Chapter 18 - Communication&Therapeutic Relationships (Week 5 Quiz)

Question 1

T or F: The Joint commision National Pt Safety goal is to improve patient safety by improving communication among caregivers.

Answer 1

True. Perf standards also state the pt has the right to receive effective, understandable information.

Question 2

Communication is….

Box 18-1

Answer 2

Sharing or transmitting thoughts or feelings

A way to meet physical, psycho-social, emotional and spiritual needs.

A process - the act of sending receiving interpreting and reacting to a message.

Content - actual subject matter words gestures and substance of the message.

It may be verbal or non verbal

Forms the basis for sharing meaning and building effective working relationships among individuals, families, and the healthcare team.

It involves talking and listening.

Question 3

Communication occurs on three levels (p.352)

1. __________ communication - conscious internal dialogue aka self-talk.
2. _______ communication - between 2 or more people.
3. _____ communication - you engage in exchange of ideas with two or more individuals at the same time.
4. _____ ______ - when a speaker addresses a large group.

Answer 3

1. INTRApersonal (can be negative or positive). Can affect your ability to perform a task - like taking a test….
   * *INTRA means on the inside
2. INTERpersonal (inter = intersection = between you and others) - usually between 2 or more people. This is the form of communication used by us to complete a pt interview/assessment.
3. Group - you may be thinking interpersonal and group seem like the same thing. The difference is the way in which communication takes place. Interpersonal is more “personal” whereas group is more formal.
   http: //www.positionignition.com/blog/2014/2/27/differences-between-interpersonal-skills-and-communication-s.html
4. Public speaking

Question 4

Communication involves content and process. Content of communcation is the actual subject matter/words/ gestures/and substance of a message. The Process refers to the act of sending/receiving/interpreting and reacting to a message. Why are both of these necessary?

Answer 4

Example:

Content: A patient (the message SENDER) says, “I slept through lunch.”

What does the pt mean by this???? What encoding (tone, gestures, symbols) did the patient use to transmit the message?

You must process the information (receive and decode) by paying attention to all forms of communication (verbal and non verbal) plus have an understanding of the person’s nature to get WHY the patient said this and WHAT they mean by it.

Was he mad about? Surprised? What does his face say? Did he yell it? etc.

This is the process….. encoding and decoding what the purpose/point is in the statement by the pt.

Question 5

Effective messages are…..

Answer 5

complete, clear, concise, organized, timely, and expressed in a manner that the receiver can understand. (To the point!)

Question 6

The _____ is the medium used to send the message.

Answer 6

Channel

Can be face to face
Written pamphlets
audiovisual aids
recordings
telephone and text messages
Touch (touching someone's hand and sitting quietly may convey caring more than words)

Question 7

The ______ of a message is the listener, observer, interpreter.

Answer 7

receiver (you when someone speak to you)

Question 8

To avoid miscommunication, confusion and misinterpretation you should give the sender (the person speaking to you) ________.

Answer 8

Feedback - it validates that you (the receiver) received the message and understood it as the sender intended it. In other words, “so what I think you are saying it…..” etc.

Question 9

When speaking to others, what should you take into consideration about them?

Answer 9

education level (if the person has a limited vocab, you should not speak over their head. They may feel too embarrassed to ask questions. Make sure you speak on their level without being condescending. Always ask if they have questions and encourage them to ask questions!)

culture

language (if the person is not fluent in English, get a translator. Again, they may be intimidated and too fearful to ask for help)

age (would you speak to a child the same as a 45 year old adult?)

etc.

Question 10

Denotation is the _____ meaning of a word.

Connotation is the ______ or _____ meaning of the word.

Answer 10

denotation = literal meaning (Baby, don’t cry. Mama is here)

connotation = implied or emotional meaning. You know the old saying, it’s not what you said it’s how you said it?
Ex:”Don’t cry baby! Grow up!” < baby is meant as an insult. “Hey baby, you look hot!”

Question 11

Why is pacing important?

Answer 11

Pacing is the speed/rhythm of the convo. If you don’t pause in between ideas/statements, you don’t allow the other person to add to the convo nor interpret what you are saying.

“God gave us two ears and one mouth so we can listen twice as much as we speak.”

If someone talks to me endlessly I drift off. Conversations should be like volleyball or tennis….ball goes back and forth!

p.354-355

Question 12

T or F: Clarity and brevity creates a clear and concise conversation that holds the interest of all parties and conveys the intended message.

Answer 12

True.

Clarity forces you to use words that convey intended meaning; ensure that your body language and words match!

Brevity keeps it brief and to the point.

My English professor calls it word economy. Don’t use fluffy words to “sound” a type of way….just say what you mean and be direct.

Question 13

Why is timing and relevance so important?

Answer 13

Timing/relevance:
If someone just told you that your house is on fire, will you be able to process a conversation about your car payment being due?

Timing
If a patient has just been told they have stage IV cancer, will they be ready to discuss their treatment options? Maybe, maybe not. It is your job to assess the scene?

Question 14

T or F: Communication is more effective when both parties value the interaction and find the discussion relevant.

Answer 14

True

Question 15

Your ______ depends on a pattern of honest and timely response to patient concerns, as well as congruence between your verbal and nonverbal communication.

Answer 15

credibility

If you make empty promises, lie, do not produce what you say…no one will have faith in you or believe in you…

Do not say things to make yourself or pt feel better. Telling them they results may be wrong, and they are not going to die, gives them false hope. It’s better to offer up counseling or the chaplain to speak with them about the diagnosis.

Question 16

Why is humor important? Why must you use it with caution?

Answer 16

1. Humor and laughter can have a positive influence on attitude and healing; can create physiologic changes that contribute to well-being and provide emotional release.
2. Humor is subjective. What is funny to some may be offensive to others. Never make mean jokes, if you have to hurt others to make the joke it’s not funny. Do not joke about the disease, treatment or direct the joke at the patient.

Question 17

Body language is a form of ______ communication. When we speak we (attempt to anyway) consciously choose the words and how we say them. Body language shows how we actually feel.

Answer 17

Nonverbal

It is important to make sure yours is appropriate (no making stink face when you are cleaning up feces) and that you pay attention to the patient’s!

Question 18

List forms of nonverbal communication and describe each…

Answer 18

1. Facial expression (frowning, smiling, raised eyebrows)
2. Posture and Gait - someone with pep in their step may be happy or may be in a hurry. Someone with slouched posture may have low self esteem. etc
3. Personal appearance - tells about a persons, socieconomic status, culture and religion. Depressed person may lack attention to personal appearance and/or hygiene
4. Gestures - is your patient’s arms folded? is their head in their hands?
5. Touch - use it consciously and cautiously. Some people may interpret it to be inappropriate (for cultural reasons). Patients with dementia or mental disease may be confused/scared or react violently. Some women may not be comfortable with men.

Question 19

What action should you take when there is a discrepancy between the client’s spoken word and nonverbal body language?

Answer 19

Answer:

You must discuss the communication discrepancy with the patient.

Question 20

What are the major factors that affect communication?

Answer 20

Answer:
Communication is affected by the following major factors:
● Environment - quiet private free of unpleasant smells with a comfy temp is optimum
● Lifespan variations - speak to people on their level! (A patient who requires frequent hospitalization may surprise you on how much they do know for their age!)
● Gender - women communicate to form connections and est relationships. Men want to maintain independence and favorable position in hierarchy. A female nurse may interpret “I feel lousy” as an invitation to talk whereas a male nurse may discuss pain control.
● Personal space - varies per person/culture. (intimate,personal, social and public distance to be discussed next card)
● Territoriality- “Mine” “my stuff” “my space”…refers to space and things a person identifies with; ask before touching a pt’s belongings.
● Sociocultural factors- Doctors and patients may view themselves as higher or lower than each other. NUrses are the middle road and approachable. Patients may as you questions they didn’t dare “embarassingly” ask the doc. Docs may treat impoverished patients with less respect than wealthy ones.
● Roles and relationships - You would never talk to your grandma the way you do your childhood best friend. Be approachable so patients can open up to you.
● Attitudes

Question 21

People vary in the amount of physical space they are comfortable with when communicating.

1. ______ distance is the area most immediately surround a person (within about 18 inches). So close you can feel their body heat, smell their breath/body, but can hear a whisper.
2. ______ distance is 18 inches to 4 feet away. This is typical space we keep with coworkers, pt families, etc.
3. ________ distance is 4ft to 12 ft. This is typical for a presenter from the crowd. It is impersonal.
4. ______ distance is considered beyond 12 feet

Answer 21

1. Intimate - we will invade this space during assessments/procedures. Remember to ask for permission and explain yourself before touching!
2. Personal (allows you to be personal and keep it personal without getting intimate).
3. Social (if you stand at the door and ask a pt a question, you may not get a great response).
4. public (group community focused)

Question 22

In what distance(s) do most nurse–client interactions occur?

Answer 22

Answer:

Most nurse–client interactions occur in either the intimate or personal distances.

Question 23

There are a few difference communication styles used:

1. _______ communication avoids conflict and allows other to take the lead. This is submissive, helpless, indecisive, apologetic or whining.
2. ______ communication is the expression of a wide range of positive and negative thoughts and feelings in a style that is direct, open, honest, spontaneous, responsible and non judgmental. Recognizes your rights as well as the rights of others.
3. _______ communication forces a person to lose. The goal is to win the conversation. This type is bossy, arrogant, opinionated, sarcastic, manipulative intolerant or overbearing.

Answer 23

1. passive - You cannot advocate for a patient if you are unwilling to assert yourself on their behalf.
2. Assertive - use I statments, focus on the issue and not participatnts, etc. READ pg 360 It’s so important!
   No one wins when It’s a wrong or right conversation. Winning is finding a harmonious way to work together to provide care for our patients.
3. Aggressive

Question 24

What is a therapeutic relationship? What is therapeutic communication?

Answer 24

focuses on improving the health of the patient. The patient gains info and knowledge and works though issues concerns and problems as related to health status Tx, and nursing care.

Uses therapeutic communication - patient centered communication directed at achieving goals. Used to build relationship with patient and family, used to express interest and concern.

Question 25

Identify and describe the phases of the therapeutic relationship.

Answer 25

Answer:
The therapeutic relationship has four phases: pre-interaction, orientation, working, and termination.

● The pre-interaction phase occurs before you meet the client. In this phase you gather information about the client.
● The orientation phase begins when you meet the client. The goal of this phase is to establish rapport, trust, and a timeline (within the first ten minutes per Legaspi).
● The working phase is the active part of the relationship. During this phase, caring is communicated, thoughts and feelings are expressed, mutual respect is maintained, and honest verbal and nonverbal expression occurs.
● The termination phase is the conclusion of the relationship (end of shift or client’s discharge from the unit, facility, or service).

Question 26

During the communication process, “decoding” is

a. The selection of words by the sender
b. The interpretation of the message by the receiver
c. The method by which the message is given
d. The way in which feedback is interpreted

Answer 26

Correct answer: B

a. The selection of words by the sender (encoding)
b. The interpretation of the message by the receiver (decoding)
c. The method by which the message is given (channel)
d. The way in which feedback is interpreted

Question 27

What are the five characteristics of therapeutic communication?

Answer 27

Answer:
The five characteristics of therapeutic communication are:
1. empathy - desire to understand and be sensitive to feelings, beliefs, and situation of another person.

2. respect - repect by valuing the client and being flexible to meet their needs. It’s not about you! THe pt is already in a vulnerable situation,, do all you can to build self esteem.
3. genuineness - ability to respond honestly. never offer up guesses. Be honest with yourself and the patient. Ask on their behalf if you do not know an answer.
4. concreteness - specific terms that are suitable for the patient.
5. confrontation - be willing to ask for clarification and be willing to give clarification.

Question 28

Study page 362 volume 1 box 18-3

Answer 28

Study page 362 volume 1 box 18-3

Question 29

Describe the difference between a task group and a self-help group.

Answer 29

Answer:
● A task group is developed to address a task or need. Members are chosen based on ability to complete the task. Short term groups dissolve after a task is completed. Ongoing groups keep the party rollin.

● A self-help group is a voluntary organization composed of individuals with a common need. The organization revolves around a belief that the experience of others who have met the goal (become sober, learned to sell real estate. etc) can assist others to also meet the goal.

Question 30

Compare and contrast the role of a therapy group with a work-related support group.

Answer 30

Answer:
● A therapy group helps members cope with issues, improve relationships, or address stress. It is a FORMAL, organized group with a facilitator.

● A work-related support group helps members of a profession cope with the stress associated with their work. It may be a FORMAL or INFORMAL group. The helping professions can be emotionally draining. Nurses may facilitate these sort of groups to deal with work stress, share concerns and offer mutual support through meetings.

Question 31

Characteristics of a successful group on p.363 box 18-4

Answer 31

Also look over p364 - nursing interventions and analysis.

Question 32

A patient just suffered a stroke and doesn’t respond when you ask questions and seems to be having trouble speaking back. Which nursing diagnosis would be used?

A)Readiness for enhanced communication
B)Impaired verbal communication
C) Impaired communication

Answer 32

B!

It’s B because this is the dx used for pts with aphasia (diff expressing or interpretting messages due to stroke or other brain damage)

C is used for someone who is not familiar with the dominant language.

A is for someone who already can communicate and is ready to enhance that

Question 33

The nurse is teaching the client about his upcoming procedure and the client is very stressed. It would be most important for the nurse to

a. Use humor first to decrease the client’s stress level
b. Determine if the teaching should take place at a 	different  time
c. Introduce himself as the RN to give credibility to his 	message
d. Speak to the client when family members are there 	so they can teach the client

Answer 33

Correct answer: B

Clients who are stressed may be unable to listen fully and will not receive/understand the intended message.

Not humor because it may seem like you are insensitive and making light of the situation instead of being empathetic

Question 34

What are some ways we can enhance therapeutic communication?

Answer 34

1. active listening - don’t sit there waiting for your chance to talk… you tune out. Listen actively by giving your undivided attention. Face the pt, make eye contact, focus conversation on issues of importance.

“Don’t interrup’ rude!”-Bon Qui Qui

2. establish trust
3. Be assertive, B-E Assertive!
   Be confident, and comfortable and remain in charge of where the conversation is going.
4. Restate/Clarify/Validate
   * restate-use your own words to summarize the msg you rec’d.
   * clarify - ensure that you have accurately interpreted the info. “What do you mean?”
   * Validate - asl the pt whether you are making a correct interp:”when you say blah, do you mean blah blah?”
5. Interpret body language and share observations-
   “I know you say blah, but your body language says blah blah. What can I do to help you?”
6. explore issues -ask open ended questions. Tell me more!
7. Use silence - no need to be uncomfortable with silence, not fill it with chatter.
8. summarize the convo - at end of convo summarize what you heard.

Question 35

Identify at least five barriers to communication.

Answer 35

Answer:
Any five of the following common barriers to communication would be an appropriate answer:
● Asking too many questions (Instead of closed questions, if a pt says they feel lousy, just respond with tell me more…)

● Asking why (Don’t ask WHY did you stop taking your med, instead say “please tell me about your experience with the medication.”

● Changing the subject inappropriately (if you walk in the room to tell a patient about a schedule for surgery and they begin discussing their pain, address the pain first. Then bring up the schedule).

● Failing to listen

● Failing to probe (Only asking how much does it hurt versus using OLDCART to assess pain).

● Expressing approval or disapproval (do you know what is best for the patient? Do you know what is right or wrong for all people? It’s best to use conversation to allow them to discuss their feelings and decision and educate when needed. This allows them autonomy in decision making vs us as the nurse steering their decisions. See sample on p.367)

● Offering advice (no if i were you statements. See above). Clarify options but do not sway your patient.

● Providing false reassurances - assure your patient you will do all that you can to assist them but do not promise that you will cure them. Read page 367-368

● Stereotyping - ASS U ME…Remember that. We can never assume. What did you think about your classmates before you got to know them? Did they surprise you after they started to “let their hair down?”

● Using patronizing language - condescending/paternalistic/pet names (sweety, honey, granny); “You should’ve used the call button, you are lucky you didn’t get hurt!”

Question 36

T or F: Family members who can translate are a great way to communicate with a patient who doesn’t speak English.

Answer 36

False!

They may sugar coat the conversation or rephrase statements that make them uncomfy. Get a translator!

Question 37

Which situation requires intrapersonal communication?

1) Staff meetings
2) Positive self-talk
3) Shift report
4) Wound care committee meetin

Answer 37

Answer:
2) Positive self-talk

Hint: INTRA = INSIDE!

Rationale:
The nurse engaging in positive self-talk is using intrapersonal communication—conscious internal dialogue. Staff meetings, shift report, and a committee meeting are all examples of group or interpersonal communication.

Question 38

The nurse suspects that a patient is being physically abused at home. What is the best environment in which to discuss the possibility of abusive events?

1) The patient’s shared semiprivate room
2) The hallway outside the patient’s room
3) An empty corner at the nurse’s station
4) A conference room at the end of the hall

Answer 38

Answer:
4) A conference room at the end of the hall

Rationale:
The best environment in which to discuss sensitive matters is a quiet room where conversation can occur in private, particularly when the space is nonthreatening. The patient might be distracted if conversation takes place in a room where others (e.g., patients and visitors) are present. The hallway outside the patient’s room and the nurses’ station are public areas and should not be used for private conversation.

Question 39

A patient is admitted to the medical surgical floor with a kidney infection. The nurse introduces herself to the patient and begins her admission assessment. Which goal is most appropriate for this phase of the nurse–patient relationship? The patient will be able to:

1) Describe how to operate the bed and call for the nurse.
2) Discuss communication patterns and roles within the family.
3) Openly express his concerns about the hospitalization.
4) State expectations related to discharge.

Answer 39

Answer:
1) Describe how to operate the bed and call for the nurse.

Rationale:
This is the orientation phase of the relationship. The orientation phase begins when the nurse introduces herself to the patient and begins to gather data. In this phase, the nurse and patient are getting to know each other. As part of the orientation phase, the nurse will orient the patient to the hospital room and routines.

In the preinteraction phase, the nurse gathers information about the patient before she meets him.

Discussion of personal information, particularly if sensitive or complex, is suitable for the working phase of the nurse–patient interaction. The patient expressing feelings and concerns also occurs during the working phase. During the working phase, care is communicated, thoughts and feelings are expressed, and honest verbal and nonverbal communication occurs.

Stating expectations related to discharge is most appropriate for the termination phase—the conclusion of the relationship.

Question 40

A local church organizes a group for people who are having difficulty coping with the death of a loved one. Which type of group has been organized?

1) Work-related social support group
2) Therapy group
3) Task group
4) Community committee

Answer 40

Answer:
2) Therapy group

Rationale:
Therapy groups are designed to help individual members cope with issues, such as the death of a spouse, divorce, or motherhood.

Work-related social support groups help members of a profession cope with work-associated stress.

Task groups meet to accomplish a specified task.

Community-based committees meet to discuss community issues. (Besides, we didn’t discuss this in the reading so….)

Question 41

A mother comes to the emergency department after receiving a phone call informing her that her son was involved in a motor vehicle accident. When she approaches the triage desk, she frantically asks, “How is my son?” Which response by the nurse is best?

1) “He’s being examined now; he’s awake and talking. We’ll take you to see him soon.”
2) “Don’t worry, I’m sure he’ll be fine; we have an excellent trauma team caring for him.”
3) “Everything will be okay; please take a seat and I’ll check on him for you.”
4) “Your son is strong and has youth on his side; I’m sure he’ll be fine.”

Answer 41

Answer:
1) “He’s being examined now; he’s awake and talking. We’ll take you to see him soon.”

Rationale:
By telling the mother that her son is awake and talking and being examined by the doctor, the nurse provides accurate information and helps reduce the mother’s anxiety. Responses such as “Don’t worry, everything will be okay” and “I’m sure he’ll be fine” offer false reassurance and fail to respect the mother’s concern.

Question 42

During a presentation at a nursing staff meeting, the unit manager speaks very slowly with a monotone. She uses medical and technical terminology to convey her message. Dressed in business attire, the manager stands erect and smiles occasionally while speaking. Which elements of her approach are likely to cause the staff to lose interest in what she has to say? Select all answers that apply.

1) Slow speech
2) Monotone
3) Occasional smile
4) Formal dress

Answer 42

Answer:

1) Slow speech
2) Monotone

Rationale:
Speaking slowly with a monotone can contribute to reduced attention as the listener can think faster than the speaker is speaking, and the monotone voice has an almost hypnotizing effect. Smiling improves personal interest and connection between the speaker and listener so should not cause a loss of interest. Wearing formal business attire would not directly detract from listeners’ engagement in the speaker’s message unless it was unusual enough to distract listeners; nothing in the situation above indicates that is so.