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Did You BATHE?. Tools for Effective Communication by Robyn L. Mendoza RN, MSN, FNPs. "The most important practical lesson that can be given to nurses is to teach them: what to observe- how to observe- what symptoms indicate improvement- what the reverse- which are of importance-

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Did you bathe

Did You BATHE?

Tools for Effective Communication

by

Robyn L. Mendoza RN, MSN, FNPs


"The most important practical lesson that can be given to nurses is to teach them:

what to observe-

how to observe-

what symptoms indicate improvement-

what the reverse-

which are of importance-

which are of none-

which are the evidence of neglect-

and of what kind of neglect....


But if you can not get the habit of observation one way or other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.


Nightingale believed nursing is about
Nightingale believed nursing is about: other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • Environmental

  • Manipulation

  • Nutrition

  • Conservation of Patient Energy.

    http://www.valdosta.edu/nursing/history_theory/florence.html


Florence also tells us what nursing is other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.not:

Nursing is not limited to, nor defined by medical acts. 


Nurse’s Additional Role other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

Make sure the patient’s environment is clean, comfortable and safe

Make sure they are “manipulated”: get up, turn, cough, sit up, etc…

Make sure they have adequate nutrition

Help them conserve their energy through supportive interventions


Listening to patients is part of assessment
Listening to Patients Is Part of Assessment other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • Important skill

  • Allows understanding

  • Shows interest

  • Helps to pick up clues as to what the concerns of the patient are

  • Establishes trust


Common listening problems
Common Listening Problems other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

Attentionwanders

Miss the real point of what is being said

Let personal emotions interfere with judgment

Interrupt or “step on” statements

Think ahead to what we want to say next and miss what is being said now


Non verbal communication
Non-Verbal Communication other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

Facial expressions:

  • Frown: displeasure, unhappiness

  • Smile: friendliness, happiness

  • Raised eyebrows: disbelief, amazement

  • Narrowed eyes: anger

  • Blushing: embarrassment


Eye contact
Eye Contact other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • Glancing: lack of interest

  • Steady: active listening, interest or seduction


Hand and arm gestures
Hand and Arm Gestures other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • Pointing finger: authority, displeasure, lecturing

  • Folded arms: not open to change, preparing to speak

  • Arms at side: open to suggestions, relaxed

  • Hands uplifted: disbelief, puzzlement, uncertainty


BATHE-ING the Patient other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.


Case study
Case Study other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • DW is a 38 year old female who you noticed looks very tense lately. She nervously laughs, talks rapidly and does not hold eye contact. She also looks fatigued and has been gaining weight.

  • How do you start the conversation?


B other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

B = Background

  • What is going on in your life?

    Reveals what is going on with the patient

    Do not ask “what is new” or stressful. If they respond “the same old thing” or “nothing” go on to “A”.


A other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

A = Affect (the feeling state)

  • “How do you feel about that?”

  • “How does that make you feel?”

  • “What is your mood?”

    Allows the patient to report their current state of feeling as they are often not in touch with their emotional responses. Expression is highly therapeutic.


T other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

T = Trouble

  • “What about the situation troubles you the most?”

    Most important question! Helps you and the patient to focus on the subjective meaning of the situation. May be an “aha” moment for patient.


H other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

H = Handling

  • “How are you handling that?”

    Gives an assessment of functioning:

    destructive behavior

    helps patients to get in touch with answers they already have, but are not aware of


E other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

E = Empathy

  • “That must be very difficult for you”

    Legitimizes the patient’s reaction

    Provides acceptance that their response is reasonable under the circumstances.


Benefits of bathe
Benefits of BATHE other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • Patient feels supported

  • Enables you to identify:

    • Depression

    • Anxiety

    • Other disturbing

      symptoms


Best time to bathe
Best time to BATHE other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • Early in your contact with patient

  • Provides time for interventions:

    referral

    social worker

    classes

    medications

    other therapy


Three step problem solving
Three Step Problem Solving other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

  • What are you feeling? (label the actual feeling)

  • What do you want? (specifically state your goal)

  • What can you do about it? (focus on what you can control)


Patient in the Driver Seat other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

Sends the message you care

Sends message they are capable of handling their situation

Help engage patient in problem solving: they will become aware they have some control over the circumstances of their lives


Patient s ability
Patient’s Ability other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

They have demonstrated the ability to survive

They are responsible

They can leave a bad situation

They can change a bad situation

They can accept it as it is

They can interpret it differently


Resist Giving Advice!!! other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be."   F.N.

Less effective

and

does not empower them



Case study1
Case Study wellness.

  • DW states: “I’m working full time, and in school part-time. I can’t sleep, in fact, I take Lunesta…two pills every night and it doesn’t work anymore. I get maybe 2 hours of sleep every night. My sister calls me all the time and my brother is not taking care of my dad, who has Alzheimer’s. He is his live in care taker and I find dad dirty, hasn’t eaten, he (dad) sometimes shows up at my work disoriented and I probably need to report my brother for neglect.