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  2. 2. • Applied communication is communication that focusses on the study of a social issue or problem with the primary purpose of identifying solutions and recommendations to address the social issue. The hallmark of applied communication are the study of topics with social relevance and identifying ways to improve the practice of communication.
  4. 4. Introduction • It’s a concept/ way of thinking • A mindset and habit of thinking • Essential nursing competency • Ability to think beyond the obvious and make connections • Refuse to accept conclusions without evaluating the facts and evidence
  5. 5. • Critical thinking as “putting it all together” through information seeking, reflecting, assigning meaning, problem solving, predicting , planning, and applying information • Critical thinking skills, which include the capacity to evaluate and respond in novel circumstances and to self reflect (Brookfield, 1991; Paul, 1997) • Critical thinking…… the awakening of the intellect to the study of itself
  6. 6. DEFINITION • The intellectually disciplined process of actively and skillfully conceptualizing, applying, analyzing, synthesizing, and or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action (Michael Scriven & Richard Paul, 1987)
  7. 7. • Is an active organized cognitive process used to carefully examine one’s thinking and thinking of others • Purposeful, goal oriented thinking aiming to make judgments based on evidence rather than conjecture. It is based on the principles of science and the scientific method and develop strategies that maximize human potential • It involves, making decision, internalize analyze and evaluate the problem to get solution, forming conclusion, drawing differences and reflecting • The nurse identifies the unique needs of each client and develops specific intervention to meet those needs. • Creative thinkers have the intellectual courage and capacity to think in a new and different way • Without critical thinking nursing would become routine and habitual • Application of critical thinking is vital to each step of nursing process • Critical thinkers develop a questioning attitude and no action should be performed without critical thinking
  8. 8. CRITICAL THINKING IN NURSING • A composite of attitudes, knowledge, and skills that include “defining a problem, choosing information for the solution, recognizing stated and unstated assumptions, formulating and selecting relevant and promising hypothesis, drawing conclusions, and judging the validity of the interferences” (Hickman, 1993) • Dewey defines critical thinking as “active persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends” (Fisher 2001)
  9. 9. NURSING AND CRITICAL THINKING • The ability of critical thinking increases as the work years increases, and the critical thinking skills can be improved during nursing education • With the rapid and dynamic change in the health care system, nurses are providing optimal patient care, problem solving, ethical decision making, determine priorities and trends in clinical decision making and critical thinking skills you need to use • It is imperative for nurses to reason critically about the judgments they face in practice and to act on those judgments in such a way that management of care, exemplifies reasoned consideration, constructive thinking and a particular disposition that leads to favorable outcomes
  10. 10. Why critical thinking in nursing is important • It helps the nurse analyze the patients condition and current treatment to predict outcomes and identify potential issues. Nurse who think critically do a better job of communicating across disciplines to ensure that all providers are aware of the patient’s status, needs and responses to treatment • Need to make accurate and appropriate clinical decisions • Need to seek knowledge and use it to make clinical decision and problem solving and find solutions • Need to be able to think creatively when planning for clients care
  11. 11. Three important aspects • Reflection; purposely thinking back or recalling a situation to discover its purpose or meaning. Looking back and reflecting on a client situation helps the nurse to have insight and meaning in the situation • Language; precise and clear resulting in clear message. To critically think you must be able to organize and focus your own thoughts • Intuition; inner sensing about a situation. To have an understanding of the particulars in a situation without conscious deliberation
  12. 12. Principles of critical thinking • Self reflection; it’s a way of assessing yourself, your ways of working and how you study • Responsibility for one’s own learning • Active approach during a lesson • Independent thinking; having confidence to draw on your own innate intelligence and depend on your own judgment, having your own views and values to guide you rather than someone else’s • Learning by cooperation; process of breaking a classroom of students into small groups so they can discover a new concept together and help each other learn • Higher thought process; human ability to take knowledge and learning and use it to create new things, ideas and concepts • Improved confidence and self esteem • Integrated curriculum; connects different areas of study by cutting across subject matter lines and emphasizing
  13. 13. Characteristics of critical thinkers • Uses a systems approach • Examine issues from different perspectives; Take time to examine situations in terms of content & context instead of jumping into action to make personal judgments and clinical decisions or to solve problems • Challenge assumptions; Critical thinkers identify and challenge assumptions questioning the usual • Identify the root cause of issues and it also involves imagining and exploring alternative ways of doing things • Are aware of cultural and contextual issues and demand that persons have logical reasons for judgments and actions • Values, intuition, emotions, empathy and take time to examine consequences of anticipated actions
  14. 14. Characteristic of critical thinking • Creativity • Logical and rational • Continuous and information seeking • Systemic • Intellectual Critical thinkers ask What m I taking for granted Did I explore all points at view Do I understand the question What information do I need
  15. 15. The critical thinking nurse Critical thinking nurse exhibit the following habits of the mind( Hood & Leddy, 2007) • Confidence • Creativity • Flexibility • Inquisitiveness • Open minded • Perseverance • Reflection • Intuition • Intellectual integrity
  16. 16. Critical thinking skills • Confidence; assurance of one's reasoning ability • Contextual perspective; considering everything relevant to the whole situation • Creativity; intellectual inventiveness ; used to generate, discover, or restructure ideas, imaging alternatives • Flexibility; capacity to adapt, accommodate, modify or change thoughts, ideas and behaviors • Inquitiveness; eagerness to know by seeking knowledge and understanding • Intellectual integrity; seeking the truth through science and honest processes, even if the results are contrary to prior assumptions and beliefs • Intuition; insightful sense of knowing without conscious use of reasons • Open mindedness; a viewpoint characterized by being receptive to divergent views and sensitive to one’s biases • Perseverance; pursuit of a course with determination to overcome obstacles • Reflection; contemplation on a subject, especially assumptions and thought process, for the purposes of deeper understanding of self evaluation
  17. 17. • Reasoning; ability to discriminate the facts • Clarifying; ability to define terms, noting similarities and differences • Reflection; looking back at what you have done • Reading • Listening • Observing • Analyzing • It calls for ability to recognize problems, find workable means for solving, understand the importance of prioritizing issues and gather pertinent information, interpret data to apprise evidence and draw conclusions
  18. 18. Critical thinking competencies ; used by many disciplines, in many everyday situation • Scientific method; an approach to seeking the truth or verifying facts. It’s a systematic, ordered approach to gather data and solve problems by nurses • Problem solving; use problem solving all the time, when problem is identified we seek information about the problem and the information plus knowledge that we already have to find solutions • Decision making; this happens when there are several options or course of action that one might take to solve a problem or take care of a situation. Best client outcomes are chosen on the basis of a clients condition and priority of a problem • Diagnostic reasoning; a process of determining a clients health status after gathering data and making a clinical judgment
  19. 19. CRITICAL THINKING AND NURSING EDUCATION • Thinking and learning are interrelated, one must think to gain knowledge • Analysis of language use, formulations of problems, explication of assumptions, evaluation of conclusions, weighing of evidence, discriminating between good and bad argumentation, and justification of facts and values that result in credible beliefs and actions • “A future of successfully intelligent thinkers is important to personal satisfaction and national achievement” Sternberg 2003
  20. 20. • Teaching students to think reflectively and critically should be a primary goal of educational institutions, for although students may be knowledgeable, they may not have been taught how to think analytically. It helps students learn task better and solve problems that they encounter in academic and non academic environments • Ultimate goal of educators is to promote lifelong learning by enhancing problem solving abilities • Critical thinking in nursing education is a means by which nurses can use analysis, questioning, interpretation and reflection to solve patient issues. The goal is to provide students with the analytical, problem solving skills needed in variety of academic settings and in their everyday lives
  21. 21. CRITICAL THGINKING AND DECISION MAKING • Decision making. Considering selecting intervention to facilitate achievement at the desired outcome • The decision is the selection of appropriate actions to fulfil the desired objective through critical thinking. Decisions should be taken when several exclusive options are available or when there is a choice of action or not. • The nurse when facing multiple needs of patients, should set priorities and decide the order in which they attend or help their patients. They should therefore examine the advantages and disadvantages of each option, implement prioritization needs by Maslows, asses what action can be delegated to others, and use any framework implementation priorities • Based on reliable information and made with as much critical thought as possible
  22. 22. • Critical thinking for decision making is the ability to think in a systemic and logical manner with openness to ask questions and reflect on the reasoning process used to ensure safe clinical practice and quality care • Nurses make decision about their personal and professional lives. The successive stages of decision making are the recognition of objective or purpose, definition of criteria, calculation of criteria, exploration of alternative solutions, considering of alternative solution, design, implementation and evaluating results
  23. 23. CRITICAL THINKING AND PROBLEM SOLVING • The nurse uses the nursing process to identify and make decisions about clients needs • Problem solving helps to acquire knowledge as nurse obtains information explaining the nature of the problem and recommends possible solutions which evaluate and select the application of the best without rejecting them in a possible appeal of the original. Also, it approaches issues when solving problems that are often used in the empirical method, intuition, research process and the scientific method modified. PROBLEM SOLVING SKILL • Mental process that involves discovering, analyzing, and solving problems • Goal is to overcome obstacles and find a solution that best resolves the issue
  24. 24. CRITICAL THINKING AND REASONING • The process of solving problems by using critical thinking skills • An attempt to figure out, solve problem or settle a question Strategies that promote development and application of critical thinking • Identify goals • Determine what knowledge is required • Asses the margin of error • Determine amount of time available for decision making • Identify available resources • Recognize factors that may influence decision making
  25. 25. CRITICAL THINKING AND NURSING PROCESS • The nursing process is an organized systematic approach used by nurses to meet individualized health care needs of their patients.it is systematic in that it consists of five steps and it considers the unique interest, ideals, desire of the health care consumer • The characteristic of nursing process are; dynamic and cyclic, client centred, planned and goal oriented, universally applicable, problem oriented and a cognitive process • It is recognized as the foundation of professional nursing practice, and provides the professional nurse with a framework for decision making and problem solving in everyday practice and situations
  26. 26. • The steps include • Assessment collect and examine information about health status, look for evidence of abnormal function or risk factors contributing to health problem e.g. smoking • Diagnosis/ problem identification; analyze data and identify actual and potential problem which are the basis for the plan of care • Planning; determine immediate priority, establish expected outcomes, determine interventions and record an individualized plan of care • Implementation; perform intervention, repeat and record • Evaluation; determine whether the desired outcomes were achieved, whether the interventions were effective and whether changes need to be made
  27. 27. Critical thinking in nursing practice • Nurse actions must be justified by appropriate reasons • The reasons for every action must be based on high quality evidence • Evidence reason action • Currently there is an emphasis on ( evidenced based practice) EBP in nursing promotes the attitude of critical thinking and asking on what basis what is done can be justified. • EBP is the use of the best available clinical evidence in making patient care decisions
  28. 28. BARRIERS TO CRITICAL THINKING • Resistance to change, rigid mindset practice guided by tradition, habit and routine • Stereotypical perception of clients • Fear of making mistakes • Unwillingness to take risks or lack of alternative strategies • Decision making without sufficient data or supported by rationale • Failure to evaluate effectiveness of a nursing action
  29. 29. To improve critical thinking; 1. Highlight the main ideas you need 2. Join a study group and use if your main ideas are the same with fellow group members 3. Dialogue with yourself to identify the main idea of your reading 4. Try to state the main idea in your own words 5. Restate the points made in a discussion with others to see if you understood them 6. Focus on what the speaker is saying and identify the key points 7. While listening make note of analyzing what you find confusing and ask about it later
  30. 30. To improve on critical observing • Remove any restriction in your mind • Eliminate or decrease any distraction • Ask yourself if you understood the important points • Create new ways of looking at situations • Always look from outside the situation To improve critical analyzing • Maintain clear and accurate logic • Take all details into considerations • Used systemic and scientific based process • Use birth cognitive and psychomotor skills
  31. 31. PROBLEM SOLVING SKILLS INTRODUCTION • Continuous monitoring and providing high quality care to patients is one of the main tasks of nurses. Nurses role are diverse and include care, educational, supportive and interventional roles when dealing with patients clinical problem • Providing professional nursing services requires the cognitive skills such as problem solving, decision making and critical thinking and information synthesis • Problem solving is an essential skill in nursing. Improving this skill is very important for nurses because it is an intellectual process which requires the reflection and creative thinking.
  32. 32. • Problem solving skill means acquiring knowledge to reach a solution, and a persons ability to use this knowledge to reach a solution requires critical thinking • Managing the complexities and challenges of health systems requires competent nurses with high level of critical thinking skills. A nurses critical thinking skills can affect patient safety because it enables nurses to correctly diagnose the patients initial problem and take the right action for the right reason • Nursing students need to promote their problem solving skills to meet the complex needs of current health care setting and should be able to respond to changing circumstances and apply knowledge and skills in different clinical situation
  33. 33. PROBLEM SOLVING PROCESS 1. Problem identification 2. Problem analysis 3. Generating possible solutions 4. Analysis of the solution 5. Selecting the best solution 6. Implementing the solution 7. Evaluation and revision
  34. 34. • Problem definition; here, there is need to write down what exactly the problem entails, which helps to identify the real problem that is under study and need an immediate solution • Problem analysis; analyze how the problem affects an individual and his or her current situation and other people involved in the situation. The gravity of the problem and all the factors that are contributing to the problem are determined • Generating possible solutions; focus must be on identifying and generating all possible solutions for the problem. Each potential idea for the solution of a problem must be considered without discarding it through value judgment
  35. 35. • Analyzing the solutions; various factors about each of the potential solutions are investigated, wherein all the positive and negative aspects of each solution are analyzed • Selecting the best solutions; an attempt is made to compare the available solutions and eventually the best solutions is selected based on careful judgment • Implementing the solutions; practically solve the problem by implementing the selected solutions • Evaluation and revision; judge the effectiveness of the solution in resolving the problem. Also redefine the problem and revise the problem solving process incase the initial solution fails to manage the problem effectively
  36. 36. Comparison of problem solving process and nursing process Problem solving process Nursing process Problem identification Assessment Data collection; history taking and physical examination Problem analysis Nursing diagnosis Plan Generate possible solutions, analyze the solution and select the best option Plan Goal identification, plan interventions Implementation Implementation Evaluate and revise the process Evaluation
  37. 37. Format for problem solving using nursing process 1. Assessment; Identification data; name, age, sex, diagnosis ,History and signs and symptoms of the patient and Physical examination 2. Diagnosis; Analyze and validate data and State the problem to be solved or formulate diagnosis 3. Plan develop outcome goals that you want to achieve. Keep the priority of needs in mind 4. Carry out interventions 5. Evaluate all the steps of nursing process and asses whether you are able to solve the problem or not 6. Document all the steps of problem solving
  38. 38. Example Assessment • Name; Mr. JS age; 60 years sex; male • Ward; medical 12 bed no; 6 diagnosis C.V.A • Brief history; Mr. JS is a known hypertensive patient who was not talking his medication regularly. On 2/10/22 he c/o of headache, vomiting, loss of speech and movement of the extremities • Presenting complain ; anorexia, lack of movement, incontinence of urine, skin excoriation at the sacral region present Nursing diagnosis; altered skin integrity related to immobility evidenced by bedsores Goals; maintain skin integrity, prevent further complication and promote health maintenance
  39. 39. Nursing interventions • Frequent 2 hourly change of position • Provide back care and catheterize • Bedsore dressing twice a day • Provide adequate nutrition Evaluation • Healing present • Patient able to move • Patient skin healthy
  40. 40. REFLECTION Reflection means analyzing your own experiences to improve the way you learn or work. Its a valuable skill that can help learners and professional nurses gain experience, confidence and self awareness Reflective practice is a process that develops understanding of what it means to be a practitioner and makes the link between theory and practice through the practitioner consciously thinking through the experience Reflection on practice is a key skill that nurses should possess. Engaging in regular reflection enables nurses to manage and cope with the personal and professional impact of meeting their patients’ fundamental health and well being needs on a daily basis
  41. 41. SOURCES OF REFLECTION Everyday experience Positive experience Negative experience Unusual incidents Routine activities Important or meaningful events
  42. 42. wrdrfttf Reflection is an acting process of witnessing one’s own experience in order to examine it more closely, give meaning to it, and learn from it • Returning to experience • Attending to feelings • Evaluating experience • Reflecting on action • Reflecting in action(“thinking in action”) Reflection involves three elements Reflection can be of two main types:
  43. 43. THE PROCESS OF REFLECTION What? So what? Now what? • What happened • Description parts • What did the experience mean • Interpretations • The feelings involved • What was learnt • What are the next steps • Seeing the bigger picture • Applying the lesson learnt • Planning future actions
  44. 44. On Reflective action • On Reflective practice On reflective practice o Reflective practice is the application of the skill of reflection to our practice in order to improve performance It involves a habit, structure of routine around reflecting experience
  45. 45. Reflective practitioner competencies Self knowledge Understanding of and insight into one’s self-worth motives, characters and capabilities. Inquisitiveness The willingness to be curious and inquiring e. g by asking reflective questions. Critical thinking The application of logical principles, rigorous standards of evidence and careful thinking of the analysis and discussion of beliefs, claims and issues. Emotional intelligence The ability to identify, assess and manage one’s own emotions and those of other individuals and groups.
  46. 46. Benefits of reflection to the individual, organization and patient • Enhances effectiveness of the individual • Improves problem solving skills of the workforce • Enhances patient care delivery
  47. 47. IMPORTANCE OF REFLECTION • Bridge the theory practice gap • Reduces practice based on customs and practice • Develop and understand your practice, decision made, lessons learnt and implication of these future practices • Ensure that care remain patient centred and based in the patient experience • Helps nurses understand what they already know(individual) • Identify what they need to know in order to advance understanding on the subject (contextual) • Make sense of new information and feedback in the context of their own experience (rationale)
  48. 48. SKILLS / ATTITUDE FOR REFLECTION • Willing to learn from experience and change things • Able to make time for reflection • Being open and honest • Willing to share and discuss your experiences • Being motivated to replay/ describe/ analyze experiences • Able to make an action plan
  49. 49. Principles of reflection Focuses on the practioner and their practice Allows us to use, value and learn fro experiences Allows us to be empowered to act based on this knowledge Knowledge generated is often context specific and provides valuable insight into local problems
  50. 50. GIBBS’S REFLECTIVE CYCLE Professor Graham Gibbs published his reflective cycle in his 1988 book “learning by doing” its particularly useful for helping people learn from situations that they experience regularly especially when this don’t go well The model can be used to explore situation yourself or you can use it with someone else Description Feelings Evaluation Analysis Conclusion Action plan
  51. 51. 1. DESCRIPTION Give a concise description of your experience, call or incident. Maintain patient confidentiality, don’t make judgments and don’t draw conclusions • Where was i? • Who else was there or who was involved ? • Why was I there and what was I doing? • What happened and when did it happen? • What was the result?
  52. 52. 2. FEELINGS What were you thinking and feeling. Just describe the feeling and don’t analyze them yet • How was I feeling at the beginning? • What was I thinking about? • What did other people ‘s action make me think/feel? • How did I feel about the outcome? • What do I think about it now? • Why is this the most important feeling?
  53. 53. 3. EVALUATION What was good and bad about the experience? • What was good about the experiences for me, the patient and others? • What was bad about the experience for me, the patient, for others • What did you do to contribute? Was it helpful or not? • What was easy and what was difficult/ • What went well and what did you do well? • Do you expect a different outcome? If so, why?
  54. 54. 4. ANALYSIS What sense can you make of the situation This analytical part, so tries to explain the causes and consequences of things that happened. Breaking it down • What broader issues arise from the event and what is really going on? • Were other people’s experiences similar or different in important ways? • What is the impact of different perspectives e.g. personal, patients, collegues perspective? • What theory/research helps me understand the experience?
  55. 55. 5. CONCLUSION What else could you have done? • Could I have done anything different? • How could I and others made the situation better? • What are the key things I have learned from this incident- about me, my performance, others and their performance? • Can this be evidence of achievement of placement outcomes/ competencies?
  56. 56. 6. ACTION PLAN If it arose again, what would you do? • What would I do in a similar situation in the future? • What aspects of my knowledge/ skills could I develop? • How will I do this? • What goals can I set myself for the future? • What outcomes/ competencies do I need to focus on now?
  57. 57. REFLECTIVE WRITING • Reflection refers to an intellectual and affective method of learning that students use to explore their experiences and foster a deeper understanding and appreciation for learning • Reflective writing is therefore writing from experience • Used to reflect on cognitive learning experiences, attitudes, and feelings related to the experience • Analyze the events of practicum course and relate them to didactic course work • It is an analytical practice in which the writer describes a real scene, imaginary event , interaction, passing thought or memory and adds a personal reflection on its meaning • Reflection offers you the opportunity to consider how your personal experiences and observation shape your thinking and your acceptance of new ideas
  58. 58. WHY USE REFLECTIVE WRITING • Reflective writing forces students to stop, think and solve problem and spot • Enables students to critically question content, process, and the premise underlying the experience • Reflective writing makes students aware of uncomfortable feelings or thoughts that leads to a change of perspective • Link the past and present experiences to prepare the students for future practice • To develop a professional identity which goes beyond technical knowledge and skills to abstract thinking • Students learn to question their own assumptions, rework problems, and take ownership for their learning • By revisiting experience, students become aware of new aspects of the situation, relating new information with what they already know; possibly finding new meaning in the experience
  59. 59. Reflective writing should Develop a perspective or line of reasoning Develop a link between your experiences or practice and existing knowledge Show understanding and appreciation of different perspective to your own Show learning resulting from the reflection and how you plan to use it Be written in an appropriate style with language relevant to your academic discipline Sometimes, but not always, use theoretical literature to inform your understanding
  61. 61. • Counselling is the process of building relationships with individuals that empower them to accomplish mental health and wellness, education and career goals. (American counselling association). It is a collaborative relationship between the counselor an their client. • Counselling is essentially a process in which a counselor assist the counselee to make interpretation of facts relating to a choice, plan or adjustment which he needs to make ( Glenn. F. Smith) • Counselling is a series of direct contacts with the individual which aims to offer him assistance in changing his attitudes and behaviors.
  62. 62. • Counselling is about creating strong relationship with your clients that will empower them to obtain mental health and to fulfill their goals. Through the use of intentional counselling techniques and and understanding of human nature developed through counselling theories, you can guide your client in reaching optimal mental health
  63. 63. Objectives of counselling • Achievement of positive mental health  Resolution of problems  Improving personal effectiveness  Maximizing behavior change  Decision making as a goal of nursing  Modification of behavior as a goal
  64. 64. THEORIES OF COUNSELLING • They are used as a guideline for understanding human nature and to determine which counselling skills will be used for the counselling sessions • Psychoanalytical theory. • has its roots with Sigmund Freud who believed there were unconscious forces that drive behavior. The technique he developed such as free association; freely talking to the therapist about whatever comes up without censoring, dream analysis; examining dreams for important information about the unconscious, and transference; redirecting feelings about certain people in one’s life onto the therapist are still used by psychoanalysts today • Counselors who use this approach direct much of their focus and energy on analyzing past relationships and in particular, traumatic childhood experiences in relation to an individual current life. The belief is that by revealing and bringing these issues to the surface, treatment and healing occurs.
  65. 65. Person centred approach • Based on Maslow's theory of self actualization. The counselors using this approach assumes that self actualization motivates human beings to exploit their capabilities or potentialities. It is assumed that people have the capability to guide , regulate and control themselves provided that certain definable conditions exist. Here it is assumed that an individuals psychological problems are caused by failure to actualize to the maximum. Psychological problems cause blockages to the process, and the work of counselling is to release the blockage. • The person centred theory helps the counsellors to identify the maladjusted behavior of the patient. Through counselling the counselor is able to identify the resources the patient has to sustain or correct the maladjusted behavior. The role of the counselor is to provide the necessary conducive climate or environment characterized by the core conditions to enable the patient solve their own problems
  66. 66. Behavioral therapy; • It is based on the belief that behaviour is learned. Classical conditioning is one type of behavioral therapy that stems from early theorist Ivan Pavlov’s research. Pavlov executed a famous study using dogs which is focused on the effects of a learned response e.g. a dog salivating when hearing a bell and through a stimulus e.g. pairing the sound of a bell with food • B.F Skinner developed another behavioral therapy approach called operant conditioning. He believed in the power of rewards to increase the likelihood of a behaviour and punishment to decrease the occurrence of a behavior. Behavioral therapist work on changing unwanted and destructive behavior through behavior modification techniques such as positive or negative reinforcements.
  67. 67. Cognitive theory; • developed by Aaron Beck in 1960s. It focusses on how peoples thinking can change feelings and behaviors. It is brief in nature and oriented towards problem solving • Cognitive therapists focus more on their client’s present situation and distorted thinking than on their past. It helps in a number of mental illnesses including anxiety, personality, eating, and substance abuse disorders
  68. 68. Humanistic approach • Humanistic therapists care most about the present and helping their clients achieve their highest potential. Instead of energy spent on the past or on negative behaviors, humanists believe in the goodness of all people and emphasize a persons self growth and self actualization • Humanist theories include client centred, gestalt, and existential therapies. Carl Rodgers developed client centred therapy which focusses on the belief that clients control their own destinies. He believed that all therapists need to show their genuine care and interest • Gestalt therapists work focuses more on what is going on at the moment vs what is being said in therapy. • Existential therapists help the client find meaning in their lives by focusing on free will, self determination and responsibility
  69. 69. TYPES OF COUNSELLING • Individual counselling; is a process through which clients work one on one with a trained counselor in a safe, caring, and confidential environment. Occurs when a counselor is working with only one person at any given time i.e. when a nurse is dealing with a single patient Counseling is focused on the individuals immediate or near future concerns. It encompasses career counselling and planning, grief after loss of a loved one or dealing with problems at a job before they become big. Individual counselling is a one on one discussion between the counselor and the client, who is the person seeking treatment. The two form an alliance, relationship or bond that enables trust and personal growth The goal of individual counselling is to talk through mental health concerns and help clients heal grow, and move toward more productive, psychologically healthy lives. Good therapy is client driven and specific goals for therapy will be determined by you and your therapist Individual psychotherapy sessions typically lasts between 45 -50 minutes. The frequency and duration of therapy will depend largely on your needs, treatment goals, and progress. Many concerns are readily resolved with short term therapy and other chronic or more complex concerns require long-term commitment before improvement is realized
  70. 70. • Group counselling; it’s a form of counselling where a small group of people meet regularly to discuss, interact, and explore problems with each other , this occurs when a counselor is working with more than one person at any given session. Group counselling is recommended for people facing the same problems e.g. alcoholics The term can legitimately refer to any form of psychotherapy when delivered in group format, including art therapy, cognitive behavioral therapy or interpersonal therapy, but it is usually applied to psychodynamic group therapy where the group context and group process is explicitly utilized as a mechanism of change by developing, exploring, and examining interpersonal relationships within the group One of the goals of group therapy is to bring people who share similar experiences together. Principles include  Instillation of hope;  Universality; brings people with similar experiences together  Imparting information; sharing information and advices  Altruism; group members support, reassure and help each other improve  Imitate behavior; imitate behavior from seniors and therapists  Interpersonal learning; improves interpersonal behavior via feedback, and self observation
  71. 71. • Marital counselling; this occurs when the counsellor is working with married couples or couples who are engaged and are on their path of getting married. Marital counselling is conducted by a trained therapist who understands the problems and trials of marriage and married life. Marital counselling is done when both couples are present. The counselor assists the couple to understand their problems and to find solutions to their problems Most of the conflicts in marriages arises either because one of the partner or both partners strive to maintain an ideal marriage. In marriage counselling, the counselor helps the couple understand each others behavior and a few aspects of their personality, and most importantly they guide the couple accept their spouse as they are Types of marriage counselling  Premarital counselling; can be opted by couples who are in a relationship and want to take their relationship to the next level. Counselor helps couple understand their compatibilities  Post marital counselling; for couples already married. Marital counselling can be opted due to communication issue, intimacy issue, extended family conflicts, infidelity, separation, divorce, parental lifestyle, rigidity, anger management etc.
  72. 72. • Family counselling; this occurs when a counselor is working with more than two members of a family at any given session. Family counselling focus on family issues and is conducted when all the family members involved are present . It’s a form of treatment that is designed to address specific issues affecting the health and functioning of a family. It can be used to help a family through a difficult period, a major transition, or mental or behavioral health problems in family members Family therapy can employ techniques and exercises from cognitive therapy, behavior therapy, interpersonal therapy. The goal of family therapy is to work together to heal mental, emotional or psychological problems tearing the family apart To guide a family towards a healthy life, family therapists aim to aid people in improving communication, solving family problems understanding and handling family situations and creating a better functioning home environment Benefits of family counselling  A better understanding of healthy boundaries and family patterns and dynamics  Enhanced communication  Improved problem solving  Deeper empathy  Reduced conflicts and better anger management skills
  73. 73. Other types of counselling • Career counselling; explores individual capabilities and job opportunities • Student/ academic counselling; its done amongst students to enable them to resolve academic and personal problem • Geriatric counselling; done among the elderly in times of behavioral problems example depression • Genetic counselling; involves counselling of parents about genetic problem and treatment options for children
  74. 74. GROUP PRESENTATION • COUNSELLING SPECIAL GROUPS • Group one -Counselling HIV/AIDS clients • Group two- Counselling rape victims • Group three Counselling a patient with disabilities • Group four Counselling a new family planning patient
  75. 75. PRINCIPLES OF COUNSELLING • Autonomy; implies respect for the clients right to self governing. As a counselor you should allow the client to make own decision. Your role is to help the client make the right decision but you should not dictate what they should decide • Non maleficence; this is the commitment to avoid doing harm to the client. As a counselor you should be committed to ensure the decisions the client makes are not in way going to cause harm to the client. The counselor should promote the wellbeing of the client • Beneficence; this is the commitment to promote the clients well being. All the decisions the counselor make should be focused towards promoting the condition of the client • Justice; this is the commitment of the counselor to provide an equal and fair services to the client. There should not be any form of discrimination. All the clients should be treated equally and should get the services they deserve • Fidelity; this refers to being honest with the client and being faithfully committed to the clients progress. It implies being trustworthy and keeping the information of the client confidential
  76. 76. Principles of counselling cont.….. • Communicate personal warmth and make the client feel welcomed and valued as an individual • Act with care and respect considering the individual cultural differences and diversity of human experience • Be empathetic and sense the feelings and experience of another person • Promote the safety and well being of the individual families and communities • Practice within the scope of the individual competence • Seek to increase the range of choices and opportunities for the client
  77. 77. Qualities of a good counselor  Patience; be very patient with the patient no matter how many times the patient repeats themselves  Warmth; smile and show a lot of concern and acceptance to the patient  Confidentiality; keep all the information given by the patient secret  Honesty; tell the truth to the patient. Never tell a lie  Empathy; ability to imagine oneself in another person, and thus understand their feelings.  Observance; as you listen to your patient talking, observe their facial expression and try to interpret the meaning of any non verbal communication  Accepting; recognize the basic rights of the patient, accept them with their own rights hence they will disclose more information. Don’t be judgmental  Avoid embarrassment; hold conversation in a private room, understand the cultural background of the patient, and avoid sensitive probing questions which make the patient develop feelings of guilt  Relevant discussion; counselling sessions should be confined to the topic. Give patient sufficient time to narrate their story. Listen observe and pick core information while noting any deviations or irrelevant information
  78. 78. TECHNIQUES FOR COUNSELLING 1. Directive counselling, the counselor plays an active role as it is regarded as a means of being helping people how to learn to solve own problems. This type of counselling is known as counselor oriented because the counselor does everything himself i.e., analyzing, diagnosing, synthesis, prognosis, prescription and follow-up 2. Non directive; it’s the counselee or client who is the pivot of the process. He plays an active role . The goal is independence and integration of the client rather than solution to the problem. The counselor assist him to analyze, synthesize and diagnose his difficulties, predict the future development of his problem, take decision about the solution to the problem, analyze the strengths and consequences of his solutions before taking final decision. 3. Eclectic counselling; combination of directive and non directive technique depending upon situational factors
  79. 79. PROCESS OF COUNSELLING 1. EXPLORATION STAGE/ ESTABLISHMENT OF RELATIONSHIP It’s the core phase in the counselling process, includes factors like respect, trust and sense of comfort. Begin phase with adequate social skills; introduce yourself, listen attentively, remember the clients name, address the individual with preferred name, ensure physical comfort. Observe non verbal communication 2. ASSESMENT; Individuals are encouraged to talk about their problem. Counsellors asks questions, collect data, observe and helps the clients clearly state thir problems. Involves skills like; observation, inquiry, making associations among facts, making educated guess, recording data should be done systematically and promptly
  80. 80. 3.SETTING GOALS It provides direction to individual and counselor. Helps us know how well counselling is working and when counselling is included. It requires differentiation, teaching individual to think realistically and the skills of drawing inferences 4.INTERVENTION/ACTION STAGE After setting goals the questions that follow is how shall we accomplish our goals? The intervention used will depend on the approach used by the counselor, the problem and the individuals. Skills needed are; skills in handling interventions, knowledge of its effect, and ability to read clients reaction
  81. 81. 5. TERMINATION AND FOLLOW UP • Ending the counselling relationship. • It is decided by the counselor when the patients shows signs of improvement and the ability to solve their problems. Always prepare the patient to be ready for termination of counseling relationship. • It should be done without destroying the accomplishment gained. It should be done without sensitivity, intention and fading. Hence termination should be planned over a few sessions. • Follow up appointments can also be fixed
  82. 82. Steps in counselling process When counselling you progress through a series of interconnected overlapping stages to help them make informed decisions Six steps include • G- great the patient • A- ask the patient about themselves • T-tell the patient about their condition • H- help the patient accept their condition • E- explain to the patient about various coping mechanism • R- return to the counselling clinic for follow up visits
  83. 83. Supportive behaviour in counselling • Verbal behavior; use language which are understood by the client (clear) Clarify Listen Acknowledge Encourage Reflect and Repeat
  84. 84. • Non verbal behavior; use tone of voice similar to that of client (roles) Relax Open and approachable Lean towards the client Eye contact Smile and sit comfortably, maintain suitable distance
  85. 85. Effect of termination of counselling Denial- characterized by feeling of shock, disbelief, panic, and refusal to accept the idea of terminating counselling relationship. The patient refuses to believe that counselling sessions stops. The counselor has to convince them that they are doing well and there is need to stop the sessions for awhile to see how they are progressing alone Anger – anger is experienced for losing a good and helpful person. The patient keep asking why such a thing should happen only to them and not to somebody else. Always encourage them to continue expressing the feelings and accept the termination Bargaining – the clients tries to change the counsellors mind about the idea of termination. The patients comes with unrealistic goals tp prolong session hoping the counsellor will change her mind. Listen attentively to their complaints and emphasize on the achievements they have made alone and the necessity of them being independent
  86. 86. • Depression – occurs when the patient realizes the counselor is serious and will definitely terminate the sessions. The patient may feel sad after realizing there is nothing they can do to change the situation. They may feel hopeless, and withdrawn fom friends • Acceptance- results when the patient accepts the reality of termination. They start to plan ways of copping with the new situation without help of the counselor. The patient gains confidence and they have the ability to manage their own independent affairs
  87. 87. Counselling skills • Listening / observing; listening is one of the most valuable counselling skills in a therapeutic relationship. It can be used in three ways • Attending ; is the ability to be physically present for the client. Giving then undivided attention and making appropriate eye contact, mirroring, body language and nodding. SOLER ( Sitting squarely, open posture, leaning forward, eye contact, relaxed) • Active listening; occurs when you are listening with all your senses. Involves listening with your body, heart, ears eyes and mouth. • Verbal listening; form of showing you are listening through the words that you use. These verbal cues are used to show attention and to encourage more exploration from a client • Asking questions; questions are helpful in the therapeutic environment because they allow you to learn more about your client
  88. 88. • Closed; a closed question is the practice of asking questions that can be answered by a yes or no. should be avoided as they do not encourage deeper exploration • Open; open question is necessary to gather information. An open question requires reflection or exploration on the client’s end. Every open question should be intentional and therapeutic • Reflection; used in the counselling process to accurately describe client’s state • Feeling reflection; reflections allow clients to hear the feelings they have just expressed. Sometimes you have to look for the descriptive feeling in a clients statement. It can also be helpful to look at a clients non verbal cues
  89. 89. • Restating/ rephrasing; rephrasing and restating can build a stronger client therapist relationship. Rephrasing a clients statement allows you you to better understand what a client has just said and to gain further clarity if you have gotten it wrong • Affirmation; form of encouragement that is used to affirm behaviors or life choices. Affirmation is important for empowering clients • Empathy; ability to put yourself in someone's else shoes. You are able to show your understanding of your clients feeling surrounding an experience • Genuineness; begin genuine is creating congruence between yourself and your words.it is important to remain genuine in all counselling techniques and verbal and non verbal cues • Unconditional positive regard; it’s the idea of accepting your client for who they are. It ia a means of expressing warmth and respect • Counselor self disclosure; only share personal information that is beneficial to the therapeutic process. Its used to help the counselor relate better with their client
  90. 90. RESOURCES FOR COUNSELLING • Medical services; clients can be referred for special examination and treatment • Mental health services; psychiatric hospital • Social welfare agencies; youth clubs, sports club and agencies for social and financial problems • Law enforcement agencies • Parent teachers association
  91. 91. PROBLEMS IN COUNSELLING • Resistance to counselling • Counselee with different cultures • Counselee with strong emotions, anxiety, depression which can hinder counselling process • Lack of awareness of value of counselling by the public • Lack of physical facilities, non availability of time and tools
  92. 92. NURSE PATIENT RELATIONSHIP • It is the interaction between the nurse and the patient aimed at enhancing wellbeing of the client who may be an individual, family, group or community • Is also defined as helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with gratification on your patients physical, emotional and spiritual needs through your knowledge and skills • A good nurse patient relationship reduces the days of hospital stay and improves the quality and satisfaction of both. • A poor nurse patient relationship decreases the quality of care and diminishes the patients autonomy
  93. 93. Phases of nurse patient relationship Peplau identified five phases of nurse patient relationship.in pepalaus theory of interpersonal relations, these phases are therapeutic and focus on interpersonal interaction • Orientation phase; the patients seeks help, and the nurse assist the patient to identify the problem and the extent of help needed. Beginning nurse patient relationship requires unique communication skills. Everyday people communicate with those around them by listening, talking, sharing, laughing, reassuring and caring. Nurse uses these basic components of communication to establish a helpful relationship • Identification phase; the patients relates to the nurse from an independent, dependent, interdependent posture, and the nurse assures the patient that he or she understand the meaning of his or her situation. The nurse and the patient works together to identify problem and set specific problem oriented goals
  94. 94. • Exploitation phase; the patient uses the nurses services and other resources on the basis of his or her. The nurse assist the patient in using health services . Interventions appropriate to the mutually planes goals are carried out with ongoing reassessment and reevaluations • Resolution phase; the patients old needs are resolved, and more mature goals emerges. Ending a therapeutic relationship requires a period of resolutions • Termination phase; the patient and the nurse evaluates the progress of the interaction towards the intended goals, review their time together and end the relationship. Endings are times for review and growths
  95. 95. Elements include • Boundaries- represent invisible structures imposed by legal, ethical and professional standards of nursing that respect the rights of nurses and the clients • Confidentiality- makes the relationship safe and establishes trust. Makes the patient comfortable in disclosing personal information and asking questions • Self awareness- internal evaluation of oneself and of ones reaction to emotionally charged situations people and places. It offers opportunity to recognize how attitudes, perception, past and present experiences and relationship frame or distort interaction with others • Genuine, warm and respectful- this empowers the patient alongside the family to get more engaged in hearing about their health and ways in which they are improved • Empathy- having the ability to enter the perceptual world of another person and understanding how they experience the situation
  96. 96. • Culturally sensitive- healthcare is a culturally diverse environment and nurses have to expect that they will care for patients from different cultures and ethnic backgrounds. The goal of the nurse is to a body of knowledge that allows them to provide culturally specific care • Collaborative goal setting- nurse should work with the patient to create goals directed at improving their health status • Responsible ethical practice- communication based relationship therefore, a responsibility to interact educate and share information genuinely is placed upon the nurse. Always protect the client from abuse
  97. 97. Tips to consider • Introduce your self to the patient and use her name while talking to her. Greetings is a good way of establish trust and respect • Make sure the patient has privacy when providing care. Meet basic needs like pain and comfort • Active listen to the patient. understands the patients concern. • Maintain eye contact. Remember too much eye contact is intimidating, smile at intervals, nod your head • Maintain professional boundaries
  99. 99. • Student centred learning ;Process of helping a student discover own learning styles, to understand their motivation and to acquire effective study skills that will be valuable throughout their lives • Student centred learning is an approach to education focusing on the need of the student rather than those others involved in the education process such as teachers and administrators • It’s a student centred activity, students understand the concept, students are questioners and problem solvers, students are searching for knowledge and thinking for themselves • Makes student responsible for their own learning
  100. 100. RESPONSIBILITY OF THE STUDENTS • Students are actively engaged in their own learning • Students make decision about what and how they will learn • Students are encouraged to think independently • Needs and interest of the students determine course activities • Students work collaboratively with other learners • Students are given authentic problem to solve • Students monitor their own learning to develop strategy for learning • Demonstrate understanding in a variety of ways • Students receive guided support and instruction
  101. 101. RESPONSIBILITY OF THE INSTRUCTORS • Recognize and accommodate different learning modalities • Provide structure without being overly directive • Listen to and respect each learners point of view • Encourage and facilitate learner’s shared decision making • Helps learners work through difficulties by asking open endd questions to help them arrive at arrive at conclusions or solutions that satisfactory to them
  102. 102. Principles of self directed learning • Should be congruent with life long, natural and individual learning drives • Should be adapted to the maturation transformation and transitions experienced by the learners • Should be concerned with all aspects of a full life • Activities should be conducted in settings suited to their development
  103. 103. SDL FOCUS ON • Learners • Put emphasis on the development of critical thinking and problem solving skills • Learners interact with peers as well as their teacher • Teachers are seen as facilitators mediators and coordinators • Students take responsibility for learning strengthening their motivation
  104. 104. • In order to achieve this, the teacher need to help the students to assess themselves and help them cooperate in groups to ensure they understand and help them cooperate in-groups to ensure they understand ways of exploiting all available resources of learning • Learning is a form of personal development and errors should be seen as constructive part of learning and not a source of embarrassment • The most important factor in learning is effective planning and time management Have a time table Do not waste time Set goals
  105. 105. PROCESS AND STAGES OF STUDENT CENTRED APPROACH Process of SDL 1. Ownership of learning • Articulate learning gaps • Set learning goals and identify learning task to achieve the goals 2. Management and monitoring of own learning • Explore alternatives and make sound decisions • Formulate questions and generate own inquiries • Plan and manage workload and time effectively and efficiently • Reflect on their learning and use feedback to improve their schoolwork 3. Extension of own learning • Apply learning in new context • Learn beyond the curriculum
  106. 106. STAGE STUDENT TEACHER EXAMPLE Stage 1 Dependent Authority couch Coaching with immediate feedback, drill, informational lectures, overcoming deficiencies and resistance Stage 2 Interested Motivator guide Inspiring lectures plus guided discussion. Goal oriented setting and learning strategies Stage 3 Involved Facilitator Discussion facilitated by teacher who participates as equal, seminar , group project Stage 4 Self directed Consultant delegator Internships, dissertation, individual work or self directed study groups
  107. 107. Skills required for student centred learning • Goal oriented skills • Information processing skills • Competency skills • Decision making skills • Self confidence • Self awareness
  108. 108. Advantages and benefits of SDL to students • Strengthen students motivation and commitments • Promotes peer communication as students can work either alone or in small groups • Promote and discover active learning as students are involved in what they study • Students have access to more materials • Students take ownership of their own learning
  109. 109. DIFFERENCE BETWEEN TRADITIONAL LEARNING AND STUDENT CENTRED LEARNING TRADITIONAL LEARNING STUDENT CENTRED LEARNING Teacher impact knowledge through lecture, teacher centred Allows interaction between the teacher and student. Student centred Low level of student choice High level of student choice Students are passive, students are receivers of information Students are active. Teacher act as couch and consultant as it allows interaction with the teacher Decision with teachers. Teacher conduct a lesson according to a curriculum course plan Decisions with the students, students begin formulating their own questions through active learning Provides a student with specific schedule that is structured with specific time devoted to specific subject Requires professional development and enrichment, students incorporate learning strategies to promote interdependence and accountability Learning takes place within the classroom and school Learning can take place in the classroom or outside location
  110. 110. WHY SDL IN NURSING • Knowledge that nursing students acquire at school may become obsolete when they join for nursing practice • Nursing students are likely to work in different contexts during their professional career • Nurses therefore need to keep learning and engaging in continuing education • The field of nursing education has witnessed a change in a student’s role from passive to active learner • This moved the centre of learning away from the teacher and close to the student
  111. 111. LIFELONG LEARNING • It is the” development after formal education; the continuing development of knowledge and skills that people experience after formal education and throughout their lives”(encarter,2008) • It is the process of gaining knowledge and learning new skills throughout your life. Many people continue their education for personal development and fulfilment, while others see it as a significant step toward career advancement • It is the ongoing voluntary and self motivated pursuit of knowledge for either personal or professional reasons • It has been described as a process that includes people learning in different contexts. these environment do not only include schools but also homes, work place and even locations where people pursue leisure activities. • Lifelong learning focuses on holistic education and it has two dimensions, namely lifelong and broad options for learning. This indicates learning that integrates traditional education proposals and modern learning opportunities, it also entails an emphasis on encouraging people to learn how to learn and to select content, process, and methodologies that pursues self designed and self perfection.
  112. 112. • Two theories of particular relevance when considering lifelong learning are the cognitivism and constructivism. Cognitivism most notably Gestalt theory, speaks of learning as making sense of the relationship between what is old and what is new. Similarly, constructivist theory states that “knowledge is not passively received from the world or from authoritative sources but constructed by individuals or groups making sense of their experimental worlds. Constructivism lends itself well to lifelong as it brings together learning from many different sources including life experiences
  113. 113. Reasons for lifelong learning • Healthcare is becoming ever more challenging in its complexity hence employees need to keep up with the fast pace of the industry they’re in • Patients and their families have expectation for the highest quality care.. Families may demand answers from the nurses who provide their care • Healthcare leadership requires knowledge and competency in staff like never before to be effective in their leadership • Healthcare employee disengagement is poor, and lifelong learning is one solution. Establishing and nurturing a culture of lifelong learning inherently promotes engagement. It keeps one motivated. Having an interest in your job help you feel more confident about your work • Lifelong learning is a mandatory career advancement requirement. It helps improve quality of your life. Lifelong learning go beyond career advancement,
  114. 114. ACTIVE VERSES PASSIVE LEARNING • Active learning • An approach in learning wherein the students engage themselves in the learning process by developing knowledge and understanding. It demands full fledged participation on the part of the learner and is not based on classroom teaching, rather it is based on interactive learning sessions • Any form of learning in which there is direct involvement in the learning process through a number of individual and group activities • The basis of active learning is constructivism theory of learning that stresses on the fact that learners construct such as developing their understanding • Active learning methods include; question –answer, brainstorming, debates, dramatizing and problem solving and assignment
  115. 115. • Passive learning • Its traditional form of learning wherein teachers are seen as experts and they are expected to transfer knowledge to the learner. Hence students have a laid back attitude as they learn from what is taught to them by instructors • Passive learners assume that the student’s mind is like empty cups which are to be filled with knowledge • The learners are perceived as a passive recipient of the instructor’s knowledge which means that the learners memorize and imitate knowledge transferred by the teacher • Passive learning methods include lectures, tutorials,programmed instructions, textbooks
  116. 116. DIFFERENCE BETWEEN PASSIVE AND ACTIVE LEARNING ACTIVE LEARNING PASSIVE LEARNING Form of learning wherein there is active involvement of the students in the concerned activities and decision Is when the learners acquire knowledge without making any conscious effort in this regard Student centred Teacher centred Used to improve learning in students Used when new material is presented Responsibility of learning taken by the students The teacher takes the responsibility for the students learning Main source of knowledge is hands on observation, practical application and experiment Main source of the knowledge is the teacher, instructor, books or online resources Teacher plays a role of a facilitator who creates a favorable environment for students to gain knowledge Teachers are regarded as primary source of knowledge so they play role of an instructor
  117. 117. SMALL GROUP DISCUSSION • Small group discussion is defined as a cooperative problem solving activity which seeks a consensus regarding the solution of a problem rather than a discussion by majority vote • Small group discussion is an educational technique that is used extensively in nurse education. • Group discussion depend on good leadership, clear identification of problem, preparation, active participation by members, Accurate information. Group work is an opportunity for sharing ideas, literature, research initiative in practice. The learning encounters is enhanced by contributions from a balanced mix to reflect a range of experiences, attitudes and knowledge. • The advantage of group work includes facilitation of deep, active and collaborative learning • However small group work can be problematic and present challenges for students because group work necessitate the coming together of collections of individuals, each with their own personalities and set of experiences
  118. 118. Purpose • It gives student opportunity • To clarify information and concepts • To learn the process of group problem solving • To develop and evaluate their beliefs and positions • To change students attitude • To raise students interest and enthusiasm for a subject or course • To motivate to attend class and to learn • To learn the value of contribution of others
  119. 119. Value of group discussion • Create analytic and critical abilities 'to interpret problem of fast, throw light on the problem of the present and to gain insight into ways for shaping the future • It helps advance creative thoughts • It enables the students to enrich his own participation • It gives the student an opportunity to learn how to adjust to social stimulus situations • Cooperation is developed • Students acquire knowledge from discussion • Self activity is increased as student participation is increased • Group benefits as there is a pooling of ideas and harmonizing of attitudes
  120. 120. Advantages • Ideas responded better by others • Nurturing environment for professional application • Students feels aided • Instant feedback for students • Ability to present information • Working in group is fun Disadvantages • Requires coordination • Uninteresting when not planned • Costs more in terms of time teacher and accommodation
  122. 122. PUBLIC RELATIONS Introduction Nurses in many developing countries have been criticized for lack of human touch in their approach. Pressure and conflicts usually arise in areas of health care delivery.. These all demand the role played by public relation practice. Nurses must therefore be good public relation practitioners in order to forestall conflicts and maintain cordial relationship amongst their various customers Public relation therefore is the management of the communication and relationships to establish good will and mutual understanding between an organization and its public. This makes it a vital tool in nursing practice and management
  123. 123. WHY NEED FOR PUBLIC RELATIONS • Investing on public relations will help the organization to achieve its objective effectively and smoothly. Effective public relations can create and build up the image of an individual or an organization or a nation • At the time of adverse publicity or when the organization is under crisis an effective Public Relations can remove the “misunderstanding” and create mutual understanding between the organization and the public
  124. 124. OBJECTIVES OF PUBLIC RELATIONS • To create or retain goodwill • Good PR will create and retain prestige and good reputation of nurses • PR will show nurses performance of action which places the clients interest above all others • To aid in promotion of health and maintenance of high health status among clients • To assist overcome misconception and deal with unfavorable publicity
  125. 125. THE TOOLS OF PUBLIC RELATIONS 1. publications; nurse managers could use published materials to influence its public. These materials should have internal and external focuses, it should meet the enlightenment needs of both the health care providers and clients. Examples are newsletters, magazines, journal and brochures 2. Events; this should involve occasions and activities organized to capture the attention and interest of clients. Examples are seminars, open day activities facility tours 3. Public service activities; there are social responsibilities undertaken to improve nurses image and reputation . Examples nurses increasingly acting as clients advocates and greater awareness of community health care needs and culture congruent health practices
  126. 126. PUBLIC RELATION PROCESS Marston’s steps “RACE” model describes the PR process • 1. R= research- listening; use research to analyze the situation facing the organization and accurately define the problem in such a way that the PR efforts can successfully address the cause of the issue. This involves probing the opinion, attitudes and reaction of those concerned with the acts and policies of an organization, then evaluating the inflow. This task also involves determining facts regarding the organization; “ what is the problem?” • A= action planning and decision making; have an overall goal, measurable objectives, clearly identified publics, targeted strategies and effective tactics. It involves bringing these attitudes, opinions, ideas and reactions to bear on the policies and programmes of the organization. It will enable the organization to chart a course in the interest of all concerned; “ here’s what we can do”
  127. 127. • C= communication- action; create communication based on self interest. Communication should be tied to their values, needs and goals. This involves explaining and dramatizing the chosen course to all those who may be affected and whose support is essential; “ here’s is what we did and why” • E= evaluation; evaluate effectiveness of PR campaigns. It involves evaluating the results of the programme and the effectiveness of techniques used; “ how did we do it?”
  128. 128. According to Stanley (2003) Public relation audit Correction of public relation weakness Setting public relation weakness Formulation of public relation programme Carrying out the programme Evaluation of programme effectiveness
  129. 129. The role of a nurse in establishing and maintaining good public relations • Nurses are found in every community as workers, wives, daughters and sons. Nurse practitioners and leaders therefore have roles to play in creating and maintaining good public relations. Nurses should maintain their professional ethics and apply the principle of to the practice of nursing. • They should strive and at all times to create and maintain a good impression with most of their numerous customers • Clients right should be discussed and maintained as much as possible • Health care needs of clients should be the focus of health care • A nurse should be friendly, empathetic, patient, understanding, tolerant, honest and trustworthy • Nurses should strive to work according to professional standard of nursing practice
  130. 130. ROLES OF A PUBLIC RELATION OFFICER • Advocate ; the public relations manager is the chief advocate for the company, he must focus all energy on building an organization that will be deemed a good corporate citizen. He is the mouthpiece for management • Communicator; the PR manager crafts communications policies and oversees the development of all statements and new releases for the company • Problem solver; the PR manager is the ultimate spin doctor. It is her job to put the best face on news and information that could embarrass or malign the company’s reputation • Opinion maestro; the PR manager directs all outreach efforts. He is responsible for media placements and coordinating organizational functions and the efforts of executives
  131. 131. Skills for handling press questions • Confidence • Ability to think and react on questions instantly • Tact • Authority • Crisis management skills
  132. 132. CRISIS MANAGEMENT Pre crisis • Anticipate crisis • Identify your crisis communication team • Identify and train spokesperson • Establish notification and monitoring systems • Identify your stakeholders • Develop holding statements Post crisis • Assess the crisis situation • Finalize and adapt key messages • Post crisis analysis
  133. 133. •CUSTOMER CARE
  134. 134. • Customer care is a form of business that tries to satisfy the customers need about a service offered to change their attitude • It’s the commitment to providing value added services to customers, including attitude, knowledge, technical support and quality of service in a timely manner • Feeling concern and interest in someone who has entered a business to buy a product or obtain a service • Basic rule of customer care; put yourself in the customer shoe; see the situation as they do
  135. 135. CUSTOMER CARE SKILLS There are 8 main customer care skills that need to be displayed when serving the customer; • Appearance • Observation • Listening • Body language and facial expression • Talking • Assertiveness • Attitude • Behavior
  136. 136. Appearance • The appearance of yourself and the other members of staff in your team will say a lot about the standards within the operation Observation • It is easy to miss shortfalls in standards because of familiarity. Try to stand back and look at your working environment in an objective way Listening • If we fail to listen to the customer they will feel that we do not really care about them and therefore not return • The 2 main ways of listen attentively are; physical attending and psychological attending • Physical attending; face the speaker, maintain eye contact, maintain an open posture, stay relatively. • Psychological attending; keep an open mind, think ahead, analyze and evaluate, don’t interrupt, interpret a tone of voice, evaluate the non verbal
  137. 137. Body language and facial expression • Reading and understanding body language is an essential part of listening. If our body language does not reflect the words that we are using then the customer will not believe us Talking • When talking to the customer we must not Complain about the company Moan, moan and moan again Take over customers head Assertiveness • We should try to apply an assertive manner at all times • By being assertive you remain in control, have greater self confidence and earn the respect of others
  138. 138. Attitude and behavior • The way we behave with customers is all important • We must display a positive approach and be courteous at all times • Remember…. Each customer is an individual Be enthusiastic – its infectious Courtesy costs nothing Treat people as individuals.. Use their name
  139. 139. Attempt the following questions 1. Describe how to handle customer requests 2. Discuss how to manage telephone calls 3. Describe the different type of customer in healthcare 4. Discuss how to handle clients complain 5. Describe how to handle different clients, silent, emotional, upset 6. Discuss the challenges clients have in health care
  140. 140. CUSTOMER LOYALTY • Loyalty is a deeply held commitment to rebuy or re patronize and preferred product or service, in the future despite situational influences and marketing efforts having the potential to cause switching behavior • Loyalty can also be defined as customer continuing to believe that your organization’s product/service offer is the best option. It bests fulfils their value proportion whatever that maybe. They take that offer whenever faced with that purchasing decision
  141. 141. • Customer loyalty is both attitudinal and behavioral tendency to favor one brand over all others, whether due to satisfaction with the product or service, its convenience or performance or simply familiarity and comfort with the brand • Customer loyalty encourages customers to shop more consistently, spend greater share of wallet, and feel positive about shopping experience, helping attract consumer to familiar brands in the face of competitive environment • To earn patient loyalty, your staffs will need to provide excellent care for every patient in every encounter hence they need actionable data and tools
  142. 142. Fundamental needs of a customer • To feel welcomed • To be understood • To retain dignity • To obtain assistance • To be valued
  143. 143. Communicate effectively with customers • Speaking;  one on one; maintain eye contact and body language, both are equally critical  telephone; remember customer service rules, identify, take the time, listen  presentation; eye contact, brevity, repetition • Listening; listen attentively and attendingly • Body language; eye contact, body language, appropriate gestures, facial expressions, voice modulation • Knowing your audience
  144. 144. Our attitude towards the customer • Employees attitudes make a difference to brands loyalty • 68% of customers leave because of poor employee • 41% of customers of customers are loyal because of good employee attitude • 70% of customers brand perception is determined by experiences with people
  145. 145. BENEFITS OF LOYALTY MARKETTING • Improves knowledge of your customer • Leverage customer insight to increase sales of undersold and or highly profitable product and services • Respond to market disruptions, keep the patients you have to earn new ones • Increase customer referrals and recommendations
  146. 146. PRACTICES FOR IMPROVING CUSTOMER LOYALTY • Increase your commitment to privacy, for many patients privacy is a major concern example when dealing with STDs or incontinence, are embarrassing • Expedite the speed of service whenever possible, some patients need faster treatment than others and there’s only so much you can do to expedite your speed of service without compromising the quality of service • Develop and execute a social media strategy, post on nsocial media band encourage your patients to engage with your brand brand in some meaningful ways • Provide more information to your patients, information and transparency can make any patient interaction more pleasant • Facilitate personal experience; patients wants to feel heard and seen as individuals and they want to engage with other individuals on a personal level when discussing their problems
  147. 147. •THANK YOU