One of the most trying aspects of training professionals to work with couples using solution-focused therapy is expecting professionals to go slowly and to develop a connection with their couples before moving on. In fact, the therapist is working to uncover the positive aspects of the couple’s life, and how they were living before their problem. Lipchik calls this process listening with a constructive ear probing for evidence of strengths, resources, and past success, learning what life was like before or without the problem, what the clients want, or anything at all that can be reinforced as a positive aspect of the client’s lives going forward. Every couple comes from a past when the relationship was working much better. The therapist listens for clues about how the relationship was built to understand what worked in the past and continues to work today.
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The biomedical model is designed to assure data gathering related to the signs and symptoms of disease, this specificity requires an emphasis on getting answers to certain key questions and risks missing important information that could have been obtained by listening for more than just the biomedical information. Listening for psychological and/or sociological issues that might be affecting the patient’s condition can provide added information that may be very important to the diagnosis. The provider quickly assesses the patient, gives a brief description of what he or she has determined the cause of the problem to be, and how it will be treated. Although it is clearly a truism that providers need to collect information from patients in order to make an accurate diagnosis and treatment plan, it is just as true that the data can be gathered in an authoritarian, aloof manner or in a collaborative, caring relationship-focused approach.
Nonverbal behaviors, like computer use during a conversation, can be distracting and add noise into the communication channel. Electronic medical/health records are intended to enhance patient care, but if they interfere with the information exchange, the provider’s focus, or the patient’s perceptions of the provider, then they will not be accomplishing the intended goal. Changing the type of computer and the timing of data entry is a great way to keep the focus on the patient and still fully utilize the electronic benefits of computer documentation. Electronic records can enhance patient care, but they must be seen as a tool to enhance, not as the primary purpose for, patient information gathering. Clearly, the rush to incorporate electronic medical/health records into current health care delivery systems has created some difficulties for providers and patients.
Follow-up visits by their very nature are different from a communication perspective because they are even more a continuous relationship than a once-a-year or an acute visit. Power can be communicated in various ways, and power sharing can be illustrated through actions such as taking responsibility for helping a patient instead of minimizing the problem or passing it off to someone else. Patient gets a chance to include pertinent psychological and sociological aspects of the situation, not just the biological issues. In some cases, especially in follow-up visits where the patient and provider have previously discussed many various aspects of the patient’s illness or injury, the important consideration is that the patient is well informed and understands what the provider is thinking and why, and the patient is then empowered to make decisions about his or her treatment.
The Joint Commission of Accreditation of Healthcare Organizations (JCAHO) described a continental divide between nursing education and practice, suggesting that nurse educators are teaching to the health care environment of yesterday. This chapter proposes few ways in which narrative could become a significant aspect of undergraduate nursing education. Students need opportunities to develop skill both in soliciting from patient’s stories of their illness and in interpreting illness narratives. Public storytelling among practitioners allows for noticing distinctions and clinical learning. Ethical learning and skillful ethical comportment are based on a continued dialogue of doing better and doing worse in specific situations. Nurses in the study have an elaborate discourse on the right kind and level of involvement with patients and families. The Dreyfus Model of skill acquisition and the original study point to a far more complex version of the theory-practice relationship than the traditional assumptions and educational practices suggest.Source:
This chapter presents an interaction among the provider, the patient, and the patient’s wife. The format a phone call helps the exchange of information between the patient, the provider, the patient’s wife and the receptionist. The patient’s ability to describe his problem potentially interferes with effective communication. The provider’s communication in the scenario decreases the need for a referral. Masculine-gendered individuals tend to be more independent and less inquisitive about their care and treatment. Feminine-gendered patients frequently want to participate more in their care, discuss their problem and treatment options, and ask questions. Providers need to understand fully the patient’s complaint and assess the medical need for referral versus the need to communicate more effectively with a patient and his or her family members. This interaction provides an opportunity to assess how miscommunication and gendered communication can contribute to a problematic information sharing and also to provider-patient relationship problems as well.
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Communicating With Seriously Ill and Dying Patients, Their Families, and Their Healthcare Practitioners
When nurses communicate with their dying patients and the patients’ families, they have a clearer understanding of their patients’ needs and goals at the end of life. This chapter explores ways to encourage both nursing students and graduate nurses to facilitate communication with dying patients, their families, and their healthcare providers. It also explores ways in which nursing faculty members might assist undergraduate nursing students to enrich themselves by working with dying patients. The chapter is organized according to the phases of the therapeutic relationship because in many ways the phases of the therapeutic relationship—introductory, working, and termination—parallel the dying trajectory. When appropriate in the phases, distinctions are made between the roles and educational needs of the undergraduate nursing student, the nurse with an undergraduate degree, and the nurse with an advanced practice degree.
This chapter focuses on the social aspects of clinical and caring knowledge. Pooled expertise, dialogue, and multiple perspectives are possible because of shared taken-for-granted background habits, skills, and practices as well as differences in practical and theoretical knowledge and experience. Advanced beginner and competent nurses are engaged in experiential learning the practical manifestations of signs and symptoms. With increased experience, the nurse gives more elaborate detail closer to the patient’s own experience. The chapter presents an interview in which a neonatal critical care nurse describes her perceptual acuity in recognizing changes in infants. An excerpt illustrates the ad hoc practical reasoning required for skillfully using technical equipment. Patients in critical care units require constant vigilance. Much in skillful clinical and caring knowledge can only be exemplified by practitioners who have embodied skills and ways of being with patients.Source:
Providers have an obligation to provide the most accurate information they can to patients. The media has an ever-increasing role in health communication and part of the empowerment efforts of providers is to help patients interpret the information provided on television, online, and via print media. Providers have to serve as an education resource for patients and present diverse views, so patients can be empowered to make informed treatment decisions. For many providers, the time it takes to educate patients and present the information is very time consuming. All too often, providers fall into the trap of making the outcome of the provider-patient communication provider focused and about their knowledge and abilities and not utilize a patient-centered approach that makes the patient’s needs and goals the primary foci of the relationship. Through education, active listening, empathy, and negotiation, the provider does not dismiss but affirms the patient’s concerns and wishes.
This chapter presents an interaction between the provider and the patient’s husband. The cultural issues impact health communication and health care delivery in this conversation. There are several ethical issues related to the cultural differences between the provider and the patient/family in this interaction. Cultural differences between providers and patients can impact health communication, diagnosis, and treatment decisions. Providers need to recognize the differences in cultural values and beliefs and assess how to use communication to build a relationship and accomplish both provider’s and patient’s goals. They constantly determine what information and what physical examination tests they need to assess the patient’s complaint. Goal attainment in health care relies on successful diagnosis and treatment, which in turn requires effective communication. However, if a patient has aphasia or dementia, providers take histories from whomever they can obtain it from.