Did you bathe
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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?

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Did you bathe

Did You BATHE?

Tools for Effective Communication

by

Robyn L. Mendoza RN, MSN, FNPs


Did you bathe

"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....


Did you bathe

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:

  • Environmental

  • Manipulation

  • Nutrition

  • Conservation of Patient Energy.

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


Did you bathe

Florence also tells us what nursing is not:

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


Did you bathe

Nurse’s Additional Role

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

  • 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

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

Facial expressions:

  • Frown: displeasure, unhappiness

  • Smile: friendliness, happiness

  • Raised eyebrows: disbelief, amazement

  • Narrowed eyes: anger

  • Blushing: embarrassment


Eye contact

Eye Contact

  • Glancing: lack of interest

  • Steady: active listening, interest or seduction


Hand and arm gestures

Hand and Arm Gestures

  • 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


Did you bathe

BATHE-ING the Patient


Case study

Case Study

  • 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?


Did you bathe

B

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”.


Did you bathe

A

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.


Did you bathe

T

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.


Did you bathe

H

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


Did you bathe

E

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

  • Patient feels supported

  • Enables you to identify:

    • Depression

    • Anxiety

    • Other disturbing

      symptoms


Best time to bathe

Best time to BATHE

  • 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

  • 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)


Did you bathe

Patient in the Driver Seat

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

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


Did you bathe

Resist Giving Advice!!!

Less effective

and

does not empower them


Nurses continue to light the way to patient health and wellness

Nurses continue to light the way to patient health and wellness.


Case study1

Case Study

  • 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.


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