Drawing up a plan for conducting a conversation with the patient. Psychological conversation with patients as a form of psychological support

There are rules for effective communication, the application of which helps to establish a relationship between a healthcare professional and a patient. Maintain an atmosphere of trust and cooperation, create and maintain a calm, respectful and friendly atmosphere nurse can do it with a few tricks:

1. « Proper name" . The conversation with the patient begins by giving his name and patronymic, position and purpose of the conversation. The patient is also addressed by name and patronymic (if age requires it) and “you”, which contributes to the assertion of a person as a person, causes him a sense of satisfaction and is accompanied by positive emotions. You can switch to "you" only if the patient himself suggests it.

2. "Comfortable environment". The conversation with the patient is carried out, if possible, providing him with a comfortable place, taking into account the lighting, the presence of noise, furniture, room, the presence of strangers, etc. It is necessary to remember about interpersonal distance, position yourself so that the face is on the same level with the patient's face. Be sure to remind the patient of the confidentiality of the conversation.

3. Relationship mirror. The reception consists of a kind smile and a pleasant facial expression, indicating that "I am your friend." The patient has a sense of security and, as a result, positive emotions. You should be open, friendly, positive and welcoming. One should not be familiar in conversation, speak down or be dismissive.

4. "Building a Conversation" The conversation with the patient begins with emphasizing his merits and positive achievements in eliminating the health problem. It is undesirable to start a conversation with a topic that is difficult for the patient. The most exciting and sensitive issues are approached gradually. Patiently and attentively listen to the problems of the patient. It is necessary, specifying the details, to keep the conversation in the right direction. This leads to the satisfaction of one of the most important needs of any person - the need for self-affirmation, which leads to the formation of positive emotions and creates a trusting attitude of the patient.

5. « Gold words". The reception consists in expressing compliments that contribute to the effect of suggestion. You should see, understand and appreciate the dignity of the person with whom the conversation is being conducted. This is expressed in words of approval and praise. Thus, there is, as it were, an "absentee" satisfaction of the patient's need for improvement, which also leads to the formation of positive emotions in him and determines the disposition towards the medical worker.

6. "Rhetorical ability". You should speak clearly, unhurriedly, intelligibly, with the maximum manifestation of friendliness (without fawning), checking whether the interlocutor understands correctly. It is necessary to try to conduct a conversation taking into account the individual age and personality characteristics, tastes and desires of the patient. In a conversation you needwithstandpause: this provides an opportunity to observe the patient and gather his thoughts and to him and the health worker. The patient's responses are accompanied by facial expressions of affirmation or a brief "yes". If the answer to the question is inaccurate, it is repeated or formulated differently.

7. "Professional Silence" In a conversation with a patient avoid the use of medical terms. Inform the patient about therapeutic measures and expected results within the limits of professional competence. They do not require the exact name of the items of care and medicines from the patient; if necessary, they simply ask to show them. You should not expect that the patient will remember the names of employees, room numbers. If this is necessary, then the information is set out on paper and left to the patient. It is impossible to create a feeling of guilt in the patient for inaccurate implementation of instructions or recommendations. Where possible, he is given clear and specific advice and recommendations.

8. "Mutual understanding". At the end of the conversation, they clarify whether a semantic barrier has arisen.

Art of communication, knowledge psychological characteristics and the use of psychological methods are extremely necessary for specialists whose work involves constant contacts of the "person-to-person" type. The ability to build relationships with people, find an approach to them, win them over is especially necessary for medical workers. This skill is the basis of life and professional success. Both natural abilities and education are important.

Getting to know the patient

The first impression has a strong effect, stays for a long time and creates an opinion about you, so a warm greeting, a nice smile is a good start. Even if there are many other things to do in the department or clinic, the patient should clearly feel a kind and sincere disposition.
1) look the patient in the face, smile, greet the patient warmly;
2) introduce yourself, tell your name, position;
3) ask the patient's name;
4) explain the situation in the department and the role that you will play in the treatment process;
5) familiarize with the department and the medical-protective regime;
6) escort the patient to the ward, point the patient to his bed;
7) check if everything is in order on his bed, in the ward;
8) introduce the patient to his roommates.

Communication with a visually impaired patient

Algorithm of communication with a patient with visual impairment (accompaniment to ultrasound examination)
1) explain in detail the purpose and course of the study;
2) explain to the patient the preparation for the study;
3) make sure she understands you;
4) take the patient to the ultrasound room;
5) provide needed help;
6) escort to the ward.

Communication with a hearing impaired patient

Always approach from the front so that the patient can see you. Use simple words in conversation, speak loudly, clearly, but do not shout, so that the patient can follow your lips and facial expressions. Pay close attention to non-verbal means of expression. Use touch as a means of encouraging the patient to communicate. Use picture cards, diagrams, or written messages. Write neatly and without mistakes.
1) reduce background noise (close the door, window, turn off the radio, TV, etc.);
2) before talking, approach so that the patient can see you;
3) invite him to use the device;
4) explain the necessary information to the patient in an accessible form;
5) make sure that the patient understands you;
6) write the information on the sheet.

Of great importance in psychological contact with the patient is the correct communication with him.

The nurse should take the time to talk to the patient. In conversations with the patient, the nurse learns his inner world and personal problems, strengths and weaknesses of character, hobbies and interests. Also, conversations with the patient make it possible to understand his psychological attitude towards recovery, the reaction of his personality to the disease. The better the nurse knows the identity of the patient, the more effectively she will provide treatment and care. The correct conversation with the patient has not only a good psychotherapeutic effect, but also has an educational goal. He corrects mistakes in the patient's behavior, corrects his inadequate reactions to the disease. The conversation should not be intrusive and take place exactly when the patient feels the need for it. Then this conversation will bring relief.

A conversation with the patient should calm him down, relieve anxiety and fear, and reduce mental stress. But it must be remembered that an inept word can turn into a tool that destroys the patient, can deeply injure him or even worsen his somatic condition. But at the same time, a skillful word spoken at the right time, unobtrusively and according to the needs of the patient, can become a miraculous healer. The nurse must be able to communicate calmly and confidentially with the patient. It is important to own your voice, the ability to regulate its strength and shades.

Entering the ward, you need to say hello, call the patient by name, patronymic, not forgetting to introduce yourself. Many patients pay attention, first of all, to the voice of a medical worker, to his intonations (patients are auditory). For them, it will be important how they are spoken to, the timbre of the voice, its pleasant shades when taking an anamnesis. Questions to the patient should be asked correctly, clearly and clearly so that they are easy to answer. Asking questions, you need to turn the patient to those problems that interest the medical worker.

The ability to listen to the patient is also very important. This ensures good rapport during the conversation. When a patient tells a nurse about himself, about his problems, he should see in her not a passive, but an active listener. He must feel that the nurse is interested, carefully following his thought, understands him.

Non-verbal ways of communication

Non-verbal communication methods include facial expressions and gestures. The facial expression (facial expression) of a nurse when communicating with a patient is of great importance. A smile on your face always invigorates, relieves stress, calms, brings you closer. A smile is always the key to success in communication.

A serious, calm facial expression indicates an understanding of the patient's problems, interest in them. When talking with the patient, one should not frown, show emotional displeasure, impatience. A gloomy, dissatisfied, irritated facial expression repels the patient, does not allow him to open up, or even frightens. Students need to remember that a frightened, timid, surprised facial expression will also not please the patient. Therefore, it is very important to control facial expressions, not to show the patient your bad mood.

Gestures and pantomime (expressive body movements) also have a strong effect on patients. If a nurse, while communicating with a patient, impatiently taps her foot on the floor or hastily glances at her watch, this has an unfavorable impression on the patient. He understands that the nurse does not have enough time for him, in a hurry.

During communication, taking an anamnesis, you can touch the back of the patient's hand approvingly, shake his hand lightly. This will calm him down. Sometimes you can lightly touch the shoulder - this is also a calming encouraging gesture.

When communicating, talking with the patient, it is best to sit opposite to see the expression on the face, to have eye contact.

To establish a trusting relationship with the patient, at the beginning of the conversation, it is necessary to introduce yourself, giving the name, patronymic, position, inform the purpose of the conversation and obtain the patient's consent to the conversation.

At the beginning of the conversation, you need to inquire about the patient’s well-being, about his complaints, start the conversation with the question: “What is bothering you?” Address your patient only by their first name and patronymic and "you". Look the patient in the face, in the eyes, observe his behavior, facial expressions, gestures. This encourages a frank conversation, and observation makes it possible to judge in which aspect it is more appropriate to conduct a conversation.

Do not start the conversation with personal, sensitive questions. It is not recommended to sit on the patient's bed during the conversation, but you should use a chair, visual contact with the patient should be at the same level.

Use exclusively positive intonation of voice. Be calm, slow, patient and polite. Do not show annoyance and irritation. Speak distinctly, intelligibly, slowly, distinctly, clearly, with each in his own language. Use terminology that the patient understands. If you doubt that the patient understands you, ask what he means by this or that concept. If you need to repeat a question, rephrase it for better understanding. Listen carefully. The Latin proverb says: "He said and thus lightened the soul." The ancient Greeks emphasized that the power of Aesculapius was not so much in how he spoke, but in how he listened. When talking, show empathy, sincere interest and participation, be natural.

“A health worker who speaks monotonously, incoherently, finds it difficult to find contact with the patient. Sound speech, if it is emotional, calm, confident, is for the physician the most important psychotherapeutic method of influencing the patient. Grando

In addition, a person can consciously present himself (build his image), instead of just being himself. However, in a situation that threatens health and well-being, this is not done as often as in ordinary life. The professional observation of a nurse consists in the art of noticing in the course of a conversation with a patient what others do not see. It is important to be able to interpret the behavior or information received from the patient in terms of the psychological problems that he has, to be able to see the psychological background of situations and evaluate them from the point of view of the patient's need for psychological help. When conducting a conversation, one should adhere to the principle of respect for the patient's personality, avoid any value judgments, accept the patient and his problem as they are, and guarantee the confidentiality of the information received. The patient, having decided to talk about the innermost, emotionally significant, wants to be listened to. Therefore, one must initially show interest in the psychological reality of the patient and listen carefully, patiently. And only then start asking questions.

A conversation with a patient gives a certain idea of ​​his cultural, intellectual level, the degree of education, individual personality traits, and dominant experiences. This knowledge helps to establish the right psychological contact and find individual approach to the patient.

The main conditions for the effectiveness of professional communication are: demonstration of goodwill, tact, attention, interest, professional competence.

The health worker needs to know the features of the psychological reflection of his condition by patients of different ages to implement, accordingly, the deontological tactics of communication.

Children preschool age. They are characterized by:

Lack of awareness of the disease in general;

Inability to formulate complaints;

Strong emotional reactions to individual symptoms of the disease;

Perception of medical and diagnostic procedures as frightening measures;

Strengthening character defects, raising a child during the period of illness;

A feeling of fear, longing, loneliness within the walls of a medical institution, away from parents.

Deontological tactics. Emotional warm attitude (to be a nurse, and an educator, and a mother), distraction from illness, organization of quiet games, reading, carrying out procedures, with persuasion. Professional treatment of relatives of a sick child.

Teenagers.

They are dominated by the psychological dominant of age - "the claim to adulthood." Bravado for them is a form of self-defense with internal psychological vulnerability. Negligently refer to the disease, risk factors.

Deontological tactics of a medical worker. Communication taking into account age-related psychological characteristics, reliance on independence, adulthood of a teenager.

The main conditions for the effectiveness of professional communication of a health worker are: demonstration of goodwill, tact, attention, interest, professional competence.

It is necessary to know the features of the psychological reflection of one's condition by patients of different ages and to implement, accordingly, the deontological tactics of communication in relation to them.

For preschool children age is typical:

Lack of awareness of the disease in general;

Inability to formulate complaints;

Strong emotional reactions to individual symptoms of the disease;

Perception of medical and diagnostic procedures as frightening measures;

Strengthening character defects, raising a child during the period of illness;

A feeling of fear, longing, loneliness within the walls of a medical institution, away from parents.

Deontological tactics - emotional warm attitude, distraction from the disease, organization of quiet games, reading, persuading procedures, professional treatment of relatives of a sick child.

For teenagers characteristic:

The predominance of the psychological dominant of age - "the claim to adulthood";

Bravado as a form of self-defense in case of internal psychological vulnerability;

Neglect of the disease, risk factors.

Deontological tactics - communication, taking into account age-related psychological characteristics, reliance on independence, adulthood of a teenager.

When working with patients workable age:

It is necessary, first of all, to know the personality of the patient and her individuality. Find out the attitude towards the disease, the medical staff, the position on the interaction of the patient with the medical staff.

Deontological tactics - focus on labor and social rehabilitation, the choice of communication tactics to be carried out depending on the VKB, the correction of inadequate attitudes, psychotherapy of anxious and suspicious patients.

For elderly and senile patients age is typical:

The psychological dominant of age is “leaving life”, “approaching death”;

Feelings of longing, loneliness, growing helplessness;

Age-related changes: decreased hearing, vision, memory, narrowing of interests, increased resentment, vulnerability, reduced ability to self-service;

Interpretation of the disease only through age, lack of motivation for treatment and recovery.

Deontological tactics - maintaining the patient's sense of self-importance; emphasized respectful, tactical, delicate attitude, without familiarity, commanding tone, moralizing; orientation to physical activity; motivation for recovery.

Features of communication with the patient in the hospital

A disease, hospitalization knocks a person out of a life rut, while he may feel offended by fate, unhappy. He is worried about illness possible complications, a forecast, a forced need to leave work, parting with home, an unfamiliar or unfamiliar environment, on which he also becomes dependent. In severe condition, in cases of development of paralysis, severe pain, the appointment of strict bed rest dependence can be absolute.

The routine of a patient's life in a hospital is determined by medical workers, the very life of a patient in a hospital depends on their knowledge, skills, responsibility, their kindness. At the same time, the relationships that he develops with paramedical workers, primarily with nurses, who communicate with patients constantly, are especially significant for the patient.

Relationships with patients should be built depending on age, profession, general cultural level, character, mood, severity and characteristics of the disease. All measures for the treatment of patients and care for them should be carried out calmly, accurately, carefully, trying not to irritate them, without causing them pain, in no way degrading their human dignity. It is necessary to take into account the feeling of embarrassment, annoyance usually characteristic of patients in connection with their helplessness and dependence.

The average health worker should know what diagnosis was made to the patient, why the doctor prescribed certain drugs, procedures, laboratory tests. However, in a conversation with a patient, care must be taken, the conversation should be soothing. In no case should he say anything that can upset him and scare him. In the process of communicating with him, it is unacceptable to say that today he looks bad, that his eyes are “hollowed out”, bad tests.

It must be remembered that in many diseases, patients experience certain features of mental activity. So, with atherosclerosis of the cerebral vessels, a significant decrease in memory, distraction, weakness, tearfulness, touchiness, egocentrism are possible. Patients with heart pathology often experience a sense of fear for their lives, are wary, and emotionally elevated. In diseases of the liver, gallbladder, irritability, causticity, and anger are often noted. In acute infectious diseases, intrathecal hemorrhage, euphoria, underestimation of the severity of one's condition are possible. With high internal pressure, the patient is usually lethargic, inactive, passive, apathetic, answers questions with delay, laconically, as if reluctantly, often stays in some fixed position. Certain features of the mental state and behavioral reactions are characteristic of many endocrinological, oncological and other diseases, various forms of endogenous intoxication, and poisoning.

The work of a nurse in children's departments has significant features, because. stay in a hospital without a mother is a significant psycho-traumatic circumstance for children. Relationships between medical workers and relatives of sick children can be difficult. Brief communication with parents can sometimes only excite a sick child who has partially adapted to hospital conditions.

When communicating with relatives of patients, it is necessary to be tactful, polite, do everything possible to calm them down, to convince that the patient is doing everything necessary. At the same time, sufficient firmness is necessary in order to prevent violations by relatives of the regime established in the hospital.

A true culture of communication is also needed in the team of health workers. Goodwill in relations with colleagues and mutual assistance are required to create an optimal psychological climate in a medical institution, to provide a full-fledged medical care. At the same time, the discipline of the members of the team and their observance of subordination are of great importance.