ATI FUNDAMENTALS- COMMUNICATION Flashcards
communication
The process of sending and receiving information. Dynamic interactions between people and their environment using a process that involves celebration (thinking), cognition, hearing, speech production, and motor coordination.
HOW IS INFO SHARED
between the sender and receiver through verbal connection, body language, emotions, and the use of technology or other equipment
SHANNON-WEAVER COMMUNICATION MODEL
1948
ONE OF THE FIRST MODELS
TECHNICAL COMMUNICATION MODEL
VERY LINEAR
6 steps of the SHANNON-WEAVER COMMUNICATION MODEL
sender- one who starts
encoder- means of transmission
channel- how it is transmitted- phone line
decoder- signal back to message
receiver - receives message
noise- environmental distractor
Schramm’s model
modified the Shannon-Weaver model to show three main components: the sender, the receiver, and the message.
suggests that communication is an engaged process where the sender and receiver send messages back and forth and receive feedback.
THEODORE NECOMB’S MODEL
ABX MODEL
explored the topic from a social standpoint and examined the role communication plays in society
Three components: sender, receiver, and topic.
WHAT MADE THE ABX MODEL DIFFERENT
this model does not have a separate placeholder to represent the message, just arrows showing the back and forth exchange. The topic (X in the model) can represent several subjects and can even be another person
DAVID K BERLO’S MODEL
SMCR MODEL
comprised of a Sender-Message-Channel-Receiver.
This model is a one-way process and does not include any feedback or cyclical processes like many other communication models.
EX INSTRUCTIONAL VIDEO
CHANNEL
The method or medium used to deliver a message.
WHAT HELPS SHAPE COMMUNICATION EFFECTIVENESS
TONE
EMOTIONAL TRIGGERS
VERBAL AND NONVERBAL LANGUAGE
FIVE LEVELS OF COMMUNICATION
VERBAL
PHYSICAL
AUDITORY
ENERGETIC
EMOTIONAL
When attempting to understand nonverbal communication, the nurse must take what into consideration
culture, age, language, physical deficits, and developmental levels
therapeutic communication
Techniques used to improve communication, such as active listening.
enhance communication skills, prevent mistakes through miscommunication, and foster better relationships with clients and team members.
auditory communication
What message the receiver hears.
includes the speed and tone of voice that the receiver perceives.
what can affect auditory communication
many factors, such as physical and intellectual disabilities or outside disruptors like noise from medical equipment. If the client does not participate in the discussion, there may be a barrier that prevents the client from hearing the nurse or causes a misunderstanding.
emotional communication
A form of communication that expresses feelings and emotions.
refers to the speaker’s emotional state when conveying a message. This emotional state can be transferred to the receivers and will affect how the message is accepted
Energetic Communication
refers to how the person projects themselves. For example, an actor who has a remarkable stage presence and a physician who is perceived as cold and unsympathetic can be viewed differently despite providing the same information
empathy
Ability to understand the feelings of another.
complementary health techniques
ex: heartmath
teaches clients the connection between emotions and the electrical communication between the heart and brain, to improve health. This technique uses biofeedback through monitoring devices to teach the client how the heart’s electrical impulses are affected by positive and negative emotions.
bioelectric energy
energetic communication component
exists in the body and how that energy affects health and communication. Many providers state that a client’s emotional state affects physical health status. This is tied to the effect emotions have on the electrical impulses in the body.
What is the difference between verbal and auditory communication?
Verbal communication is what the sender said, while auditory communication is what the receiver heard. In theory, these two types of communication should have the same message, but often they do not. A variety of communication barriers can affect the message of what one said to what another hears.
four modes of communication:
verbal, nonverbal, electronic, and written.
Verbal communication commonly refers to
oral communication. This mode can occur through face-to-face communications and via telephone.
baby boomers commonly prefer what mode of communication
verbal
Depending on the age, culture, and socioeconomic background of the client, electronic communication methods may be
underused or viewed as uncompassionate and lacking a personal connection
Nonverbal communication is
body language. Actions such as eye contact, facial gestures, posture, and overall appearance send messages to the receiver in addition to what the sender is saying. These messages may support or contradict what is being said in the verbal mode of communication.
why do Many people who value face-to-face communication appreciate being able to perceive the nonverbal communication from the speaker
because it can provide emotional feedback.
nonverbal cues can also lead to
confusion and misunderstandings, depending on the sender’s competence with face-to-face interactions and the receiver’s ability to interpret.
electronic communication
This mode includes email, texting, video conferencing, and social media. This technology can allow health care team members to communicate with each other and their clients more efficiently, but also can lead to privacy violations, mistakes from typographic errors, and distractions.
the joint commision requires the use of
electronic communication
secure messaging when transmitting client information to help maintain client confidentiality and reduce Health Insurance Portability and Accountability Act (HIPAA) violations.
According to the HIPAA Security Rule, any electronic communication containing PHI must have the following safeguards:
each user must have a personalized login that can be monitored, the system must have an automatic logoff function if left unattended, and PHI sent as attachments must be indecipherable if intercepted.
The Health Insurance Portability and Accountability Act, also known as the Privacy Act, legislation is to protect insurance coverage and private information of clients. Its purpose is to
protect client privacy and personal health information from security breaches, particularly electronic data. It was established by the federal government with the goal of making health care more efficient. Established in 1996 to reduce fraud and deter inappropriate use of client health care information.
Written communication
includes electronic communication and can be in the form of a letter, handwritten or typed, or an email or computer-based post. These modes of communication lack the nonverbal cues that face-to-face interactions possess, leading some users to view them as detached.
lack of body language and nonverbal cues in written communication can make it difficult for the recipient to
determine tone and may lead to misunderstandings even if the sender resorts to the use of emoticons and avatars to represent emotions.
shortcomings to written communication
include the receiver’s need to be able to read the words. Literacy, language differences, and visual impairments may all present a barrier to effective written communication.
A postoperative care nurse is teaching a 76-year-old client who had cataract surgery about how to administer their eye drop medication after discharge. Which of the following forms of communication should the nurse use for this client?
A
Verbal
B
Nonverbal
C
Electronic
D
Written
a
Much like the various forms and modes of communication, the tone and style of communication affect
how a message is received and understood.
communication styles
passive, assertive, and aggressive. Some models also include a fourth type, referred to as passive-aggressive.
the most effective communication style is
assertive, due to its cooperative and straightforward style. The other three types tend to take the focus from the message being sent and place it on either the sender or receiver. This approach can hinder open communication and lead to misunderstandings.
passive communication points
conflict avoidance
anxious
hesitates to stand up for self
common in novice nurses to provider/authority due to lack of confidence
Assertive Communication
most effective because they communicate clearly and honestly. They advocate for their opinions, rights, and needs without violating the rights of others. Assertive communication is fundamental for good communication, mental health, and healthy relationships.
honest and clear communication
advocates for self
uses i statements
aggressive communication
uses you statements
verbally abusive
controlling
interruptive
blame receiver
antagonistic/hostile when challenged
quick to react
passive agressive communication
acts out anger in indirect way
feels powerless and resentful
sarcastic
passive on the surface
subtle, indirect, secretive anger
rarely interrupts
says will do but doesn’t
ignores call light
A nurse manager is precepting a newly licensed nurse. At the end of the day, the nurse manager tells the newly licensed nurse, using a condescending tone and facial expression, that she did a good job considering her newness. Which of the following types and modes of communication are occurring here? (Select all that apply.)
A
Passive
B
Aggressive
C
Passive aggressive
D
Verbal
E
Nonverbal
c d e
factors influencing communication
Cognitive, intellectual, or developmental deficits, such as dementia, Down syndrome, and autism spectrum disorder (ASD)
what can influence one’s ability to effectively communicate a message
Physical deficits, such as hearing loss; cultural differences; language barriers; and environmental factors like a noisy emergency department
dementia
A cognitive disorder that can impair communication ability due to language and memory changes
down syndrome
A developmental disorder that can cause physical, cognitive and communication deficits.
Nursing is often faced with a lack of available staff and time constraints. As a result
many nurses try to focus on what they believe to be the most important client care tasks while other aspects of client care, such as providing emotional support, may be overlooked.
The Hearing Loss Association of America suggests
clients and providers use a communication access plan to help determine what the client needs to communicate effectively.
what does a communication access plan offer
strategies for hearing-impaired clients, such as face-to-face communication, communication in writing, or using an assistive device. Strategies such as varying volume and slowing speech to accommodate for a client’s hearing impairment and environmental distractions can be useful.
autism spectrum disorder (ASD)
A developmental disorder that can cause barriers in social interaction and communication.
Clients who have developmental and cognitive factors influencing their communication abilities may
be distracted by an environment that is very noisy or bright, more so than clients without these deficits.
how can you enhance communication with developmental or cognitive factors
by giving short, directive instructions that are clear and free from slang, medical terminology, or abstract imagery.
Physiological issues and disease processes can also affect cognitive function, such as
poorly controlled chronic pain, Parkinson’s disease, and multiple sclerosis.
Environmental factors such as (blank) can hinder the connection between nurse and client and act as a distraction
excessive noise, extreme temperatures, poor or too bright lighting, and other elements that can make those trying to communicate uncomfortable
outside interferences such as (blank) are detrimental to effectively sharing a desired message.
the use of social media or texting during communication sessions
situational issues that can hinder effective exchange
issues that cause strong emotions, such as fatigue, anxiety, and fear
Cultural and demographic factors include many influences that can enhance or hinder communication
A client’s language, religion, sexual orientation, age, and gender can all affect the way communication occurs. The nurse’s cultural competency or biases influence this communication as well.
health care itself is affected by
institutional racism, resulting in inequitable access to care and minorities being underrepresented among professional caregivers.
Sexual orientation may influence communication among health care providers and clients
Some clients may fear disclosing this information, especially transgender clients, who research states tend to receive less support due to health care providers’ lack of education about lesbian, gay, bisexual, transgender, and queer (LGBTQ) topics
You are the nurse for a 10-year-old client who has ASD. What communication skills and actions can you use to make the environment more comfortable for them?
You could be sure they are in a room farther away from the nurses’ station and entryways so it will be quieter. You could use bedside lighting rather than the overhead fluorescents. You should give short, clear instructions before actions, such as “Please give me your hand so I can check your IV.” You could also speak with their caregiver, if possible, to see where their communication deficits are and what behaviors they respond best to.
how do nurses use therapeutic communication
use listening skills, empathy, and a desire to build a professional relationship with the client to provide holistic and patient-centered care.
nontherapeutic communication results in
misunderstandings, poor patient care, and decreased patient satisfaction.
nontherapeutic communication
Techniques that hinder communication, such as stating the person is wrong.
these three characteristics are often described as the cornerstones of a therapeutic relationship
Communicating a compassionate, caring, and empathic attitude toward clients is an expected skill in nursing.
Jean Watson’s Theory of Human Caring embodies the key components of therapeutic relationships:
being authentic, protecting human dignity, and practicing loving-kindness
The 10 Caritas Processes, or caring practices,
serve as guidelines for the nurse to develop these caring relationships with clients and colleagues. Utilizing these guidelines can help the nurse make each client encounter a “heart-centered encounter” or “healing moment”.
The nurse-client relationship can be defined by four phases, originally identified by Hildegard Peplau in her Theory of Interpersonal Relationships, as
orientation, identification, exploitation, and resolution/termination.
The orientation phase is
the initial phase in which the client reaches out to the nurse or other health care provider for help.
Identification occurs when
the two establish a mutually respectful relationship.
Exploitation is
the active phase of the relationship where the nurse educates the client to change the situation or behavior.
In the final phase, resolution or termination,
the client has had the issue resolved and the relationship between the nurse and client is terminated until the next event.
the nurses role in developing relationships
the nurse acts as a guide to help the client receive the needed care.
Therapeutic Communication Techniques to improve the nurse-client communication
Examples include using silence, engaging in active listening, asking open-ended questions, accepting, giving recognition, restating, summarizing, and reflecting.
In active listening, the nurse considers
both the client’s verbal and nonverbal messages to understand the true meaning of the exchange. This technique requires each participant to focus on the speaker, rather than planning what the listener will say next.
Asking open-ended questions encourages communication between the nurse and client because
it requires more interaction than a simple yes or no answer.
the use of silence gives both the nurse and client a chance to absorb the conversation and determine what should be discussed next. Using silence encourages
the client to disclose more information, reduces the physical space between the nurse and client, and focuses on a topic area to learn more. It is recommended the nurse allow the client to choose the topic and be the one to break the silence.
Restating, paraphrasing, and summarizing all require
the nurse to repeat the message back to the client to ensure there was no misunderstanding between the participants. This gives the client a chance to clarify if the nurse misheard or misunderstood.
Active listening and restating are helpful to
clarify what has been said.
restating
A therapeutic communication technique where the receiver summarizes or paraphrase the message back to the sender to ensure understanding.
reflection
is comparable to restating, but instead of repeating the client’s message back to them, the nurse attempts to reveal the client’s feelings behind the message.
Reflection is used most often when
clients are asking for advice or the nurse’s opinion about a topic
Other therapeutic communication techniques a nurse can use include
accepting, which is acknowledging that the nurse has heard and understood the client; giving recognition of changes without compliments, which can be seen as bias; and offering to spend time with the client by simply sitting with them.
what happens When there is an understanding of each team member’s worth and role
interprofessional cooperation improves, leading to better communication, improved client outcomes, less duplication of work, and fewer errors.
The Interprofessional Education Collaborative created
competencies to direct and support the cooperative effort among different providers. Many of the competencies are similar to those required to form a therapeutic relationship with clients.
IPEC asks health care providers to
have mutual respect, to understand one’s own role and that of their colleagues, to communicate with clients and each other in a manner that is timely and focused on prevention, and to support positive teamwork.
The four core competencies are
to work with each other respectfully, to work together utilizing each other’s knowledge to care for clients and promote health, to communicate effectively as a team to promote clients’ health, and to use effective dynamics and values within the team to develop and use client-centered care and health promotion policies.
motivational interviewing (MI)
Communication strategy that empowers the receiver to make positive changes.
OARS
Mnemonic for motivational interviewing techniques: Open-ended questions, Affirmations, Reflective listening, Summarizing.
affirmations
Positive comments that help build the receiver’s confidence.
open ended questions
Mi uses four main therapeutic techniques described by OARS:
allow the client to disclose more information. Strategies such as asking the client “Tell me more about…” rather than “Why did you…” tend to be perceived as less judgmental.
Affirmations
Mi uses four main therapeutic techniques described by OARS:
are statements that encourage the client, such as “You did very well with your food diary this week”.
reflective listening
Mi uses four main therapeutic techniques described by OARS:
restates what the client said, encouraging clarification of feelings, such as “So you are worried that you will get diabetes like your mother”.
summarizing
Mi uses four main therapeutic techniques described by OARS:
seeks to ensure understanding by paraphrasing what the client said, such as “Your mother also had diabetes”.
individual communication
A client dealing with a recent diagnosis of diabetes mellitus (DM) might benefit more from individualized communication about the next steps in the treatment plan, rather than attending a group presentation on DM.
group communication
clients who need continued education and support might find group communication, such as community classes or support groups, valuable
Examples of nontherapeutic communication techniques include
not listening or rejecting what the client is saying, being critical, trying to reassure the client by dismissing concerns, and giving advice
nontherapeutic communication can result in
increased stress in the client; a poor relationship with the nurse; and, ultimately, a poor outcome.
telling a client what they should do is often seen as
belittling and disrespectful. Rejecting or disagreeing with the client may result in defensiveness or stop the communication altogether.
Probing is
another nontherapeutic technique that may cause the client to cut off communication, especially if the topics being asked about are not viewed as relevant to the client.
changing the subject can hamper communication because
the client might see the exchange as one-sided and that the nurse does not genuinely care for them.
The nurse uses active listening to demonstrate attentiveness when talking with Ms. Hutchison. Which of the following actions should the nurse take when using this therapeutic communication technique? (Select all that apply.)
A
Sit facing the client
B
Use a closed posture
C
Make eye contact with the client
D
Take notes on the client’s comments
E
Minimize distractions
a, c, e
Reflect on a time when someone wanted to talk with you about a concern. Drawing on your past experiences, what are some techniques you can use to help your clients communicate their feelings?
To help clients communicate their feelings or concerns you should use therapeutic communication techniques including active listening, asking relevant questions, providing information, and silence. It is also helpful to share your observations about the situation, show empathy, and instill hope.
When talking with Mr. Toledo about his concerns, which of the following statements should the nurse make to demonstrate therapeutic communication?
A
“Why do you feel that you’re having a nervous breakdown?”
B
“I’m so sorry that you feel as if you don’t have anyone.”
C
“Losing someone is hard. I think you should try to plan activities with other people you know.”
D
“Tell me more about what you mean when you say you don’t think you can do this.”
d
communication barriers
Language differences, cultural diversities, speech or hearing impairments, developmental or cognitive disorders, medication effects, effects of recreational drugs, emotional distress, and environmental factors
The use of a qualified medical interpreter is
a strategy to overcome this communication barrier and, as of 2000, is mandated for any health care facility that receives federal funding (Medicare or Medicaid reimbursement).
The Department of Health and Human Services, Office of Minority Health developed and revised
the National Cultural and Linguistic Appropriate Services (CLAS) standards for all health care facilities to follow.
client does not make eye contact, folds arms across chest. which form of communication are they using
a. auditory
b. nonverbal
c. emotional
d. energetic
b
client tells nurse thank you for telling them something they didn’t know. this is an example of:
a. sender
b. channel
c. feedback
d. receiver
feedback
which action would enhance learning
a. ensure room is well lit
b. have soft music playing
c. distribute samples during teaching
d. talk softly
a
which is motivational interviewing
a. what is making you feel sad
b. why do you keep eating fast food if you want to lose weight
c. have you always struggled with depression
d. do you have any health problems
a
if you speak and the client continues watching tv at a loud volume, which should you do
a. go check on other clients
b. ask why they are ignoring you
c. repeat question louder
d. lower tv volume
d
when a nurse provides instructions during a follow up phone call, which component of the shannon weaver communication model is the nurse demonstrating
a. receiver
b. sender
c. channel
d. decoder
b
when a nurse instructs a client regarding heart healthy activities, which phase are they representing in the nurse-client relationship
a. identification
b. orientation
c. exploitation
d. resolution
c
which strategy should the nurse implement when communicating with a client that has dementia
a. explain in detail
b. turn on overhead lights when speaking
c. speak in loud voice
d. speak clearly and slowly
d
which action should the nurse take when planning to reconcile meds for a client that speaks a different language
a. ask a staff member to interpret
b. ask family member to interpret
c. use app to translate
d. request facility interpreter
d
which method should a nurse manager use to introduce a new scheduling policy to the staff
a. send email
b. schedule face to face
c. place a copy on bulletin board
d. leave voicemail on staff’s phone
b
what factor is influencing a client to request to have their last rites before they die
a. cultural
b. developmental
c. environmental
d. physiological
a
