中医《护理学导论》课件-护理工作中的人际沟通

第七章护理工作中的人际沟通,基础护理教研室-范文静,课程内容,2,Definitionofcommunication:,信息发送者遵循一系列共同规则，凭借一定渠道，将信息发送给既定对象，并寻求反馈已达到理解的过程IterpersonalcommunicationIstheartoftransferringorexchanginginformationideasorthoughtseasilyandcorrectlythroughverbalornon-verballanguage.,人际沟通要素-Hein(1973),触发体,信道,文化背景价值观礼节习俗宗教信仰,社会因素,个性特征精神状态,心理因素,性别年龄身体状况,生理因素,SR,人际沟通的层次P173,小张是病人李女士的责任护士，李女士对小张非常信任，经常把自己心里话都告诉小张，家里的事也常请小张帮忙出主意，小张和李女士的沟通层次属于？Howareyou?Fine,thankyou,andyou?毕业时，我们彼此紧紧拥抱对方，拍拍肩膀，互道珍重。,人际沟通的主要障碍-P178,Sender缺乏沟通动机信息量超载缺乏沟通技巧不注重信息反馈编码不当,Receiver对信息不感兴趣心理障碍缺乏信息接收能力解码不当,人际沟通的基本方式,语言性沟通-P174口头书面类语言非语言性沟通-P177面容表情（眼神）身体姿势/手势（触摸）仪表空间布置/位置/距离,Typesofcommunication:,1-Verbalcommunication:Iswhatissaidandheard.*Itisthecontentofcommunication:Useanappropriatetoneofvoice.Giveverbalencouragement.Askquestions.Paraphrase.Seekclarification.,Typesofcommunication:,2-Non-verbalcommunicationIswhatisobservedandsend.*Isoftenmoreimportantthanverbalcommunicationitincludes:Paralanguage:(toneofvoice,streamoftalk).Kinesis:(allbodylanguagesandfacialmovement).Proxemies:(thedistancebetweenthesenderandthereceiver).Touch.Culturalartefacts:(thewayapersondressed,makeup).,病人王某，女，43岁，因急性胆囊炎发作被亲属搀扶走入普外科病房，痛苦面容，家属手持入院单，十分焦急，护士小王快步迎上前来，面带微笑，轻轻点了点头，说：“您好，是新入院的吧？请跟我来，我带您到病室。”然后与病人亲属共同搀扶病人来到病室安排好的床位。用手摸了摸病人的额头，又触其腕部，测了脉搏，接着又测量了体温和血压。然后，小王扶助病人躺在病床上，又帮病人盖好被子，并用亲切清晰的语言向病人介绍了医院的环境、卫生间的位置、医院的制度、护理和查房时间、探视时间等。病人痛苦的表情上勉强露出笑容，频频点头，说：”谢谢护士。”,非语言沟通的特点-P175,多渠道多功能无意识真实性情绪表现多种含义文化差异性,Environment环境,人文环境：文化背景/隐私,空气/光线噪音空间布置/距离,物理环境,护患沟通（N-PCommunication）-P183,Goalsoftherapeuticcommunication:,Establishingatherapeuticprovider-clientrelationship.Identifyclientsconcernsandproblem.Assessclientsperceptionoftheproblem.Recognizeclientsneeds.Guideclienttowardsasatisfyingandsociallyacceptablesolution.,治疗性沟通的步骤-P184,准备与计划阶段：资料、环境、时间、通知交谈开始阶段：称呼对方、自介、解释目的、帮助患者采舒适体位交谈进行阶段：提出问题（开放式、闭合式）、易懂原则语言表达技巧（安慰、鼓励、解释性、指导性、疏导性、暗示性、劝说性）非语言沟通，关注对方的表情、眼神及时反馈交谈结束阶段：根据计划适时结束、核实收集重点内容、致谢,Communicationtechniquesandskills:,TalkingTechniques:Questioningandgeneralleads.Makebroadopeningstatements.Paraphrase（阐释）,reward（鼓励）orsummarizewhathasbeensaid.Reflectfeelings.Re-stateorrepeattheclientsstatement.Clarify.Focusandre-focus.,促进有效护患沟通的技巧P180,倾听同理他人（自学）自我暴露（自学）沉默,AidstoCommunication,Activelistening积极倾听ExpressionofinterestLeaningforwardNoddingheadVerbalizationssuchas“Uh-huh/Goon”FrequentvalidationAttempttofullyunderstand,护患交谈注意事项,目的明确，寻找有价值的信息控制干扰，避免注意力分散目光接触，30%60%，10S/次，平视，部位姿势，距离/微前倾/适度表情手势及时反馈，点头/应答“哦，嗯”慎重判断，全面了解，不急于判断耐心倾听，不插话/不打断综合了解病人想法,倾听（listening）,倾听的原则聆听（耳到）观察（眼到）思考（脑到）感受（心到）询问（口到）记录（手到）,倾听的技巧参与核实复述改述澄清总结反映,ToolsforEffectivecommunication,Communicationskills:Effectiveofverbalandnon-verbalcommunication.Activelistening.Questioning.Useofsimplelanguage.Reflectingfeelings.Paraphrasing.Silence.,沉默（Silence）,Silence沉默Ifyoudontknowwhattosay,saynothingGivespatienttimetothinkGivesnursetimetothinkMayallowpatienttoexpanduponwhathewassayingorthinkofanewtopictodiscussAsanxietygrows,patientismorelikelytosaysomething,broadopening开放式提问,“Tellmewhathappened?”“Howareyoutoday?”“Wouldyoutellmemoreaboutthat?”“Whatelsemakesyoufeelthatway?”,护理工作中常见的沟通错误-P188,病人对护士说：“我明天要做胃镜检查，真不想去”此时护士最佳的反应A.“您害怕做这项检查”B.“您觉得没必要做这项检查吗？”C.“您能否告诉我您为什么不想做”D.“您一定害怕疼，不必担心，您完全可以承受”E.“您可能是怕疼，我会陪着您”F.”你的状态看上去还不错”G.”抱歉，昨天答应要给你带胃镜检查方法的宣传册，因工作忙忘记了”,Non-therapeuticCommunication,FalseReassurance（不恰当的保证）Pt.:“ImafraidIwontwakeupfromthesurgery.”Nurse:”Sureyouwill.”MinimizingfeelingsPt.:“Imquitescaredaboutthissurgery.”Nurse:”Oh,everyonefeelsthatwaybeforeanoperation.”,Barrierscont.,Givingapprovalordisapproval;beingjudgmental;agreeingordisagreeing“Iwouldntsaythat.”“Ofcourse;Iagree.”Givingadvice“IfIwereyou”“Ithinkyoushould”“Itseemstomethebestcourseofactionis”,Barrierscont.,DefendingPt.:“Thenurseswereveryslowansweringmylightlastnight.”Nurse:”Idontknowhowyoucansaythat.Thisfloorhasthebestnursesinthehospital.”,Barrierscont.,ChangingthesubjectPt.:“Ihopesomeonecomestovisitmetoday.”Nurse:”Itssuchabeautifuldaytoday.”,TheQualitiesofaGoodcommunicator:,Respectandempathyfortheclient.Goodcommunicationskills.Toleranceofvaluesa