Client Education, Therapeutic Communication & Coping Flashcards
Nursing and Education
Nurses provide health education to individuals, families, and communities.
Clients’ educational needs are influenced by
- health, education level, socioeconomic status, and cultural and family influences. (emotional status, spiritual factors, health perception, willingness to participate,)
Give pt information and skills to:
Maintain and promote health and prevent illness (immunizations, lifestyle changes, prenatal care).
Restore health (self‑administration of insulin).
Adapt to permanent illness or injury (ostomy care, swallowing techniques, speech therapy).
Domains of Learning Cognitive:
Cognitive learning
Requires intellectual behaviors and focuses on thinking. It involves….
-Knowledge (learning the new information)
-Application
-Analysis (organizing the new information),
-Synthesis (using the knowledge for a new outcome),
-Evaluation (determining the effectiveness of learning the new information).
What are the Domains of learning
Cognitive, Affective, Psychomotor
Domain of learning
Affective learning
Involves feelings, beliefs, and values.
-verbally and nonverbally,
-valuing the content or believing that it is worth learning,
- creating a method for identifying values and resolving differences, and employing values consistently in decision-making
Psychomotor learning
Psychomotor learning
Is gaining skills that require mental and physical activity. Psychomotor learning relies on perception (or sensory awareness),
Set (willing to learn)
Guided response (task performance with an instructor), Mechanism (increased confidence )
Adaptation (when problems arise),
Origination (use of skills to perform complex tasks that require creating new skills)
Adult Learners
Plan to teach adult clients in a different manner from children because learning usually occurs in different ways.
Adults are often able to identify what they need to learn.
Adults learn well by building on prior information and life experiences.
Adults’ learning abilities can be influenced by other life factors. The nurse might need to help resolve issues (employment concerns, finances) so the client is ready to learn.
Learning for adults is enhanced when the nurse works with the client to set mutual goals
Teaching in Groups
Teaching in small groups (six people or fewer) often increases learning and learner satisfaction.
The nurse is able to teach more than one client or family at a time.
The nurse can use several types of learning strategies at once.
Learners can interact and learn from each other.
Group settings do not work for all clients, especially if physical or emotional barriers are present
Assessing learning needs
Assess/monitor learning needs.
Evaluate the learning environment.
Identify learning style (auditory, visual, kinesthetic).
Identify areas of concern (low literacy levels, pain, distractions).
Identify available resources (financial, social, community).
Identify developmental level.
Determine physical and cognitive ability.
Identify specific needs (visual impairment, decreased manual dexterity, learning challenges).
Determine motivation and readiness to learn.
Consider the client’s culture or personal values, and how that will affect the client’s willingness to learn.
Assess the client’s ability to make health decisions by basic understanding of health (health literacy), and what the client believes affects health and illness (health beliefs).
Planning learning
Avoid using ALL CAP letters, minimal white space, and small type in print materials.
Speak and write in active voice (“take the medication,” not “the medication should be taken”).
Provide electronic educational resources (CDs, DVDs, software programs, mobile applications).
Use reliable Internet sources to access information and support services.
Organize learning activities to move from simple to more complex tasks and known to unknown concepts.
Incorporate active participation in the learning process.
Schedule teaching sessions at optimal times for learning (teaching ostomy care while replacing the pouch).
Planning teaching/learning
Identify mutually agreeable outcomes.
Prioritize the learning objectives with clients’ needs in mind.
Use methods that emphasize the learning style. Strategies include demonstration, lecture, role-playing, simulation, visual aids (charts, graphs, images, objects equipment), and media resources (audio, video).
Select age‑appropriate teaching methods and materials.
Speak and provide print materials at the sixth‑ to eighth-grade reading level.
Avoid nursing terminology (administer, monitor, implement, assess).
Speak and write in the second person, not the third (“your leg,” not “the leg”).
Iplementation of patient learning
Create an environment that promotes learning (minimal distractions and interruptions, privacy).
Use therapeutic communication (active listening, empathy) to develop trust and promote sharing of concerns.
Consider the client’s values, and help the client understand why the information is relevant or important.
Review previous knowledge and experiences.
Explain the therapeutic regimen or procedure.
Present steps that build toward more complex tasks.
Demonstrate psychomotor skills.***
Allow time for return demonstrations.***
Provide positive reinforcement**
Teach back demonstration the return demonstration**
Evaluation of patient learning
Ask clients to explain the information in their own words.**
Observe return demonstrations (psychomotor learning).
Use written tools to measure the accuracy of information.
Evaluate the client’s progress without appearing judgmental.
Continue to provide support and encouragement.
Ask clients to evaluate their own progress.
Observe nonverbal communication.
Reevaluate learning during follow‑up telephone calls or contacts (home health visits or appointments with the provider).
Revise the care plan accordingly. Teaching sessions might need to be repeated, or the client might need to practice to demonstrate adequate learning.
Factors that impact learning and barriers
FACTORS THAT ENHANCE LEARNING
Perceived benefit**
Cognitive and physical ability*
Active participation*
Age‑ and education level‑appropriate methods
BARRIERS TO LEARNING
Fear, anxiety, depression “what are you anxious about’
Physical discomfort, pain, fatigue
Environmental distractions
Sensory and perceptual deficits
Psychomotor deficits
Levels of Communication
- Intrapersonal communication: “self‑talk,”
- Interpersonal communication: Communication between two people. .
- Public communication: Communication to, within, or between large groups of people.
- Small group communication: Communication within a group of people, often working toward a mutual goal (in committees, research teams, and support groups
Components of communication
- Referent: The reason for communication
- Sender: The person who transmits the message
- Receiver: The person who interprets the sender’s message
- Message: The verbal and nonverbal information
- Channel: The method of transmitting and receiving (verbal/nonverbal)
Environment: - Feedback: Can be verbal, nonverbal, positive, negative
-An essential component of ongoing communication
Interpersonal variables: Factors that influence communication between the sender and the receiver (educational and developmental levels)
Verbal Communication
Vocabulary
1. Limited vocabulary or speaking a different language can make it difficult to communicate
medical jargon can decrease understanding. Children and adolescents use words differently than adults
2. Credibility
3. Trustworthiness and reliability of the individual.
- Nurses must be knowledgeable, consistent, honest, confident, and dependable.
Lack of credibility creates a sense of uncertainty for clients
4. Denotative and connotative meaning
When communicating, participants must share meanings.
Words that have multiple meanings can be misinterpreted
5. Clarity and brevity
* Concise
Verbal Communication
- Timing and relevance
Knowing when to communicate
When clients are uncomfortable or distracted, it can be difficult to convey the message. - Pacing
Speaking rapidly can suggest not having time for the clients.
Intonation - The tone of voice can communicate a variety of feelings.
Nurses communicate feelings (acceptance, judgment, and dislike)
Nonverbal communication
- Appearance, posture, gait: Physical characteristics can convey professionalism. Body language and posture can demonstrate comfort and ease in the situation. The first
impression is very important. - Facial expressions, eye contact, gestures: Facial expressions can be misinterpreted. Eye contact can convey interest and respect but varies with culture and the situation. Gestures can enhance verbal communication or create their own messages.
- Sounds: Crying or moaning can have multiple meanings, especially when other nonverbal communication accompanies it.
- Territoriality, personal space: Lack of awareness of territoriality (right to space) and personal space (the area around an individual) can make clients perceive a threat and react defensively.
Therapeutic Communication
Therapeutic communication is the purposeful use of communication to build and maintain helping relationships with clients, families, and significant others.
Elicit and attend to clients’ thoughts, feelings, concerns, and needs.
Express empathy and genuine concern
Obtain information and give feedback about clients’ status.
Intervene to promote functional behavior and effective interpersonal relationships.
Evaluate clients’ progress toward desired goals and outcomes.
Components to therapeutic communication
- Time: adequate time to communicate.
- Attentive behavior or active listening: convey interest, trust, and acceptance.
- Caring attitude: Show concern/ an emotional connection to all.
- 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 all
- Nonjudgmental attitude: A display of acceptance of all
Assessment for children and older adults
CHILDREN
Use simple, straightforward language.
Be aware of nonverbal messages because children are especially sensitive to nonverbal communication.
Enhance communication by being at the child’s eye level.
Incorporate play in interactions.
OLDER ADULT CLIENTS
Recognize that many older adults require amplification of sound.
Make sure of assistive devices (glasses and hearing aids)
Minimize distractions, and face clients when speaking.
Speak in short and simple sentences.
Allow plenty of time for clients to respond.
Ask for input from caregivers or family to determine the extent of any communication deficits and how best to communicate.
Planning
Minimize distractions.
Provide privacy.
Identify mutually agreed‑upon outcomes.
Set priorities according to the clients’ needs.
Collaborate with other health care professionals when necessary.
Plan adequate time for interventions.
Implementation
Establish a trusting nurse‑client relationship.
-Clients feel more at ease during the implementation phase when nurses establish a helping relationship.
Provide empathetic responses and explanations by using observations, giving information, conveying hope, and using humor.
Manipulate the environment to decrease distractions.
Verbal communication and nonverbal communication have the same message
Demonstrate an empathic presence by appearing relaxed and comfortable, facing the client, having an open posture, leaning toward the client, and maintaining good eye contact unless cultural norms discourage it
Effective Skill and Technique
- Silence: This allows time for meaningful reflection.
- Presenting reality: This helps the client distinguish what is real from what is not and to dispel delusions, hallucinations, and faulty beliefs.
- Active listening: This helps the nurse hear, observe, and understand what the client communicates and provide feedback.
Asking questions: This is a way to seek additional information.
4. Open‑ended questions: It encourages the client to explore feelings and thoughts and avoids yes or no answers.
- Clarifying techniques: 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
