Did You BATHE? Did You BATHE? Tools for Effective Tools for Effective Communication Communication by by Robyn L. Mendoza RN, MSN, Robyn L. Mendoza RN, MSN, FNPs FNPs
Jan 17, 2016
Did You BATHE?Did You BATHE?
Tools for Effective CommunicationTools for Effective Communicationbyby
Robyn L. Mendoza RN, MSN, FNPsRobyn L. Mendoza RN, MSN, FNPs
"The most important practical "The most important practical lesson that can be given to lesson that can be given to nurses is to teach them: nurses is to teach them:
what to observe-what to observe-how to observe-how to observe-what symptoms indicate what symptoms indicate
improvement-improvement-what the reverse-what the reverse-which are of importance-which are of importance-which are of none-which are of none-which are the evidence of which are the evidence of
neglect-neglect-and of what kind of neglect.... and of what kind of neglect....
But if you can not But if you can not get the habit of get the habit of observation one observation one way or other, you way or other, you had better give up had better give up being a nurse, for it being a nurse, for it is not your calling, is not your calling, however kind and however kind and anxious you may anxious you may be." F.N.be." F.N.
Nightingale believed nursing is Nightingale believed nursing is about:about:
Environmental Environmental ManipulationManipulation NutritionNutrition Conservation of Conservation of Patient Energy.Patient Energy.
http://www.http://www.valdostavaldosta..eduedu/nursing/history_theory//nursing/history_theory/florenceflorence.html.html
Florence also tells us Florence also tells us what nursing is what nursing is notnot: :
Nursing is not limited Nursing is not limited to, nor defined by to, nor defined by medical acts. medical acts.
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
Nurse’s Additional Role
Listening to Patients Is Part of Listening to Patients Is Part of AssessmentAssessment
Important skillImportant skill
Allows understandingAllows understanding
Shows interestShows interest
Helps to pick up clues as to what the Helps to pick up clues as to what the concerns of the patient areconcerns of the patient are
Establishes trustEstablishes trust
Common Listening ProblemsCommon Listening Problems
Attention wanders
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 CommunicationNon-Verbal Communication
Facial expressions:Facial expressions:Frown: displeasure, Frown: displeasure, unhappinessunhappinessSmile: friendliness, Smile: friendliness, happinesshappinessRaised eyebrows: Raised eyebrows: disbelief, amazementdisbelief, amazementNarrowed eyes: angerNarrowed eyes: angerBlushing: Blushing: embarrassmentembarrassment
Eye ContactEye Contact
Glancing: lack of Glancing: lack of interestinterest
Steady: active Steady: active listening, interest or listening, interest or seductionseduction
Hand and Arm GesturesHand and Arm Gestures
Pointing finger: authority, Pointing finger: authority, displeasure, lecturingdispleasure, lecturing
Folded arms: not open to Folded arms: not open to change, preparing to change, preparing to speakspeak
Arms at side: open to Arms at side: open to suggestions, relaxedsuggestions, relaxed
Hands uplifted: disbelief, Hands uplifted: disbelief, puzzlement, uncertaintypuzzlement, uncertainty
BATHE-ING the Patient
Case StudyCase Study
DW is a 38 year old female who you DW is a 38 year old female who you noticed looks very tense lately. She noticed looks very tense lately. She nervously laughs, talks rapidly and does nervously laughs, talks rapidly and does not hold eye contact. She also looks not hold eye contact. She also looks fatigued and has been gaining weight. fatigued and has been gaining weight.
How do you start the conversation?How do you start the conversation?
BB
B = BackgroundB = Background
What is What is going ongoing on in your life? in your life?
Reveals what is going on with the patientReveals what is going on with the patient
Do not ask “what is new” or stressful. If they Do not ask “what is new” or stressful. If they respond “the same old thing” or “nothing” go on respond “the same old thing” or “nothing” go on to “A”.to “A”.
AA
A = Affect (the feeling state)A = Affect (the feeling state)
““How do you How do you feelfeel about that?” about that?”““How does that make you feel?”How does that make you feel?”““What is your mood?”What is your mood?”
Allows the patient to report their current state of Allows the patient to report their current state of feeling as they are often not in touch with their feeling as they are often not in touch with their emotional responses. Expression is highly emotional responses. Expression is highly therapeutic.therapeutic.
TT
T = TroubleT = Trouble
““What about the situation What about the situation troublestroubles you the you the most?”most?”
Most important question! Helps you and the Most important question! Helps you and the patient to focus on the subjective meaning patient to focus on the subjective meaning of the situation. May be an “aha” moment of the situation. May be an “aha” moment for patient.for patient.
HH
H = HandlingH = Handling
““How are you How are you handlinghandling that?” that?”
Gives an assessment of functioning:Gives an assessment of functioning:destructive behavior destructive behavior helps patients to get in touch with answers they helps patients to get in touch with answers they already have, but are not aware ofalready have, but are not aware of
EE
E = EmpathyE = Empathy
““That must be very difficult That must be very difficult forfor you” you”
Legitimizes the patient’s reactionLegitimizes the patient’s reaction
Provides acceptance that their response is Provides acceptance that their response is reasonable under the circumstances.reasonable under the circumstances.
Benefits of BATHEBenefits of BATHE
Patient feels supportedPatient feels supported
Enables you to identify:Enables you to identify: DepressionDepression AnxietyAnxiety Other disturbing Other disturbing
symptomssymptoms
Best time to BATHEBest time to BATHE
Early in your contact with patientEarly in your contact with patient
Provides time for interventions: Provides time for interventions:
referralreferral
social workersocial worker
classesclasses
medicationsmedications
other therapyother therapy
Three Step Problem SolvingThree Step Problem Solving
What are you feeling? What are you feeling? (label the actual (label the actual feeling)feeling)
What do you want? What do you want? (specifically state your (specifically state your goal)goal)
What can you do What can you do about it? (focus on about it? (focus on what you can control)what you can control)
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 AbilityPatient’s AbilityThey have demonstrated the They have demonstrated the
ability to surviveability to survive
They are responsibleThey are responsible
They can leave a bad situationThey can leave a bad situation
They can change a bad They can change a bad situationsituation
They can accept it as it isThey can accept it as it is
They can interpret it differentlyThey can interpret it differently
Resist Giving Advice!!!
Less effective and
does not empower them
Nurses continue to light the way to Nurses continue to light the way to patient health and wellness.patient health and wellness.
Case StudyCase Study
DW states: “I’m working full time, and in school DW states: “I’m working full time, and in school part-time. I can’t sleep, in fact, I take Lunesta…part-time. I can’t sleep, in fact, I take Lunesta…two pills every night and it doesn’t work two pills every night and it doesn’t work anymore. I get maybe 2 hours of sleep every anymore. I get maybe 2 hours of sleep every night. My sister calls me all the time and my night. My sister calls me all the time and my brother is not taking care of my dad, who has brother is not taking care of my dad, who has Alzheimer’s. He is his live in care taker and I find Alzheimer’s. He is his live in care taker and I find dad dirty, hasn’t eaten, he (dad) sometimes dad dirty, hasn’t eaten, he (dad) sometimes shows up at my work disoriented and I probably shows up at my work disoriented and I probably need to report my brother for neglect.need to report my brother for neglect.