Week 2: Communication, TIP, Cultural Safety Flashcards
why is effective communication important in nursing?
- therapeutic relationship; individualized care; safety, trust, caring; good nursing care
- basis for nursing process
- client autonomy
- better client outcomes
- increases professional credibility
- relational practice
what are some strategies for communicating with the older adult? (BOX 25.1 p.415)
- Try to find a quiet room with minimal outside noises for communication
- sit facing the patient so that they can watch your lip movements and facial expressions
- if masks must be worn for safety, consider how to maintain an interaction that is warm, open, and demonstrates interest in what the older person is sying
- if needed, make sure that glasses and hearing aids are being worn
- speak slowly and clearly (do not speak loudly)
- keep your tone of voice low; older persons can hear low-frequency sounds better than high-frequency sounds
- periodically summarize what has been said to clarify that you have understood what the older person was saying and repeat key points
- ask the older person to explain what they understood and invite questions to clarify information. there may also be cultural asepects related to communication
- emphasize and integrate emotional and personal values in the acquisition of skills and ideas
what are three possible outcomes when nurses communicate ineffectively?
- ineffective communication may lead to poor patient outcomes, increases in adverse incidents and decreaseds in professional credibility
wha are the levels of communicaiton?
- intrapersonal communication: self-talk or inner thought. it is a form of communciation that occurs within an individual and relates to personal qualities and values yet is also highly consequnetial to interpersonal communicaiton and collaborative practice
- interpersonal communication: is the one-to-one interaction between nurse and patient that occurs face to face. it is the level most frequently used in nursing practice.
- tanspersonal communication: occurs within a person’s spiritual domains. spiritual inquiry is an approach to communication whereby nurses can join with thier patients to creat a road map fo what is meaningful for the patients in their context
- small group communication: the interaction that occurs when a small number of people meet for a common purpose. this type of communications is usually goal-directed and requires an understanding of group dynamics
- public communication: is interaction with an audience. nurses have opportunities to speak with groups of consumers about health-related topics, presents scholarly work to colleagues at conferences, and lead advocacy and media activities
what can nurses do to help develop communication skills?
- perceptionis based on information acquired through the five senses of sight, hearing, taste, touchand smell. it is a process of mentally organizing and interpreting sensory info to arrive at a meaningful conclusion
- critical thinking and self reflection can help nurses overcome perceptual biases
- the nature of communication processes requires nurses to constantly make decisions about what, where, why and how to convey messages to other people. In nursing communication, seeking contextual knowledge is the building block to providing context-based and relevant care.
what are the basic elements of the communication process?
- referent: motivate one person to communicate with another. in the health caersetting, sights, sounds, odors, time schedules, messages, objects, emotions, sensations, perceptions, ideas and other cues trigger communication
- the sender: the person who encode & delivers the message,and the receiver is the person who receives and decodes the message. (the sender puts ideas or feelings into a form that can be transmitted and is responsbile for accuracy and emotional tone)
- message: the contect of the communication (verbal,nonverbal and symbolic expressions of thoughts or feelings that are transmitted from the sender to the receiver)
- channels: means of conveying and receving messages through visual, auditory and tactile senses. the more channels the sender uses to convey a message, the more clearly the message is usually understood
- feedback: does the receiver return the message. it indicates whether the intended meaning of the sender’s message was understood by the receiver
- interpersonal variable: characteristics within both the sender and the receiver that influence communication. people perceive events differently
- the environment: the setting for sender-receiver interaction. for effective communication, the environment should meet nurse and patient needs for physical and emotional comfort and safety environment should meet nurse and patient needs for physical and emotionalcomfort and safety
h
how does verbal and communication impact the message?
(verbal)
vocabulary: communication is unsuccessful if senders and receivers cannot decode each other’s words and phrases. when a nurse cares for a patient who speaks another language, the services of an itnerpreter may be necessary
- denotative meaning: a single word can have several meanings. individuals who use a common language share the denotative meaning (e.g. the code specifically denotes cardiac arrest to health care providers)
the connotative meaning = the interpretation of a word’s meaning influenced by thoughts, feelings, or ideas that people have about the world - pacing: messages are conveyed more successfullywhen sent at an appropriate speed or pace. it is important to speak slwoly enough to enunciate clearly
- intonation: depeding on intonation, even a simple question or statement can express enthusiasm, anger, concern, or indifference
- clarity and Brevity: effective communication is simple, brief and direct
- timing and relevance: timing is critical in communication. even though a message is clear, poor timing can limit its effectiveness
how does non-verbal and communication impact the message?
: is consciously motivated and thus reflects a person’s intended meaning more accurately than spoken words
* general appearance: (includes physical chracteristics, facial expression, manner of dress and grooming and adornments) nurses learn to developa general impression of patient health and emotional status through aspects of patient health and emotional status through aspects of a patient’s appearance and patients develop a general impression of a nurse’s professionalism and caring in the same way
- posture & Gait: the way that people sit, stand, and move reflect attitudes, emotions, self-concept, and health status
- facial expression: an incongruent effect is a facial expression that does not match the content of a verbal message. people are sometimes unaware of the messages their expresisons convey.
- eye contact = allows people to closely observe one another. eye movements can also communicate feelings and emtions
- gesture = gestures alone carry specific meanings and create a message
- sound =when combined with other nonverbal communciation, sounds help sendmessages - sound can be interpreted in several ways: sighing often suggests boredom or anxiety
- personal space = is invisible and individual, connoting boundaries beyond the physical territory
initmate zone (0-45)/ personal zone (1-4m)/ public zone (4m- greater) - symbolic communication: art and music are forms of symbolic communicationthat nurses use to enhance understanding and promote healing
what facotrs influence communication?
- courtesy
- use of name
- trustworthiness
- autonomy and responsibility
- assertive communication
what are therapeutic and nontherapeutic Communication Techniques
(therapeutic communication tech): are specific responses taht encourage the expression offeelings and ideas and convey acceptance and respect
* active listening
* sharing observation
* sharing empathy
* sharing hope
* sharing humor
* sharing feeling
* using touch
* using sliences
* providing info
* clarifying
* focusing
* paraphrasing
* asking the relevant questions
* summarizing
* self-disclosure
* confrontation
(nontherapeutic communication tech): often cause respients to activate defense to avoid being hurt or negatively affected. it tends to discourage further expression of feelings and ideas and may engender negative responses or behaviours in other people
* asking personal question
* giving personal opinions
* chaning the subject
* false reassurance
* sympathy
* automatic response
* asking for explanation
* approval or diapproval
* defensive response
* passive or aggressive response
* arguing
what elements contribute to professional communication?
4R’s: realize/ recognize/ respond/ resist
guiding principles:
1. safety
2. trust & transparency
3. peer suport,
4. empowerment, voice and choice
5. collaboration & mutuality
6. cultural, historical & gender issues
How can you adapt communication techniques for the patient with special needs?
- patients expreincing Aphsia may be unable to produce or understand language. expressive aphasia, a motor type of aphasia, is the inability to name common objects or to express simple words or writing. e.g. a patient may undersand a question but be unable to express an answer.
- sensory or receptive aphasia is teh inabiility to understand written or spoken language. the patient may be able to express words but is unable to understand the questions or comments of others.
- global aphasia is the inability to understnad language or communicate orally
- when caring for patient with special needs, you need to direct nursing actions toward meeting the goals & expected outcomes identified in the plan of care, addressing both the communication impairment and its contributing factors
what are the common risk factors for delirium, demntia (Alzheimer’s, Vascular and Lewy body) and depression?
age
genetic
health conditions
lifestyle choices
why are older adults particularly vulnerable to delirium, dementia and depression?
because of age-related changes in the brain, including reduced functional reserve, decreased neural connectivity, and changes in neurotransmitters level
What is the 4Rs
realize/ reconize/ respond/ resist
What are the gender equity/ cultural safety/ cultural humility/ health equity
- gender equity: elimination of systematic health disparties/ associated with social advantage & disadvantage
- cultural safety: recognizing power and resource distribution/ awareness of institutional discrimination
- cultural humility: lifelong leraning, interpersonal respect and reflection
- health equity: equal treatment of all, regardless of gender, no gender discrimination
what are the aspects of cultural safety?
► Socioeconomic status
► Age
► Gender
► Sexual orientation
► Ethnic origin
► Migrant or refugee status
► Religious belief
► Disability
what is cultrual safety
to prevent fear of discrimination and lack of trust in the health care system - necessary interventions are prolonged leaving the client and familie to suffer consequences
what are the factors tha can be seen as cultural conflicts?
- implicit bias = unknowingly
- explicit bias = knowingly/ recognized bias
- ethinocentrism
- stereotypes
- discrimination
- racism
How can nurses make changes for cultural safety
- education
- equity guidelines
- self-advocacy
through..:
- undestanding relationships
- recognizing power imbalances
- awareness of institutional discrimination
- eliminate systemic disparities
what are the aspects of cultural humility?
- ensuring culturally congruent and equitable care
1. personal self-awareness
2. professional self-awareness
3. originational awareness
4. community awareness
Define the Trauma infomed practice.
“Trauma is often closely tied to substance use, mental illness, stigma, health care access barriers, and other challenges” (PHSA, 2022).
define: understanding and responding to the impact of trauma. Ensure physical, psychological and emotional safety
prevention: prevent more harm & triggers
safety: take down barriers & reduce stigma
“if they say no, listen to them (and try to talk later), offering options- autonomy”
what are the 4R’s & guiding principles
4R’s: realize/ recognize/ respond/ resist
guiding principles:
1. safety
2. trust & transparency
3. peer suport,
4. empowerment, voice and choice
5. collaboration & mutuality
6. cultural, historical & gender issues
why is the communciation in nursing practice important?
- therapeutic relationships:
* individualized care
* safety, trust, caring
* good nursing care - the basis for the nursing process
- client autonomy (e.g. providing options)
- better client outcomes
- increases professional credibility
how do we perceive and assume in the nursing process to develop communication skills? & what are the 5 levels of communication?
- perception
- reflexivity
- perceptual biases
- contextual knowledge
5 levels of communication:
1) intrapersonal (self/ spiritual)
2) transpersonal
3) interpersonal (the most focused in class)
4) small-group
5) public
where the communication happens (the communciation process)
- the sender
- the message
- channel
- receivers
Make sure there’s all the information
- feedback between environment and interpersonal variables
what is matcognition?
- actual spoken word: doesn’t take that much (7%)
- tone (37%)
- body language (55%)
what are the important factors of verbal communication?
- it is mostly written, oral or sign language
- meaning (definition), denotative, connotative (assigned meaning)
1. vocabulary (e.g. using medical terms to the clients? use simple words instead)
2. pacing
3. tone
4. brevity
5. timing
6. relevance
what can be considered as nonverbal communication
- supplement
- reinforce
- undermine
(all together verbal)
1. personal appearance
2. facial expression
3. posture & gait
4. eye contact
5. touch, gestures, & sound
6. personal space
(be mindful what you wou dbe appreciate or not)
personal space and touch (4 types, ft)
- intimate: 0-1.5ft
- personal: 1.5-4ft
- social: 4-12ft
- public: 12+ft
elements of professional communication?
- courtesy
- use of names
- trustworthiness
- autonomy and responsibility
- assertiveness (“i” language/ e.g. I feel ( ) about ( ) because
What can be helping with the professional communication with clients?
client narrative & client collaboration
family relationship
interprofessional collaboration
community relationship
Therapeutic communciation techniques (what are do and donts)
(do)
* prepaharsing and ensure that the patient organize their concerns
* summarizing and providing information
(dont)
* avoiding making promises, being missed, not or over validating and making comments
What can be barriers or roadblocks in communication
1) asking personal questions
2) givier personal opinions
3) changing the subject
4) automatic responses
5) false reassurance
6) sympathy
7) asking for explanations: “why”
8) approval or disapproval
9) defensive responses
10) passive or aggressive responses
11) arguing
what are the strategies for Active listening
(SOLER)
S - sit facing the pt
O- open posture
L- lean foward
E - eye contact
R - relax
what are the difference between open and close ended questions?
- open ended questions:
(when do they work?/ when are they not so great?; e.g. how may i help you?) - close ended quetions:
(when do they work?/ when are they not so great?; e.g. can i help you?)
specific client needs for apahsia
aphasia: inability to produce/ understand language
- cannot speak clearly
- cognitively impaired
- hearing impaired
- visually impaired
- touch
- unresponsive
- speak a different language (typically not recommended to have family members as a translater)
specific needs for older adult client (age-specific approach)
- Physical and psychosocial
- Function impacted by disease and disability
- Decreased homeostasis
- Lack of standard norms
- Altered manifestations and responses
define cognitive changes
: structural and physiological changes within the brain are normal with aging
truth symptoms:
* disorientation
* loss of language skills
* loss of the ability to calculate
* poor judgement
; theses are not normal changes with aging - can indicate something is wrong
Dementia, delirium and depression
Dementia: a broad term for a set of symptoms that affect the brain; generalized impairment of intellectual functioning; gradual deterioration
Delirium: an acute, reversible state of disorientation, in attentiona and confusion
Depression: a mood disorder characterized by feeling of sadness and despair
What are the signs and symptoms of delirium
increased prevalence with age & more likely to occur in acute care settings (“out of track”)
* Confused/ disorientated
* Visual hallucinations (auditory hallucinations - less common)
* Difficulty thinking/ focusing attention
* Behaviour or personality different than usual
* Day/ nights are mixed up
* Drift between asleep and awake
* More alert and more tired
* if the client is CAM+, do PRISME (delirium assessment)
- PRISME
○ Pain/ poor nutrition
○ restraints/ retention
○ Infection (illness)/ immobility
○ Sleep/ skin/ sensory
○ Mental status/ medications/ metabolic
○ Environment
why does delirium happen? why is it a medical emergency?
◊ infection: causes inflammation - confusion in the older adult
◊ Low Na+ (sodium): cell swelling-confusion
◊ Impaction: dehydration, nausea, irritation, constipation can lead to obwel perforation
◊ Poor outcome (can lead to falls, injury etc.)
◊ Increase L.O.S (length of stay)
◊ Death
the management for delirium
- Find and treat the underlying cause
- Include family and friends
- Keep the clients routine as simple as possible
- Keep the environment calm – reduce distractions
- Encourage healthy eating and promote drinking fluids
- Keep sentences short and simple
- Make sure the pt has their glasses, hearing aids etc.
- Do not argue with the pt re: hallucinations
what are the signs/ symptoms of dementia?
Dementia: generalized impairment of intellectual fuctioning; gradual deterioration
warning signs:
* Memory loss affecting day-to-day abilities
* Difficulty performing familiar tasks (ADL’s)
* Problems with language
* Disorientation in time and space
* Impaired judgment
* Problems with abstract thinking
* Misplacing things
* Changes in mood/behavior
* Changes in personality
Mini-mental (MMSE) soore of 23 or less = cognitive impairment
(alzheimer’s disease/ vascular demntia/ lewy body)
3 types of dementia
Alzheimer’s disease
vascular disease
Lewy body
What are cause/ risk factors/ cognition/ diagnosis of Alzheimer’s disease
Alzheimer’s disease:
cause; genetics, lifestyle, environmental factors
risk factors: age, genetics, general health
cognition: gradual decline
diagnosis: decreased cognitive function; rule out other possibilities
What are cause/ risk factors/ cognition/ diagnosis of vascular disease
cause: stroke, transient ischemic attact (TIA) - blood supply issue
risk factors: heart disease, diabetes, hypertension, high cholesterol
cognition: rapid decline
diagnosis: decreased cognitive function following a stroke or TIA & CT or MRI
What are cause/ risk factors/ cognition/ diagnosis of Lewy Body
cause: abnormal buildup of protein
risk factors: age, gender (men), family history of LBD or Parkinson’s
cognition: gradual decline
diagnosis: rule out other possibilities/ decreased cognitive function +2 of the following: visual hallucinations; Parkinsonian symptoms; REM sleep behaviour disorder (acting out dreams)
what are the signs and symptoms of depresison
- ADLs
- Loses interest
- Feelings of worthlessness and sadness
- Sleep changes
- Nutritional changes
- Physical symptoms
- Lethargy
- Difficulty concentrating
- Spends more time alone
- Suicide
*GDS: geriatric depression scale
what would be depression management
→ Diet
→ Exercise
→ Manage Stress
→ Avoid drugs/alcohol
→ Medications (anti-depressants)
→ Suicide risk?
- report to your instructor/RN,
- refer to resources.
what would be difference between Delirium vs. Demntia vs. Depression
delirium/ dementia/ depression
Onset: actue (hours to days)/ insidious (months to years)/ acute or insidious (wks to month)
Course: Fluctuating/ Progressive/ May be chronic
Duration: Hours to weeks/ Months to years/ Months to years
Consciousness: altered/ usually clear/ clear
Attention: Impaired/ Normal except in severe dementia/ may be decreased
psychomotor changes: Increased or decreased/ often normal/ may be slowed in severe cases
Reversibility: usually/ irreversible/ usually
How to communicate with people living with dementia
- Identify yourself, e.g. ”My name is…
I’m here to help you get into your wheelchair.” - Approach the person from the front.
- Move slowly; maintain eye contact.
- Address the person by name; speak slowly and clearly.
- Present one idea at a time.
- Repeat/rephrase responses to clarify what the client is trying to tell you.
- Ask “yes” or “no” questions & allow time for a response.
- Back up your words with actions using gestures.
- Listen actively/ acknowledge the person’s emotional state.
- Touching too roughly quickly could cause increased stress.`
Applying TIP (trauma informed practice), Cultrual safety and communication to practiec
A nurse discovers a client crying. The client says “I am just so overwhelmed with everything and I do not know what to do!”
Which response by the nurse would be an example of a therapeutic clarifying statement?
1. “I’m sorry to hear that you’re feeling overwhelmed. Can you tell me more about why you are feeling overwhelmed?”
2. “So, you feel like you have too much going on and you are not sure of what to do?”
3. “I see you have been biting your nails; is this due to the stress?”
4. “When you get overwhelmed do you have any physical symptoms?”
- “So, you feel like you have too much going on and you are not sure of what to do?”
An 86-year-old client with a history of Alzheimer’s disease is admitted to the hospital for surgery. The client lives at home alone with mild cognitive impairment. Over the course of the day the nurse notices that the client is hallucinating and has increased verbal rambling. Which of the following health problems should the nurse assess for in this client?
1. dementia
2. depression
3. delirium
4. cancer
- delirium
Delirium is an acute reversible event that is more likely to occur in acute care facilities due to severe illness, metabolic changes, infection, surgery, or medication changes.
The nurse is working with an older adult who is struggling with depression. The client has chronic pain and is diagnosed with multiple chronic health conditions. The client says to the nurse “nothing ever goes right for me, I just want to die”.
Which response demonstrates therapeutic communication?
- “do not say that, we have some fantastic doctors here and they will help you to feel better” (nurse exits room)
- “I have some information for you about depression, I think if you can use these resources you will see your depression will improve” (nurse provides pamphlet to client)
- “this feeling is because of your depression, I am so sorry you feel this way” (nurse holds clients hand)
- “It sounds like you are going through a tough time” (nurse then sits in silence)
“It sounds like you are going through a tough time” (nurse then sits in silence)
Correct! This is an example of showing empathy followed by silence. This shows patience from the nurse.
Which of the following best describes dementia?
1. Difficulty coping with physical and psychological change
2. Severe cognitive impairment that occurs rapidly
3. Loss of cognitive abilities, impairing ability to perform activities of daily living
4. Memory loss occurring as part of the natural consequence of aging
- Loss of cognitive abilities, impairing ability to perform activities of daily living
The impaired ability to perform self-care is an important measure of a client’s dementia progression and loss of cognitive abilities. Difficulty or impaired ability to perform normal activities of daily living, such as maintaining hygiene and grooming, toileting, making meals, and maintaining a household, are significant indications of dementia. Slowing of processes necessary for information retrieval is a normal consequence of aging. However, the global statement that memory loss occurs as part of natural aging is not true.
A nurse states to a client, “things will look better tomorrow after a good night’s sleep.” This is an example of which communication technique?
- the therapeutic technique of “sharing hope”
- the nontherapeutic technique of “giving personal opinion”
- the nontherapeutic technique of “givine false reassurance”
- the therapeutic technique of “sharing empathy”
- the nontherapeutic technique of “givine false reassurance”
The nurse’s statement, “Things will look better tomorrow after a good night’s sleep.” is an example of the nontherapeutic technique of giving false reassurance. Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client’s feelings.
(1) is the most common form of dementia, (2) dementia is most commonly caused from stroke and (3) dementia is associated with Parkinson’s.
options:
(1) - vascular, alzheimer’s, Lewy body, mixed
(2) - vascular, alzheimer’s, Lewy body, mixed
(3) - vascular, alzheimer’s, Lewy body, mixed
(1) = alzheimer’s
(2) = vascular
(3) = lewy body
A student nurse is learning about the appropriate use of touch when communicating with clients. Which statement by the instructor best provides information about this aspect of therapeutic communication?
1. “Touch is best combined with empathy when dealing with anxious clients.”
2. “Touch carries a different meaning for different individuals.”
3. “Touch is often used when deescalating client situations where the client is upset”
4. “Touch is always appropriate to show emotional support and encouragement”
- “Touch carries a different meaning for different individuals.”
Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.
Which nursing response is an example of the nontherapeutic communication block of requesting an explanation?
1. “That was wrong.”
2. “Why did you say that?”
3. “Keep your chin up. I’ll explain the procedure to you.”
4. “There is always an explanation for both good and bad behaviors.”
- “Why did you say that?”
This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking “why” a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings.
