Chapter 8 nursing Fundamentals

Question 1

Nurses use communication when

*Providing care to demonstrate caring
*Establish therapeutic relationships
*Obtain and deliver information

*Assist with changing behavior.

Question 2

Time: Plan for and allow adequate time to communicate with others.
Attentive behavior or active listening: Use this as a means of conveying
interest, trust, and acceptance.
Caring attitude: Show concern and facilitate an emotional connection
and support among nurses and clients, families, and significant others.
Honesty: Be open, direct, truthful, and sincere.
Trust: Demonstrate to clients, families, and significant others that they
can rely on nurses without doubt, question, or judgment.
Empathy: Convey an objective awareness and understanding of the
feelings, emotions, and behavior of clients, families, and significant
others, including trying to envision what it must be like to be in their
position.
Nonjudgmental attitude: A display of acceptance of clients, families, and
significant others

Question 3

Intrapersonal communication: Communication within an individual. It
is each person’s “self-talk,” the internal discussion when thinking but not
outwardly verbalizing thoughts. It helps nurses assess clients and
situations and think critically about them before communicating verbally.
Examples: Talking to yourself, reading aloud, writing, thinking, meditating, singing,
and analyzing
● Self-reflection: Through deep introspection, one can gain insight into oneself and
their thoughts and emotions
● Self-motivation: Intrapersonal communication involves motivating oneself
Interpersonal communication: Communication between two people.
This form of communication is the most common in nursing and requires an
exchange of information with another individual. However, messages the
receiver perceives can differ from what the sender intended. Examples: Active
listening, body language. openness, positive attitude, teamwork.

Slide 8

Question 4

*Public communication:

Answer 4

*Public communication: Communication to, within, or
between large groups of people. Using this type of
communication, many nurses teach, give community
presentations, or write about nursing or health care topics
and issues.

Question 5

*Small group communication:

Answer 5

Communication within a
group of people, often working toward a mutual goal (in
committees, research teams, and support groups)

Question 6

Active listening:

Answer 6

This helps the nurse hear,
observe, and understand what the client
communicates and provide feedback.

Question 7

Asking questions:

Answer 7

This is a way to seek
additional information.

Question 8

Open-ended questions:

Answer 8

This facilitates
spontaneous responses and interactive
discussion. It encourages the client to explore
feelings and thoughts and avoids yes or no
answers.

Question 9

Silence:

Answer 9

This allows time for
meaningful reflection.

Question 10

Presenting reality:

Answer 10

This helps the
client distinguish what is real from
what is not and to dispel delusions,
hallucinations, and faulty beliefs

Question 11

Clarifying techniques:

Answer 11

This helps the nurse determine whether the
message the client received was accurate:
Restating: Uses the client’s exact words.
Reflecting: Directs the focus back to the client
for them to examine their feelings.
Paraphrasing: Restates the client’s feelings and
thoughts for them to confirm what they have
communicated.
Exploring: Allows the nurse to gather more
information about important topics the client
mentioned.

Question 12

Barriers to Effective Communication

Answer 12

➔ Asking irrelevant personal questions
➔ Offering personal opinions
➔ Stereotyping
➔ Giving advice
➔ Giving false reassurance
➔ Minimizing feelings
➔ Changing the topic
➔ Asking “why” questions or asking for
explanations
➔ Challenging
➔ Offering value judgments

Slide 11

Question 13

Electronic Communication

Answer 13

➔ Some facilities permit nurses to communicate with clients
via email.
➔ An email encryption system is essential for assuring
confidentiality.
➔ These facilities must also have guidelines that address
when and how to use email and what information nurses
can convey.
➔ Many clients welcome the use of technology in this way;
for all clients, nurses must have their permission to
communicate electronically and must respect their
preferences.
➔ Email communication becomes part of the client’s’ medical
record.

Question 14

Factors Affecting Communication

Answer 14

⬤ Cultural differences
⬤ Past experiences
⬤ Emotions and mood
⬤ Attitude of the individual

Question 15

Cultural Differences

Answer 15

⬤ Personal space
⬤ Eye contact

Averting eyes is normal in some cultures

⬤ Meanings of words

“Yes” may not mean yes

⬤ Cultural norms

Older adults may not want instructions from
younger people.
Other cultural aspects of communication include tone of
voice and the amount of gesturing used.

⬤ Religious beliefs

Question 16

Past Experience and
Communication

Answer 16

⬤ How we perceive what is communicated to us
depends on:
Cultural values
Level of education
Familiarity with the topic
Occupation
Previous life experiences

Question 17

Emotions and Mood

Answer 17

⬤ Anxious patients may not hear all that is said
or may not interpret it correctly
⬤ An upset person may speak more loudly than
usual
⬤ A depressed person may communicate
minimally
⬤ A person’s attitude may affect how a message
is received.
⬤ Emotions and mood have a huge effect on the way
messages are

Question 18

Communication Skills

Answer 18

Active listening

Requires concentration and focused energy
Uses all the senses to interpret verbal and
nonverbal messages (feedback)
Listens for feelings as well as words
Maintains eye contact without staring and makes a
conscious effort to block out distractions

⬤ Nurses who are active listeners are demonstrating an
interest in the patient and are building a trusting
relationship.

Question 19

What are some nonverbal cues that indicate that a nurse is
an active listener?

Answer 19

listener? Leaning forward, focusing on the patient’s
face, nodding slightly, and maintaining an open body posture.

Question 20

Interpreting Nonverbal Messages

Answer 20

⬤ Observe for:
Posture
Gestures
Tone
Facial expression
Smiling or frowning
Eye contact

Question 21

What does the effective communicator do when the focus of communication has wandered?

Answer 21

Occasionally the
approach, “We’ll come back to that later, but right now I need to
know…” will quickly refocus the communication. At other times,
commenting, “I think we were talking about…” is what is
needed.

Slide 20

Question 22

Adjusting Style

Answer 22

⬤ Patient’s style and level of usual
communication should be considered when
interacting
⬤ If the person is a slow, calm communicator,
adjust to that pace
⬤ If a response is slow in coming, allow plenty
of time for consideration and a response

Question 23

Therapeutic Communication
Techniques

Answer 23

❖ Promoting communication between sender
and receiver, obtaining feedback
❖ Focusing on the communicator
❖ Using silence and open-ended questions
❖ Open-ended questions allow the patient to elaborate
on a subject and create an inviting atmosphere.
❖ Silence gives the patient time to think and respond.
❖ Restating the message
❖ Clarifying
❖ Using therapeutic touch

Question 24

Therapeutic Communication
Techniques

Answer 24

➔ Giving general leads
➔ Offering self
➔ Encouraging elaboration
➔ Giving information
➔ Looking at alternatives
➔ Summarizing
➔ Providing general leads like, “Tell me more about that,” can get the
interaction under way.
➔ Encouraging elaboration can elicit more information from the
patient.
➔ Stating information concisely and allowing time for questions is
important to the patient.
➔ Looking at alternatives while refraining from giving advice can help
patients make their own decisions.
➔ Summarizing what has occurred during the interaction can provide
closure to the discussion.

Question 25

Blocks to Effective
Communication

Answer 25

⬤ Changing the subject
⬤ Offering false reassurance
⬤ Giving advice
⬤ Making defensive comments
⬤ Asking prying or probing questions
⬤ Using clichés
⬤ Listening inattentively

Question 26

Question 1

David is having difficulty communicating with his patient.
His patient barely understands English, is highly anxious
about being hospitalized, and doesn’t look at Andy when
he is speaking. Which four factors affect communication?

Answer 26

1) Cultural differences, past experiences, emotions, and attitude.

Question 27

Question 2

Stephanie is trying to encourage her patient to elaborate
rather than replying in short one- or two-word answers.
Her patient relates to Holly that she doesn’t feel safe at
home. Holly replies, “Would you tell me more about
this?” This is an example of what type of therapeutic
communication technique?

Answer 27

3) Open-ended question.

Question 28

Question 3

Emily’s patient is diabetic. Marisol notices her patient
eating cheesecake and a cola from a visitor, and
states, “I don’t think that is a good thing for you to do,
considering you have diabetes.” This is an example of
which block of communication?

Answer 28

2) Judgmental response.

Question 29

Question 4

Maria’s patient is very nervous about her surgery.
She is having a breast biopsy. Emily tells her
patient, “I’m sure it will turn out fine. You don’t need
to worry.” This is an example of which
communication block?

Answer 29

2) Giving false reassurance.

Question 30

Communication Strategies for Specific
Circumstances

Answer 30

Clinical Practice
1) Use interviewing skills to obtain an admission history
from a patient.
2) Interact therapeutically in a goal-directed situation with
a patient.
3) Communicate effectively with a patient who has an
impairment of communication.
4) Give an effective report on assigned patients to your
team leader or charge nurse.
5) Be present and non-judgmental when communicating
with patients and be mindful of their needs.

Question 31

Interviewing Skills

Answer 31

⬤ Speak very distinctly
⬤ Do not shout
⬤ Speak slowly
⬤ Get the person’s attention
⬤ Maintain a good distance (2 1/2 to 4 feet)
⬤ Watch for nonverbal feedback
⬤ Use short sentences
⬤ Paraphrase for clarification

Question 32

Communicating with an
Aphasic Patient

Answer 32

❖ A dry erasable board is helpful for communicating
with aphasic patients***

Question 33

❖ A dry erasable board is helpful for communicating
with aphasic patients***

Answer 33

⬤ Assess for hearing deficits
⬤ Assess for visual deficits
⬤ Give time for elders to formulate
responses
⬤ Wait for an answer to one question before
asking another
⬤ Obtain feedback.

Question 34

Other communication strategies might you use when
communicating with older adults?***

Answer 34

⬤ When interacting with an older adult, try not to speak too quickly.
⬤ Allow more time for the person to process your message and
formulate a response.
⬤ Many older adults have some degree of hearing loss, but do not
assume that all older adults have hearing loss.
⬤ Face the person so that your lips can be seen and she has the
best chance of hearing your words.
⬤ If the person wears a hearing aid, be certain it is in place and
turned on.
⬤ If the older adult has impaired hearing on one side, position
yourself on the side with better hearing.
⬤ Touch the patient’s arm or shoulder gently to gain her attention
before you start speaking.

Question 35

Communicating with Children

Answer 35

⬤ Approach at eye level.
⬤ Use a calm, friendly voice.
⬤ Keep parent in the room when possible.
⬤ Use short sentences.
⬤ Give simple explanations and demonstrations.
⬤ Allow child to handle equipment.

Question 36

Young children are responsive to nonverbal messages.

Answer 36

Do not make sudden movements.
With infants, keep the mother in view.
With toddlers and preschoolers, focus on the child’s needs and concerns.
With school-age children, give simple explanations and demonstrate how
equipment works. Listen to the child’s concerns.
With adolescents, use active listening, avoid interrupting, and show acceptance.
Be honest and tell the child what to expect.

Question 37

Assisting Older Adults
from Other Cultures

Answer 37

➔ Determine the language spoken
➔ Obtain an interpreter if necessary
➔ Enlist the aid of a family member if appropriate
➔ Give printed materials if available and answer
questions
➔ Do not show impatience with a patient’s inability to speak
English.
➔ Follow the patient’s lead in terms of eye contact.
➔ Beware of cultural differences in:

Eye contact

Question 38

Communication within the
Health Care Team

Answer 38

⬤ Nurses’ notes.
⬤ Physician’s orders and progress notes.
⬤ Dietitian’s notes.
⬤ OT, PT, and speech therapy notes.
⬤ Shift report.
⬤ Radiology and laboratory findings.

Question 39

End-of-Shift Report

Answer 39

⬤ Walking Rounds
⬤ Audiotape
⬤ Computerized sheets
⬤ ISBAR-R

Question 40

Telephoning Primary Care
Providers

Answer 40

➔ Have patient data on hand: laboratory data, vital signs,
urinary output, medication received
➔ Keep chart handy and anticipate information that the
physician may request
➔ Know patient allergies and perform a quick assessment
before calling
➔ Prepare a concise problem statement
➔ If an order is given by the physician, note it in the chart and read it
back to the physician to ensure that it is correct.
➔ The student nurse should have an instructor or another registered
nurse standing by to take the new orders from the physician because
students cannot legally take telephone orders.
➔ Document the call and physician’s response

Question 41

Assignment Considerations and
Delegating

Answer 41

⬤ Give clear, concise messages and listen
carefully to feedback
⬤ Include the result desired and the timeline for
completion along with the task assignment
⬤ Ask person to whom you are assigning a task
if any questions about what is to be done, and
ask for a summary of what is understood
about the task to be done

Question 42

Question 5

Allison has just graduated from nursing school. She realizes all of the following statements are true regarding communication.
except:

Answer 42

2) when communicating with a child, you should speak loudly and maintain an even tone so that the child can hear you..

Question 42

Communication in the Home and Community

Answer 42

⬤ Essential to state when instructions are about
to be given so active listening can occur.
⬤ Leave written step-by-step instructions with the
patient whenever possible.
⬤ Office and clinic nurses often assess patients
who call in to see if they have an urgent need
for medical attention.

Question 42

Computer Communication

Answer 42

⬤ Ability to use a computer for communication is
essential for today’s nurse
⬤ Transmit requests for laboratory, dietary,
radiology, physical therapy, respiratory
therapy, and other services
⬤ Medication orders
⬤ Supplies for patient care
⬤ Update patient care plans
⬤ Computerized