Module 2 Communicating and Therapeutic Relationships

Question 1

Who states that people have a right to an interpreter and to understand information

Answer 1

the joint commission

speak up campaign - ask family or friend to listen to providers and ask questions on your behalf, learn about your conditions, make sure you are reciving the right treatment, and speak up if you don’t understand.

Question 2

National patient safety goal 2

Answer 2

improve communication among caregivers

Question 3

National Academy of medicine NAM (used to be IOM)

Answer 3

communicate that respects their preferences, differences, needs

health maintenance, involvement, foster informed decisions

Question 4

National League of Nursing

Answer 4

open respectful clear communication is the foundation for providing quality care in nursing

Question 5

Define communication

Answer 5

• a dynamic, reciprocal process of sending and receiving messages using words, sounds, expressions, body movements, written symbols, and behaviors
• A way to meet physical, psychosocial, emotional, and spiritual
  needs
• basis for sharing meaning, expressing needs, building relationships
• Content—the actual subject matter, words, gestures, and
  substance of the message
• Bidirectional exchange of thoughts or feelings
  *more than the act of talking and listening

Question 6

Define intrapersonal communication

Answer 6

conscious internal dialogue, sometimes known as self-talk. For example, if you discover your patient is pale, diaphoretic (perspiring profusely), and moaning, you may ask yourself, “What’s happened? This patient appears to
be in a lot of pain.”

Question 7

Constructive affirmation vs negative self talk

Answer 7

Constructive affirmation is positive self talk that helps you complete tasks. Negative self talk affects your ability to do it.

Question 8

Interpersonal communication

Answer 8

between two or more people

Question 9

Group communication

Answer 9

engage in an exchange of ideas with two or more individuals at the same time

Question 10

Public speaking

Answer 10

a presentation

Question 11

Sender

Answer 11

uses nonverbal and verbal methods to deliver a message

Question 12

Encoding

Answer 12

selecting the words, gestures, tone of
voice, signs, and symbols used to transmit the message

Question 13

message

what’s important about the message?

Answer 13

verbal and nonverbal information the sender
communicates.

The message must be appropriate for
the situation and for the developmental level of the person receiving the message.

Question 14

channel

Answer 14

method in which the message is conveyed. Face-toface communication is a commonly used channel. Nurses may use touch
as a nonverbal way to communicate caring and concern. Other channels
include written pamphlets, audiovisual aids, recordings, telephone and text messages, and the Internet.

Question 15

reciever

Answer 15

observer, listener, and interpreter of the message. The
receiver interprets (decodes) by relating the message to past experiences to determine the sender’s meaning. The receiver uses visual, auditory,
and tactile senses to decode the message

Question 16

Feedback

Answer 16

verbal, nonverbal, or both. Once the receiver has received and interpreted the message, they may be stimulated to respond by providing feedback to the sender. Feedback validates that the receiver
received the message and understood it as the sender intended.

Question 17

Verbal communication

Answer 17

spoken and written words to send a
message. It is influenced by educational background, culture, language, age,
gender identification, and past experiences

Question 18

Denotation vs Conotation

Answer 18

Denotation is the literal (dictionary) meaning of a word. Connotation is
the implied or emotional meaning of the word.

Question 19

Intonation

Answer 19

pitch, cadence (rise and fall), volume

Question 20

Clarity and brevity

Answer 20

• a clear and brief conversation holds your interest and conveys message.
• brevity is using the least amount of words possible.

Question 21

What is timing

Answer 21

assess your client before starting a conversation to see if they are ready to hear the message. if they are hungry, in pain, distracted

• consider presence of others. ask in private.
• interaction must allow ample time for a response.

Question 22

what is relevance

Answer 22

communication is effective when those involved find the discussion to be important. remind them of the purpose of the discussion.

Question 23

credibility

Answer 23

patients judge what you say based on your trustworthiness.

always be open and honest. give info only if you are certain of the facts. if a situation makes you uncomfortable, its better to acknowledge that than risk loss of credibility.

Question 23

touch

Answer 23

don’t use it on angry or emotionally unstable because it can be interpreted as sexual or an attack

Question 24

humor

Answer 24

use humor cautiously, and never direct humor at the client, disease process, or treatment team.

Question 25

Variables affecting communication

Answer 25

an environment should be private, quiet, no smells, comfy temp. No distracting sounds. Being around other people who are freaking out or in pain.

Question 26

Places for communication

Answer 26

hospital chapel, a conference room, or private room. if none are available, use the privacy curtains

Question 27

Communication w/ infant

Answer 27

attach to a caregiver, nurturing, physical stimulation

Question 28

Comm w. a older toddler

Answer 28

more vocal ability. prefer to have a parent nearby but they will talk to you

Question 28

Comm. w young toddler

Answer 28

nonverbal w/ limited verbal skills. your response can combine nonverbal and verbal. give them a toy and say mom will be right back

Question 29

school age comm.

Answer 29

comfy interacting verbally.

Question 30

adolescence comm.

Answer 30

understand disease process, treatments, abstract.

Question 31

older adults

Answer 31

hearing loss or vision changes, possibly dementia

Question 32

Gender

Answer 32

use gender neutral language

talk about testicular health rather than men’s health

ask about pref. pronouns

listen to how they talk about their relationships or partner

reflect on own biases

Question 33

Intimite distance

Answer 33

less than 18 inches

Question 34

personal distance

Answer 34

18 in to 4 feet

HEALTHCARE PROVIDER TO PATIENT

Question 35

social distance

Answer 35

4 to 12 feet
when interacting w a group or formal interaction

can’t physically reach patient from here

have to speak up

if you ask a patient how they doing while standing at the door, they don’t give you as much info as if you were at a personal distance

Question 36

public distance

Answer 36

12 feet
loudest speech

Question 37

Territorialtiy

Answer 37

Refers to the space and things an individual considers to be their own.

patients consider their hospital room and their belonings as their own. If you change or rearrange the space, or interfere they get uncomfortable. you have to ask permission to handle, move or discard any personal item even its hospital property.

Question 38

unclear roles

Answer 38

can confuse patients because they don’t know who to ask questions towards

-don’t let UAP or MAs call themselves nurses
-direct the question to the right people

Question 39

Communication styles

Question 40

What is collaborative professional communication

Answer 40

• uses an assertive style
• uses standard communication tools

Question 41

Passive

Answer 41

avoid conflict and allow others to take the lead. Passive communicators may exhibit timid posture or negative body language; they tend to be submissive, indecisive, apologetic, or whining. For example, “Whatever you want. I’ll just wait for you to decide what you’re going to do.” Not taking phone calls or ignoring requests are other examples of a passive approach.

Question 42

Passive aggressive

Answer 42

avoids direct confrontation but subtly achieves goals through manipulation. Passive-aggressive communicators may appear cooperative or passive on the surface, yet they typically undermine the efforts of others. As a result, passive-aggressive communicators often become alienated from others. Facial expressions and body language do not match with how the person feels.

Question 43

Aggressive

Answer 43

to win and be in control. Aggressive communicators try to dominate others using intimidation and humiliation. They often blame or criticize others, events, or situations. They are poor listeners, tend to be impulsive, and have a low tolerance for frustration. Intimidating posture and overbearing voice tone are common. “My way is the correct way. You don’t know what you’re talking about,”

Question 44

Assertive

Answer 44

• positive and negative thoughts and feelings in a style that is direct, open, honest, spontaneous, responsible, and nonjudgmental.
• take responsibility for your own thoughts and actions without blaming others, encourages feedback
• enables you to find mutually satisfying solutions

Question 45

Assertive: maintain professional composure

Answer 45

• Maintain eye contact, as culturally appropriate. Speak clearly and firmly in a respectful manner. Project a clear tone of voice.
• Communicate self-confidently.
• Convey a can-do attitude.
• Refrain from sarcasm.
• Do not invite negative responses.

Question 46

I statements for assertiveness

Answer 46

Use I statements.

An I statement should include the elements of behavior (or facts), feeling, and effect (on you). For example, instead of saying, “Why haven’t you ordered Ms. Sadiq’s pain medications yet?” you might say, “I contacted you this morning about Ms. Sadiq’s lack of pain relief, but I don’t see a change in her analgesic order. I am concerned about her discomfort and the effect it may have on her
willingness to ambulate.”

Question 47

Other assertive components

Answer 47

Focus on the issue, not the participants. For example, “I think thisapproach might be the best, but I’d like to hear your thoughts.” Use effective nonverbal language.

Your body and verbal language should be congruent.

Eye contact demonstrates interest and shows sincerity.
**Posture also communicates your attention **and interest in the dialogue.
Invite positive responses. For example, say, “I would really appreciate it if you could help me weigh Mr. Kudari on the bed scale,” rather than, “Would you want to help me weigh him?”
Learn to **accept criticism **without becoming anxious or defensive.
Acknowledge that you might not have had experience with a particular patient situation or have depth of knowledge in an area. Suppose Ms. Nobu’s prescriber says, “Are you playing pharmacist today?” You might respond, “It’s true I am not an expert on analgesics. However, Ms. Nobu needs pain relief, and I need your help prescribing pain medication.”
Strive for a workable compromise, but not if it affects patient well- being or your feelings of self-respect. Suppose an administrator comes to a patient’s room while you are inserting a nasogastric tube and says, “I need to see you right now. Come to the desk immediately.” An example of a workable compromise would be to say, “I understand that you need to talk to me right away, but I need to finish what I am doing. What about meeting you at the nurses’ station as soon as I finish in about 10 minutes?”

Question 47

When comm w/ someone:

Answer 47

• use CUS language concerned, uncomfortable, safety if you need further dialogue
• closed loop communication so that you confirm you recieve the information
• use checklists
• add debriefs at the end of shifts to discuss what went well and what could be a teachable moment

Question 48

When speaking to a physician:

Answer 48

S - Situation
B - Background
A - Assessment
R - Recommendation

situation introduces yourself, clarify who you are speaking to, provide basic details of patient, their location. explain why u are callling.

background is brief overview of patient including relevant clinical details.

assessment communicates relevant clinical findings (vital signs, exam findings, overall impression, investigation)

recommendations - state what you would like to happen. ask if you should take any further action. clarify expectation of response.

Question 49

What is patient rounding?

Answer 49

healthcare team gathers at the patient care area to discuss goals for care and/or changes in the plan of care and to respond to the questions of the patient, family, and healthcare staff. Meeting for rounds allows the nurse to provide input that leads to improved interprofessional working relationships and professional satisfaction.

Question 50

What is a handoff report?

Answer 50

communicating patient info to provider at end of shift or when transfering care to a diff provider

Question 51

therapeutic relationship vs therapeutic communication

Answer 51

A therapeutic relationship focuses on improving the health of the client, individual or community.

Therapeutic communication is directed at achieving client goals. Creates therapeutic relationship, get information, and express interest in patient.

Question 52

Phases of the therapeutic relationship

Answer 52

Pre-interaction phase
Orientation phase
Working phase
Termination phase

Question 53

Pre-interaction phase

Answer 53

before you meet the client. You lay the groundwork for communication by gathering information about the client, but you do not communicate directly with the client. As a student, you initiate this phase as you prepare for clinical shifts. The client also experiences a pre-interaction phase, which begins when they identify the need for healthcare.

Question 53

Orientation phase

Answer 53

establish rapport and trust through the use of verbal and nonverbal communication. This phase begins when you meet the client and introduce yourself and your role in the relationship.

Because the clients may not be immediately ready to communicate, it is important to be sensitive to mood, past experience, and overall physical and psychological state. Try to understand the cause of your client’s behavior, comments, and attitudes, and respond with patience and wisdom. Orientation ends when the relationship has been defined.

Question 54

Working Phase

Answer 54

active part of the relationship. During this phase, the nurse communicates caring, the patient expresses thoughts and feelings, mutual respect is maintained, and honest verbal and nonverbal expression occurs. Key communication goals are to assist the client to clarify feelings and concerns. A professional relationship is courteous, trustworthy, and confidential, and accomplished by active listening.

Question 55

termination phase

Answer 55

end of the nurse’s shift or on the client’s discharge from the unit, facility, or service. Reviewing and summarizing help to bring the relationship to a comfortable closure. If communication has been effective, the termination phase prepares the nurse and client for future interactions. Unsuccessful communication may affect the client’s health outcomes or understanding of their disease process, as well as affect the nurse’s job satisfaction.

Question 56

Therapeutic Communication has 5 characteristics

Answer 56

empathy, respect, genuineness, concreteness, and confrontation

Question 57

empathy

Answer 57

The desire to understand and be sensitive to the feelings, beliefs, and situation of another person is called empathy

Question 58

Respect

Answer 58

In the therapeutic relationship, you communicate respect by valuing the client and being flexible to meet the client’s needs. You show respect when you introduce yourself to your clients and ask for their preferred way to be addressed. Making even minor adjustments in patient care, such as delaying breakfast for an hour to allow the client to sleep, communicates that you respect the client’s wishes. When a relationship is grounded in respect, both parties maintain power and self- esteem.

Question 59

Genuineness

Answer 59

When interviewing clients, we expect them to respond truthfully. Similarly, clients have a right to expect truthful responses from healthcare providers.

Genuineness requires honesty. If you are unable to answer a client’s question, do not offer guesses. Make a response such as, “I don’t know, but I’ll find out and let you know.”

Genuineness also involves willingness to self-evaluate. How well did I communicate? Did I handle that situation appropriately? How could I improve my communication?

Question 60

Concreteness

Answer 60

offer understandable responses to a client’s questions and concerns. To do so requires you to express in concrete, specific terms what you mean. The message must be constructed and delivered in a manner that is suitable for the client.

Question 61

Confrontation

Answer 61

If your client is unable to express thoughts clearly, you must be willing to ask him directly to say it another way or clarify the point further. Similarly, you must be willing to be challenged if you are unclear.

Question 61

Identify different types of groups

Answer 61

• Task Groups - formed to fufil a need to perform a task. rapport limited. focus on task at hand. disband when done.
• Ongoing groups - address recurrent issues. ex: committee. usually leader elected
• Self help groups - peer led voluntary for a concern, experience or need
• Therapy groups - help cope w issue
• work related social support groups - help members cope with. thestress of their profession

Question 61

What does it mean to validate a message?

Answer 61

Asking the client if you are making the correct interpretation

Question 62

Methods to enhance communication

Answer 62

• addressing the patient
• active listening
• being assertive
• restate, clarify, validate
• interpret body language
• share observations
• explore issues with open ended questions
• use silence to let them talk
• summarize the conversation
• use process recordings

Question 63

What are process recordings?

Answer 63

two people converse while a third records the conversation. Sometimes two people converse while one of them takes notes or records from memory after the conversation.

Audio recording captures the words and intonation of the conversation, but it must be supplemented by notes describing the nonverbal communication.
Video recording allows participants to examine both verbal and nonverbal communication.

Afterward, the participants analyze the interaction. As you examine an interaction, evaluate how well you showed empathy, respect, and genuineness. Identify techniques you used to enhance the communication (e.g., active listening, restating, reflective listening). Be alert for barriers to therapeutic communication.

Question 64

What are barriers to therapeautic communication

Answer 64

• ask too many questions
• fire hosing info
• asking why (why did you stop taking your meds will put them on the defensive)
• changing the subject
• failing to probe conveys lack of caring
• expressing approve/disapprove
• offering advice “if I were you”
• false reassurance
• stereotyping (he’s old, he wont remember anything u tell him)
• patronizing language like elderspeak
• sweetie, dearie, mama, altering pronouns to WE. “are we ready” sounds like talking to a child

isntead of asking why, say ‘what are your concerns regarding x’

Question 64

When is it ok to have the family help communication?

Answer 64

• if interpreter is also there to give info to patient
• if they understand english but can’t verbally communicate

Question 65

Communicating with other cultures

Answer 65

ask preference for name

-on site and phone accessed interpreter or video remote interpreter