fundamentals- chapter 8 Flashcards
communication
- occurs when one person sends a message and another person receives it, processes it, and indicates that the message has been interpreted
- continual circular process
- verbal or nonverbal
verbal communication
spoken or written words
nonverbal communication
without words
- gestures
- posture
- intonation
- general appearance
factors affecting communication
- cultural differences
- past experiences
- emotions and mood
- attitude of the individual
cultural differences
- personal space
- eye contact
- averting eyes is normal in some cultures
- meanings of words
- cultural norms
- older people might not want instructions from
younger people
- older people might not want instructions from
- religious beliefs
past experience and communication
how we perceive communication depends on:
- cultural values
- level of education
- familiarity with the topic
- occupation
- previous life experiences
emotions and mood
- anxious patients may not hear or interpret you correctly
- an upset person may speak loudly
- a depressed person may communicate minimally
- a person’s attitude may affect how a message is received
active listening
- requires concentration and focused energy
- uses all senses to interpret verbal and nonverbal messages (feedback)
- listens for feelings as well as words
- maintains eye contact without staring
- makes a conscious effort to block out distractions
interpreting nonverbal messages
observe for:
- posture
- gestures
- tone
- facial expression
- smiling or frowning
- eye contact
obtaining feedback
- checking to see if you interpreted a message in the way the speaker meant it
- accomplished by rephrasing the meaning of the message or directly asking a feedback question
- helps assess if a patient understands what you are saying
focusing
- keeping attention focused on the communication task at hand
- continually check to see that the patient is still the topic of interaction
adjusting style
- patient’s style and level of usual communication should be considered
- 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
therapeutic communication
- promoting communication between sender and receiver, obtaining feedback
- focusing on the communicator
- using silence and open-ended communication
- restating the message
- clarifying
- using therapeutic touch
therapeutic communication techniques
- general leads
- open-ended questions or statements
- offering self
- restatement
- reflection
- seeking clarification
- focusing
- encouraging elaboration
- giving information
- looking at alternatives
- silence
- summarizing
blocks to effective communication
- changing the subject
- offering false reassurance
- giving advice
- making defensive comments
- asking prying or probing questions
- using cliches
- listening inattentively
general leads
“go on”
“I see”
“please continue”
open ended questions or statements
“tell me more about that feeling”
“I’d like to hear more about…”
offering self
“I’m here to listen”
“can I help in some way?”
restatement
- restates in different words what the patient said
- encourages further communication on that topic
reflection
- reflects received message (verbal or nonverbal) back to patient
- reflects feelings
- encourages further verbalization
- can be useful if patient struggles with verbalization
seeking clarification
- seeks clarification about the source of an upset feeling
- helps patient clarify their own thoughts
focusing
asking a goal-directed question helps the patient focus on key concerns
ex. “do you have any questions about your chemotherapy?”
encouraging elaboration
'’tell me what that felt like”
“I need more information about that”
giving information
provides patient education relevant ton specific health care needs
looking at alternatives
“have you thought about…?”
“would this be an option?”
silence
allows patient time to gather thoughts and sort them out
summarizing
sums up the important parts of an interaction
interviewing skills
- establish a rapport
- the nurse-patient relationship
- empathy
- becoming nonjudgemental
- maintaining hope
- truth telling
- application of the nursing process
- nurse-patient communication
sympathy vs. empathy
changing the subject
deprives the patient of the chance to verbalize concerns
giving false reassurance
negates the patients feelings and may result in false hope
judgmental response
- implies patient must take on nurse’s values
- demeaning to the patient
defensive response
- nurse responds by defending the doctor
- prevents patient from feeling free to express feelings
asking probing questions
- pries into patient’s motives
- invades privacy
using cliches
- negates the patient’s individual situation
- sounds flippant and prevents building trust
giving advice
- controlling
- diminishes patient’s responsibility for taking charge of their own health
inattentive listening
- indicates the patient is not important, the nurse is bored, or what is being said doesn’t matter
interviewing skills
- establish rapport (relationship of mutual trust)
- introduce yourself and ask how the patient wishes to be addressed
- include family in greeting
- explain purpose of interview
- provide privacy
- ask if patient wishes guests to remain in the room
- eliminate excess noise
- be certain patient is comfortable
- draw up chair within 3-4 feet
- sit facing patient
the nurse-patient relationship
empathy
becoming nonjudgmental
maintaining hope
truth telling
application of the nursing process
nurse-patient communication
communicating with the hearing-impaired
- speak very distinctly
- do not shout
- speak slowly
- get the person’s attention
- maintain a good distance (2.5 to 4 feet)
- watch for nonverbal feedback
- use short sentences
- paraphrase for clarification
communicating with an aphasic patient
- aphasia = difficulty expressing or understanding language
- this patient requires specialized nursing interventions
- a speech therapist can identify methods to facilitate communication for these patients
strategies for communicating with an aphasic person
- make sure you have their attention before you start
- make the environment as relaxed & quiet as possible
communicating with older adults
- assess for
communicating with children
- 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
assisting older adults from other cultures
- determine the language spoken
- obtain an interpreter if necessary
- enlist the help of a family member if appropriate
- give printed materials if available and answer questions
- beware of cultural differences in eye contact & personal space
communication within the health care team
- nurse’s notes
- physician’s orders and progress notes
- dietician’s notes
- OT, PT, and speech therapy notes
- shift report
- radiology and lab findings
ISBAR-R
Introduction
Situation
Background
Assessment
Recommendation
Readback
SBAR-Q
Situation
Background
Assessment
Recommendation
Questions
walking rounds
computerized documentation
telephoning primary care providers
- have patient data in hand (lab data, vitals, output, med record, etc)
- keep chart handy and anticipate info the physician may request
- know patient allergies and perform a quick assessment before calling
- prepare a concise problem statement
- document the call and physician’s response
assignment considerations and delegating
- give clear, concise messages and listen carefully to feedback
- include
computer communication
- computer communication skills are essential
- transmit requests for lab, dietary, radiology, PT, RT, and other services
- medication orders
- supplies for patient care
- update care plans
- computerized form of charting
communication in the home and community
