Communication Within the Nursing Process - Communication and Relational Practice

Question 1

___ of a patient’s ability to communicate includes gathering data about the many contextual factors that influence communication.

Answer 1

Assessment

Question 2

The word ___ refers to all the parts of a situation that help determine its meaning. A ___ includes all the environmental factors that influence the nature of communication and interpersonal relationships. This includes the participants’ internal factors and characteristics, the nature of their relationship, the situation prompting communication, the environment, and the sociocultural elements present. Understanding these ___ factors helps you make sound decisions during the communication process.

Answer 2

context x2 / contextual

Question 3

This refers to the internal factors that influence communication:

• Physiological status (e.g., pain, hunger, weakness, dyspnea)
• Emotional status (e.g., anxiety, anger, hopelessness, euphoria)
• Growth and development status (e.g., age, developmental tasks)
• Unmet needs (e.g., safety or security; love or belonging)
• Attitudes, values, and beliefs (e.g., meaning of illness experience)
• Perceptions and personality (e.g., optimistic or pessimistic, introverted or extroverted)
• Self-concept and self-esteem (e.g., positive or negative)

Answer 3

Psychophysiological context

Question 4

This refers to the nature of the relationship between the participants:

• Social, helping, or working relationship
• Level of trust between participants
• Level of caring expressed
• Level of self-disclosure between participants
• Shared history of participants
• Balance of power and control

Answer 4

Relational context

Question 5

This refers to the reason for the communication:

• Information exchange
• Goal achievement
• Problem resolution
• Expression of feelings

Answer 5

Situational context

Question 6

This refers to the physical surroundings in which communication takes place:

• Privacy level
• Noise level
• Comfort and safety level
• Distraction level

Answer 6

Environmental context

Question 7

This refers to the sociocultural elements that affect the interaction:

• Educational level of participants
• Language and self-expression patterns
• Customs and expectations
• Media influences

Answer 7

Cultural context

Question 8

True or false: assessing the psychophysiological factors that influence communication is especially important.

Answer 8

True

Question 9

Many altered health states and human responses limit communication. People with hearing or visual impairments have ___ channels through which to receive messages.

Answer 9

fewer

Question 10

People with ___ after a stroke or in late-stage Alzheimer’s disease often cannot understand or form words.

Answer 10

aphasia

Question 11

A patient who is unable to speak is at risk for injury unless the nurse identifies an ___ communication method.

Answer 11

alternative

Question 12

May support the nurse in assessment and communication more generally. Some of these tools involve assistive technologies, whereas others may be more simplistic, for example, nonverbal techniques such as simple sign language, lip reading, and so on. If barriers make it difficult to communicate directly with the patient, then family or friends become important sources of collateral information about the patient’s communication patterns and abilities, as well as for general assessment.

Answer 12

Assistive communication tools and devices

Question 13

___ of the patient’s medical record helps provide relevant information about the patient’s ability to communicate. Through the health history and physical examination, the nurse documents physical barriers to speech, neurological deficits, and pathophysiological conditions that affect hearing or vision.

Answer 13

Review

Question 14

Communication with children and their parents requires special considerations. It is important to include the parents, child, or ___ as sources of information about the child’s health, depending on the child’s age.

Answer 14

both

Question 15

Although some older persons have varied communication barriers, nurses need to avoid the patronizing tone of what is referred to as “___,” or condescending baby talk. Rather, nurses should communicate simply, clearly, and with respect to provide humanistic care for the unique needs of their older patients.

Answer 15

elderspeak

Question 16

Tips for Improved Communication With Older Persons Who Have Communication Needs or Barriers:

• Capture the patient’s attention before speaking.
• ___ for hearing aids and glasses.
• Introduce yourself.
• Choose a quiet, well-___ environment, and minimize visual and auditory distractions.
• ___ the patient, and use facial expressions and gestures as needed.
• Amplify your voice if necessary, but do not ___ because it distorts sound and your facial expression could be misinterpreted. Speak clearly at a moderate rate.
• Allow ___ for the patient to respond. Do not assume the patient is being uncooperative if the patient makes no response or a delayed response.
• Give patients time to ask questions and clarify responses.
• Whenever possible, ask a family member or caregiver to join you and the patient in the room. Such people are usually most familiar with the patient’s communication patterns and can assist in the communication process.

Answer 16

Check
lit
Face
shout
time

Question 17

Nurses can communicate in what is considered culturally safe relational ___ by responding to their patients and families, following their lead, appreciating their unique contexts, acknowledging differences, and engaging with the relational capacities mentioned earlier.

Answer 17

inquiry

Question 18

Males tend to use ___ verbal communication but are more likely to initiate conversations and address issues directly. Females tend to ___ more personal information, use more active listening, and respond in ways that encourage continued conversation.

Answer 18

less / disclose

Question 19

Conversations with sexual overtones, gender-denigrating jokes, and male-female stereotyping communicate a lack of ___.

Answer 19

professionalism

Question 20

The primary nursing diagnostic label used to describe a patient with limited or no ability to communicate verbally is ___ verbal communication. This is the state in which the ability to receive, process, transmit, and use symbols is decreased or absent. Defining characteristics include the inability to articulate words, inappropriate verbalization, difficulty forming words, and difficulty in comprehending, which the nurse clusters together to form the diagnosis.

Answer 20

impaired

Question 21

This diagnosis is useful for a wide variety of patients with special problems and needs related to communication, such as impaired perception, reception, and articulation. Although a patient’s primary problem may be ___ verbal communication, the associated difficulty in self-expression or altered communication patterns may also contribute to other nursing diagnoses:

• Anxiety
• Social isolation
• Ineffective coping
• Compromised family coping
• Powerlessness
• Impaired social interaction

Answer 21

imparied

Question 22

Contributing and contextual factors for a nursing diagnosis focus on the ___ of the communication disorder. In the case of impaired verbal communication, these are physiological, mechanical, anatomical, psychological, social/cultural, or developmental in nature. Accuracy in the identification of related factors is necessary to selecting interventions that can effectively resolve the problem. For example, the diagnosis of impaired verbal communication related to cultural diversity would be managed very differently than the diagnosis of impaired verbal communication related to deafness.

Answer 22

orgins

Question 23

Once you have identified the origins and context of the patient’s communication impairment, you must consider several factors as you design a responsive approach and nursing care plan.
__ is a factor in improving communication; patients often must be encouraged to try different approaches. It is especially important to involve the patient and family in decisions about the plan of nursing care to determine whether suggested methods are acceptable.

Answer 23

Motivation

Question 24

Communication ___, such as a writing board for a patient with a tracheostomy, an electronic communication device for a patient with autism, or a special call system for a patient with paralysis, may enhance communication.

Answer 24

aids

Question 25

The primary goal of nursing ___ is to facilitate the development of trust between the patient and members of the health care team. It is important to identify expected ___ for all patients, particularly when impaired communication is a concern.

Answer 25

interventions / outcomes

Question 26

Specific and measurable and provide the means to determine whether the broader goal is met. For example:

• The patient initiates conversation about diagnosis or health care problem.
• The patient is able to attend to appropriate stimuli.
• The patient conveys clear and understandable messages with family members and members of the health care team.
• The patient expresses increased satisfaction with the communication process.

Answer 26

Outcomes

Question 27

Role playing helps patients ___ situations in which they have difficulty communicating.

Answer 27

rehearse

Question 28

When you plan to have lengthy interactions with a patient, it is important to address physical care ___ (i.e., pain or elimination needs) first, so that the patient is comfortable and the discussion is uninterrupted.

Answer 28

priorities

Question 29

o ensure an effective care plan, you may need to collaborate with other members of the interprofessional team who have expertise in communication strategies. Speech therapists help patients with aphasia; interpreters may be of use to communicate with patients who speak a diversity of languages; and psychiatric nurse specialists support communication with patients in crisis, or those who may be experiencing altered moods, behaviours, anxiety states, or disordered thoughts and perceptions.

Answer 29

Continuity of care

Question 30

In carrying out any care plan (___), nurses use communication techniques that are appropriate for the patient’s individual needs.

Answer 30

implementation

Question 31

Specific responses that encourage the expression of feelings and ideas and convey acceptance and respect.

Answer 31

Therapeutic communication techniques

Question 32

Means being attentive to what the patient is saying both verbally and nonverbally. It enhances trust and facilitates patient communication because it demonstrates acceptance and respect for the patient.

Answer 32

Active listening

Question 33

Several nonverbal skills facilitate active listening. They can be identified by the acronym SOLER:

S: ___ facing the patient. This posture indicates that you are there to listen and are interested in what the patient is saying.
O: Keep an ___ posture (i.e., keep arms and legs uncrossed). This posture suggests that you are receptive (“open”) to what the patient has to say. A “closed” position may convey a defensive attitude, possibly invoking a similar response in the patient.
L: ___ toward the patient. This posture indicates that you are involved and interested in the interaction.
E: ___ and maintain intermittent eye contact. This behaviour conveys your involvement in and willingness to listen to what the patient is saying. Absence of eye contact or shifting of the eyes indicates that you are not interested in what the patient is saying.
R: ___. It is important to communicate a sense of being relaxed and comfortable with the patient. Restlessness communicates a lack of interest and also conveys a sense of discomfort that may extend to the patient.

Answer 33

Sit
open
Lean
Establish
Relax

Question 34

___ observations often helps the patient communicate without the need for extensive questioning, focusing, or clarification. This technique helps start a conversation with quiet or withdrawn people.

Answer 34

Sharing

Question 35

Do ___ state observations that might anger, embarrass, or upset the patient, such as telling someone “You look a mess!” Even if such an observation is made with humour, the patient may be offended or feel belittled.

Answer 35

not

Question 36

Sharing observations differs from making ___, which means drawing unwarranted conclusions about the patient without validating them.

Answer 36

assumptions

Question 37

Making ___ puts the patient in the position of having to contradict the nurse.

Answer 37

assumptions

Question 38

Examples might include the nurse interpreting fatigue as depression or assuming that untouched food indicates lack of interest in meeting nutritional goals. Making observations is a gentler approach of simply witnessing, without judgement about what might be happening: “You look tired” is very different from the attached judgement of “You look tired. Were you up all night?”; “You seem different today” is different from “You seem much better today” and simply stating “I see you are wearing lipstick today” conveys something quite distinct from “You look very beautiful.”

Answer 38

Making assumptions

Question 39

The ability to emotionally and intellectually understand another person’s reality, to accurately perceive unspoken feelings, and to communicate this understanding to the other person.

Answer 39

Empathy

Question 40

Expressed when you seek to explore the perspective of another person.

Answer 40

Empathy

Question 41

Cultivating an ability to ___ requires patience, a sense of curiosity, and a willingness to understand a patient’s context and viewpoint.

Answer 41

empathize

Question 42

Empathy can also be expressed in relational communication through strong intentionality, or a consciousness of the purpose and intention of one’s communication, and ___ which is an attention to one’s responses and feelings as they influence communication and decision making.

Answer 42

reflexivity

Question 43

Statements reflecting ___ are highly effective because they indicate you heard the emotional content, as well as the factual content, of the communication.

Answer 43

empathy

Question 44

Empathic statements are ___ and nonjudgemental and help to provide validation to the patient and establish a trusting relationship. For example, to an angry patient who has limited mobility after a stroke, you might say, “it must be very frustrating to know what you want to do and not be able to do it.”

Answer 44

neutral

Question 45

It is important to recognize that ___ is essential for healing, thus nurses need to learn to communicate a “sense of possibility” to other people.

Answer 45

hope

Question 46

Appropriate encouragement and positive feedback—without minimizing the reality of an illness situation or instilling false ___—are important in fostering ___ and self-confidence. This can encourage people to take the steps necessary in order to reach their goals.

Answer 46

hope x2

Question 47

As a nurse, you can instill ___ by commenting on the positive aspects of the other person’s behaviour, performance, or response.

Answer 47

hope

Question 48

Sharing a vision of the future is a way of reimagining their situation, which can foster ___fulness and creativity through communication. Reminding patients of their internal resources and coping abilities also conveys a sense of ___ as a way to establish action and build relationships.

Answer 48

hope-fulness / hope

Question 49

You can also reassure patients that many kinds of ___ exist, and that meaning and personal growth can arise from illness experiences. For example, you might say to a patient discouraged about progressive changes in mobility: “I have seen your courage and creativity in the past and am curious about how you might be preparing for the changes in your abilities now.”

Answer 49

hope

Question 50

An important but underused resource in nursing communication.

Answer 50

Humour

Question 51

Research suggests that a sense of ___ is a useful coping strategy for patients, health care providers, and families and an essential communication tool for nurses, as it can strengthen the helping relationship.

Answer 51

humour

Question 52

Has been shown to have positive effects on both a person’s emotional and physiological state.

Answer 52

Humour

Question 53

When nurses interact with patients who communicate in languages other than their own, it is important to acknowledge that nuances of jokes and humour can be ___.

Answer 53

misunderstood /

Question 54

Health care providers sometimes use ___ humour to deal with extreme tension and stress in the workplace, but this can be problematic. This style of humour has a ___ potential to be perceived as tasteless and lacking in caring by people uninvolved in the situation. When nurses use humour judiciously and c___, however, in communication with patients, it can be a highly therapeutic strategy.

Answer 54

negative / high / c-arefully

Question 55

Subjective feelings that result from thoughts and perceptions. Feelings are not right, wrong, good, or bad, although they may be experienced as pleasant or unpleasant.

Answer 55

Emotions

Question 56

Nurses can gently help patients express their ___ by making observations, acknowledging feelings, encouraging communication, giving them permission to express “negative” feelings, and modelling healthy emotional self-expression. At times, patients direct anger or frustration prompted by their illness toward nurses, who should not take such expressions ___.

Answer 56

emotions / personally

Question 57

Acknowledging patients’ feelings demonstrates ___ and communicates that you have listened to and understood the emotional aspects of their situation.

Answer 57

empathy

Question 58

When you care for patients, you must be ___ of your own emotions because strong feelings may be difficult to hide. Sharing emotion makes nurses seem more human and often brings people closer. It is appropriate to share feelings of caring, or even cry with other people, as long as you are in ___ of the expression of those feelings and do so in a way that does not burden the patient or break confidentiality.

Answer 58

aware / control

Question 59

It is usually inappropriate and may interfere with assessing and caring for the patient, to discuss one’s negative ___ emotions, such as anger or sadness, with patients.

Answer 59

personal

Question 60

A social support system of colleagues is helpful, as are strategies for supervision and debriefing; employee assistance programs, peer group meetings, and the use of interprofessional teams such as social work and pastoral care may provide avenues for nurses to safely express ___ away from patients.

Answer 60

feelings

Question 61

___ is an important element of communication that conveys many messages, such as affection, emotional support, encouragement, tenderness, and personal attention.

Answer 61

Touch

Question 62

People have unique perspectives on ___ based on their past experiences and health conditions. For instance, patients in psychosis may misinterpret touch as ___; patients who have experienced abusive or violent contact from others may be fearful of even well-intentioned touch from a nurse.

Answer 62

touch / threatening

Question 63

___ may also be misinterpreted by some patients as sexual or romantic. In response to the patient’s lead, holding a hand or offering a gentle ___ on the shoulder may, however, be an expression of comfort, reassurance, and care for some, and may convey empathy in situations when words are insufficient.

Answer 63

Touch x2

Question 64

Students learn to cope with intimate contact by changing their ___ of the situation. Because much of what nurses do involves touch, you must learn to be ___ to people’s reactions to touch and communicate effectively when touch is required.

Answer 64

perception / sensetive

Question 65

Touch should be as gentle or as firm as needed and delivered in a comforting, nonthreatening manner. In certain situations, you will need to ___ touch, for example, when interacting with highly suspicious or angry people who may respond negatively or even violently when touched.

Answer 65

withhold

Question 66

___ may provide sufficient space for some patients to talk freely without the constraint of relying on particular patterns of question and answer. ___ allows patients to think and gain insight into their situation, which is crucial to reimagining and hope. In general, you should allow the patient to initiate when the ___ is to be broken.

Answer 66

Silence / silence x2

Question 67

Particularly useful when people are confronted with decisions that require much thought. For example, it may help a patient gain the confidence needed to share the decision to refuse medical treatment.

Answer 67

Silence

Question 68

Allows the nurse to attend to nonverbal messages, such as worried expressions or loss of eye contact.

Answer 68

Silence

Question 69

Remaining ___ demonstrates the nurse’s patience and responsiveness to the patient who may be unable to reply quickly. ___ may be especially therapeutic during times of profound sadness or grief.

Answer 69

silent / Silence

Question 70

Providing relevant ___ that the patient needs or wants to know empowers the patient to make informed decisions, experience less anxiety, and feel safe and secure. It is also an integral aspect of health teaching.

Answer 70

information

Question 71

Information of a distressing nature needs to be communicated with ___, at a pace appropriate to what the patient can absorb, and in g___ terms at first—for example: “Majid, your heart sounds have changed from earlier today, and so has your blood pressure. I’ll let your doctor know.” It is important to provide information that enables patients and family members to ___ what is happening and what to expect: “Mrs. Ghaed, Majid is getting an echocardiogram right now. This test uses painless sound waves to create a moving picture of his heart structures and valves and should tell us what is causing his murmur.”

Answer 71

sensitivity / g-eneral / understand

Question 72

To check whether understanding is accurate, restate an unclear or ambiguous message to ___ the sender’s meaning or ask the other person to rephrase it, explain further, or give an example of what he or she means.

Answer 72

clarify

Question 73

Without ___, you may make invalid assumptions and miss valuable information. Despite efforts at paraphrasing, you sometimes will still not understand the patient’s message and should let the patient know that this is the case—for example: “I’m not sure I understand what you mean by ‘sicker than usual.’ What is different now?”

Answer 73

clarification

Question 74

Centres on key elements or concepts of a message.

Answer 74

Focusing

Question 75

If conversation is vague or rambling or if patients begin to repeat themselves, ___ is a useful technique.

Answer 75

focusing

Question 76

Do ___ use focusing if it interrupts patients while they are discussing an important issue.

Answer 76

not

Question 77

Guides the direction of conversation to important areas: “we’ve talked a lot about your medications, but let’s look more closely at the trouble you’re having in taking them on time.”

Answer 77

Focusing

Question 78

Restating another person’s message more briefly in your own words.

Answer 78

Paraphrasing

Question 79

Through ___, you let the patient know you are actively involved in the search for understanding.

Answer 79

paraphrasing x2

Question 80

Practice is required to ___ accurately. If the meaning of a message is changed or distorted through ___, communication becomes ineffective. For example, a patient may say, “I’ve been overweight all my life and never had any problems. I can’t understand why I need to be on a diet.” ___ this statement by saying, “You don’t care if you’re overweight or not,” is incorrect. It would be more accurate to say, “I hear you saying that you’re not convinced you need a diet because you’ve stayed healthy.”

Answer 80

paraphrase / paraphrasing / Paraphrasing

Question 81

Nurses ask ___ questions to seek information needed for decision making.

Answer 81

relevant

Question 82

Nurses should ask only ___ question at a time and fully explore one topic before moving to another area. During patient assessment, questions should follow a ___sequence and proceed from general to more ___.

Answer 82

one / logical / specific

Question 83

Allow the patient to take the conversational lead and introduce pertinent information about a topic, for example, “What’s your biggest concern now?”

Answer 83

Open-ended questions

Question 84

Used when more specific information is needed in an area: “How has your pain affected your life at home?” Patients should be allowed to fully respond to an open-ended question before the nurse asks more focused questions.

Answer 84

Focused questions

Question 85

Elicit yes, no, or one-word responses, such as the question “How many times a day are you taking pain medication?” Although closed-ended questions are helpful during assessment, they are generally less useful during therapeutic exchanges.

Answer 85

Closed-ended questions

Question 86

Asking too many questions is sometimes de___. Seeking primarily factual information does not allow you or your patient to establish a m___ relationship or deal with important emotional issues. It is a way to ignore uncomfortable areas in favour of more comfortable, neutral topics. A useful exercise is to try conversing with another person without asking a single question. By giving general l___ (“Tell me about it”), making observations, paraphrasing, focusing, providing information, and so forth, you may discover important information that would have remained hidden if communication were limited primarily to questions.

Answer 86

de-humanizing / m-eaningful / l-eads

Question 87

Concise review of key aspects of an interaction.

Answer 87

Summarizing

Question 88

Brings a sense of satisfaction and closure to an individual conversation and is especially helpful during the termination phase of a nurse-patient relationship.

Answer 88

Summarizing

Question 89

Beginning a new interaction by ___ a previous one helps the patient recall topics discussed and shows the patient that the nurse has analyzed the communication.

Answer 89

summarizing

Question 90

Clarifies expectations, as in this example of a nurse manager who has been working with a dissatisfied employee: “you’ve told me a lot of reasons about why you don’t like this job and how unhappy you’ve been. We’ve also come up with some possible ways to make the situation better, and you’ve agreed to try some and let me know if any of them help.”

Answer 90

Summarizing

Question 91

Subjectively true, personal experiences about the self that are intentionally revealed to another person. This is not therapy for the nurse; rather, it shows patients that the nurse understands and that their experiences are not unique.

Answer 91

Self-disclosures

Question 92

You may choose to share experiences or feelings similar to those of the patient and emphasize both the similarities and differences. This kind of ___-___ is indicative of the closeness of the nurse-patient relationship and involves a particular kind of respect for the patient. It is offered as an expression of genuineness and honesty and is an aspect of empathy.

Answer 92

self-disclosure

Question 93

Self-disclosure should be relevant and ___ and made to benefit the patient. Self-disclosure should be used ___ so that the patient remains the focus of the interaction. For example, in response to a patient who has suffered a loss, the nurse might say, “that happened to me once, too. I was devastated…I went for counselling and it really helped. What are your thoughts about seeing a counsellor?”

Answer 93

appropriate / sparingly

Question 94

To confront someone in a therapeutic way, you help the other person become more ___ of inconsistencies in his or her feelings, attitudes, beliefs, and behaviours.

Answer 94

aware

Question 95

Use of this technique improves patient self-awareness and helps the patient recognize growth and deal with important issues and should be used only after you have established a trusting relationship with the patient as it requires gentleness and sensitivity. For example, the nurse might say to a patient who has chronic pain and decided to forego surgery, “you say you’ve already decided what to do, but you’re still talking a lot about your options.”

Answer 95

Confront

Question 96

Certain communication techniques hinder or damage professional relationships. These specific techniques are referred to as ___ or ___ and will often cause recipients to activate defences to avoid being hurt or negatively affected.

Answer 96

nontherapeutic / blocking

Question 97

Tend to discourage further expression of feelings and ideas and may engender negative responses or behaviours in other people.

Answer 97

Nontherapeutic techniques

Question 98

Asking personal questions that are not relevant to the situation but simply to satisfy one’s curiosity (e.g., “Why don’t you and John get married?”) is ___ appropriate professional communication. Such questions are ___ and unnecessary. If patients wish to share private information, they will. To learn more about the patient’s interpersonal roles and relationships, ask a question such as “How would you describe your relationship with John?”

Answer 98

not / invasive

Question 99

When the nurse provides a personal ___ (e.g., “if I were you, I’d put your mother in a long-term care facility”), it takes decision-making away from the patient.

Answer 99

opinion

Question 100

It inhibits spontaneity, stalls problem solving, and creates doubt.

Answer 100

Giving personal opinions

Question 101

Personal ___ differ from professional advice. At times, patients need suggestions and help to make choices. Suggestions should be presented to patients as ___ because the final decision rests with the patient. Remember that the problem and its solution belong to the patient. A much better response is “Let’s talk about what options are available for your mother’s care.”

Answer 101

opinions / options

Question 102

When another person is trying to communicate something important, ___ the subject (e.g., “let’s not talk about your problems with your job. It’s time for your walk”) is rude and shows a lack of empathy and mutuality.

Answer 102

changing

Question 103

It tends to block further communication and the sender then withholds important messages or fails to openly express feelings. Thoughts and spontaneity are interrupted, ideas become tangled, and information provided may be inadequate.

Answer 103

Changing the subject

Question 104

In some instances, this serves as a face-saving manoeuvre. If this happens, reassure the patient that you will return to his or her concerns: “after your walk, let’s talk some more about what’s going on with your job.”

Answer 104

Changing the subject

Question 105

“Older persons are always confused” or “administration doesn’t care about the staff” and labels are generalized beliefs held about people.

Answer 105

Stereotypes

Question 106

A generalizing comment such as “you can’t win them all” that tends to dismiss the other person’s feelings and minimize the importance of his or her message.

Answer 106

Cliché

Question 107

Clichés and stereotypes are ___ responses that communicate that you are not taking concerns seriously or responding thoughtfully.

Answer 107

automatic

Question 108

Another kind of automatic response is ___, repeating what the other person has said, word for word.

Answer 108

parroting

Question 109

Overused and is not as effective as paraphrasing.

Answer 109

Parroting

Question 110

Automatic remarks about other people lead to ___ and closed communication that reflects poor nursing judgement and may well threaten nurse-patient or nurse–team relationships.

Answer 110

assumptions

Question 111

Nurses may get in the habit of these ___ responses as a defence mechanism or as a way to compartmentalize and organize their work. Observation of one’s habitual techniques and approaches is key to self-awareness and communication with others.

Answer 111

automatic

Question 112

When a patient is seriously ill or distressed, you may be tempted to offer hope to the patient with statements such as “don’t worry, everything will be all right”; “you’ll be fine”; or “you have nothing to worry about.” When a patient is reaching for understanding, false ___ discourages open communication.

Answer 112

reassurance

Question 113

Offering ___ not supported by facts or based in reality typically does more harm than good. Although you may be attempting to be kind, such ___ has the secondary effect of helping you avoid the patient’s distress, tends to block conversation, and discourages further expression of feelings. A more relational nursing response is “it must be difficult not to know what the surgeon will find. What might be helpful to you at this time?”

Answer 113

reassurance x2

Question 114

Concern, sorrow, sadness, or pity felt for the patient generated by personal identification with the patient’s needs.

Answer 114

Sympathy

Question 115

A subjective vision of another person’s viewpoint that prevents a clear perspective of the issues confronting that person. If you overidentify with the patient (e.g., “I’m so sorry about your mastectomy; it must be terrible to lose a breast”), you will lose objectivity and be unable to effectively help the patient work through his or her situation.

Answer 115

Sympathy

Question 116

Although ___ is a compassionate response to another’s situation, it may not be as responsive and therapeutic as empathy. A more empathic approach is “the loss of a breast is a major change. How do you think it will affect your life?”

Answer 116

sympathy

Question 117

You may be tempted to ask your patient to explain why he or she believes, feels, or has acted in a certain way (e.g., “Why are you so anxious?”). Patients frequently interpret “___” questions as accusations or think you already know the reason and are simply testing them.

Answer 117

why

Question 118

“___” questions tend to interrupt patients’ descriptions of their feelings and experience and cause them to refocus their energy into intellectual or defensive responses.

Answer 118

Why

Question 119

Regardless of your motivation, “___” questions can cause resentment, insecurity, and mistrust.

Answer 119

why

Question 120

If you require additional information, it is best to phrase questions to avoid using “___”—for example, “you seem upset. What’s on your mind?” or “tell me about how you are feeling today compared to yesterday” is more likely to help the anxious patient to communicate.

Answer 120

why

Question 121

It is important to not impose your personal attitudes, values, beliefs, and moral standards on other people while in the professional helping role (e.g., “you shouldn’t even think about assisted suicide; it’s not right”).

Answer 121

Approval or disapproval

Question 122

J___ responses often contain terms such as should, ought, good, bad, right, and wrong.

Answer 122

J-udgemental

Question 123

Conveys the subtle message that you are making value judgements about the patient’s decisions.

Answer 123

Agreeing or disagreeing

Question 124

Implies that the behaviour being praised is the only acceptable one.

Answer 124

Approving

Question 125

Often the patient shares a decision not in an effort to seek ___ but to provide a means to discuss feelings.

Answer 125

approval

Question 126

Implies that the patient needs to meet your expectations or standards. Instead, help patients explore their own beliefs and decisions. The nursing response “I’m surprised you’re considering assisted suicide; tell me more” gives the patient a chance to express ideas or feelings without fear of being judged.

Answer 126

Disapproving

Question 127

Becoming ___ in response to criticism (e.g., “no one here would intentionally lie to you”) implies that the other person has no right to an opinion.

Answer 127

defensive

Question 128

The sender’s concerns are ignored when you focus on the need for self-defence, defence of the health care team, or defence of other people. When patients express ___, it is important to listen to what they have to say. Listening does not imply agreement. To discover reasons for a patient’s anger or dissatisfaction, you must listen without defensiveness or judgement and ___. By avoiding defensiveness, you can defuse anger and uncover deeper concerns: “it sounds as if you believe people have been dishonest with you. That must make it difficult for you to trust anyone.”

Answer 128

criticism x2

Question 129

“Things are bad, and I can’t do anything about it”; serves to avoid conflict or sidestep issues.

Answer 129

Passive responses

Question 130

They reflect feelings of sadness, depression, anxiety, powerlessness, and hopelessness.

Answer 130

Passive responses

Question 131

“Things are bad, and it’s all your fault”) provoke confrontation at the other person’s expense and reflect feelings of anger, frustration, resentment, and stress.

Answer 131

Aggressive responses

Question 132

When nurses lack assertiveness skills, they may also use t-___, complaining to a third party rather than confronting the problem or expressing concerns directly to the source. This lowers team morale and draws other people into the conflict situation.

Answer 132

t-riangulation

Question 133

Establishes boundaries and expectations without the blame or judgement implied in passive and aggressive responses.

Answer 133

Assertive communication

Question 134

An ___ approach imparts intention and action that will support the ongoing professional therapeutic relationship.

Answer 134

assertive

Question 135

Challenging or ___ against perceptions (e.g., “how can you say you didn’t sleep a wink, when I heard you snoring all night long?”) denies that they are real and valid to the other person.

Answer 135

arguing

Question 136

Implies that the other person is lying, misinformed, or uneducated.

Answer 136

Arguing

Question 137

Skillful nurses give information or present reality in a way that avoids ___: “you feel as if you didn’t get any rest at all last night, even though I thought you slept well because you seemed peaceful when I checked your room during the night.”

Answer 137

argument

Question 138

E___ aphasia, a motor type of aphasia, is the inability to name common objects or to express simple ideas in words or writing. For example, a patient may understand a question but be unable to express an answer.

Answer 138

E-xpressive

Question 139

Sensory or r___ aphasia is the inability to understand written or spoken language. The patient may be able to express words but is unable to understand the questions or comments of others.

Answer 139

r-eceptive

Question 140

G___ aphasia is the inability to understand language or communicate orally.

Answer 140

G-lobal

Question 141

• Listen attentively, be patient, and do not interrupt.
• Ask simple questions that require yes or no answers.
• Allow time for understanding and response.
• Use visual cues (e.g., words, pictures, and objects) when possible.
• Allow only one person to speak at a time.
• Do not shout or speak too loudly.
• Encourage the patient to converse.
• If you have not understood the patient, let him or her know.
• Collaborate with a speech therapist as needed.
• Use communication aids:
• Pad and felt-tipped pen or Magic Slate
• Communication board with commonly used words, letters, or pictures denoting basic needs
• Call bells or alarms
• Sign language
• Use of eye blinks or movement of fingers for simple responses (“yes” or “no”)

Answer 141

Patients Who Cannot Speak Clearly (Aphasia, Dysarthria, Muteness)

Question 142

• Reduce environmental distractions while conversing.
• Capture the patient’s attention before you speak.
• Use simple sentences, and avoid long explanations.
• Ask one question at a time.
• Allow time for the patient to respond.
• Be an attentive listener.
• Include family and friends in conversations, especially in topics known to the patient.

Answer 142

Patients Who Are Cognitively Impaired

Question 143

• Check for the presence of hearing aids.
• Reduce environmental noise.
• Get the patient’s attention before you speak.
• Face the patient so that your mouth is visible.
• Do not chew gum.
• Speak at normal volume; do not shout.
• Rephrase rather than repeat, if your message is misunderstood.
• Provide a sign language interpreter if this is indicated.

Answer 143

Patients Who Are Hearing Impaired

Question 144

• Check for use of glasses or contact lenses.
• Identify yourself when you enter the room, and notify the patient when you leave the room.
• Speak in a normal tone of voice.
• Do not rely on gestures or nonverbal communication to convey messages.
• Use indirect lighting, avoiding glare.
• Use an appropriate font size for the impairment (i.e., at least 14-point print).

Answer 144

Patients Who Are Visually Impaired

Question 145

• Call the patient by name during interactions.
• Communicate both verbally and by touch.
• Speak to the patient as though he or she can hear.
• Explain all procedures and expected sensations.
• Provide orientation to person, place, and time.
• Avoid talking about the patient to other people in his or her presence.
• Avoid saying things that the patient should not hear (e.g., gossip or speculations about patient’s condition).
• Always assume that patients can hear and understand everything said at their bedside.

Answer 145

Patients Who Are Unresponsive

Question 146

• Speak to the patient in a normal tone of voice (shouting may be interpreted as anger).
• Establish a method for the patient to signal a desire to communicate (call light or bell).
• Provide an interpreter (translator) as needed (for further information on working with an interpreter see Chapter 9).
• Develop communication board, pictures, or cards.
• Translate words from the English list into the patient’s native language for the patient to make basic requests.
• Ensure that a dictionary (English-French, English-Blackfoot, and so forth) is available if the patient can read.

Answer 146

Patients Who Do Not Speak English

Question 147

Effective communication involves a___ to any special needs resulting from sensory, motor, or cognitive impairments that are present.

Answer 147

a-dapting

Question 148

To determine whether the plan of care has been successful, both the nurse and patient ___ the patient’s communication outcomes.

Answer 148

evaluate

Question 149

You need to ___ nursing interventions to determine what strategies or interventions were effective and what changes in the patient’s situation resulted because of the interventions. For example, if using pen and paper proves frustrating for a nonverbal patient whose handwriting is shaky, you need to revise the care plan to include use of a picture board instead. If expected outcomes are not met or progress is not satisfactory, you need to determine what factors influenced the outcomes and then modify the plan.

Answer 149

evaluate

Question 150

PATIENT: All right, then: Why wouldn’t that girl tell me what my blood sugar was?
NURSE: I’m not sure. If I were you, I’d forget about it and get a fresh start

Answer 150

Giving advice and using cliché, which is nontherapeutic; would have been better to acknowledge that the patient had a right to know the information

Question 151

NURSE: This hospital has a fine staff, Mr. Simpson. I’m sure no one would intentionally keep information from you.

Answer 151

• Feeling threatened and being defensive: a nontherapeutic technique

Question 152

NURSE: I’m going to test your blood sugar levels in a minute, and I’ll tell you the results. [Performs test] Your blood sugar level was 20.

Answer 152

• Providing information, demonstrating trustworthiness

Question 153

NURSE: [Nods; long pause]

Answer 153

• Nonverbal affirmation, use of silence to allow patient time to absorb information and gather thoughts

Question 154

NURSE: What kinds of things are you worried about?

Answer 154

• Open-ended question to elicit information

Question 155

PATIENT: I could lose a leg, as my mother did. Or go blind. Or have to live hooked up to a kidney machine for the rest of my life.
NURSE: You’ve been thinking about all kinds of things that could go wrong and it adds to your worry not to be told what your blood sugar is.

Answer 155

• Summarizing to let patient “hear” what he has communicated

Question 156

NURSE: I’ll pass along to the technician that it’s okay to tell you your blood sugar levels. And later this afternoon, I’d like us to talk more about some things you can do to help avoid these complications and set some goals for controlling your blood sugar. [Stands up, keeps looking at patient]

Answer 156

• Providing information, encouraging collaboration and goal setting; giving nonverbal cue that conversation is nearing end

Question 157

Nurses are further able to engage with complexity and uncertainty and expand their capacity to communicate by focusing on their r___ capacity and the following skills:

• Letting be
• Listening
• Self-observation
• Questioning to look beyond the surface
• Intentionality
• Interrupting contextual constraints
• Reimagining

Answer 157

relational