5: Communication in the Nurse–Patient Relationship

Question 1

therapeutic communication

Answer 1

facilitates interactions focused on the patient and the patient’s concerns

Question 2

Hildegard Peplau

Answer 2

theory of interpersonal relations:
interpersonal competencies of nurses are key to helping patients regain health and well-being. In short, communication is at the heart of all nursing.

Question 3

communicate

Answer 3

A system of sending and receiving messages, forming a connection between the sender and the receiver.

Question 4

Written communication

Answer 4

a means to document and convey legible and comprehensible information to others.

Question 5

Verbal communication

Answer 5

It is an exchange using the elements of language and the spoken word

Question 6

nonverbal communication

Answer 6

A person communicates by gestures, facial expressions, posture, space, appearance, body movement, touch, voice tone and volume, and rate of speech, or silence

Question 7

metacommunication

Answer 7

verbal or nonverbal communication about the communication or lack thereof

Question 8

congruent communication

Answer 8

There is a “good fit” among verbal communication, nonverbal communication, and metacommunication

Question 9

incongruent communication

Answer 9

Verbal communication, nonverbal communication, and metacommunication do not “fit” with one another

Question 10

sender

Answer 10

a person or group with a purpose for the communication

Question 11

encoding

Answer 11

The process of getting the information translated into the code is called encoding and results in a message

Question 12

communication channel

Answer 12

the medium or carrier of the message

Question 13

receiver

Answer 13

the target of the communication

Question 14

decode

Answer 14

to understand

Question 15

Feedback

Answer 15

the sender and the receiver use one another’s reactions to produce further messages.

Question 16

nurse–patient relationship

Answer 16

focuses on the patient, is goal directed, and has defined parameters
three phases: 
orientation
working
termination

Question 17

orientation phase

Answer 17

introductions and an agreement between nurse and patient about their mutual roles and responsibilities

Question 18

working phase

Answer 18

the nurse and patient explore and develop solutions that are enacted and evaluated in subsequent interactions

Question 19

Termination phase

Answer 19

the closure of the relationship

Question 20

informal contractual relationship

Answer 20

Verbal and assumed by both parties. Patients are seen as having control over the significant decisions that affect their own bodies

Question 21

Advocacy

Answer 21

taking the patient’s side

Question 22

circle of confidentiality

Answer 22

it includes all the people in a nursing unit who have responsibility for the patient. It usually includes the family unless the patient objects

Question 23

Empathy

Answer 23

encompasses the ability to look at things from another’s perspective, to walk in his or her shoes, and to be able to share the essence of that understanding through verbal and nonverbal communication

Question 24

Positive regard

Answer 24

refers to warmth, caring, interest, and respect for the person, seeing the person unconditionally or nonjudgmentally

Question 25

Self-evaluation

Answer 25

taking responsibility for one’s actions as a professional

Question 26

compassion fatigue

Answer 26

nurses continue to care for their patients, in addition to their families and significant others, but become unable to care for themselves

Question 27

Restatement

Answer 27

After listening carefully to the patient, repeat the content of the message back to the patient in order to verify understanding with the patient.

Question 28

Reflection

Answer 28

identifying the main emotional themes contained in a communication and directing them back to the patient.

Question 29

Exploring

Answer 29

communicating therapeutically without giving direct advice

Question 30

Focusing

Answer 30

involves asking goal-directed questions to help the patient stay on the topic and talk more about it.

Question 31

Nontherapeutic responses

Answer 31

responses such as rescue feelings, false reassurance, giving advice, changing the subject, being moralistic, and nonprofessional involvement, all block communication

Question 32

Nontherapeutic communication may interfere with professional nursing care by hindering the patient–nurse relationship. Which of the following are examples of nontherapeutic communication?
Select all that apply:
a. A nurse provides education on smoking cessation: “The same thing happened to me and I was able to quit.”
b. A nurse attempts to distract a patient at the end of their life: “Let’s focus on your walking for the day, not your worries about death.”
c. A nurse states during report that “the patient should not get an abortion because it is wrong.”
d. A nurse is sending a pediatric patient for cardiac surgery. As he leaves she states “Don’t worry, everything will be fine!”
e. A nurse is discussing care options with the family of a patient: “What have your experiences been like with home healthcare in the past?”

Answer 32

a. A nurse provides education on smoking cessation: “The same thing happened to me and I was able to quit.”
b. A nurse attempts to distract a patient at the end of their life: “Let’s focus on your walking for the day, not your worries about death.”
c. A nurse states during report that “the patient should not get an abortion because it is wrong.”
d. A nurse is sending a pediatric patient for cardiac surgery. As he leaves she states “Don’t worry, everything will be fine!”

Question 33

A previously healthy and active 31-year-old patient with a radical mastectomy snaps at the nurse and asks her to leave her alone. In analyzing this, the nurse is able to attribute the behavior to:

a. Empathy
b. Comfortable sense of self
c. Developmental stage of intimacy versus isolation
d. Vulnerability of illness

Answer 33

d. Vulnerability of illness

Question 34

In communicating with a developmentally delayed adult patient, which of the following would be the best techniques for the nurse to use?

a. Silence
b. Providing reassurance at all times
c. Setting clear limits while allowing participation
d. Establishing a contract including values and rights

Answer 34

c. Setting clear limits while allowing participation

Question 35

A patient’s sister expresses her dissatisfaction to the nurse regarding the discharge care coordination between the physician and cardiology team. In order to practice client advocacy, what should the nurse do first?

a. Call the social worker to coordinate the discharge care
b. Call the physician immediately to request a visit with the patient’s sister
c. Assist the patient’s sister in compiling a list of questions related to discharge
d. Admit to the patient’s sister that there are problems with the discharge system and resolve to correct these oversights

Answer 35

c. Assist the patient’s sister in compiling a list of questions related to discharge

Question 36

The circle of confidentiality is essential in maintaining sensitive information among appropriate professionals. A nurse overhears a conversation about an unknown patient’s care in the elevator. The best immediate response would be:

a. “Clinically relevant information should be shared with the healthcare team, thanks for your report.”
b. “I’m concerned to hear discussions like this in nonprivate areas, let’s be mindful of patient privacy.”
c. An incident report describing the event with the names of those employees involved.
d. Interjections with suggestions for the patient’s care plan considering his or her current situation.

Answer 36

b. “I’m concerned to hear discussions like this in nonprivate areas, let’s be mindful of patient privacy.”