all right y'all [Music] so so [Music] so so communication what does communication mean to you think about communication just in general communication ation nonverbal talking right acknowledging information so communication the purpose of communication is for us to elicit a respon and or obtain information right so I am eliciting a response from you and you are here to obtain information me ultimately that is what the purpose of communication is so how does this affect nursing right communication is very powerful therapeutic tool n has to be a powerful therapeutic tool in nursing and all to be effective with the patients right so what is therapeutic what does that mean are we like Angry are we happy are we sad what are we doing in a therapeutic relationship with the patient relaxed comfortable how do we make the patience feel in a therapeutic relationship and communic like you they trust you absolutely trust is the big one empath empathy is definitely a big one right so all those things that you P out that's support of a therapeutic communication which is what we do in nursing right we have to build a therapeutic uh communication with the patient so that way they trust us because if they don't trust us in nursing right to communicate with them honestly open right then that establishes a relationship for mistrust and right then now they're not going to believe what you're telling them when you're communicating with them so communication is the key to successful nursing right is used is a critical skill used in nursing to convey empathy caring concern and it provides Optimum care for the patient right when we talk to the patient we show how we communicate with them uh we show how we care for them by communicating the way the style that we communicate with them it's all a form and or a skill of nursing for this read happen with that miscommunication right so the mom thought she was being so endearing and so loving to send her son this text message because his aunt passed away and she said LOL and he's like why are you laughing and she's like I thought that meant lots of love no right so that miscommunication you have to be mindful of when you're communicating how you're communicating and ensure that the type of communication is for the person right because some people don't know what acronyms mean some people may not understand how you're communicating so we have to ensure that the way we're communicating with patients is at their level and a way that they can understand the nursing practice and communication it is a dynamic process used to gather assessment data right when we get report from the nurses the off-going nurses or when we get report from another unit um when we see the patient when we doing an admission interview or an assessment interview to teach the patient right so when we talk to the patients we're communicating we have to teach them at their level collaborating with other Healthcare professionals on different units different disciplines respiratory Cas Canin other doctors right so this is our collaboration advocated for the client how the patient how can you advocate for the patient by communicating what do you do what is advocacy being their voice right speaking up for the patient so if you don't know how to communicate effectively with the other collaborating team members then you may not be a good advocate for the patient because the purpose for us is to ensure that this patient is one alive on your shift you have 12 hours 8 hours whatever your shift is 16 and the purpose for you being at work that day is to ensure that this patient remains alive while in your care and you are advocating for this patient at that time right expressing caring a big one we have to show caring concern empathy we're not just cold right some people are but we don't in nurs and we don't expect to be cold angry upset when we walk into a patient room whatever you have going on you have to leave that out the door you into that patient's room and you are there to express caring concern empathy and care for that patient as best you can and then providing Comfort right because people are in the hospital they don't want to be there is that because they have to be and if you go in that room and you're like oh you want to pay medicine again I don't want to be because I have to be here I'm here because of because I want to be here I'm here because I have to be here I'm here because I need to get better to go home and you making me feel like I'm a burden doesn't help me be here right so showing care and comfort concern communication defined it is any needs of sending and receiving information or feelings between two or more people it is the basic component of nursing it can be used by using sounds words facial expressions gestures right I talk with my hand so this is a gesture body movement written symbol and behavior all of those are basic components of communication so communication is a process who's the sender in this room I'm the sender right I'm the sender I am sending you a message you are the receiver of this message that I am sending to you and then you provide feedback to me right so the purpose of communication the process so the sender I send an encoded message communication lecture to you you then break down this encoded message communication you're going home to study and then you provide feedback applied to the exam right so that is the purpose of communication when I talk to you or when you talk to somebody you are sending them a message they process it break it down and then they respond whatever that response is uhhuh yes okay yes I don't understand it I do understand that whatever the case is but there a process to receive the messenger send a message you receive it and respond back the modes of communication have verbal nonverbal and electronic what's ver right I'm up here now we talk compation we talk back verbally we are communicating it's uses spoken word or written word as well your nonverbal your body language right how you're sitting with the patient if you have your arms crossed or not if you have your legs person not if you're moving your hands if you're fidgeting this is your nonverbal communication so you're communicating with the patient and guess what they're paying attention to your nonverbal language most people look at your facial expressions like nobody hear because I know everybody's ready to learn this communication leure but if you're just looking at your instructor like I'm to get out here you in your phone your fidget and you just not paying attention that's your non-verbal language and you supposed to read into that such as the if you're in the patient's room and you're communicating with them and they're fidgeting or maybe they're looking out to the sky or maybe their head is low you're like are they depress can they hear me what's going on right so you're supposed to pay attention to the nonverbal language because it sometimes speaks ler than the verbal communication right some people that's in a relationship that say well I love you but your actions don't show it you hear that right so it's the same thing and then electronic this is any form of things that are being sent Electronics so um text messages emails um any other EHR electronic health Breakers that are sent via electronic method so verbal communication this is conscious and purposeful right I am consciously and purposely up here communicating with you to give you this lecture it includes your pace and intonation which is your rate see which is speaking your and the tone if I got up here and I was kind of softspoken and kind of shy and timid and you be like I can't hear a word she this don't make no sense she is talking about communication right so this is your pace and ination rate Rhythm and tone how fast you speak with the patient do you want to sit with a patient and Jibber all all everything within a minute it's so fast some people wouldn't grasp that right so make sure that you include make sure that you include their culture their age education um and the socioeconomic status when you're communicating with them their culture some people may not want you to look at them eyes to eye right in American culture it's customary that we look people in their eyes when we're communicating with them so we know you're paying attention if I like eye contact with you I'm talking to you don't dare at the person in the because it's just weird right just stare you break eye contact at some point right so don't just stare at him but break eye contact and other cultures they may not want you to make eye contact that is their cultural preference as well as age so you're going to tell somebody that's five you got a go versus somebody that's 35 you got a like I am 35 years old I don't use the restroom right so make sure that you apply their age to the conversation educational status somebody who has a third grade education versus somebody who has a PHD you think that you're going to speak to that same person the same way no right the person who has a third grade education you're going to go in there and say oh well you have hypertension they say no I don't I have high blood pressure you're right I have you have high blood pressure right so be mindful of how you speaking to the person and then with your vocabulary avoid medical terms use Simple age appropriate terms right and then appropriate terms as in high blood pressure as I stated if you have diabetes mtis know don't I have high sugar right most people say that I got sugar what do you mean you got sugar okay she did have sugar this morning but you have diabetes as well so then you educate is that's your time to educate them because most of them they don't know the difference right they say oh I have sugar same thing or they'll say the A1C is there a blood sugar that you took no there two different things right till you have to educate them Clarity and stand precisely what is meant be direct be free and annunciate words clearly be direct be free and annunciate your words so how many people have you heard um IND young boy I example because that little boy I can understand that a word he says it is horrible it sounds like he's talking under his breath and it just don't make no sense don't go in your patient room talking like that right speak loudly well in a tone of voice that they can hear and annunciate and pronunciate your words so your patients can understand what you're saying to them time and relevance communication should be effective when the patient expresses interest so let's just say your patient got um just got out of surgery and they're in posttop and they're supposed to go home because it's outpatient surgery but they still look a little briy is that the time for you to go and say okay well it's time for you to go home you ready for your discharge instructions probably not right this person is still under anesthesia you may want to wait another hour to a periodically check on the patient to ensure that they're ready to learn credibility be consistent with your care your communication be dependable and honest we don't know how many times you've going into it'll be all right some right or you say oh I'll be back in 30 minutes knowing you about to go to lunch and you're not back in that patient room right so be honest with the patient tell them I'm not coming back in 30 minutes I'm about to go to lunch but there's somebody else that'll come back in if you need me I'll be back in in two hours right because that establishes trust for the patient and then humor this can be positive and Powerful with hair hence with hair highlight all of that right because your humor it may not be funny to somebody else so if you come in the room and I don't know you and you have a joke about black people and I don't know you it's not F to me you come in the room you have a joke about white people it's not funny because I don't know you and I don't joke with you like that right so be mindful of your humor because it matters to certain people some people may not care but you don't know the patients you don't know if they mind you having a joke with them or not so be mindful of humor all right nonverbal commun communication so your personal appearance this communication physical wellbeing personality social status religion and culture so your personal appearance right if anybody would come in here me with your head to shovel um close the mask wrinkle everything what in the world is going on what she want probably I got three kids eight months six years old so maybe but I try to get it together right so your personal appearance or if you see somebody whose shoulders are hung low whose head is down you think they what depressed right probably that the depressed right so the personal appearance your posture and gate the way people walk and carry themselves can give Clues to and to Attitudes emotions physical wellbeing and self-concept right you heard of the words own the room right when you walk in you own the room by the way that you walk in the room because you just capture people's attention same thing when you walk in that patient's room you want to own the room because I am the nurse here I am here with you for 12 hours I'm going to take care of you my posture and gate is erect my head is straight and I'm going to take care of you I know what I'm doing because I was taught what to do facial expressions they communicate Joy anger sadness shock concern or fear and again be careful with that eye contact your facial expression some people say I where my emotions you think I may not say it but you can see it all on my face be mindful of your facial expressions right I know the patient stinks it stinks in here but you have to try to smile through it because the patient does not want to see you frowning while changing the diaper because they ultimately don't want you to change that diaper but they need you to change that diaper but they don't need youing like oh my I get it go out get you some coffee bean all right so your facial expressions be mindful your gestures they offer emphasis they punctuate clarify the spoken word and they may stand alone so your gestures how you're moving your hand movements um any other gestures and then touch empathy right the patient in the room crying you don't have to say anything just put your hand on their shoulder they know you there caring concern and encouragement 7% of uh words 7% of communication is transmitted by words 38% is presented by vocal cues right the tone The Voice the RM and then 55% of that is by your body language so most of what people hear with communication or see with Comm is through your body language how they see you how you present yourself right so they're looking at that electronic advantages fast efficient convenience aing medications is what it's used for as well and reminding patients of appointment so that's some advantages of it disadvantages confidentiality why would that be a problem right we don't know as many hackers have nowadays that they hacking into this they've hacked into that you've probably got an email that they've hacked into all kinds of stuff and the confidentiality of the patient's information is at risk potential misuse of information right sharing the patient information somebody else maybe trying to take a screenshots of something social economic status this patient who may be homeless or somebody who don't have a cell phone or email access right so socioeconomic I can't afford aell I can't get internet on that cell phone this cell phone is just us to di that's it unable to communicate tone what is the worst thing that you can do in the email old cap do not in your life ever old cap me because I feel like it's a problem and I feel like you got a problem with me right all C and an email and several exclamation points that is a problem you are yelling at me and I need to know why because I feel like you got a problem right so unable to communicate your tone you might just be excited by saying that but I don't know know that electronic mode right all I know is that you old caps me and in the digital world old caps mean that you are yelling at me and it's a distraction right if you ain't pun your head down and your instructors talking to you and you're in your phone you're not paying attention if you in lecture and you in your phone you're not paying attention and you don't have to right so factors that influence communication developmental so you want to know the patient developmental stage 18 ver 35 65 right because a 18 year old you cannot communicate with that person as the say you will communicate with a 65 year old who devel two different developmental States they will not communicate the same ideally would not communicate the same gender use a Pati State and name what they say their name is that is what it is if he is him is Kim that is what you call him if he wants to be Kim you'll call him Kim and his pronouns is she her and whatever else he chooses to be right we cannot allow our personal beliefs to affect the care that we give to somebody else so whatever they're stated gender name is that's what you have to call them personal space so this is the distance that people allow or feel comfortable with with talking to people right so in this setting right we're not in a personal setting at this moment moment this is more of a social setting you have an intimate setting right your intimate setting if I went up to him and I'm talking to him like this and I'm like you see what he just did he backed up because it's too close so your intimate setting is within 18 inches of somebody this is we are going to communicate very sensitive information right patient got a cancer diagnosis you want to be way back here the patient well your prob is that you're going to die in the next three months exactly how sensitive is that rather you go sit down next to them have an intimate conversation and say this is your prosis I know it's called understand whatever so your empathy and caring within 18 in is your intimate space your personal space is 18 in to 4T right so we're now in a personal space so this is our personal space with me him within 4 feet he's more comfortable because if you get too close most people going to do that right all your too close to me and I don't want to smell your breath that close if I can smell your breath a little too close right so your social is 4et to 12 feet this is this setting right we we're ideally not close enough to touch each other but in this setting for y'all close enough to touch each other and then public 129 your concerts big conventions or anything like that so your intimate is within 18 Ines your personal 18 inches to four feet your public um your social rather is four feet to 12 feet and your public is 12et in beyond your roles in relationship right so your roles in relationship the new patient versus a repeat offender right somebody that comes in frequent or we call him a frequent Li right this is a repeat offender who's there every week oh there goes Mr Joe again he coming in for his pain medicine there go Mr Joe and you can joke with Mr Joe Mr Joe you back for your pain medicine yeah I'm back for my pain medicine you know Mr Jo firstus Mr Johnson you don't know Mr Johnson Mr Johnson why you here again what you me you don't know me you don't know why I'm here you may have some name but this is your first time taking care of me and you don't know me just because you looked at my chart that doesn't even me know me right so you can't joke with me like you joke with Mr Joe because you don't know me and you don't know the role that I have in this relationship and then your environment making sure that the environment is set the temperature right if there's distraction there's noise anything that's going to be a distraction to you and the patient for the patient to rece receive the information that you are delivering right so make sure that it's not too cold that it's not too hot that the temperature is right that there's no distractions right most older people um they want to watch prices right the stories if it's on TV I can guarantee you they're not paying attention to you so avoid the distraction and then territorial who territorial anybody SE anybody in hospital territorial with the i so what type of patient have you seen I got one specific group that I've seen territory homeless right homeless almost every homeless patient that I've come into contact with in the hospital is very territorial of their belongings of the food and anything else that's brought in their room and maybe because they're homeless right and this is all that they have this is what they feel like I need to hard this I need to keep this so I have a tendency and I teach my students clean the room this is the room is meth we not going into met and just going gra and like no wait that's mine don't touch that I need that and I'm sorry do you want this can I no keep it okay let me just straighten it up for you because I can't think in CL too dirty I need to clean up so be mindful of somebody this territorial right most homeless patients that I've encountered a territorial of their belongings so can I throw this way can I move this around do you need this right now okay you don't need let's put it in the bag so be mindful of that and there there social cultural factors right so this means that the social culture what is a cultureal preference right do you want to be touched do you want a female versus a male you want to do eye contact they may not tell you but if they look nervous if they not make an eye contact don't think that it's your shoe maybe it's that cultural practice I don't want you to touch me I don't want a male doctor I don't want a female nurse right it's their cultural preference and it's not personal issues that this is what we do within our culture any questions soate is within 18 in Intimate within 18 in personal space is 18 in to 4T social 4T to 12T and public is 12T and Beyond the sender and receiver so communication process I am the sender you I am sending you a message so the send the person that's currently talking is send sending a message that message is been sent to you for you to decode or break that message down and provide feedback so the me the sender sends a message the receiver gets the message breaks the information down and then responds so the types of communicating that we have you have aggressive right right you have these people they focus on their own needs it it's all about me me me look at me look at me look at me I an aggressive person I need you to focus on me I don't mind getting to an off that's just who I am right I don't mind resorting to violence because well I'm aggressive I don't mind you taking the blame because I'm not going to accept the blame because well it's your fault not mine I want to say well I want to be in control I need to win they try to dominate and they may try to blame are criticize other people these are aggressive people these are aggressive communicators your passive communicators they focus on other people they're very passive they're very timid they hide their feelings they avoid confrontation or conflict they may have a timid posture shoulders hanging down right they may not make eye contact they're indecisive apologetic or overly apologetic the're wiers right oh I'm so sorry I didn't mean to and it's like how many time somebody apologizing for you you know what just stop apologizing just don't do it all just don't do it right so that your passive communicator and then your passive aggressive Communicator they avoid direct confrontation right they don't want the direct confrontation but they don't mind the confrontation but I don't want to do it directly so what I'm going do is I'm G manipulate you to get you to do what I want you to do right so that's your aggressive passive aggressive I'm going to manipulate you to do what I want you to do and to get you to say what I want you to say because I don't want the direct confrontation but I want to wrong the about way of getting you to do that your assertive communicators so this person this is what everybody should have uh strive to be they declare and affirm so they say this is the most productive Communicator they stand up for themselves while remaining open to new ideas and respecting other people's opinion so they say oh well I'm going to use this cuss I am uncomfort I am concerned C I am concerned I am uncomfortable this is unsafe I am concerned I am uncomfortable this is unsafe they may use eye statements right they say I you know what it's not TR me that's the form of passive aggressiveness as well but they use eye statement right they say you know what next time I'm going to show you right maybe I didn't teach you how to do that correctly so it's not you it's me let me show you how to do it correctly so that's in St of Communicator they have a professional composure eye statements like I said to express the feelings versus if somebody tells you in princi you didn't do this right do you feel a Tex versus say you know what I see that you didn't do it right but maybe I didn't teach you the right way to do it so let's revisit it to do it the right way right it's a different way as he still did wrong he just communicated it better right and then that's the way you should do be in relationship it's not true it's me let me see how I can make this relationship better they focus on the issue so they're not saying that it's not true they're not saying that there's not an issue but let's let's see how we can come to a common ground to fix the problem they have effective nonverbal language which means that body language matches what they're saying their arms are not crossed while smiling at you and say oh I like you really your body language is giving me off a different vibe they have positive responses I really would appreciate if you could help me do this versus you need to do this I really would appreciate if you could do this now there are times when an Asser person may need to do this but that may be an emergency situation right or whatever the case is it's not offensive it's just that at this time I can't speak to you in that manner they accept criticism it was my fault I did it my bad how can we fix it just accept person I know some men most my husband don't accept it right you was wrong just a minute they keep it moving accept it keep it moving apologize that's all we want that's all women want accept it apologize and keep moving and then workable compromise how can we come together for a common goal to get this done oh you can't come to work at 4 well I can't come till 6 okay maybe come at five you miss an hour I'm coming an hour early and that's a workable compromise and then they think before speaking because how many times you heard somebody what comes up comes out I say whatever's on my mind well sometimes you just shouldn't right because one you don't know when what you're saying to somebody's GNA push them over the edge right you don't know how that person's feeling and there's better ways to say things you stupid really verus you know what that wasn't a good response but let's see if there's better answer to that same concept it's just that I'm not telling you you're stupid right so think before you speak any questions about this communicators types of communicators so communication in the nursing process so identify impairments to communication you have language deficits sensory deficits cognitive impairment and life Spain you want to assess to be sure to evaluate how the patient will communicate with you and look for communication barriers so when you're getting all of your assessment data right you're getting report looking at the patient sh you're getting all of your assessment data and you're saying okay this patient had a Str will they communicate can they communicate do they have a fasia expressive a phasia meaning that they can express themselves you want to collect the data communicate to be a report with the patient to put the patient at ease nonverbal cues are important consider their culture we're thinking about verbal and nonverbal communication language deficit do they speak a different language is English their second language right because it may be that this person they speak Spanish that's their primary language and they speak some English and you think that they're hearing what you're saying when really is choppy in their mind I don't know what that means I'm not going to say anything well I don't know what that means because well English is not my first language so consider their language barrier any sensory deficits are they de did they look at you when a door open right because most people if they hearing door open or something open the automatic response is to look to see who's coming in so did they look if they didn't look are they able to hear are they following you with their eyes as you're walking through the room right if not maybe they can't see maybe they have glaucoma maybe their peripheral vision is all so you want to consider all of that as well and then cognitive things like a stroke if you have a traumatic brain injury do they have dementia and physical emotional and environmental factors if they're hungry how many people get hangry I get hry it takes too long I get hangry like I don't want to talk and not only hangry I get sleepy angry if I am tired I am angry like I just want to go to sleep that is it right so consider that physical emotional and environmental factors if they're hungry if they're in pain they're not going to want to communicate nausea the nauseous or the noise level right is it too loud in the room is it uh any distraction that distractions that's allow not allowing you to communicate effectively and always the level of education and the socioeconomic Factor always always always consider that so we analyze nursing diagnosis this is impaired communication or communication and Readiness for enhanced communication so when you assess and gather data right this is your an assess diagnose plan Implement and evaluate you'll get that next week in clinical decision making with every concept you have an adod attached so you assess you diagnose you plan you implement and you evaluate first step is this where we've gathered all of our data and ready to go in this patient room now we're going to come up to a nursing diagnosis based on the data that we've collected this patient has impair communication so what's the defining characteristics this is basically saying based on the assessment data what we deemed to be a nursing diagnosis is defined by difficult words so patient has impaired communication defined by difficulty forming words you have your nursing diagnosis and it always has to have a defining characteristic so impair oral communication inability to articulate words right that is a defining characteristic Readiness for enhanced communication defined by lacking skills in attending listening or self-expression or Readiness for enhanced communication difficulty with comprehension so again your assessment data leads to your nursing diagnosis and then your defining characteristics there can be other things that can lead to communication problems or a diagnosis anxiety right if somebody's nervous they may fumble over their words or speak too fast uh social isolation does not allow them to communicate effectively in effective hope and right is they not grieving properly that can affect that our communication compromise family coping powerlessness if they feel like in a relationship that they've had outside of the hospital that they were inferior and they were timid they may not know how to communicate with you and speak up for themselves right so that's a form of impaired communication or impaired oral communication and then once you go from your assessment your data um your assessment information your diagnosis now you're going to plan right so set goals and determine expected outcome they should be specific and measurable so this means to you that any patient that you have you want to set goals whenever they come in the hospital it's always planed for discharge so your information should be specific smart specific measurable attainable realistic and time specific measurable attainable realistic and time any goals that you set for the patient they have to have those five criteria right so that means that you're saying something very specific patient will use alternative methods of communication to help the patient Express their thoughts and feelings by day three post stroke it's specific it's measurable because we said by day three it's attainable right attainable basically means that can this patient Reach This goal or if you're Say by post up day one patient will have a pain of zero is that obtainable probably not post up day one right so you need to make sure it's attainable and realistic patient will have um pain of five by post update one and by post upd three patient will be able to ambulate with the pain of to right so you see has specific measurable attainable realistic and time you have to be able to measure it because if you can't measure it time to time then how do you know the goal you met how do you know you need to change anything right set your priorities with your goals always what is the priority goal for this patient and then utilize teamwork and collaborations interpreter a speech therapist um anything to help that patient be able to communicate better with you and then after that so you assessed you diagnosed you plan and now you are ready to implement your plan so utilize therapeutic communication techniques adjust the environment Provide support employ measures to enhance communication and educate the patient in the family so maybe you need to make the environment quiet turn the TV off limited distractions ask them to put their phone down adequate lighting is it too dark maybe the bedside uh lighting is not enough maybe support be mind mindful of their body language ask an open-ended questions using pictures of Bo to communicate with the patient so implementation you've assessed you diagnos you plan and based on that plan and now you're ready to implement the things that you plan for this station and then lastly you want to evaluate so everything you've done leads up to an evaluation anything that you implemented in nursing anything does not matter what it is if you implemented it if you did it if you did an intervention you have to evaluate that so the nurse and patient determines if goals and expected outcomes have been met has this patient been able to meet this goal by post3 has this patient been able to meet this goal by the end of the day or whatever you chose your implementation to go to be EV the interventions were effective and if they weren't modify that's it we're not going to change anything we're just going to modify it to the patient maybe we need to step back maybe we need to see if the patient will have ambulate with the pain of eight instead of two right so modify if the goal we're not any questions about the nursing process Nur process you're going to use the nursing process in all of Nursing so communication therapeutic and non-therapeutic communication opportunity is missed by most people because it is dressed in overalls and looks like work so on that note we're going to take a break heretic communication therapeutic and non therapeutic communication techniques therapeutic communication it should be interactive involving the patient right this is the most effective form of communication you should strive for communication to be therapeutic so what does that mean to you therapeutic empathy right showing care concern understanding right your tone of voice all those things that we talking about attentively listening actively listening right not in your phone while talking to the patients not writing on the board while talking to the patient or maybe you're doing something stting an i and you're talking to the patient and you may miss something right so show ensuring that you are paying attention effectively attentively listening and paying to the paying attention so therapeutic communication if I say oh your hair is cute somebody ask you or do you like my you say it's all right it's all right you or that's not really for me right so you want to be mindful of your therapeutic communication so there's a table in your book and it have some open-ended questions that you can use for good therapeutic communication so would be tell me how you feel right because we want to elit their response from the patient tell me how you feel oh I don't feel that good but do you feel bad that's the Clos in right so that's just one answer no yes Clos in questions so you're going to give me one response or a limited response and it does not allow room for the patient to express how they feel so you want to strive for open in question tell me how you feel where would you like to begin and then what happens tell me more about that right those are open and question so using silence giving them time to collect their thoughts you said a bunch give them time to process it respond and then carry on clarifying see if the patient interprets the message or information correctly I am not sure I understand would you tell me more right so that's allowing them to clarify focusing helping the patient to um to focus and expand on their decisions right so they're just rambling on and rambling on and then you say you know what all of that's important but let's focus on this right I understand we're going to get to that but right now we're going to focus on this so having them to focus on one topic versus coming in yeah well my head was hurt my knee was hurt my ear was hurt and then the other night I had this pain in my knee but you know I have arthritis and when that arthritis come you know oh AR when it gets cold a whole lot you just say however let's focus on while you're here you came in for a headache your blood pressure was 190 over 100 let's focus on that right now we'll get to all the other stuff so helping them to focus and then paraphrasing restating what the person said so if I if you tell me something I'm going to restate what you said in my own words so if somebody says I have a hard time studying with my kids at home so what I'm hearing you saying is you are having a difficult time managing studying and spending time with your kids typically that's the problem right you got a three-year-old threey old want attention the school requires attention what you going to do and more than likely your three-year-old is because you can't s your three-year-old all to the side to study not going to happen right so that's a difficult decision so being therapeutic providing information that is relevant to the patient right don't going and give this patient all this information about how to eat that right now that's not important what's relevant is let's get your blood pressure down let's get this medications so you can take it so we can get your blood pressure down and then we'll revisit everything else sharing observation right if their patient is viting maybe you mentioned their husband and they look down or they you know got nervous so you notice that they kind of shifted a little bit right sharing an observation of how their body language oh I noticed that when I mentioned your husband you got a little you know you shifted you got te ey there something going on tell me more about that right so you want to make make sure you share those observations oh I noticed that when you speak about this you get excited does that make you happy tell me more about it so sharing your observation about what you see when you're with that patient and then summarizing and planning so in summary this is what we discuss and this is the plan that we have moving forward any questions about therapeutic communication so you want to make sure open any questions using silence clarifying focusing par phasing providing information sharing observation summarizing plan and then non therapeutic anden is listening right we talked about that a bunch on cell phone cell phone cell phone you go in the patient room and nurses they'll have their um cell phone are they on the work phone are they're writing on the board and not paying attention to patient in in attentive listening personal questions it is not your business who that baby daddy is it is not your business they got to this point well how in the world did you let your blood pressure get this High yes it is your business but that is a different way that you can ACC that as more of a personal question versus eliciting information to understand how to got to that point approval or disapprove should I have this weight loss surgery well I think you should because it's not your it's not your place say you should or shouldn't you offer information that is factual these are the signs and symptoms that you will see now here you go to make an informed decision but we cannot offer approval or disapproval automatic responses but I would know tell somebody knowing this situation so I'm just going to say no well we can't everything is not an absolute nursing everything is not an absolute and medical care so we can't apply all responses in that situation to all people and false reassuring it'll be okay you'll be fine or this person just got a cancer diagnosis and you say it'll be okay to who for you for you maybe but I just got this cancer diagnosis and I don't know if it's going to be okay I had a patient who had one and he just um the doctor said that the prognosis was good and he was like well I just I'm depressed like you know I just got this cancer diag lung cancer and you know it's depressing it's understandable right so nobody wants a cancer diagnosis at the end of the day for most people a cancer diagnosis is a Deb so when you got that like I'm depressed the worst thing you can tell somebody in that moment is it'll be okay because you don't know that's offering urance more than like you can say you know I understand or maybe you say you know I know it's difficult to hear but let's try to focus on getting you better and see what we can do to get you through this right you're not offering folks reassurance and you're hopefully giving them hope because that's ultimately what they want is Hope without giving them F reassurance asking for explanation questions that that tells them that you are mistrust right I don't trust what you're telling me what do you mean you did that well why didn't you take so what are you saying why didn't you do this that's mistrust so you don't trust what I'm saying while the nurses last night they didn't do this well I know my nurses wouldn't do that what what you mean saying I'm lying well I just know my nurses wouldn't do that but I'm telling you what they did and this is how I feel arguing again that's going back so you telling me I didn't give you a pain medicine I know I gave you a pain medicine you didn't give me you are arguing you're not arguing with the patient and becoming defensive right we don't want to be defensive with the patients because again this is this mistrust and this makes the patient become non defensive with you as well so phases of a therapeutic relationship this is the pre-interaction phase before meeting the patient so your pre- interaction for this class was you went to canvas you got the information you needed you read ahead if you needed to if you wanted to if you felt like you needed to and then you came to class okay that's those years this is a lecture enjy don't enj whatever free interaction phase so this is when you gather information you review it prior to meeting the patient gather the information this is done through report this is done when you are uh looking at the patient's CH any form of assessment data Gathering your introductory phase or your orientation phase this is when the nurse and the patient meet for the first time and set the tone for the relationship you walk into the patient's room and just went there andot on the board and get acknowledge the patient that set the tone for that day doing that patient Pati's like I don't really like her she just woke in here didn't say good morning didn't say anything and didn't acknowledge me being here versus me when I walk to the patient room I'm like good morning it's morning time patients upet at the moment are you turning up all these like it is 7:00 in the morning it is to early but it's morning time and I'm going to be your nurse how are you and then they change your attitude and they're happy again right so it just depends on how you set the tone for your patient for that day what you do in your first meeting for that patient determines how they will respond to you for your shift and then your working Faith the nurse communicates caring patient um patient expressing thoughts and feelings so this is the most therapeutic phase this is this means you're there for 12 hours all 12 hours this is your working phase you're working you're back and forth you're in and out you are building a rapport with this patient throughout these 12 hours and then your termination phase this is with you going into the patient's room at the end of the day okay yourse so and so is going to be your nurse tonight I'll be back tomorrow morning or I'm not going to be back tomorrow but I'll be back in 3 days if you're still here I'll come and see you if the right is not have a good night any questions about this therapetic relationship so therapeutic techniques communication techniques active listening listening with multiple senses right listening listening listening I don't know how many times you can talk about active listening but listening is very important component to communication establishing trust reading the patient by their name actively listening being assertive right that assertive communication that we talked about directly communicating being brief being concise being complete restating using your own words to summarize what you just heard right so restating so this is what I heard you say clarifying to ensure you have accurately interpreted the information so when you say you are worried what do you mean by that so when you say you have some pain for the last three days what do you mean by that when you say you're scared to go home what do you mean by that and then valida ensuring you are making the correct interpretation when you say you are worried about your diabetes do you mean you afraid you will die soon validate so this is what I hear you telling me I need you to validate what I'm telling you on what I heard you say and then your body language this is attentive to who is what is being said KN the tone of voice the rate of speech the distance from which you are at the patient the eye movement the facial expressions and the gestures all of this is included in your body language and observation so with that you have four face the patient right nobody wants to talk to somebody that's not looking at them or fa right so face the patient sitting or standing at their eye level right if somebody you're giving a diagnos are doing something and they standing and they're sitting down it is best you to sit down that ens show that the patient is comfortable it provides this practice andless the patient oh she's here she's understanding she's Fair she's the prophetic and then you're old this is when you're going to use a open posture right this is a closed body language this means you are not ready to receive arms closed folded legs closed folded that is a closed body posture that means you are not ready to receive the information first is your arm flag you're looking at the patient legs are not crossed this means that if they're crossed you don't want to really communicate first is the open body language and the patient is ready to talk to you and receive the patient that you're going to give them and then lean towards the patient if you have to communicate or there's something important so let me tell you oh Mr Joe are you sure you want to this is what happen right lean towards the patient and then keep and maintain eye contact intermittently right do not there break eye contact periodically but keep and maintain eye contact so that is your F exploring issues right so asking open ended questions open-ended questions right tell me more you want to in a response so they can tell you instead of saying um do you take your pain medication every day versus tell me how you take your med right and then they'll be able to say oh I take my pain medication three times a day prescribe once today oh really I didn't know right so making sure you allow them to explain what they're doing using silence talk about that I walk quietly with the patient allow them time to process what you said and then summarizing the convers conversation summarize what youve heard and then leave the patient with any clarifying information at that time and then some barriers asking too many questions that can make the patients feel like they're being interrogated well why did you do you sure you want to do that why did you do this asking why this suggest criticism the patient may become defensive why didn't you take a b well why did you put that on why did you do this why did you do that right that makes somebody become defensible why are you asking me so many questions it's probably going to be very next question bu your hold information this is sharing too much information at one time so fire hold information I'm just giving off information this information back to back back to back back to back back to back fire hold information I'm giving you so much information I have not allowed you time to process what you what I am what I am telling you right so that's your Fire H you don't want to Fire H because you want to give them time to process the information changing the subject inappropriately yes I understand that's important but let's focus right focus on there but if you say oh no that's not important let's go that's inappropriate failing to Pro which means that you failed to ask additional question so the patient comes in and say you know I've been depressed lately um and every time I go home I'm just kind of scared and you byass that and then they go home and their husband K them or their wife kill them right domestic violence happens all the time right because people fail to proe they just take it for a face value oh [Music] maybe not is that one time that you failed to prob ask questions tell me more so tell me more about that so what I hear you saying that you're scared to go home but tell me why what's going on how you feeling when you go home tell me how you're feeling about that expressing approval or disapproval right we don't do that because we can't do that because it's not our job to say I approve of this or disapprove of it offering advice well if I was you I would leave but you ain't so right you don't offer advice but if I was you I would take that to but you're not so we don't offer advice and then again that false reassurance well it'll be okay everything's all right we can't overfall to this stereotyping all that people don't like chicken I love chicken I love but all people right all white people may not go in the rain and get their hair wet it may not smell like a certain that people say that's not true right that's a stereotype all black people when they come into the hospital pregnant that their pain level is the 10 and they're complaining that's not true that's a stereotype and when you stereotype people that puts you at a disadvantage to properly care for that patient so you need to take whatever whatever stereotypes that you have set it to the side and go in that room and say this is a patient that I'm going to care for any stereotypes misconceptions anything that I have about I'm might leave that at the door while this homeless person didn't take a b you don't know he going in the McDonald's bathroom and taking a b you don't know that right so you cannot stereotype all people because the nurses all Nam is not definite patronizing language well you don't want toat simple as that any questions about that baras of communication therap communication any of that questions questions questions [Music] so you know there's domestic violence hotlines and then you have to probe more right we can't force them to say a talk but we have to try to set them up so there social workers as case management to see how we can help that patient in that situation but if let's say the husband is in the room or the the fending person is in the room and they don't want to talk you can ask the person to you know I have to do this you can do so they don't know or understanding um I have to do this procedure do you mind stepping out so I can do this and usually they'll be apprehensive but if you push more you have to get them out the room to make the person more comfortable to talk because more than likely if the offending person is in the room they're not going to talk open right so if you notice that they're kind of shy they're scared they looking down they're looking away and they're not speaking and use your Telltale sign is if the person is talking more than the patient then that's probably that's happening or that type of situation so prepareing for the interview prepare yourself know your purpose know why you are doing the interview reading the patient's chart obtaining data for the interview be openminded on some goals right this is what I want to get out of this interview when you go on an interview you want to have okay I'm going on this job interview this is when I want to get out I want to know the PTO I want to know the days I'm G to have on I want to know U my schedule I want to know all of this prior to leaving this meeting schedule uninterrupted time if you know you have to break from lunch at 10:30 and you schedule meeting at 10: you're going to rush through that meeting because you're trying to meet that dayline at 10:30 go to lunch right so make sure there's uninterrupted time gather necessary equipment and form anything that you need pen pen light SC whatever forms consent all of that compose yourself right making sure that you are ready for the in and then prepare the space provide privacy ask visitors to leave or ask do you mind them saying in this room make sure you know who theti is and don't assume because I did that to one patient and I was like oh that's your mom and that's my wife didn't mean it my bad sorry right so focus on the patient remove any distractions phones TVs whatever um and then sit down and talk to the patient and then prepare the patient introduce yourself call the patient by their name tell the patient what you will be doing and why you're doing it provide Comfort assess for anxiety and assess for Readiness to learn because if they're not ready to learn well they just going he anything that you did so make sure that they're ready to learn conducting the interview individualize your approach so this means that you want to base on the age soci economic status culture anything like that be culturally sensitive again some people may not want to make eye contact some cultes don't scream when they're in pain if they having a given child birth right but we can't assume that they're not in pain just because they're not screaming right so that's a cultural thing we have to be mindful and sensitive to their culture begin with Neal topics such as your address the contact person um and then more personal questions should be left for the end after you establish aort use active listening right listening with all our senses do not get caught up and note taken right if you are taking notes taking notes taking notes you may have missed that station saying that I'm scared to go home and all know Tak not and when you miss that moment you fail to probe now that patient home with this person that's potentially going to harm them pay attention to nonverbal CU Right Way fidgeting anything that's nonverbal that let you know that this patient um is bothered or concerned or maybe even excited use open-ended questions this encourages the patient to talk asking avoid asking too many questions right too many questions why questions this does not allow for the patient to be open right you want to allow the patient to elicit the information as well new to statement instead of how many children do you have tell me about your family that's a new tell me about your family avoid asking why why did you do this why did you do that why didn't you do that avoid health right we don't want to tell somebody your high blood I mean your hypertension well your high blood pressure your diabetes you say diabetes M they may not know so use the language that they use uh do not talk down to the patient gotta go p 50 years old man I'm not uh be sure the patient understands what they are saying right that's that reating clarifying validating information so be sure the patient uh understands what they are saying refocus and redirect as needed so I know that's important to you but let's focus on this right now Curve Your curiosity you did what and then what happened oh my God I can't believe it tell me more right that's your curiosity and then avoid giving advice so that is what we don't want to do we don't want to give advice we just want to give the facts and allow them to make an inform decision so collect data You observe you notice select organize interpret you use your vision smell hearing and touch this is your observation your observation for any patient on any day at any time should start from the door you're looking for any signs of um anything on the floor you're looking at the patient's overall appearance you're looking at the IVs you're looking at if they have adju equipment your observation starts at the floor uh at the door to ensure that everything is safe for you and the patient yes listening you're asking questions open Clos neutral eeding right open ended tell me more clo did you take your pain medicine this morning neutral tell me about your family leading questions don't you want to take a bath wasn't that fool good you're leading them to a response that you want them to that you want them to say and then mentally retain information and that comes with time it comes with time any questions collecting data any all right so open any questions tell me how you are feeling describe how your wife has been helping you give me an example of how you get me from Pain closing it are you feeling okay yes no who helped you at home home my husband my sister my mom my daddy what medications are you take open end versus cled again those neutral questions are very neutral tell me about your say something that want to say any questions that's what you want them to say yes no vers how do you take your M now I have to explain but they had stroke and they can't say all of that so it's still therapeutic but it just depends on the situation of that patient therapeutic communication ultimately is saying um I want to make sure that you're comfortable in this situation and we can both obtain the information that we need I communicate with you you hear what I'm saying you communicate with me I understand what you're what you're telling me and we walk away both feeling validated with how we communic so this link will not this video will not play since I'm doing a recording on PowerPoint but I will attach the links here but you can also um go to YouTube and type in this name is fatal medical errors a leading cause of death death medical errors that lead to sen events so te St because well when we're communicating when we're on the unit when you're ininal we want to be in teams and we want to work cohesively team steps is strategies and tools to enhance performance and patient safety teamwork cannot occur in the absence of a clearly defined team so the outcom of Team competency there should be a shared mental model this basically means that everybody has a common goal we're on the same page and we understand each other we share the same concept of why we are here we are all here to talk about communication Mutual trust you trust that the information that I am presenting to you is going to help you to study and hopefully get the answers right on the test team orientation when you went to clinical there was an orientation adaptability being able to adapt to certain situations like last week when y I had to have zoom lecture for clinical hated it Whatever It Is What It Is accuracy right we need to be accurate in the task that we're performing while on this team being productive meaning hold your weight on this team be productive don't let one person P more weight than the other be efficient in what you're doing and do it safely so what defines the team two or more people who interact dynamically interdependently and and adaptively toward a common and valued goal they have specific roles or functions and have a Time limited membership so this is a team to people who are who interact dynamically interdependently and adaptively toward a common and value go so the structure understanding the team structure and how multiple teams interact is critical for implementation and planning you have your performance your leadership your situation monitoring your attitude and your skills which is your Mutual support your communication so you have performance attitudes and knowledge knowledge this is your team structure so teams that perform well teams that perform well they will hold a shared meal model right meaning we are all on the same page they have clear roles and responsibilities they optimize resources they have clear value and shared Vision this is the vision for this right the vision is that everybody on team three because I am a part of te3 will pass this semester we have a shared Vision right that is the goal I have strong team leadership Le is now the uh Team right so she's going to be a strong leader for you all and represent you all well in the meetings engage and regular discipline of feedback develop a strong sense of collective trust and confidence create mechanisms to cooperate and coordinate manage and optimize performance outcomes so this is a team that perform well to some barriers is inconsistency and team membership got eight people on a team well some people just not showing up lack of time the meeting is for one hour you came 30 minutes late lack of information sharing I got the test questions I'm not sharing the test test questions with you lack of information sharing hierarchy if you feel like you're better than the tee you're probably not a part of the team being defensive well you know you can do that the right way or there's a better way well I know what I'm doing my bad go ahead and do it conventional thinking varying communication styles conflict lack of coordination and followup distractions fatigue workload misinterpretation of Fes and lack of Ro clarity so partnering with the patient strategies to involve the patient's care so you want to always involve the patient in their care it is a must that the patient is involved in their care does not matter whether they want to participate or not because of patient should always be involved include the patient in the B rounds some hospitals do it most of them are supposed to do it that basically means we're going to the patient's bedside we're talking about the care that this patient has received for the last 12 hour conduct handoff at the patient's bedtime provide patient with tools for communicating with the care team and actively enlist the patients participation so the team's responsibility listen to the patients and their families right we always have to listen to their concerns assess the patients preference regarding their involvement how involved we need you involved but how involved do you want to be in this decision making ask patients about their concern ask for their feedback what's your concern tell me how you feel give them access to relevant information the facts the details encourage patients and their families to proactively participate in patient care and then how the patient and family have responsibilities in their care as well they should provide accurate patient information withholding information is a problem like if you don't tell me everything I cannot properly treat you comply with the prescribed plan of care unless you have an issue with this voice that concern ask questions and or voice any concerns regarding the plan of care Monitor and report changes in the patience condition manage family members follow instructions of the clinical team so effective communication skills are vital for patient safety this enable team members to effective relate information and the mode by which most team step strategies and tools are communication but the importance of communication right remember we said eing cause of death and medical errors was from 1995 to 2005 any of communication was identified as a rule C for nearly 66% of all reported s event anyone does not know what senal event means it is causing harm to the patient near death or up to death so causing harm that is a sentinal event basically something has happened in the hospital that shouldn't have happened it caused harm and now ineffective communication was 66% of that cost from 2013 to 2015 ineffective communication was among the top three root causes of a uh Sentinal event so there was something that happened to me in the hospital bir transplant unit and my patient she was supposed to go home that day and like fix the CL we have to give a certain medication by a certain time so that they could have their labs in the morning by a certain time and this particular patient she was supposed to go home her daughter was in the room and I'm pulling my medication so I'm at the pixes and she called the daughter called and says hey I need to um my mom to the restroom okay I'm coming doing Med later I'm going to send another nurse in well when that nurse got to that patient was already in the restroom her and in the midst of that she cold in the midst of all of that she died she didn't die right away but days but nonetheless she died and I was just destroyed I didn't know what happened I it wait on me I went home I'm like this baby was supposed to go home like what happened what did I do wrong what could I have done differently what did I do because ultimately this lady was supposed to go home why did she not go home why did this lady die so they did a root cause analysis and found out that was really nothing that I did WR that wasn't anything that I could have done differently I answered the phone both times I told her what I was doing the first time told I'll be right in after I finished that she called again I sent another nurse in and this was just unfortunate event that happened and it weigh on so heavy right but being mindful right that if had I not answer the phone or had I not gotten another nurse to go and check on the patient and effective communication it could have been on me like but you didn't do your job you failed to communicate with the patient you failed to communicate with another nurse and now as a cause of that as a result of that rather this patient died probably still wouldn't have been my fault would have right I didn't follow steps so stands of effective communication complete communicate all relevant information should be clear convey information that is plainly understood free communicate the information in a concise manner And Timely offer and request information in appropriate time frame verify authenticity and validate or acknowledge information so it should be complete this is Advantage complete clear [Music] time mayday mayday [Music] [Applause] you hello this is [Music] the you thinking about tring to themselves he what they're thinking about I'm thinking about youing me me I want you to save me so be clear concise and complete so strategies for any questions about are very important Nur is very important for you call out take back hand off you may not do the last three but the first one you will definitely do in clinical so your situation your background assessment and recommendation this is a framework for team members to effectively communicate information to one another for your situation what is going on with the patient what is currently going on not why they came in the hospital not that they came in the hospital for a stroke but rather what is currently going on the patient has a pain 10 out of 10 um in their right leg that's the current situation they're here for a stroke but the current situation is they have pain 10 out of 10 background information what is the clinical background of context why they came in any other background information that youve been offer the doctor that's relevant to the situation they don't need to know that they had a UTI for the last three weeks right that's not relevant to this situation assessment what do you think the problem is and then recommendation what would I recommend if you don't have a recommendation what do you recommend can you so I am R the nurse taking care of Mrs Joseph in room 251 I'm calling to let you know that her she has a complaint of charlot of breath of new onset she's a 62y old female post that day one from abdominal surgery she has no prior history of cardiac Al disease her breath sounds a decrease on the right side with acknowledgement of pain uh and I would like to rule out a numo thorax I feel strongly that you should be assessed now and you come to room 21 simp as that don't have to be long and drawn out it's whatever you see and if you don't have a recommendation it's easy to say I don't know what's going on with this patient but this is not that BAS I don't know what's going on with this patient but something is not right because because something is not right it's your feeling saying that this patient is about to go B so make sure you pay attention to that something is not right if you do a good assessment you have a good Baseline IE you actually did your physical assessment when you came on the unit that morning or your first Shi the beginning of the ship you're going to be able to understand and know and see what's going on that patient with that patient I tell my students all the time if you know it's normal you can identify with but if you don't know what's normal there's no possible way to identify what's abnormal even if you don't know what's going on you still have to be able to identify that this is not a normal finding in this patient something is wrong and I don't know what it is but I need help questions about esbar call out so this is their strategy used to communicate important or critical information it informs all team members simultan anly during emergency situations which situation can you think of c a cold blue right main one it helps team members to anticipate Next Step It directs responsibility to a spe specific individual assigned to carry out the test I'm the team leader on the cold you go and give me an ID you start the ID you go and get some blood you go and push the EP in one minute I need this right this is the call out everybody should be hearing the same thing one of them is going in cold cards here this is happening that's happening everybody has to be on the same page especially in emergency situations specifically a cold blue because there's a recorder and everything has to be recorded and documented accurately so you're call out somebody said something you're calling it out loud I confirm I'm doing it your check back sender initiates a message receiver accepts the message provide feedback confirmation and it looks back to the cender verifies the message was received I needed one of that in five minutes one of be's going in five minutes heard that and then five minutes later one of's going in one of one of went in Clos Loop communication means that I'm sending that message you verify you heard it you say it back to me I verify what you say and now everybody has heard the same thing and we are happy with what we just said [Music] do something very important all right want you to run home I want you to call ER of North Bank General Hospital 932100 immediately and contact anesthesiologist isor 472 211212 an ambulance Witham crew got [Music] [Music] it's years of Nursery School you think you know it all you're still behind the it's not a subur it's epidural so here um what you're going to do is if you have somebody to partner with you're going to partner with someone if not don't worry about it because obviously this is a recording but the intent is each person needs a piece of paper and a pen can person a do not let partner B see your paper they can see your you sketching a drawing but they cannot see your paper now without looking at your partner's paper partner B describe to them how to draw the same picture this is supposed to identify closed loop Communication in addition to that what you should do if you're with a group of people is um what you're going to do is get a piece of paper and you are going to do this so you're going to fold in half horiz onally the paper tear off the top right corner of that paper fold it then in hot dog style tear off the bottom left corner of that paper fold it one more time and tear off the top left corner reveal your paper and then hopefully you got a snowflake this is just a handoff um and this shows you the transfer of information during transition and care across the Continuum so basically any person that is leaving place to place if they're going from the unit to uh CAT scan if they're going from CAT scan to the unit if they're going to um nursing home or wherever they're going whenever they are leaving out the present person's um care you are going to provide a handoff to this person and this handoff consists of the transfer of information during transitions and care across the Continuum this includes an opportunity to ask questions clarify and confirm so this basically means that when you are calling or and or resp receiving a handoff you have the opportunity to ask questions about this um patient to clarify any information received and to confirm information that you may have received um and it consists of transfer of responsibility from you or that person to uh the other person and then accountability as accountability as well so you are not responsible or accountable once you hand that patient off Clarity of information is verbal communication of information so there's no electronic transfer communication and a handoff and then there is an opportunity to review and also acknowledgement by the receiver and then this is what's typically used in the hospital so it's ey pass the Baton and so what this basically means is that in the hospital most people most facilities use iPad of baton for a handoff communication I introduce yourself patient identifier your age sex location assessment present Chief complaint Vital sign symptoms and diagnosis situation the current situation including cold status level of uncertainty recent changes and response to treatment and then safety critical lab values reports socioeconomic factors allergies and alerts and then background comorbidities previous episodes current medications and family history actions what actions were taken or will be required and give a brief ra rationale of that timing level of urgency and explicit time and prioritization of actions who is responsible for the patient included family members numbers um and then what will happen next anticipated changes for that patient what is the plan for that patient and is there a contingency plan and then lastly tools and strategies to summ in summary so this is a list of barriers that we've talked about throughout this lecture on uh barriers to communication the tools and strategies for communication are Asar call out checkback and handoff and then the outcomes of teen step is shared mental model adaptability team orientation Mutual team performance and patient safety so as stated on the previous videos um this is going to be this video will not play so it is going to be a link sent in hopefully you watch it and gather some insightful information about um Dr hatchet's uh judge hatchet's uh daughter-in-law um and then hopefully this has been informational