NSG 1610 - Communication Flashcards
What is the goal of a health assessment?
To obtain information or data about the patient
What four components should you prepare before completing a general health assessment?
- proper equipment (i.e., stethoscope, gloves, pen light)
- perform hand hygiene - whether hand washing or ABHR
- prepare yourself - education on assessment techniques, leaving emotions at the door, etc.
- consent
What are the three types of consent and define/give an example of each?
- Implied - someone giving their arm out after you say “Is it okay if I take your BP?”
- Implicit - someone saying “yes” when you ask “Is it okay if I take your BP?”
- Informed - patient agrees/disagrees on something after being educated about risks, benefits, etc. of treatment
Who can obtain informed consent?
Physicians and NPs only
What are the four different types of health assessment?
- Emergency
- Problem-centered/Focused
- Follow-Up
- Baseline/Comprehensive
Describe an emergency health assessment (procedures, types of questions)
- ABCDEs (airway, breathing, circulation, disability, and exposure)
- close-ended questions because the assessment is focused on determining the problem to find critical interventions
Describe an problem-centered/focused health assessment (focus, types of questions)
- trying to determine the status in relation to specific symptoms or patient concerns
- typically focused on one or two main systems where subjective data is collected that is relevant to the problem
- a mixture of open-ended and close-ended questions
Describe a follow-up assessment (focus, types of questions)
- comparing a patient’s current state with previous presentations
- aiming to determine if any further assessments or treatment are required AND/OR aiming to determine if interventions utilized are actually working
Describe a baseline/comprehensive assessment (procedures, types of questions)
- perform a complete health history and full physical exam
- intended to establish a baseline and serves as a comparison for future assessments
- should include ALL body systems/head-to-toe approach
- mixture of open-ended and close-ended questions
What does IPPA stand for?
Inspection, Palpation, Percussion, Auscultation
List/describe 4 general components we are observing through inspection
- physical appearance - symmetry, skin colour, signs of distress, etc.
- LOC - name, knows why they are there, current location, date & alert/responsiveness
- mobility - assess posture and ROM
- body structure - body size, shape, etc.
What are the two types of palpation? Describe them
- Light - pushing down on the tissue to the depth of approx. 1cm (using 2-3 fingers)
- Deep - using one or two hands to the depth of 3-4cm to palpate deep structures (discontinuous pressure is used)
What part of the hand do you use to palpate for moisture? For temperature?
Moisture - palmar
Temperature - dorsal
What are we listening for with percussion? What are the two types of percussion?
We are listening for sounds produced in the body that allow for determination of the density of underlying tissue
- direct - tapping on the exact structure/area (bone, muscle, etc.)
- indirect - tapping the index finger on the second joint of the finger
When do we use the bell of a stethoscope? The diaphragm?
Bell - utilized for low pitch and vascular sounds (ventricles, carotid artery, aortic artery, renal arteries)
Diaphragm - utilized for higher pitch sounds (intercostal spaces, BP)
What are the four main goals/things we are attempting to demonstrate with caring/therapeutic communication?
- demonstrate interest
- respect
- empower the individual
- share decision making
What does FOCUS stand for in nurse presence/caring communication?
Feel - stay in the moment, one thing at a time
Observe - watching your patients in terms of emotion, fear, verbal/nonverbal cues
Connect - approach, listen, share, and communicate with your patients
Understand - try to meet your patient where they are, see things without judgement
Share - each client should have your full attention
What is geographical privacy?
if discussing a sensitive matter, moving your client to another room is most appropriate to ensure their privacy/protection
What is psychological privacy?
Allowing the client to feel physically protected even if they may not be completely - closing curtains to provide a sense of security
What 5 components are part of the linear model of communication? When is this form of communication best used?
- sender - the person initiating the communication
- message
- receiver - responsible for listening, observing, and decoding the message
- channel of communication
- context
Best used in emergency situations
What are components of the transactional model of communication?
It is a co-created model of communication, reciprocal (the client has a role) and it has feedback loops (can mediate, correct, vary)
requires more time and is complex
What is are the components of a therapeutic model of communication?
dynamic, interactive, follows a process, has purpose, goal-directed, and always with the intent of advancing the best interest of and outcomes of the client
What does SURETY stand for in active listening?
Sit, Uncross, Relax, Eye contact, Your intuition
What five factors are at the core of patient-centred communication?
- Engage the patient
- Build rapport
- Develop a shared partnership
- Find common ground
- Observe nonverbal cues
Describe clarification as a method of active listening
Clarifying the patient’s statements, asking for more detail through open-ended questions
Used as a way to ensure that we have heard the client correctly and to check or verify information that feels unclear
Describe restatement as a method of active listening
repeating the client’s word almost exactly as they were said to prove you are listening/understand
describe paraphrasing as a method of active listening
The ability to repeat in your own words the essential thoughts, ideas, and feelings a client is trying to convey
By using this method, the client understands that we are actively listening, are engaged, and care
describe reflection as a method of active listening
allow yourself and the patient to reflect on the conversation or life events together
describe summarizing as a method of active listening
at the end of conversations or statements, summarize the content to prove and synthesize understanding
describe silence as a method of active listening
we allow our patients time and space to think of what they want to say and to sit in their own thoughts/emotions by using silence
describe minimal cues and leading as a method of active listening
we want to do this as little as possible to ensure patient autonomy - we want to allow them to state their thoughts in their own words without guidance
What does it mean to listen for themes in communication with clients?
underlying emotions that are not being expressed in words, body language, etc.
What are open-ended questions?
the what, why, when, where, how, and who questions
the intent is to encourage the client to talk by exploring, clarifying, or describing their thoughts and feelings
What is a focused question?
Questions that focus on a specific topic or problem
What are close-ended questions?
Questions that elicit yes/no responses
What is matching in verbal communication?
you recognize your client’s limitations and strengths to utilize those in conversations
also, pulling out information from what they said in conversation
What is metacommunication?
Looking at both verbal and nonverbal
what factors can influence how my message is being received?
What are the verbal components in communication?
pitch, tone, frequency of the voice is all affected by choices and life experiences
What are the differences between denotation and connotation?
denotation - a word has a generalized meaning (the literal meaning)
connotation - a word has a personal meaning (subjective and comes from emotional experience)
What are the 6 verbal styles that influence communication?
- moderate pitch and tone
- vary vocalizations
- encourage involvement (not having conversations TO the pt)
- advocate for the pt
- validate worth
- appropriately provide information - give as many times as needed
what 6 factors influence nonverbal styles of communication?
- allow/use of silences - allow them to reflect, think, and prepare
- use congruent nonverbal behaviours - “my office is always open”
- facilitate appropriate physical body language
- touch
- proxemics
- watch the pt’s nonverbal cues
what is the accommodation theory?
when communicating with other people, we will adjust and change our speech to accommodate their needs
things such as vocal pattern, enunciation, word choices, etc. may be altered
What are examples of organizational/system barriers in therapeutic relationships?
- heavy workloads
- production expectations (only having 15 mins of funding to complete a task)
- inconsistent caregivers
What are 10 factors that are bridges or barriers to therapeutic relationships?
- respect
- caring
- empowerment
- trust
- empathy
- mutuality (finding common ground)
- veracity (truthfulness)
- patient centered
- acceptance
- confidence/anxiety
What is the definition of communication deficits in patients?
some impairment in the ability to receive, send, process/comprehend, verbal, nonverbal, graphic, or symbols
could be congenital or acquired
How does hearing create functional impairments to communication? what are behaviours you may notice?
Clients will try to hide their deficits and withdraw from communication – they will be less likely to ask questions because they are embarrassed
What are 5 things we can do to improve/provide successful aging to an older adult?
- create situations of empowerment
- provide assistance as needed
- provide opportunities to stay active
- create moments that support autonomy
- create moments that allow engagement
What are 6 factors that could increase empowerment in older adults?
- remind them of their lifetime of strengths
- get to know your older adults - listen to their stories
- reminisce with your clients
- encourage social and spiritual supports
- support independence
- medication supports
What is transference and countertransference?
transference - a pt projects their feelings about someone or something onto the practitioner
countertransference - the practitioner projects their feelings onto the pt.
What is the importance of theories of communication?
they provide us an understanding patient issues, concerns, helps guide communication
What are the 4 phases of Peplau’s theory?
- pre-interaction phase
- orientation phase
- working phase
- termination
*note: in order for communication to be successful, pt. needs to pass through each phase correctly and fully
Describe the pre-interaction phase
patient is not participating, entirely you
patient will be unprepared and lost if you do not complete this step
i.e., looking in their charts, observe them, look at resources
describe the orientation phase
patient is involved, it is when they realize they need help (awareness)
describe the termination phase
met the needs of the patient, working relationship has come to an end
What are the six nursing professional roles?
- You are responsible for yours and patient’s conduct and boundaries
- We keep this type of communication on a specific health-related purpose that has goals to be met
- Communication focuses on the needs of the patient
- The only reason for a relationship is because the patient has a need
- Pre-designed roles – nurse is nurse, patient is patient
- Limited self-disclosure by the nurse, but expected self-disclosure by the patient
Define/describe Rogers theory of communication
client-centered model
pt. has the innate ability to heal themselves, meaning the pt. has capacity to do so if given support, respect, and unconditional positive regard
What are the three main factors of Rogers model?
- authenticity - nurse has to be real
- prizing - trust and respect are demonstrated
- empathetic - nurse demonstrates understanding
Define the five stages of Maslow’s hierarchy of needs
- deficiency needs - fundamental needs that have to be met for survival/basic physiological needs (i.e., hunger, thirst, appetite)
- safety and security - basic physical and emotional safety (i.e., financial safety, freedom from injury or abuse, safe neighbourhoods)
- love and belonging - emotional connecting
- self-esteem - individual has a need for recognition and appreciation, sense of dignity, respect, and approval
- self-actualization - assist in achieving the client’s true potential
Describe Leininger’s theory of communication
nurses must have knowledge of diverse cultures to provide care that fits the client
*first major theory based on culture related within healthcare
Describe Purnell’s theory of communication
an all encompassing cultural competence from a micro to macro level
understanding individual differences leads us to create a comprehensive cultural assessment which leads to culturally congruent individualized patient-centred approach to patient care
leads us to understand the patient’s healthcare concerns from a cultural perspective
Define relational continuity & what are the three C’s at the core of it
therapeutic relationships with a practitioner span more than one episode
it extends across time
it is centred, collaborative, and coordinated
define informational continuity
deals with the use of data - how we use information to tailor patient care and specific treatments to their needs
requires accurate, real-time, specific record sharing
define management continuity
appropriate care management approaches - they need to be consistent, coherent, and flexible
what is the goal of interprofessional communication? what five factors does it require?
provide quality care safely and function as a purposeful team member
should be timely, accurate, complete, unambiguous, and understood
What are the three considerations for teamwork and communication?
- be aware of barriers
- be aware of past conflicts in a team setting
- be aware of disruptive behaviours, and what potentially could go wrong
what are the six considerations for collaborative communication?
- common goal - the patient
- open and safe communication
- should be demonstrating mutual respect
- shared decision making
- role clarity needs to occur
- message clarity
What are the three steps of conflict resolution?
- identity source of the conflict (possible causes and identify own feelings)
- set goals (immediate, specific, measurable)
- implement solutions that are high quality and mutually accepted
what are six considerations or steps to take when implementing solutions in conflict resolution?
- reframe
- assume responsibility
- identify goal(s)
- obtains factual data
- intervene early
- DESC - describe, express concerns, specify course of action, and consensus
What are 6 special considerations for conflict resolution?
- avoid negative statements (i.e., this is your fault)
- consider others’ viewpoints
- manage emotions
- talk and listen
- problem solve together
- act it out
