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Positive nursing communication skills with : the stroke patient, an angry family, Displaying empathy and compassion, A nurse story. NURSING COMMUNICATION SKILLS POSITIVE AND NEGATIVELike it or not, every nurse engages in communication. When Communication Skills are LackingLinda is sleep deprived and has beenworking too much overtime. Our mission is to provide teaching, training and consulting in the Communication Skills Process to children on the autism spectrum, neuro-typical children, parents, therapists, educators, and corporate professionals. For over 35 years, Gorman John Ruggiero has been teaching the art of Communication Skills Process. Most teens don't know what to expect when they come to their first group session; they often perceive their attendance at Step-Up as a punishment. Discussion: Goals for Teens, Ground Rules for the Group, Rules for Attendance, and Communication Contract.
Refer teens to their workbook and ask teens to introduce themselves by answering the questions under Introductions. Have parents and teens spend a few minutes writing down responses to the Warm-Up Exercise questions in their workbooks.
The two wheels show two different kinds of behavior used in relationships with family members. What does this person do that helps you feel close to him or her?Draw a square around the family member you have the most conflict with. What is the conflict usually about?Draw a triangle around the family member you admire the most. What does this person do that you admire?Draw a diamond around the family member you respect the most. What does this person do that earns your respect?Think of one thing that you can change about your behavior that will help you have a better relationship with people in your family.
Ask teens to try making behavior changes (the changes they wrote about in the My Family Relationships exercise) during the following week. Figuring out what you need to do so that you can change your behavior: You will make a plan for what steps you need to take to be able to stop the old behavior and replace it with a new behavior. Pick one behavior from the abuse wheel or respect wheel you want to work on during the following week.
Violent and abusive behavior has negative consequences for the person who is abusive, as well as for the person who is the target of the behavior. Discussion: Violent and Abusive BehaviorAfter check-in, lead the teens in a discussion of the following questions. Refer the group to Time-Out Rules in the workbook and go over the rules together as a group. Ask group members to take at least one time-out this week and to fill out the Time-Out Log in the workbook.
Make a decision to take a time-out to prevent yourself from being abusive to another family member. Before you return to the conversation, look at what your choices are, and decide what you're going to do. When you are calm, explain time-outs to any members of the household who aren't already familiar with them. It is not a time-out if you go to a friend's house, or if you take off and don't say where you are going.
When you are in a time-out, do something to calm down (by thinking, taking deep breaths, walking, etc.). It is best to have an agreed-upon amount of time for all time-outs so that you don't have to talk about it when you take a time-out. While you are cooling down, you may realize that whatever you were arguing about doesn't really matter that much. During the following week, use a time-out whenever you are starting to feel upset or angry during a conflict. If we pay close attention to our bodies, thoughts and feelings, we can find some warning signs that we are getting angry or upset and may become abusive to our family members.Paying attention to these warning signs in ourselves is the first step in taking a time-out.
Describe a situation in the recent past when you were upset, and write down what your red flags were.
In the space below, write down some things you can think about or say to yourself that will calm you down.The next time you start feeling upset or angry, think one of these things. During the following week pay attention to your red flags and add them to the (Your Red Flags) worksheet.
One day, after Robin finishes talking to Devon on the phone, her mom says, "I thought we already talked about Devon. After you are sure the teens have a good sense of personal power, have them fill out the What Personal Power Do You Have?
Ask the teens to think of ways they use their personal power during the next week and let them know they will report back to the group during check-in. Read each scenario below and ask: How could the person use his or her personal power in a negative way?How could the person use his or her personal power in a positive way?
You have a choice about what to do with your anger, and you are responsible for the way you choose to respond. You are not responsible for someone else who chooses to respond to his or her anger with violence. Use the illustration of the iceberg in the worksheet to introduce participants to the idea that anger is used to mask other feelings.
If a five-year-old girl comes into the house crying and tells her mom that her brother said she couldn't play with him because she was stupid, her mom may say, "Oh, he's just being a boy. Ask group members to pay attention to other feelings they are having when they get angry during the following week. For a lot of people, anger is used to mask other feelings and the iceberg is a way of showing how this works. Read each scenario below and write down the feelings, besides anger, the person might be having.Barb gets kicked out of math class for arguing with the teacher again. Explain the following:The biggest goal of Step-Up is to learn how to stop abusive behaviors and how to use more respectful behaviors. Teaching Communication Skills addresses communicative needs of children with autism and Asperger Syndrome as well as the needs of nonverbal and beginning communicators. Contents include: Assessments, teaching communication skills, motivation and communication, using cues and prompts, teaching verbal language, using AAC, combining methods, following directions, tone of voice and emphasis, echolalia, appropriate communication, conversation skills, developing social understanding, and teaching across environments. Written by Pat Crissey, an autism consultant and author of Picture Directions and Getting the Message. This is all incorporated in:- Assessment- Intervention- Documentation- EducationThese are just a few of the responsibilitiesof a nurse.
Recognized by universities, mental health centers, social service agencies, and public and private schools. This first session is a time that they can ask questions about the program and voice their opinions about being required to attend.
Welcome parents and teens to the group and tell them that during this session the group will get to know each other and learn about the program. Invite parents to say their names and what they want to get out of the group.What is your name?What behavior got you here? Explain that the communication contract is a guideline for how to communicate in the group. After check-in, there will be a break, followed by a session in which teens and parents will learn new skills.
Ask parents and teens to think about the teens personal strengths during the following week.
The behaviors on the abuse wheel are behaviors that emotionally or physically hurt family members and are used to gain power over them.
Goal planning includes how each teen is going to accomplish his or her goal, or the steps he or she is going to take to change his or her behavior. In this session you will ask teens to think about how their choice of violent and abusive behavior has affected their lives.
As appropriate, stress the important messages for this session when you discuss their responses to these questions. Explain to the group that it is important for everybody in the class to follow common guidelines, so there is no confusion about how to take a time-out. Be sure to stress that what a family does after taking a time-out is just as important as taking the time-out. You can then take a short walk or go into another part of the house where you can be alone. If you leave the house to take a walk, let your parent know where you are walking and for how long.A time-out is a time to be alone, to calm down and to think about how to deal with the problem without being abusive. Sometimes your parent may need to tell you to take a time-out if you are being abusive and are not taking a time-out.Let your parent know how long you will be in a time-out. For example, it may not be worth your energy to continue a discussion about small problems, so just let it go.Put it on holdYou may recognize that some circumstance prevents you from being respectful while you talk about the issue.

It is more difficult to take a time-out when you are angry or agitated.Identify the first red flag that indicates you may get abusive.
Time-outs help us to control our bad feelings and have more respectful relationships with others.
It is how we use our power with others that can sometimes be a problem.We can use our power in positive or negative ways.
Use one or both of the following examples to illustrate the point: Your math teacher has power because she has certain skills and knowledge about teaching math.
Her mom already told her that she needs to stay home all weekend and study because her grades are dropping. Be sure to emphasize any important points that come out of the discussion by writing them on the board.How is anger used to justify violent or abusive behavior?How do people use anger to have power over others?
She is sent to the vice principal, who tells her that she'll be suspended for a week because this is the third time she's been kicked out of class.
What else might she be feeling?Think of a situation when you were really angry and got abusive to another person. We might say things like, "My mom makes me mad," "My sister makes me frustrated," "My girlfriend makes me happy." Other people definitely influence us, but we can get pretty good control of our own feelings and behavior. No one can "make" us behave in a certain way (for example, someone is not raising my hand for me to hit this person--I make the choice and act).
This completely comprehensive book covers the widest range available of perspectives, methodologies, and strategies for working with students of all ages.
Communications skills for the nurse is an essential part of a day's work.Good Communication SkillsAn ICU nurse is confronted with an angry family because of adying relative. The nurse also followsup later (per unit's policy) that medication has been effective.Wong Baker Faces Pain Scaleis one that is used for adults and children as young as 3 years of age.
His work has proven effective for children on the autism spectrum, neuro typical children, educators and corporate professionals. Let participants know that any unexcused absences and tardiness will be reported to the court. Tell the group that the goal is for teens to communicate this way with family members at home, too.
Sometimes teens and parents will work together, and at other times they will work separately.To explain the check-in process, start by reviewing the abuse and respect wheels.
In other words, when a teen has an unexcused absence, he or she will be required to do two additional sessions. The behaviors on the respect wheel are ones that acknowledge other people's value and that consider other people's concerns. This is the first teen group session and many teen group members may still feel uncomfortable talking about themselves. When you talk through setting goals, prompt the teens to think about the exact behavior they currently use. When you choose a behavior you want to stop, be sure to describe the behavior you will do instead. Ask the group for examples of behaviors a teen might want to change to make things better at home. It is important to stress that violence includes any behavior that physically harms, scares or threatens a person, and emotional abuse includes any behaviors that verbally attack, put down, humiliate, or are intentionally hurtful to a person. Then, read through the guidelines with the group and invite participants to share any questions or comments they have about each guideline. For example, if you keep thinking about how "mean" your mom is, you will just keep getting angrier, and the argument will get worse.
For example, you may be too upset, too tired, or too hungry to talk through the problem effectively. The goal is to recognize that you need a time-out, and then to take it, before you become abusive. When Jack walks in the door, his mother asks, "Where were you and why are you so late?"Jack: "I don't want to talk about it.
What could Sara do?Larry just had an argument with his girlfriend, Lindsey, about their plans for the weekend. During this session, we want to help teens recognize that when they are angry they also have other feelings. When we feel anger we know that we need to do something--to figure out a problem, make a change, talk to someone about our feelings, or make a decision to try to let it go. Point out that it is these types of experiences that teach us that anger is a much safer feeling to show than other hard feelings.When you are sure the class recognizes that anger is not felt in isolation from other emotions, tell them that it is more helpful to communicate the feelings they are having than to act out the anger.
When she was at his house, he talked about how he thinks the divorce was all her mom's fault. An encyclopedic look at educational tools for working with your children and a unique resource that focuses on the most critical issue for individuals on the spectrum—that of communication. The nurse takes the time to introduce herself,listen to their concerns and tells the other members of the medical team what their needs were. You should, however, always remind group members to speak respectfully in the group.The warm-up exercise is a relationship-building activity for parents and teens. Group members can help each other follow the communication contract in the group by reminding others when they are not communicating by the guidelines. Tell the class the following:The two wheels show two different kinds of behavior used in relationships with family members.
This session is more about their families than themselves and can indirectly lead the teens to talk about themselves.The My Family Relationships exercise gives the teens a chance to think about positive qualities and strengths of people in their families.
Session 3: Goal Planning (Teen Session)Background InformationIn the first session of this program, teens had an opportunity to think about some of the positive attributes of their family members.
For example, when a teen says he fights with his brother, ask for specific details of actions, such as yelling or pushing.
For example, if your goal is to stop yelling at your little brother, you need to think about what you will do when you feel like yelling at him (for example, ignore him, go to another room, talk to him in a normal voice).
When teens are violent and abusive, they usually act without thinking about the outcomes and consequences of the behavior they use.
So, you can agree to put it on hold for a while until both people feel calm and ready to talk.
As group members share their red flags, ask each teen to try to figure out what his or her earliest red flag is. Why do you have to go on and on and on about it?"Mom: "I don't think you understand how important details are and not forgetting about them. The facilitator can help teens understand this by asking them what feelings they are having besides anger when they talk about being angry. Use the following story to illustrate this point:Let's say you are mad at your mom because she picked you up late. Have them share their answers with the whole group while you write down the feelings on the board.
Ask the volunteers to try to communicate any feelings they might have other than anger and consider how their choices might change the outcome of the experience. She says, "No, I don't want pizza, and I really don't want to hang out with you anymore." Jake yells at her, calls her a name and walks off.
In difficult situations, our thinking will determine how we behave and what choices we make. The purpose is to have parents and teens begin thinking and talking with each other in positive ways. Let the group know that they will be learning more about each principle listed during the coming weeks in the group. It also provides an opportunity for group members to get to know each other and to learn about each other's families. Have each group member fill out the worksheet with a behavior he or she will work on during the following week. An important step toward choosing nonviolent and nonabusive behavior is to recognize the consequences of violent and abusive behavior.
Remind the group that a time-out is not a time to take off from home without telling anyone. Session 6: Understanding Warning Signs (Teen and Parent Session)Background InformationIn this session parents will help teens to identify their red flags and use self-calming thoughts. Let them know that it's important to take a time-out at the earliest red flag.Next, explain to the group that their thinking can affect their feelings and behavior. How are you going to remember more important things if you can't remember the little stuff like taking out the garbage?"Raul: "Just shut up. Or maybe she has a lot of patience and is willing to spend extra time so everyone in the class can learn.
You may need to help them with this by giving them examples of feelings they might be experiencing. Anger has been the force that changed many injustices in our country's history, and has brought communities together to create positive change.
If you think about it, you can figure out what other feelings you are having besides anger.

Encourage group members to help each other identify possible feelings and how to communicate those feelings. We begin by asking teens to be aware of the things they say to themselves or things they are thinking in difficult situations. This brought calm to the situation.On admission to the surgical floor, a nurse walks into the room,never introduces herself and begins her daily routine.
Many teens and parents who come to this program are in the habit of communicating negatively with each other. The behaviors on the respect wheel are ones that acknowledge other people's value and that consider other people's concerns.The purpose of Step-Up is to help you move from the abuse wheel to the respect wheel in your relationships with family members. Each week teens will make a goal of working on a specific behavior during the following week. Group members may want to use the behaviors they talked about changing in the My Family Relationships exercise.
In this session and throughout the program, you can help teens think about their behavior by asking, "What were the consequences of your behavior?" Use the questions on the back of the abuse and respect wheels for further guidelines. Red flags are personal warning signs that a time-out is necessary or a situation may get abusive.
Point out that some thought patterns get people more worked up and angry, like dwelling on how stupid they think their parents are.
What could Larry do?Jennifer is tired of her younger sister going into her room and borrowing her clothes without asking. Maybe you are worried you will be late for practice, or something else you had planned to do.
When teens can identify what thoughts they are having, they can then decide if their thoughts are helping them resolve problems or are making the problems worse. This exercise helps them remember what it is like to relate with each other in a positive way. All of the skills we teach in the program will help you replace behaviors on the abuse wheel with behaviors on the respect wheel.We will use the abuse and respect wheels for check-in each week.
Encourage teens to choose small realistic goals, rather than big goals that will be harder to accomplish.
Parents are included in this session so that they can support their teens in using time-outs. If you decide to put the discussion on hold, make sure to set a specific time (for example, after dinner, or Saturday morning) when you are going to discuss it.Discuss itIf you feel calm after the time-out, you may decide that you are ready to talk about the issue with the other person. Self-calming thoughts are used to help de-escalate one's emotions and separate from a potentially difficult situation. Conversely, people can choose to think about things that help them calm down and deal with the situation, like, "This is getting me nowhere. She can use her power in a negative way by yelling at you, humiliating you in front of the class, or threatening to fail you.You are baby-sitting your little brother, who is watching a show on TV. What could she do?Max's dad said that Max has to clean out the garage before he goes anywhere today.
More specifically, anger should not be used to justify violence and abuse, or to intimidate or make other people feel powerless.
Instead of just telling her how mad you are, or acting angry with her, you can tell her how you feel--"I'm worried I will be late for practice." Then your mom can understand why you are upset, and it is less likely to turn into an argument that escalates into blaming and anger. If they are successful at examining their thinking, they can change their thoughts during difficult situations so they can resolve conflicts without abuse and violence. We will begin every session by referring to the wheels in your workbook and pick out behaviors you have used during the week. If teens have a hard time choosing a behavior, ask them to pick one from the abuse or respect wheel.Each week at check-in, each teen will report on his or her progress in achieving his or her goal for that week, and then choose a goal for the next week. After everyone finishes the worksheet, have each teen share what he or she wrote.Refer the group to the My Goal for the Week worksheets at the end of their workbooks. Parents may want to let their teens know if they see that the teens need a time-out; or, parents may want to take their own time-outs when they recognize that conflicts are escalating. You must be ready to listen to the other person, use problem-solving skills, and communicate respectfully. Tanisha's younger sister, Vanessa, is listening in on her conversation, which makes Tanisha mad.
After you talk about the behaviors you have used on the wheels, your parents will look at the wheels and identify behaviors you have used during the week.If you have been physically abusive to a family member, made serious threats of physical abuse, or destroyed property during the previous week, you will be asked to answer the questions from Taking Responsibility for Your Behavior. Explain that during each group session, each teen will choose one goal to work on during the following week. Parents will learn more about taking their own time-outs in the parent group.Go over the time-out rules to help parents and teens understand the appropriate use of a time-out.
While parents can help their teens figure out warning signs, it is not appropriate or helpful for teens to tell their parents what their red flags are.
You have the power to change the channel, because you are older, bigger, have more knowledge and skills, and are responsible for your brother.
Anytime you are angry, you also have other feelings.When you express feelings other than anger, people are more likely to listen to you and understand you. The teen will write down his or her goal on the worksheet, and at the beginning of the next week's session, the teen will rate how he or she did on a scale of 1-10, and how the teen changed his or her behavior.
It is important to point out that teens are responsible only for their own behavior; it is not appropriate for teens to tell their parents to take a time-out.
If he objects, you can use your power in a negative way by threatening to hit him or lock him out of the house. Have each teen identify one or more behaviors he or she used in the previous week on both wheels. Each person will report his or her progress to the group after check-in, and then make a new goal for the following week. Otherwise, teens may try to control their parents by telling the parents when to take a time-out. I need to calm down." Have the group think of examples of calming thoughts that might help them take a time-out. Or, you can use your power in a positive way by negotiating a plan with him, like letting him have the TV for the rest of the evening after the game. The patient is discharged and calls to find outone week later, when to remove the hose.ERPoor communication in the ER - The triage nurse who did notfully communicate to the paramedics the patient capacity of theEmergency Room. After the teen has talked about his or her behaviors on the wheel, have the teen's parent look at the wheel and point out behaviors the teen used during the week. Teens may also use a time-out as a way to avoid discussing an issue or as an excuse to leave the house. Continue the discussion of personal power by putting the following headings on the board: Strengths, Skills, Knowledge, Resources.
She has had problems with keeping to her curfew and forgetting to call when she will be late.
The paramedics arrived to a full ER and hadto travel to another Emergency Room.ConclusionFinally, there are no easy answers.
Let parents know that if teens are misusing time-outs, they can talk about strategies for handling the problem in the group. Ask, "What did you think or say to yourself that helped you stay in control?" Exercise: My Self-Calming ThoughtsRefer teens to My Self-Calming Thoughts in the teen workbook. It is obvious that not everynurse will communicate to suit every patient, family or coworker.However, every attempt should be made to improve effectivecommunication skills. Have them answer the questions for each of the scenarios and share the answers with the group.
When teens identify their strengths, skills, knowledge, and resources, they can begin to recognize that they can use their personal power to make nonviolent and non-abusive choices. What could he do?Lisa's parents have been checking on her a lot lately because she was going places she wasn't supposed to go. First, let each pair read through their scenario and decide when the people in the scenario should take a time-out. She walks over to her sister and slaps her.Scene ThreeMaria's mother is planning to go out with her friend to have dinner and to see a movie. Her mom wants to know the phone numbers where Lisa is all the time and she calls to check on her. Maria decides to ask some of her girlfriends over to hang out in her room while Max watches a movie in the living room. You're a creep and a narc."Scene FourRaul is supposed to take out the garbage on Tuesday mornings.

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