Mod 1 Ch 24 communication

Question 1

social communication

Answer 1

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

Question 2

therapeutic communications

Answer 2

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

Question 3

nontherapeutic communication

Answer 3

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

Question 4

confidentiality

Answer 4

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

Question 5

key concepts professional communication

Answer 5

respect, assertiveness, advocacy, professional boundaries

Question 6

impact nontherapeutic communication

Answer 6

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

Question 7

nontherapeutic methods to avoid

Answer 7

asking why, closed-ended questions (yes/no), changing subject, giving advice, approving or disapproving, agreeing or disagreeing

Question 8

nontherapeutic techs that discount pt feelings

Answer 8

false reassurances or false hope, generalized responses, excessive self-disclosure or comparison, comparing pt experiences, personal terms of endearment, being defensive

Question 9

4 phases nurse-pt helping relationship

Answer 9

preorientation
orientation
working
termination

Question 10

interaction spaces

Answer 10

Intimate (0 to 1.5 feet)
Personal (1.5 to 4 feet)
Social (4 to 12 feet)
Public (greater than 12 feet)

Question 11

standard communication techniques

Answer 11

active listening, silence, touch

Question 12

active listening

Answer 12

• intermittent eye contact
• eye level, open posture
• face pt, lean forward
• avoid distracting movements
  Why
• shows interest and concern, undivided attention

Question 13

silence

Answer 13

no verbal communication

• concern and caring during a difficult time
• gives pt time to think and reflect

Question 14

touch

Answer 14

use discriminately, hold hand, light touch arm, shoulder or feet
- empathy and emotional support, comfort

Question 15

verbal techniques initiate and encourage communication

Answer 15

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

Question 16

promote understanding

Answer 16

decrease confusion, reduce misunderstanding, validate pt perspective

• restate/rephrasing
• seeking clarification
• summarizing
• validating

Question 17

promote insight

Answer 17

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

Question 18

Which behaviors would the nurse implement when using active listening?

Answer 18

Maintaining eye level with the patient
Keeping arms uncrossed
Facing the patient
Leaning toward the patient

Question 19

Match the verbal therapeutic technique to its example.

Answer 19

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

Question 20

social range

Answer 20

4-12 ft

Question 21

Match the phase of the nurse–patient helping relationship with its activity.

Answer 21

Collaborating among the nurse, patient, and others
- Working
Transitioning to another caregiver
- Termination
Predetermining topics of interaction
- Preorientation
Observing, interviewing, and assessing patients
- Orientation

Question 22

Which techniques promote therapeutic communication? (Insight)

Answer 22

Conveying acceptance
Using focused comments
Using humor

Question 23

Hearing impaired

Answer 23

• 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

Question 24

comms w/visually impaired

Answer 24

• describe objects and hazards
• use clock for locations
• use comm tools
• speak before touching to alert
• in-depth procedure explanation
• eyeglasses present

Question 25

comms w/impaired consciousness

Answer 25

• 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

Question 26

comms w/pt special eq

Answer 26

• 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

Question 27

comms w/ pt dementia

Answer 27

• 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

Question 28

defense mechanisms

Answer 28

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

Question 29

comms w/ family

Answer 29

essential, info is a secondary source
may provide insight into:
- relationship dynamics
- effects illness
- support systems availability

Question 30

Which impairments may impede communication?

Answer 30

hearing, visual, cognitive, physical

Question 31

Which technique would the nurse use to facilitate communication with a hearing-impaired patient?

Answer 31

make sure area is well lit

Question 32

Which strategy would the nurse use to facilitate communication with a visually impaired patient?

Answer 32

use analog clock descriptors to specify location

Question 33

Match the defense mechanism to its definition.

Answer 33

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

Question 34

Which important patient insight may be gained by communicating with family members?

Answer 34

recognizing the existence of support systems

Question 35

Which scenario complies with regulations of confidentiality?

Answer 35

refusing tell pt partner about diagnosis w/out pt authorization

Question 36

Which scenario complies with professional role boundaries?

Answer 36

Visiting a patient to provide home health care

Question 37

Which standard communication strategies would the nurse use to positively influence the nurse–patient helping relationship?

Answer 37

• leaning toward pt as they speak
• hold pt hand while hcp provides results biopsy
• remaining silent while being present in room

Question 38

Which nursing behaviors are therapeutic?

Answer 38

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

Question 39

Which response would the nurse use when the patient avoids eye contact when discussing a sensitive subject?

Answer 39

you seem uncomfortable

Question 40

Which action would the male nurse take when a female patient from another culture does not want him to perform an assessment?

Answer 40

request female nurse perform assessment

Question 41

Which actions would the nurse implement for a patient with visual and hearing impairments?

Answer 41

raise voice slightly above normal level
speak to pt before touching
display active listening

Question 42

Which question or comment is an effective verbal technique for obtaining more information?

Answer 42

tell me more about your diet

Question 43

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”?

Answer 43

assertiveness
advocacy

Question 44

Which techniques would the nurse use for a male patient who identifies as a female?

Answer 44

establish trust
touch pt shoulder for comfort

Question 45

Which approach would the nurse use to communicate with a patient who is on a ventilator and is paralyzed in all extremities?

Answer 45

use eye movements to indicate yes or no

Question 46

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?

Answer 46

i understand you are nervous tell me about how you’re feeling

Question 47

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?

Answer 47

sit down w/pt to verbally answer questions

Question 48

Which response would the nurse make to a female patient who is crying and asks the nurse if she should get chemotherapy treatments?

Answer 48

what are your concerns about the chemotherapy

Question 49

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?”

Answer 49

summarizing
using open ended questions
calling the pt by name

Question 50

Which patient situation describes projection?

Answer 50

an adult pt feels ugly but calls the nurse ugly

Question 51

Match the communication technique to its example.

Answer 51

“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

Question 52

Which actions would strengthen the nurse–patient helping relationship?

Answer 52

• not leaving severely anxious pt alone
• postponing teaching if the pt in severe pain
• observing family dynamics when interacting with pt and family

Question 53

Match the type of communication to its characteristic.

Answer 53

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

Question 54

For which reason would the nurse avoid nontherapeutic communication in a nurse–patient helping (therapeutic) relationship?

Answer 54

Requires justification of actions from the patient

Question 55

Which nursing responses are considered nontherapeutic?

Answer 55

Asking “why” questions
Offering advice
Agreeing with the patient

Question 56

critical thinking

Answer 56

helps nurses overcome perpetual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others

Question 57

Communicating throughout the nursing process

Answer 57

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

Question 58

nurses use ___, ___, ___, ___ to build therapeutic relationships

Answer 58

self-awareness, motivation, empathy, and social skills

Question 59

intrapersonal communication

Answer 59

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

Question 60

small group comms

Answer 60

small number people, goal oriented and requires understanding group dynamics

Question 61

circular transactional model

Answer 61

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

Question 62

special zones of touch

Answer 62

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

Question 63

Improved Communication With Older Adults Who Have Hearing Loss

Answer 63

• 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.

Question 64

1. When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? (Select all that apply.)

Answer 64

1. Check for needed adaptive equipment.
2. Give the patient time to respond to questions.
3. Keep communication short and to the point.

Question 65

2. Nurses must communicate effectively with the health care team for which of the following reasons? (Select all that apply.)

Answer 65

2. To reduce the risk of errors to the patient
3. To provide an optimum level of patient care
4. To improve patient outcomes

Question 66

3. 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.)

Answer 66

1. Gaining an understanding of the patient’s motivations
2. Recognizing the patient’s strengths and supporting his or her efforts
3. Identifying differences in patient’s health goals and current behaviors

Question 67

4. The nurse therapeutically responds to an adult patient who is anxious by: (Select all that apply.)

Answer 67

2. Providing good eye contact
3. Demonstrating a calm presence
4. Spending time attentively with the patient

Question 68

5. 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.

Answer 68

4. “The patient started to complain of nausea yesterday evening and has vomited several times during the night.”
5. “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.”
6. “The patient reported feeling very nauseated after her dose of levofloxacin an hour ago.”
7. “Is it possible to make a change in antibiotics, or could we give her a nutritional supplement before her medication?”

Question 69

6. The patient states, “I don’t have confidence in my doctor. She looks so young.” The nurse therapeutically responds: (Select all that apply.)

Answer 69

1. Tell me more about your concern.
2. You are worried about your care?

Question 70

7. The nurse applying effective communication skills throughout the nursing process should: (Place the following interventions in the correct order.)

Answer 70

4. Complete a nursing history using verbal communication techniques.
5. Validate health care needs through verbal discussion with the patient.
6. Provide support through therapeutic communication techniques.
7. Compare actual and expected patient care outcomes with the patient.

Question 71

8. 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.

Answer 71

2. The nurse is mindful of his/her own biases and knowledge in working with the patient with B12 deficiency.
3. After providing introductions, the nurse defines the scope and purpose of the nurse-patient relationship.
4. The nurse states, “Let’s work on learning injection techniques.”
5. The nurse summarizes progress made during the nursing relationship.

Question 72

9. 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.)

Answer 72

1. Collaboration between staff members from sending and receiving departments
2. Using a standardized transfer policy and transfer tool

Question 73

10. The nurse uses silence as a therapeutic communication technique. What are the purposes of the nurse’s silence? (Select all that apply.)

Answer 73

2. Prompts the patient to talk when he or she is ready
3. Allows the patient time to think and gain insight

Question 74

Define Elderspeak

Answer 74

-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

Question 75

factors influencing comms

Answer 75

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