prejudices he adheres to, customs, and the behavior of others.
How the patient endures his illness is reflected in his behavior:
· a sick fighter does not close his eyes to trouble; he treats illness as an enemy that must be overcome; doing everything possible in the interests of recovery
· a capitulating patient becomes passive, helpless; they need to study all the time
· a patient who denies the fact of the disease does not want to hear anything about treatment or disease
Therapeutic environment- an environment that promotes self-respect and personal responsibility, and involves the patient in meaningful activities.
The relationships between patients have a significant impact on their well-being. Medical staff should cultivate camaraderie and compassion for each other in patients. He must also ensure that the patient’s individual regimen, which mobilizes his defenses, organically fits into the medical and protective regimen of the department.
The therapeutic and protective regime provides for the protection of the patient’s central nervous system from excessive external influences: creating conditions for maximum gentle treatment of the affected organs and systems; maintaining comfortable conditions for the body in new conditions of existence for it - in conditions of illness. Applying the principle of protective treatment and creating a healing environment in a medical institution is not so easy. In addition to material costs, it requires, first of all, constant education and self-education of all medical workers.
A healthy socio-psychological climate of a medical institution presupposes mutual trust among employees, the desire to conscientiously perform their work according to the principle of “no leniency,” constant exchange of information, monitoring the results of program implementation, the efficiency of the hospital administration and the style of its work.
The joint work of a doctor and a nurse on a team basis as professionals who respect and depend on each other increases the responsibility of the nurse and allows each professional to perform the functions for which he was trained. The basis for the success of teamwork is a relationship of cooperation and mutual assistance as opposed to conflict and confrontation.
Conditions for the formation of cooperative interdependence:
1. Freedom and openness of information exchange
2. Mutual support for the actions that the group has to take, conviction of their justification
3. Trust and friendliness between the parties
4. Effective feedback
Building a successful team is an art. For a team to succeed, it needs to be assembled and grown. It is important that people have the desire to cooperate and work together.
Communication with the patient's relatives. The illness of one of the family members imposes restrictions on the family, requires a special regime, changes in the usual way of life, forces them to change plans for the future, redistribute responsibilities, and causes a feeling of fear, uncertainty, and helplessness.
The psychology of relatives is determined by their personality, formed by their previous life, and their attitude towards the patient. The interest of most relatives is focused on promoting a speedy recovery. Often relatives are more concerned about the disease than the patient himself. They are concerned about all sorts of conversations, rumors, problematic information about the disease, medical personnel, and try to do something in favor of the patient.
Overprotective relatives often burden the medical staff with extensive questions and discussions about the patient’s condition and treatment. You need to be patient and remember that the relative is worried and also needs primary psychological help.
If a nurse notices that the condition of a patient in a hospital regularly worsens after visits from visitors, she should tell the attending physician about this, who can regulate visits.
Both the patient and relatives have the right to information concerning each of them. However, the rights of one sometimes conflict with the rights of the other (for example, a patient wants to know what is happening to him, but does not want his relatives to know about some aspects of his illness). Sometimes relatives of the nurse want to clarify some information. The nurse needs to be very careful and not convey unnecessary information to either the patient or his relatives without coordinating her actions with the attending physician.
Communication management involves an impact on the communication process, which is selected from a variety of possible ones, taking into account the set goal, the state of the control object, and leads to the approach of the goal.
A person can consciously control his communication, influence his relationships with other people, and his attractiveness in the system of interpersonal relationships.
Three interrelated areas can be identified that require the nurse’s attention and her ability to manage the processes in them:
1. Directly professional work to implement the nursing process
2. Your internal mental processes and states included in interpersonal interaction with the patient
3. Emerging interpersonal relationships with the patient, level of trust established
All these areas are interconnected and affect the effectiveness of the nurse’s professional activities, because she works not only through nursing technologies, but also through her personality, through the relationships she creates between herself and the patient.
Communication is all the behaviors that one person uses, consciously or unconsciously, to influence another.
COMMUNICATION IN NURSING - the exchange of information and (or) emotions between the nurse and the patient.
Exists three levels of communication:
Intrapersonal (mental communication of a person with himself, when he develops some plans, develops ideas, preparing to communicate with someone)
Interpersonal (between two or more people)
Public (between large groups)
COMMUNICATION FUNCTIONS:
1. INFORMATIONAL.
Receiving and communicating the necessary information. The nurse needs information about the patient’s well-being, his reaction to the medical staff, treatment and hospital stay. In turn, the nurse provides the patient with information about the medication regimen, the nature of preparation for the upcoming instrumental examination, etc.
2. EXPRESSIVE (emotional).
Patients expect an emotional response, sympathy, and warmth from the nurse. You should not gasp and lament unnecessarily over the patient, but coldness and aloofness, the habit of constantly controlling your emotions create the impression of callousness and soullessness. On the other hand, any emotions, especially negative ones, are contagious and quickly spread to others.
3. REGULATORY.
In the process of communication, the nurse influences the consciousness and behavior of patients, using their life values and interests, emotional background and other “levers of control” over people. In turn, the nurse is also influenced by her patients. For example, nurses in intensive care units often work under conditions of chronic stress.
There are TWO TYPES OF COMMUNICATION:
1. VERBAL (verbal) - the most common means of communication between people using speech.
Conversation with a patient is a whole science and a real art. It is impossible to master it perfectly without a high culture of professional speech. It is necessary not only to have in-depth knowledge of the specialty, but also to have a good command of the literary language and be able to competently express one’s thoughts. The dialogue with the patient should be conducted in such a way that everything said is perceived easily and unambiguously, so that explanations and answers to questions are correctly formulated and convincing. Avoid language standards, all kinds of verbal garbage, professional jargon, and swagger.
2. WORDLESS (non-verbal)
This type of communication represents a more authentic expression of feelings, since interpersonal contact occurs on a subconscious level. Remember the communication between mother and baby - they understand each other perfectly, although the mother’s speech is not comprehended by the child.
This type of communication includes:
a) APPEARANCE, MANAGEMENT AND CLOTHING.
Appearance and behavior reflect certain aspects of a medical worker’s personality, in particular the degree of his care, attention to the patient, and ability to empathize. Hippocrates also pointed out that “one should keep oneself clean, have good clothes and rub oneself with fragrant ointments, for all this is usually pleasant for the sick.” Bright lipstick, an ultra-fashionable hairstyle, ringed hands, high heels - all this reminds a seriously ill patient of the joys that he has temporarily or forever lost. He feels sorry for himself, involuntary envy, a feeling of inferiority, and dissatisfaction with the nurse. The suffering gets worse.
b) FACIAL EXPRESSION, FAMILY AND GESTURES (“body language”).
How strictly it is necessary to control your gestures, facial expressions and words is illustrated by the following example from the memoirs of doctor Ibragim Akhmedkhanovich Shamov:
“In October 1983, my fellow villager and distant relative, an elderly man whom I had long treated for a serious heart disease, suddenly died in Derbent. When I met his son shortly after this, he said:
You know, all this month he lived in some kind of anxiety, worry. The fact is that the last time he visited you, he arrived completely devastated and told us: “Oh, how Doctor Shamov shook his head! Although he didn’t say anything to me, he looked at my legs and shook his head like that!” And he repeated this phrase many times in the days before his death.”
c) POSITION OF THE BODY IN SPACE IN RELATION TO THE PATIENT.
Maintain a distance of “psychological comfort.” There are usually four psychological distances:
Intimate - less than 40 cm,
Personal - 40cm -2m,
Social - 2 - 4 m,
Open - more than 4 m.
If an attempt has been made to establish psychological contact with the patient, you cannot “break into” his intimate area without permission, guided only by your desire. On an unconscious level, this causes a sharply negative reaction, being regarded as disrespect, a certain violence. In order for the communication between the nurse and the patient to be comfortable, they must let each other into their personal zone. If the patient moves towards you or moves away, then this is an important sign of how successful your attempt to carry out the process of understanding communication is. When talking with a patient, do not “hover” over him; it is better to sit down near the bed. It is helpful to position yourself so that your eyes and the patient's are at the same level, with neither one dominating the other.
d) COMMUNICATION TIME.
The patient will never be trusting and frank with a nurse who is in a hurry, expressing impatience and concern with her whole appearance. When communicating with a patient, the nurse must carefully control the nonverbal information conveyed to the patient. For example, if a patient starts vomiting, it will be extremely unpleasant and painful for him to watch the expression of disgust and disgust on the nurse’s face, even if she professionally provides him with the necessary help.
The so-called non-verbal type of communication is related to paralinguistic effects:
* intonation
*whoops and exclamations
*speech speed
Factors facilitating or hindering the organization of communication:
*confidentiality
*adequate lighting, heating and ventilation
*comfortable pose
In addition to the external side of communication (verbal and non-verbal), there is also an internal, hidden side of communication - psychological patterns of perception each other's people. These patterns are determined by:
*degree of familiarity
*previous information about the person
*personal life experience of communication, for example, with the category of medical workers
*emotional background
An important role is played by the “halo effect” - the first image of perception, which subsequently dominates for quite a long time.
In the process of communication it is very important communication style.
There are 5 communication styles:
2) concessions;
3) compromise;
4) cooperation;
5) avoidance.
Communication effectiveness determined by two criteria:
a) business (achieving the goals and objectives of everyone in communication).
b) interpersonal, that is, emotionally charged. In this case, there is not only the realization of communication goals, but also a feeling of satisfaction from communicating with each other.
Distinguish two types of communication:
1) therapeutic, effective
2) non-therapeutic, ineffective
THERAPEUTIC COMMUNICATION is a beneficial effect on the patient’s psyche.
Example of therapeutic communication:
“The child became naughty, fell, there was an abrasion on his knee, he was crying bitterly. How to relieve pain in a baby?
You can apply local anesthesia with a solution of novocaine, you can give painkillers - analgin or morphine, you can finally offer anesthesia. However, the child's mother simply takes him in her arms, gently hugs him, kisses him and blows on the sore spot. The sobbing stops immediately, and after another minute the baby is frolicking again, as if nothing had happened. What happened? After all, not a kiss, not blowing on a bruise cannot stop the irritation of the sensitive nerves!” (Shamov). It is appropriate to recall again the words of M.Ya. Mudrova, who wrote back in 1820: “There are also spiritual medicines that heal the body.”
REMEMBER!
THE FOUNDATION OF THERAPEUTIC COMMUNICATION -
FRIENDLY ATTITUDE TOWARDS PEOPLE.
In the fight against illness, a medical worker must look for and prepare an ally in the person of the patient himself.
The 12th century Syrian doctor Abul Faraj said: “Look, there are three of us - me, you and the disease. If you are sick, there will be two of you, and I will remain alone and you will defeat me. If you are with me, there will be two of us, but the disease will remain alone and we will overcome it.”
The nurse puts goals of therapeutic communication:
1) Providing the patient with information about his condition within the limits agreed with the doctor. The nurse should be prepared to answer numerous questions from the patient. For example:
What happened to me?
Can I see my medical history?
Isn't it harmful to take this medicine for so long?
Why are they giving me oxygen? Is my condition really that critical? I know that oxygen is only given to the dying.
2) Removing fear of the disease and its treatment.
Fear is a negative emotion that arises as a result of a real or imagined danger that threatens life. An ordinary environment, family concerns, a familiar place of work and leisure, friends and acquaintances create a feeling of inner confidence and security. With any disease, stability is disrupted temporarily or permanently. The patient suffers not only from unpleasant sensations (pain, shortness of breath, nausea, chills), he also suffers from fear, anxiety, despondency, melancholy, powerlessness and other painful feelings. He doesn’t understand what happened to him, he’s not sure whether doctors can help him, he’s worried about his future. External manifestations of fear vary: from anxiety and excitement to internal numbness and seeming indifference (“withdrawn into oneself”). Hence the patient’s “strange” actions and conversations, whining, tearfulness, eternal complaints, aggressiveness, and pickiness. Feelings of fear aggravate the outcome of the disease, and the humanity of the medical worker lies in helping to overcome them.
Free the patient from fear! Fear is the equivalent of pain.
3) Instilling hope and confidence in improving well-being.
Thus, the main goal of communication in nursing, its super task, the central idea is to help the patient overcome the maladjustment associated with the disease.
An example of non-therapeutic communication: a nurse says to a patient who came to her twice for an analgin tablet: “You won’t die from a headache, you’ll rather die from the disease you came here with.”
Communication means are divided into two groups: therapeutic and non-therapeutic.
THERAPEUTIC COMMUNICATION:
1)Close attention.
Alexander Flint, director of the St. Demetrius School of Sisters of Mercy, writes:
“Many of a nurse’s duties involve the need to communicate: with the patient, his relatives, and other doctors. The ability to communicate can, in many cases, even replace other skills. For the patient, communication with you is part of the treatment.
You must know the patient well. Not just his last name, first name and patronymic. It's important to get to know him as a person. And this person should be interesting to you. Every person needs attention. The sick, like the elderly, and especially children. For many unfortunate people, your attention is the only real value in life. Look, don't take it away!
Communicate with the patient as much as possible; especially at first, do not leave him alone, tell him about everything that is happening to him and will happen in the near future, reassure him and approve of him.
Do this even when it seems to you that the patient does not hear or understand you. Do this always. Speak clearly, confidently and affectionately: “Nothing, Ivan Petrovich, don’t worry, we will definitely help you. Everything will be fine. We will not leave you."
Ask the patient as often as possible:
Maybe you need something?
This will help solve many problems. And simple things can annoy a person, for example, water dripping from an open tap at night, or a hard fold on a pillow, or an itchy eye.
You should learn the art of small signs of attention to the patient.
When you call him by his first name and patronymic, this is already the first sign. When you know on which side it hurts him to sleep and what newspaper he likes to read, what the name of his beloved and unlucky granddaughter or daughter-in-law is, what makes him happy and sad, when you can stir him up, amuse him, make him happy - you are already a master of your craft. Try to find a photograph of the sea for a sailor, and for a grandmother who lived her whole life in Tula - a photograph of old Tula, and you will understand the value of little things.”
2)Therapeutic touch.
Nurses often use touch to comfort a withdrawn, depressed patient, to somehow reach him. It often happens that a warm human touch is the only connection with the world that a seriously ill person has. Touch can not only communicate moral and personal support, but also physically stimulate or calm the patient.
It is not for nothing that the kind hands of a nurse have become a symbol of the profession. This means any physical contact: touching the arm, hugging the shoulders or lightly touching the shoulder, stroking the head - this will be that “thirty-second therapy that some patients need to the point of heartache” and for which no additional time is needed at all.
Says the nurse: “It’s very human to just sit with someone and have a real conversation. And sometimes, a feeling of closeness just arises. A person is scared - so sit down, listen, hold his hand, you don’t even need to say anything. And, in my opinion, this is very important, because I don’t always have something to answer them, but even if I just sit and be silent, sometimes everything works out even better than when I speak. Here is the very fact that they are sitting with them, listening to what worries them, and the point here is not that they are waiting for an answer or advice from you, but simply otherwise they have no one to talk to. And this way it immediately becomes easier for them” (Patricia Benner).
3) Eye contact.
The famous French surgeon Leriche said that he, then still a young doctor, was invited to consult the famous Marshal Faucher. After examination, he recommended surgery. The marshal told him: “I turned to many medical luminaries, they also offered to operate, but I did not agree. Now I want you to perform this operation on me, because you are the first who spoke to me, looking me straight in the eyes. I believed you."
What is eye contact? You look directly into the other person's eyes. Most people don't realize how crucial this is. Have you ever tried to talk to a person who stubbornly turns away, avoiding looking at your face? This is difficult and very dramatically affects our attitude towards him. Eye contact should convey only positive emotions. We like people with an open and friendly look, a sincere smile, a friendly and friendly expression, and a predominantly low voice.
NONTHERAPEUTIC COMMUNICATION:
Selective or inattentive listening.
Stated conclusion.
For example: a patient came to the appointment whose diagnosis of “scabies” was, as they say, “written” on his hands and face. The doctor turned to the nurse and said one single word: “Wilkinson.” This meant that the patient should be prescribed a special medicine for the treatment of scabies - Wilkinson's ointment. The nurse wrote out a prescription and silently handed it to the patient. He took the piece of paper, silently left the office, and when he came home, he wrote a complaint.
Impersonal attitude.
You can often hear people say about a patient: “diabetic”, “ulcer”, “rheumatic”. These neologisms obscure and push into the background the patient’s individuality, causing him to have a negative reaction. In order to avoid the reproach of impoliteness, or even rudeness, sometimes diminutive epithets are used when addressing the patient: “darling”, “granny”, etc. Medical workers seem to fence themselves off from the patient, erecting an invisible but insurmountable barrier between themselves and the patient.
Unjustified trust.
The nurse instructs an elderly patient to take his own medication at certain times. Of course, the patient often forgets about this and the treatment becomes ineffective.
Stubborn or frightened silence.
False reassurance.
In the emergency room, the doctor washes his hands and mechanically, without thinking about his words, says to a patient brought in after a car accident: “Don’t worry, your leg will still grow.”
Moralizing.
The nurse inspires the patient: “Illness is a punishment for your sins. Think about why God is punishing you and repent.”
Criticism, ridicule, threat.
A midwife says at a reception to a young pregnant woman: “And who will you give birth to, so thin and pale, with such and such hemoglobin, I’m interested to know!”
KEEPING IN CONTACT WITH PATIENTS UNABLE TO VERBAL COMMUNICATION
In your practice, you may encounter patients who are deaf and mute from birth or who have lost speech as a result of a disease (stroke, a consequence of a skull injury, etc.).
You can chat with them:
In writing;
Through cards with pictures depicting: a glass of water or a urine bag, etc.
Through physical contact (have your patient close their eyes or shake your hand every time they want to answer “Yes” to your question).
SIX RULES FOR EFFECTIVE DATING
WITH THE PATIENT
1. Create a pleasant atmosphere when talking.
First, evaluate the lighting. Too much or too little light will tire and strain your eyes and the patient's eyes. Will the noise interfere with your or the patient's ability to concentrate on the questions? If you cannot eliminate it, offer to move to another room to continue the conversation. Your patient may act awkward if he feels that the conversation is disturbing someone. If possible, try to plan your introduction so that your roommate is not present at the time. Ask visitors to leave temporarily in the lobby, but allow friends or family members to be present if the patient wishes.
Is the patient ready to talk? If he is tired, afraid of something, something hurts, he will be too depressed and taciturn. Reschedule the acquaintance. If the patient has pain, perform the procedures prescribed by the doctor. Allow at least 1 person to talk 5 minutes. Do not hurry; For good results, the conversation can last an hour. Let's assume that you don't have time for continuous conversation. Divide it into several parts and explain to the patient why you are doing this.
2. Get all the information you have about your patient before talking to him.
Find as much information as possible from available sources and previous treatment locations (if any). This way, you will save your time and not tire the patient. However, try to quickly draw conclusions from the information received, since the patient may not have given complete information before. Make sure you have the patient's correct address, phone number, age, place of work, and so on.
3. Try to build trust with your patient.
Before moving on to the essence of the conversation, talk with him for 5 minutes on abstract topics. If you stand, the patient may feel overwhelmed and will cut off answers or miss important information. Show genuine interest in what he tells you. An interested look and periodic repetition of his words will help achieve the desired results. If you look harsh, inaccessible, indifferent, he will not trust you. Explain the purpose of the conversation to the patient so that he understands how he will benefit from it. Emphasize the need for his honesty and openness. Provide examples of how the information received helped determine appropriate treatment and care.
4. Set the tone of the conversation.
Start the conversation by asking: “How are you feeling?” or “What worries you most?” By letting him talk about his illness, you can identify symptoms that need to be examined. This will also help assess the emotional state of the patient and his level of understanding. Do not disclose information received from the patient. Give the patient the opportunity to answer your questions freely, but if he deviates too much from the topic, return him to the subject of conversation. To do this tactfully, ask him a question regarding his illness: “Tell me more about the pain in your legs.” During the conversation, control yourself, speak simply and clearly. Avoid using medical terms. Your patient will not want to remain in the dark about them. Not sure that the patient understood the questions? Ask him to repeat in his own words what you said. Pay close attention to how he responds. Does the patient realize that he is sick? Thus, understanding the patient's feelings will help you learn more about him.
5. Formulation of precise questions.
Try asking questions that require more answers than “YES” or “No.” “Unfinished” questions focus the patient’s attention and force him to give more complete answers. If the patient asks you to pay attention to one of his complaints, ask him to tell you about it in more detail. Detailed descriptions are important when a patient uses terminology that is unfamiliar to you. Listen to your patient's answers. They may lead to other questions. For example: “How is your vision?” If he answers, “Sometimes the light fades in the eyes,” continue asking questions. Ask: “How often does this happen and how long does it last?”
6. Take notes.
Do not try to write down all the information you received from the patient. Instead, jot down dates, times, key words or phrases and use them later to supplement your notes.
