Mod 1 Ch 24 communication Flashcards
social communication
information interactions among friends, neighbors, and acquaintance
- not focused, informal, mutual sharing of ideas, blurred boundaries, appropriate/inappropriate emotions, be ethically fluid, little effect on nurse-patient relationship
therapeutic communications
positive, beneficial interactions focus on patient
- pt/fam and healthcare team, focus on pt and health topics, limited sharing from nurse’s point of view, clear boundaries, unacceptable for bad bx, ethical boundaries, positive effect nurse-patient relationship
nontherapeutic communication
negative, harmful interactions not focused on pt’s needs
- unprofessional bx, not pt focused, inappropriate bx, nurse might overshare, cross boundaries, adverse nurse-pt helping relationship
confidentiality
ethical and legal responsibility in formal and informal interactions with pt, by Health Insurance Portability and Accountability Act (HIPAA)
- no sharing unless w permission, no sharing w healthcare team until related to pt care, no talking public, etc
key concepts professional communication
respect, assertiveness, advocacy, professional boundaries
impact nontherapeutic communication
criticism and judgment by nurse
- reasons to avoid:
- block comms, discourage open emotions, make pt feel defensive, shift focus away from pt, belittling pt feelings and problems, avoiding talking critical topics, discourage effective pt decision-making, don’t find solutions and just point blame
nontherapeutic methods to avoid
asking why, closed-ended questions (yes/no), changing subject, giving advice, approving or disapproving, agreeing or disagreeing
nontherapeutic techs that discount pt feelings
false reassurances or false hope, generalized responses, excessive self-disclosure or comparison, comparing pt experiences, personal terms of endearment, being defensive
4 phases nurse-pt helping relationship
preorientation
orientation
working
termination
interaction spaces
Intimate (0 to 1.5 feet)
Personal (1.5 to 4 feet)
Social (4 to 12 feet)
Public (greater than 12 feet)
standard communication techniques
active listening, silence, touch
active listening
- intermittent eye contact
- eye level, open posture
- face pt, lean forward
- avoid distracting movements
Why - shows interest and concern, undivided attention
silence
no verbal communication
- concern and caring during a difficult time
- gives pt time to think and reflect
touch
use discriminately, hold hand, light touch arm, shoulder or feet
- empathy and emotional support, comfort
verbal techniques initiate and encourage communication
offering self, call pt by name, sharing observations, give info, open-ended questions/comments
- introduce by sirname then ask how want to be addressed
- establish nurse-pt helping relationship
- respect and concern
- explore openings
- allow pt confirm nurse observations
- provide info to pt
promote understanding
decrease confusion, reduce misunderstanding, validate pt perspective
- restate/rephrasing
- seeking clarification
- summarizing
- validating
promote insight
explore problems, gain insight, emotional growth, id progress, increase self-awareness
- used focused questions
- provide general leads
- conveying acceptance
- reflecting feelings
- using humor (be careful and use at right time)
- verbalizing the implied
Which behaviors would the nurse implement when using active listening?
Maintaining eye level with the patient
Keeping arms uncrossed
Facing the patient
Leaning toward the patient
Match the verbal therapeutic technique to its example.
I’ll sit with you for a while.”
- Offering self
“You seem frustrated.”
- Sharing observations
“Tell me about some of your concerns.”
- Using open-ended comments
“It is time for physical therapy.”
- Giving information
social range
4-12 ft
Match the phase of the nurse–patient helping relationship with its activity.
Collaborating among the nurse, patient, and others
- Working
Transitioning to another caregiver
- Termination
Predetermining topics of interaction
- Preorientation
Observing, interviewing, and assessing patients
- Orientation
Which techniques promote therapeutic communication? (Insight)
Conveying acceptance
Using focused comments
Using humor
Hearing impaired
- hearing aid usage and proper
- minimize background noise
- area well-lit for lip reading
- speak clearly
- raise voice slightly and low tones
- 3-6 ft distance for non-verbal cue awareness
- face pt
- use writing aids
comms w/visually impaired
- describe objects and hazards
- use clock for locations
- use comm tools
- speak before touching to alert
- in-depth procedure explanation
- eyeglasses present
comms w/impaired consciousness
- continue physical touch
- communicate and teach as if pt can hear
- friend/family stay and talk w pt
- speak before touching/care
- observe nonverbal signs
- use nonverbal signs if pt able to do
comms w/pt special eq
- gestures, head nods, eye movements
- if completely paralyzed, DO NOT use hand squeezes
- use assistive/electronic devices can interpret gestures/eye movements and connect to computers
comms w/ pt dementia
- talk w family effective strategies
- gain insight lifelong habits to prevent disruption
- DO NOT confront or continually reorient pt - lead agitation
- reminisce
- when all refusal, distract pt with activity
- accept pt erroneous thought process
defense mechanisms
compensation - using strengths to overcome inadequacy
denial - refusal of reality
displacement - transferring emotions away from source to another person or object
introjection - taking charact of another individual’s personality
rationalization - denying true motives with more socially acceptable explanation
regression - reverting bx
repression - storing painful feelings in unconscious, be forgotten
- sublimation - rechanneling unacceptable impulses to acceptable
- suppression - choosing not to think about unpleasant feelings *** only non-unconscious defense
comms w/ family
essential, info is a secondary source
may provide insight into:
- relationship dynamics
- effects illness
- support systems availability
Which impairments may impede communication?
hearing, visual, cognitive, physical
Which technique would the nurse use to facilitate communication with a hearing-impaired patient?
make sure area is well lit
Which strategy would the nurse use to facilitate communication with a visually impaired patient?
use analog clock descriptors to specify location
Match the defense mechanism to its definition.
Refusing to admit the reality of a situation
- Denial
Using personal strengths to overcome feelings of inadequacy
- Compensation
Choosing not to think consciously about unpleasant feelings
- Suppression
Taking on certain characteristics of another
- Introjection
Which important patient insight may be gained by communicating with family members?
recognizing the existence of support systems
Which scenario complies with regulations of confidentiality?
refusing tell pt partner about diagnosis w/out pt authorization
Which scenario complies with professional role boundaries?
Visiting a patient to provide home health care
Which standard communication strategies would the nurse use to positively influence the nurse–patient helping relationship?
- leaning toward pt as they speak
- hold pt hand while hcp provides results biopsy
- remaining silent while being present in room
Which nursing behaviors are therapeutic?
allowing older adults more time to answer
not touching the top of a pts head who is from another country
asking family members to leave when talking about personal issues
Which response would the nurse use when the patient avoids eye contact when discussing a sensitive subject?
you seem uncomfortable
Which action would the male nurse take when a female patient from another culture does not want him to perform an assessment?
request female nurse perform assessment
Which actions would the nurse implement for a patient with visual and hearing impairments?
raise voice slightly above normal level
speak to pt before touching
display active listening
Which question or comment is an effective verbal technique for obtaining more information?
tell me more about your diet
Which key concepts of professional communication are represented when the circulating nurse in the operating room says, “The patient’s arm is not straight; it needs to be repositioned”?
assertiveness
advocacy
Which techniques would the nurse use for a male patient who identifies as a female?
establish trust
touch pt shoulder for comfort
Which approach would the nurse use to communicate with a patient who is on a ventilator and is paralyzed in all extremities?
use eye movements to indicate yes or no
Which response would the nurse make to a patient who is about to undergo a stressful procedure in 1 hour and yells at the nurse who is 5 minutes late with the medications?
i understand you are nervous tell me about how you’re feeling
Which action would the nurse take for an older adult female patient who left her glasses at home but is wearing her hearing aid and wants information about her newly prescribed medications?
sit down w/pt to verbally answer questions
Which response would the nurse make to a female patient who is crying and asks the nurse if she should get chemotherapy treatments?
what are your concerns about the chemotherapy
Which techniques are being used when the nurse says, “Mrs. Sharp, we have discussed your medications, treatments, and next appointment. What else would you like to discuss?”
summarizing
using open ended questions
calling the pt by name
Which patient situation describes projection?
an adult pt feels ugly but calls the nurse ugly
Match the communication technique to its example.
“You have no reason to be crying.”
– Approval/disapproval
“You won’t get better care anywhere else.”
- Being defensive
“And then?”
- General leads
“It will work out.”
- Generalized responses
Which actions would strengthen the nurse–patient helping relationship?
- not leaving severely anxious pt alone
- postponing teaching if the pt in severe pain
- observing family dynamics when interacting with pt and family
Match the type of communication to its characteristic.
Has fluid ethical and legal boundaries
- Social
Has sharing but in a limited capacity from the nurse
- Therapeutic
Has the focus on the nurse
- Nontherapeutic
For which reason would the nurse avoid nontherapeutic communication in a nurse–patient helping (therapeutic) relationship?
Requires justification of actions from the patient
Which nursing responses are considered nontherapeutic?
Asking “why” questions
Offering advice
Agreeing with the patient
critical thinking
helps nurses overcome perpetual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others
Communicating throughout the nursing process
Assessment
• Verbal interviewing and history taking
• Visual and intuitive observation of nonverbal behavior
• Visual, tactile, and auditory data gathering during physical examination
• Written medical records, diagnostic tests, and literature review
Nursing Diagnosis
• Intrapersonal analysis of assessment findings
• Validation of health care needs and priorities via verbal discussion with patient
• Documentation of nursing diagnosis
Planning
• Interpersonal or small-group health care team planning sessions
• Interpersonal collaboration with patient and family to determine implementation methods
• Written documentation of expected outcomes
• Written or verbal referral to health care team members
Implementation
• Delegation and verbal discussion with health care team
• Verbal, visual, auditory, and tactile health teaching activities
• Provision of support via therapeutic communication techniques
• Contact with other health resources
• Written documentation of patient’s progress in medical record
Evaluation
• Acquisition of verbal and nonverbal feedback
Comparison of actual and expected outcomes
• Identification of factors affecting outcomes
• Modification and update of care plan
• Verbal and/or written explanation of care plan revisions to patient
nurses use ___, ___, ___, ___ to build therapeutic relationships
self-awareness, motivation, empathy, and social skills
intrapersonal communication
powerful form of comms
Self-talk - provides mental rehearsal for tasks so you can be more effective and increase confidence
- most often face-to-face and ost frequent
small group comms
small number people, goal oriented and requires understanding group dynamics
circular transactional model
elements:
referent- motivates one person to comm with other
sender and receiver-
message, channels (audio, visual, tactile), environments
feedback - message understood?
interpersonal variables- perception allows personal view of reality formed by indiv culture, expectations, and experiences… must have cultural sensitivity
roles:
complimentary- one person holds elevated position over other.. this is rn educating pt
symmetrical - more equal
special zones of touch
Social Zone (Permission Not Needed) -- Hands, arms, shoulders, back
Consent Zone (Permission Needed) -- Mouth, wrists, feet
Vulnerable Zone (Special Care Needed) -- Face, neck, front of body
Intimate Zone (Permission and Great Sensitivity Needed) -- Genitalia, rectum
Improved Communication With Older Adults Who Have Hearing Loss
- Make sure the patient knows that you are talking.
• Face the patient, be sure that your face/mouth is visible to him or her, and do not chew gum or talk while chewing.
• Speak clearly but do not exaggerate lip movement or shout.
• Speak a little more slowly but not excessively slow.
• Check whether patient uses hearing aids, glasses, or other adaptive equipment.
• Choose a quiet, well-lit environment with minimal distractions.
• Allow time for the patient to respond. Do not assume that patient is being uncooperative if he or she does not reply or takes a long time to reply.
• Give the patient a chance to ask questions.
• Keep communication short and to the point. Ask one question at a time.
- When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.)
- Check for needed adaptive equipment.
- Give the patient time to respond to questions.
- Keep communication short and to the point.
- Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.)
- To reduce the risk of errors to the patient
- To provide an optimum level of patient care
- To improve patient outcomes
- Motivational interviewing (MI) is a technique that applies understanding a patient’s values and goals in helping the patient make behavioral changes. When using motivational interviewing, what outcomes does the nurse expect? (Select all that apply.)
- Gaining an understanding of the patient’s motivations
- Recognizing the patient’s strengths and supporting his or her efforts
- Identifying differences in patient’s health goals and current behaviors
- The nurse therapeutically responds to an adult patient who is anxious by: (Select all that apply.)
- Providing good eye contact
- Demonstrating a calm presence
- Spending time attentively with the patient
- A nurse prepares to contact a patient’s physician about a change in the patient’s condition. Put the following statements in the correct order using SBAR (Situation, Background, Assessment, and Recommendation) communication.
- “The patient started to complain of nausea yesterday evening and has vomited several times during the night.”
- “She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on levofloxacin at 5 PM yesterday. She states she has a poor appetite; her weight has remained stable over the past 2 days.”
- “The patient reported feeling very nauseated after her dose of levofloxacin an hour ago.”
- “Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?”
- The patient states, “I don’t have confidence in my doctor. She looks so young.” The nurse therapeutically responds: (Select all that apply.)
- Tell me more about your concern.
- You are worried about your care?
- The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.)
- Complete a nursing history using verbal communication techniques.
- Validate health care needs through verbal discussion with the patient.
- Provide support through therapeutic communication techniques.
- Compare actual and expected patient care outcomes with the patient.
- A nurse works with a patient using therapeutic communication and the phases of the therapeutic relationship. Place the nurse’s statements in order according to these phases.
- The nurse is mindful of his/her own biases and knowledge in working with the patient with B12 deficiency.
- After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.
- The nurse states, “Let’s work on learning injection techniques.”
- The nurse summarizes progress made during the nursing relationship.
- Which strategies should a nurse use to facilitate a safe transition of care during a patient’s transfer from the hospital to a skilled nursing facility? (Select all that apply.)
- Collaboration between staff members from sending and receiving departments
- Using a standardized transfer policy and transfer tool
- The nurse uses silence as a therapeutic communication technique. What are the purposes of the nurse’s silence? (Select all that apply.)
- Prompts the patient to talk when he or she is ready
- Allows the patient time to think and gain insight
Define Elderspeak
-Speech style similar to baby talk -Conveys the message of dependence and incompetence in older adults -Does not communicate respect -Many professionals are not aware that they use elderspeak -Inappropriate terms of endearment (diminutives) -Tag questions -Slow, loud speech
factors influencing comms
Psychophysiological Context (Internal Factors Affecting Communication) • Physiological status (e.g., pain, hunger, nausea, weakness, dyspnea)
- Emotional status (e.g., anxiety, anger, hopelessness, euphoria)
- Growth and development status (e.g., age, developmental tasks)
- Unmet needs (e.g., safety/security, love/belonging)
- Attitudes, values, and beliefs (e.g., meaning of illness experience)
- Perceptions and personality (e.g., optimist/pessimist, introvert/extrovert)
- Self-concept and self-esteem (e.g., positive or negative)
Relational Context (Nature of the Relationship Among Participants) • Social, helping, or working relationship
- Level of trust among participants
- Level of caring expressed
- Level of self-disclosure among participants
- Shared history of participants
- Balance of power and control
Situational Context (Reason for Communication) • Information exchange
- Goal achievement
- Problem resolution
- Expression of feelings
Environmental Context (Physical Surroundings in Which Communication Occurs) • Privacy level
- Noise level
- Comfort and safety level
- Distraction level
Cultural Context (Sociocultural Elements That Affect an Interaction) • Educational level of participants
- Language and self-expression patterns
- Customs and expectations
