121 Module 8

What is acceptance and how does it apply to patient relationships?

-Accept everything a patient says without judgment, whether we agree with them or not -Essential in the helping relationship -Avoid stereotyping

Strategies for empowering patients

-Accept patients as they are -Assess level of understanding -Establish mutual goals for health care -Learn the information patients want to know -Reinforce autonomy -Offer information -Make sure patients actively participate in care -Encourage networking with a support group -Clarify patient's responsibility for care decisions

What is trust and how does it apply to patient relationships?

-People must feel comfortable and safe revealing their needs -Maintaining an open exchange of information contributes to trust. -Nurse needs to be perceived as dependable

How to avoid triggering patients (Box 13.1)

-Recognize signs of anger -Help patient express anger in an acceptable manner -Defuse hostility -Analyze the situation disturbing the patient -Prevent escalation of conflict

How is aggressive behavior different from assertive behavior?

-aggressive behavior has a goal of dominating while suppressing another person's rights -Assigning blame ('you' statements instead of 'I' statements)

What is the optimal amount of territorial space in western culture?

86-108 sq. ft.

Which of the following describes caring? a. It is difficult to demonstrate professionally. b. It is an ethical responsibility. c. It is an intuitive process. d. It is not influenced by past experience.

ANS: B Caring is an ethical responsibility that guides a health care provider to advocate for the client. Caring is demonstrated professionally in the therapeutic relationship. It is an intentional action that is learned. A person who has received caring is more likely to be able to offer it to others.

Stereotypes are learned during a. Exposure to early education. b. Childhood and reinforced by life experiences. c. Limited contact with other cultures. d. Uncomfortable experiences with culturally diverse clients.

ANS: B Stereotypes are learned during childhood and reinforced by life experiences.

A patient states to the nurse in a hostile voice, I am sick of being poked at and stuck with needles. Go away and leave me alone. Which of the following is the best statement by the nurse? a. I am not surprised that you wish to be left alone. b. I'm so sorry you are feeling so upset. c. You feel vulnerable and depressed as a result of all these treatments. d. Okay, I will go away.

ANS: B Validating the anger and reframing are useful. Comments such as, I'm sorry you are feeling so upset, recognize the significance of the emotion being expressed without getting into the cause. I am not surprised that you wish to be left alone validates the patient's anger, but does not reframe the situation. The nurse should not make inferences about what the patient is feeling without first validating. Okay, I will go away is avoidant behavior by the nurse.

When interacting with the nurse, a patient makes several condescending remarks directed toward the nurse. The nurse recognizes this behavior as an example of a. The use of humor. b. Active listening. c. A verbal clue to anger. d. Assertiveness.

ANS: C Nonverbal clues to anger include grimacing, clenching jaws or fists, turning away, and refusing to maintain eye contact. Verbal clues by a patient may, of course, include use of an angry tone of voice, but they may also be disguised as witty sarcasm or as condescending or insulting remarks. The patient's remarks are condescending, not humorous. The patient's remarks are verbal, not nonverbal. Use of condescending remarks is an example of Passive-aggressive communication.

When entering a client's room, the nurse notices the client standing while wringing her hands and wearing street clothes over pajamas. On further examination, it is noted that the client is hyperventilating with elevated vital signs. Which level of anxiety is the client experiencing? a. Mild b. Moderate c. Severe d. Panic

ANS: C Signs of severe anxiety include elevated vital signs, impaired problem-solving, and a confused mental state. Signs of mild anxiety are enhanced problem-solving and increased alertness. Signs of moderate anxiety do not include high blood pressure. During panic, the client is immobilized with no cognitive or coping abilities.

5 styles of response to conflict

Avoidance Accommodation Competition Compromise Collaboration

Negative effects of non-assertive behavior by the nurse

Can lead to lower autonomy and negative influences on the standard of care the nurse provides

3 P's of Crisis De-escalation

Position (face patient, remain close to exit, only 60% eye contact) Posture (relax stance, uncrossed arms, rotate/relax shoulders) Proximity (stay 1.5-3 feet away)

Components of assertive communication

To say no To ask for what you want To appropriately express both positive and negative thoughts and feelings To initiate, continue, and terminate the interaction

Compromise

a common conflict resolution style by nurses that only works when both parties hold equal power. In other words, a lose-lose situation, no one is satisfied.

Competition

a response style characterized by domination. You exercise power to gain your goals at the expense of the other person. This style is only effective when there is a need for a quick decision, but is not meant to use on a regular basis.

Collaboration

solution-oriented in which there is an agreement to finding a mutually agreeable solution. This requires directly confronting the issue, acknowledge your feelings, and using open communication. To be effective, this requires identifying the concerns of each party, clarifying assumptions, communicating honestly to identify the real issue, and working collaboratively. This is considered the most effective win-win situation.

Accommodation

surrender own needs in order to smooth over the conflict. This is a cooperative but passive response which may involve a quick compromise or false reassurance

Avoidance

when the cost of addressing the conflict is higher than the benefit of resolution. This is an easy go-to for novice nurses. In this case nurses distance themselves from their patients or provide less support.

How to defuse violent patient behavior (Table 13.1)

-Approach - de-escalate and contain OR leave if you are in danger -Actions - diffuse, stay calm, don't get defensive, use empathy -Reporting - report all incidents -Analysis - how to prevent future incidents -Staff-focused consultation - debrief with peers/managers

What is empowerment and how does it apply to patient relationships?

-Assisting patients to take charge of their lives -Form partnerships in order to help patients build skills to reach their health goals -Empowered patients feel valued and more likely to adopt successful coping methods -The more involved people are in their own care, the better the health outcome

C.A.R.E. (Nursing communication interventions)

-Clarify the behavior that is a problem -Articulate why the behavior is a problem -Request a change in the problem behavior -Evaluate progress

Three general categories of causes of conflict

-Communication issues -Psychological issues (e.g. stress, personality) -Cultural or ideological differences (e.g. anti-vax)

C.A.R.E. (steps for caring communication)

-Connect with your client -Appreciates the client's situation -Respond to client needs -Empower the client to partner in problem solving

What is respect and how does it apply to patient relationships?

-Conveying genuine respect for your patients' values and opinions -E.g. what they prefer to be called and then always addressing them by as such -Respect between team members is also necessary

Conflict

-Disagreement arising from differences in attitudes, values, or needs, in which the actions of one party frustrate the ability of the other to achieve their expected goals -The result is stress or tension -Serves as a warning that something in the relationship needs closer attention -It can become a positive force leading to growth in relationships

What is caring and how does it apply to patient relationships?

-Intentional human action characterized by commitment and a sufficient level of knowledge and skill to allow you to support integrity. -The behavior of caring is not an emotion, but rather a chosen response to need.

How to avoid violent patient behavior

-Maintain self-control (appear calm) -Nonthreatening body posture (respect personal space) -Talk about it -Use tension-reducing actions -Use therapeutic communication skills -Containment (maintain safety, call security, leave) -Evaluation: Immediate debriefing (what could have prevented this?)

What is mutuality and how does it apply to patient relationships?

-Maximize the patient's involvement in all phases of the nursing process -Collaboration in problem solving -Accept a patient's decisions even if we do not agree with them

4 levels of anger

-Mild - tension, irritability, argumentative, sarcastic, difficult to please -Moderate - observably angry, motor agitation, loud voice -Severe - acting out, cursing, violent gestures -Rage - out of control, physically aggressive

Levels of anxiety (Table 11.1)

-Mild anxiety - heightened alertness, enhanced learning, mild restless -Moderate anxiety - with guidance can expand sensory files, with directions can cope to reduce anxiety, increased muscle tone, incomplete verbal responses. -Severe anxiety - decreased sensitivity to pain, unable to solve problems even with guidance, high blood pressure & hyperventilation -Panic - no response to sensory perceptions, without intervention death is imminent, and immobilization

4 ways to prevent conflict

-Model behavior by adopting a professional, calm demeanor and a low tone of voice -Signal your readiness to listen with eye contact, receptive facial expression, etc. -Give undivided extra attention to a patient or visitor whom you identify as potentially becoming aggressive. -Note that anti-communication attitudes act as a barrier.

Signs that conflict is present

-Patient criticizes you, becomes demanding or impatient

Empathy in action (3 ways to apply empathy in patient relationships)

-Recognize and classify requests (understand how the patient can be involved) -Attend behaviors (respond appropriately to verbal and nonverbal cues) -Empathetic responses (use verbal and nonverbal cues to show you understand what they're feeling)

Reducing barriers (Box 11.3)

-Recognize barriers -Establish trust. -Demonstrate caring and empathy. -Empower the patient. -Recognize and reduce patient anxiety. -Maintain appropriate personal distance. -Practice cultural sensitivity and work to be bilingual. -Use therapeutic relationship-building activities such as active listening. -Avoid medical jargon

Two possible outcomes of conflict

-Resolved --> positive growth -Unresolved --> dysfunction

Strategies to help patients remain a sense of control over their space (proxemics)

-Standing close to them at their side instead of directly in front of them -Sitting or standing at the same level as the patient -Encourage bringing special items from home whenever possible -Advocate for your patients' personal space by communicating the patient's preferences to members of the healthcare team -Recognize that behaviors of 'taking over' may feel like an invasion of personal space.

Barriers to patient relationships

-Stereotyping -Mistrust -Anxiety -Violation of personal space -Time limitations -Cultural barriers -Gender differences -Lack of respect, care, empathy, honesty -Overworked, stressed nurses -Inconsistent caregiving -Etc.

Strategies for responding to conflict

-Structure your response/organize the info (e.g. list consequences) -Manage your own emotions -Focus on the present -Put the situation into perspective (pick your battles) -Have the conversation at a time that will allow for collaboration (not in the heat of the moment) -Limit the discussion to one topic at a time -Use 'I' statements to avoid sounding accusatory -Make clear, succinct statements rather than questions -Use moderate pitch and vocal tone -Verbal and nonverbal message should be consistent -USe therapeutic communication skills

What is empathy and how does it apply to patient relationships?

-The ability to perceive and understand the patient's emotions accurately -Recognizing the emotions a patient feels, while maintaining your own separate identity -If you over identify, or internalize the feelings of your patient, then you lose objectivity. It is important to recognize that the feelings belong to them, and not to you.

What is proxemics and how does it apply to patient relationships?

-The study of an individual's use of space -Intrusion potentially impacts negatively on patient-centered communication -Procedures (intubation, catheterization) intrude on a patient's personal space, e.g., loss of control over personal territory -Advocating for the patient client's personal space needs is an aspect of the nursing role. -Varies by age, gender, anxiety, esteem

What is veracity and how does it apply to patient relationships?

-Truthfulness in communication, the most important aspect in upholding a high standard of ethical nursing -Limitations exist such as the case of not informing a patient about their condition if it would produce harm and interfere with recovery -When patients know they can expect the truth, the development of trust is promoted and helps build the nurse-patient relationship

4 steps to understand conflict

-Understand your own response -Recognize your triggers ('hot buttons') -Understand the context behind the patient's response -Develop your conflict management style

Nurse behaviors that might create conflict (Box 13-1)

-Violating patient's personal space -Speaking in a threatening tone -Providing unsolicited advice -Judging, blaming, criticizing, or conveying ideas that try to create guilt -Offering reassurances that are not realistic -Communicating using gloss it over positive comments -Speaking in a way that shows you do not understand your patient's point of view -Exerting too much pressure to make a person change their unhealthy behavior -Portraying self as an infallible I know best expert -Using an authoritarian, sarcastic, or accusing tone -Using hot button words that have heavy emotional connotations -Failing to provide health information in a timely manner to stressed individuals

Assertive communication

-conveying objectives in a direct manner without anger or frustration -Setting goals, acting on those goals in a clear, consistent manner, and taking responsibility for the consequences of those actions. -The assertive nurse is able to stand up for their personal rights and the rights of their patients.

Which of the following demonstrates the use of the caring process? a. Respecting the uniqueness of every client b. Problem solving for the client c. Performing tasks for the client d. Communicating expectations of the health care team

ANS: A Caring is described as a commitment by the nurse that involves profound respect and concern for the unique humanity of every client and a willingness to confirm the client's personhood. Caring is demonstrated by problem-solving with the client, not for the client. Encouraging self-care empowers the client. The nurse needs to respond to the client's expectations for health care.

Which of the following is true about assertion communication? a. Components include the ability to say no and to ask for what you want. b. It includes a demonstration of deference to the demands of others. c. It consistently violates the needs of others. d. It includes the expression of only positive thoughts and feelings.

ANS: A Components of assertion communication include the following four abilities to: (1) say no, (2) ask for what you want, (3) appropriately express both positive and negative thoughts and feelings, and (4) initiate, continue, and terminate the interaction.

Which of the following should be achieved first in establishing the nurse-client relationship? a. Trust b. Empathy c. Mutuality d. Empowerment

ANS: A Establishing trust is the foundation in all relationships. The development of a sense of interpersonal trust, a sense of feeling safe, is the keystone in the nurse-client relationship. Empathy is used by the nurse after trust is established. Mutuality is important in establishing client goals. Empowerment occurs when the client actively participates in his or her care plan.

Which of the following describes mutual goals? a. Mutuality is based on client goals. b. Mutuality is based on interdisciplinary health team goals. c. Mutuality is based on the nurse's goals. d. Mutuality is based on the physician's goals.

ANS: A Evidence of mutuality is seen in the development of individualized client goals and nursing actions that meet a client's unique health needs—not on the goals of the health team, the nurse, or the physician.

The nurse is teaching an unlicensed assistive personnel (UAP) on potential approaches for dealing with difficult patients. The nurse recognizes that additional teaching is required when the UAP states a. I will be assertive by conveying my irritation toward the patient's behavior. b. I will collaborate with staff so we all use the same uniform approach when responding to the patient's demands. c. I will promote trust in the patient by providing immediate feedback. d. I will explain to the patient the limits of my role as an UAP.

ANS: A Potential approaches for dealing with difficult patients include using a calm tone and avoiding conveying irritation. Potential approaches for dealing with difficult patients also include: working with staff so all use the same uniform approach to the patient's demands; promoting trust by providing immediate feedback; and explaining the limits of one's role.

Which of the following is a barrier to communication? a. Intrusion into personal space b. Unconditional acceptance c. Self-awareness d. Gender differences

ANS: A Understanding communication barriers in a relationship (e.g., anxiety, stereotyping, or violations of personal space or confidentiality) affects the quality of the relationship. Unconditional acceptance is an essential element in the helping relationship. Self-awareness enhances communication. No evidence exists showing that gender differences obstruct the therapeutic relationship

A nurse manager is educating nurses about the risk of violence experienced by nurses and social workers in their workplace when compared to other professionals. The nurse manager states that nurses and social workers are at a. Three times greater risk to experience violence in their workplace than are other professionals. b. Four times greater risk to experience violence in their workplace than are other professionals. c. No greater risk to experience violence in their workplace than are other professionals. d. Two times greater risk to experience violence in their workplace than are other professionals.

ANS: A Violence against health care workers is increasing. Nurses are at greater risk because of their close contact with patients. In fact, nurses and social workers are at three times greater risk to experience violence in their workplace than are other professionals.

Which of the following are strategies the nurse should use when dealing with an angry patient? (Select all that apply.) a. Defuse hostility b. Avoid responding to a patient's anger by getting angry c. Speak quickly and use a higher tone of voice d. Use empathy when communicating with the patient e. Remain with the patient

ANS: A, B, D The nurse should defuse hostility by avoiding responding to a patient's anger by becoming angry also. The nurse should use empathy in his or her communication. An angry patient needs to have the nurse acknowledge both the issue and his or her feelings about that issue. Only then can the patient begin to interact in a meaningful way. Empathy by the nurse may help defuse the situation. The nurse should deliberately begin to lower his or her voice and speak more slowly. When we get upset, we tend to speak quickly and use a higher tone of voice. If the nurse does the opposite, the patient may begin to mimic him or her and thus calm down. The goal is to maintain safety while helping the patient. Therefore, it may not always be appropriate to remain with the patient because this may place the nurse in danger of physical harm. If the nurse feels in danger of physical harm, he or she should always maintain a space for safety and plan an exit.

When providing home health care to a patient suffering from Alzheimer's disease who fell and broke his hip 3 weeks ago, the nurse teaches the patient's family correct use of the walker. This represents which stage of the nurse-caregiver relationship? a. Worker-helper b. Worker-worker c. Nurse as manager; family as worker d. Nurse as nurse for family caregiver

ANS: B A Canadian study of home health nurses and family caregivers of elderly relatives identified four evolving stages in the nurse-caregiver relationship. The initial stage is worker-helper, with the nurse providing care to the ill patient with the family helping. Next comes worker-worker, when the nurse begins teaching the needed care skills to family members. Third is nurse as manager; family as worker, as the family members learn needed care skills. The final stage, nurse as nurse for family caregiver, occurs as the family member becomes exhausted. In the worker-helper stage, the nurse provides care to the ill patient with The family helping. In the nurse as manager; family as worker stage, the nurse acts as manager with the family learning care skills. In the nurses as nurse for family caregiver stage, the family member is exhausted and the nurse cares for him or her as well as the patient.

After fasting from 10 p.m. The previous evening, a patient learns that the procedure has been cancelled. The patient curses at the nurse and accuses the nurse of being incompetent. The nurse's best response would be a. You have no right to say that to me. You are nasty. b. I can understand that you're upset, but I feel uncomfortable when I am cursed at. c. Perhaps we shouldn't get so angry when things don't work out the way we think they should. d. To leave the room and refuse to return to answer the call light when the patient calls.

ANS: B Assertive behaviors range from making a direct, honest statement about one's beliefs to taking a very strong, confrontational stand about what will and will not be tolerated in the Relationship. Assertive responses contain I statements that take responsibility. This behavioris in contrast to aggressive behavior, which has a goal of dominating while suppressing the other person's rights. Aggressive responses often consist of you statements that fix blame on the other person. We statements should be used only when the nurse actually means to look at an issue collaboratively. Thus, the statement, Perhaps we both need to look at this Issue a little closer. May be appropriate in certain situations. However, the statement, Perhaps we shouldn't get so angry when things don't work out the way we think they should. Is a condescending statement thinly disguised as a collaborative statement. What is actually being expressed is the expectation that both parties should handle the conflict in one way—the nurse's way. Some nurses were socialized to act passively. Passive behavior is defined as a response that denies our own rights in order to avoid conflict.

A patient yells at the nurse frequently and uses profane language. Which of the following is the most appropriate response by the nurse? a. Remain silent and do not respond. b. Use an I statement when speaking to the patient. c. Tell the patient, You make me angry. d. Ignore the behavior and walk away

ANS: B Assertive responses contain I statements that take responsibility. This behavior is in contrast to aggressive behavior, which has a goal of dominating while suppressing the other person's rights. The goal of assertiveness is to communicate directly, standing up for one's personal rights while respecting the rights of others. Conflict creates anxiety, which may prevent one from behaving assertively. Aggressive behavior has a goal of dominating while suppressing The other person's rights. Aggressive responses often consist of you statements that fix blame on the other person. Assertive behaviors range from making a direct, honest statement about one's beliefs to taking a very strong, confrontational stand about what will and will not be tolerated in the relationship.

The nurse is caring for an intoxicated patient who has been admitted to the emergency department. The patient appears very angry and frequently shouts at the nurse and demands to see the physician. The best response by the nurse is to use a. Blaming. b. Empathy. c. Competition. d. I statements.

ANS: B Effective nurse-patient communication is critical to efficient care provision and to providing quality care. Knowing how to respond in emotional situations allows the nurse to use feelings as a positive force. Nurses often find themselves in dramatic situations in which a calm response is required. Some patients approach their initial encounter with a nurse with hostility or embarrassment, such as the intoxicated patient admitted to an emergency department. To Listen and to respond creatively to intense emotion when the nurse's first impulse is to withdraw or to retaliate demands a high level of skill. It requires self-control and empathy for what the patient may be experiencing. The nurse should avoid blaming, which will only make the patient feel defensive or angry. Competition is a response style characterized by domination. In this contradictory style, one party exercises power to gain his own goals at the expense of the other person. It is characterized by aggression and lack of compromise. Authority may be used to suppress the conflict in a dictatorial manner. This leads to increased stress. It is an effective style when there is a need for a quick decision, but it leads to problems In the long term, making it a lose-lose situation. Timing is also important if an individual is very angry. The key to assertive behavior is choice. Sometimes it is better to allow the patient to let off some emotional steam before engaging in conversation

Which of the following situations is an example of the nurse using empathy? a. Setting up a rehabilitation placement for a client addicted to heroin b. Sitting quietly and holding a client's hand while she cries following the news that she has inoperable cancer c. Giving a bed bath to a client who suffers from a cerebral vascular accident (CVA) d. Telling a client all about the fun night at one of the local clubs

ANS: B Empathy is the ability to be sensitive to and communicate understanding of the client's feelings. The client should be encouraged to be involved in his or her own care and to assume responsibility. The nurse should not tell a client about extracurricular activities because this is an example of nontherapeutic self-disclosure by the nurse.

The nurse knocks on the client's door and waits for the client to answer before entering the room. The nurse is demonstrating a. Nonverbal communication skills. b. Respect for the client's personal space. c. Respect for the client's confidentiality. d. Respect for the client's gender difference.

ANS: B Giving warning before entering a client's room demonstrates respect for personal space. Knocking is not a demonstration of nonverbal communication. Knocking at a door before entering the room does not relate to respect for a client's confidentiality. Respect for a client's personal space should be demonstrated regardless of gender.

The initial interpersonal strategy to help the patient reduce strong emotion to a workable level involves a. Talking the emotion through with someone. b. Providing a neutral, accepting, interpersonal environment. c. Taking action that might help the patient come to terms with the emotional consequences. d. Obtaining more information.

ANS: B The initial interpersonal strategy used to help patients reduce strong emotion to a workable level is to provide a neutral, accepting, interpersonal environment. The second step in defusing the strength of an emotion is to talk the emotion through with someone. The third phase is to take action. The specific needs expressed by the emotion suggest actions that might help the patient come to terms with the consequences of the emotion. This responsibility might take the form of obtaining more information or of taking some concrete risks to change behaviors that sabotage the goals of the relationship.

Which of the following best describes the goal of assertiveness? a. Offering responses that contain you statements b. Indirect communication c. Standing up for one's personal rights d. Ignoring the rights of others

ANS: C Assertive behavior is defined as setting goals; acting on those goals in a clear, consistent manner; and taking responsibility for the consequences of those actions. Assertive communication is conveying this objective in a direct manner, without anger or frustration. The assertive nurse is able to stand up for personal rights and the rights of others.

The nurse's first response in dealing with a conflict situation that involves a patient is to a. Understand the context of the situation. b. Impose more controls on the patient. c. Gain a clear understanding of one's own personal response. d. Encourage the patient to discount statements made by the nurse.

ANS: C Conflicts between nurse and patient are not uncommon. The first step for the nurse is to gain a clear understanding of one's own personal response. No one is equally effective in all situations. The second step is to understand the context of the situation. Most interpersonal conflicts involve some threat to one's sense of control or self-esteem. Nurses have been shown to respond to the stress of not having enough time to complete their work by imposing more controls on the patient, who then often reacts by becoming more difficult. Other situations, which may lead to conflict between the nurse and the patient, include having statements discounted.

In order to reduce clinical bias in nursing practice, the nurse should a. Memorize beliefs held by different cultures. b. Generalize beliefs based on ethnic membership. c. Develop a nonjudgmental, neutral attitude. d. Recognize that individuals of the same religion share the same characteristics.

ANS: C Developing a nonjudgmental, neutral attitude toward a client helps the nurse reduce clinical bias in nursing practice. The nurse does not have to memorize beliefs to become culturally sensitive. Stereotypes are generalized beliefs based on ethnic membership. All individuals of a particular social group, race, or religion do not share the same characteristics.

Which of the following describes proxemics? a. Study of relationship between message and topic at hand b. Study of implied meanings within individuals c. Study of an individual's use of space d. Study of the emotional personal space boundary

ANS: C Proxemics is the study of an individual's use of space. The study of relationships between messages and topics at hand and the study of implied meanings within individuals do not involve the use of space. An individual can use space as an invisible boundary

A patient yells, Take this mess away from here. How could anyone eat this food? What kind of place are you running here? The nurse uses skills of assertiveness to promote change that is focused on a. Feelings. b. Attitudes. c. Behaviors. d. Motivations.

ANS: C Undesired behaviors, not feelings, attitudes, and motivations, are the focus for change. Feelings, attitudes, and motivations are not the focus for change.

When a physician writes an order for the nurse to withhold life-saving treatment from a terminally ill patient, the nurse is faced with two different choices, each supported by a different ethical principle. This type of conflict is known as a. Covert conflict. b. Overt conflict. c. Interpersonal conflict. d. Intrapersonal conflict.

ANS: D A conflict can be internal (intrapersonal); that is, it can represent opposing feelings within an individual. Intrapersonal conflict arises when nurses are faced with two different choices, each supported by a different ethical principle. More often, conflict is covert and not so clear-cut. The conflict issues are hidden. The patient talks about one issue, but talking does not seem to help and the issue does not get resolved. Overt conflict refers to conflict that is observable in the patient's behavior and expressed verbally. Interpersonal conflict occurs between two or more people.

The most effective problem-solving style for genuine resolution that creates a win-win situation is a. Accommodation. b. Avoidance. c. Competition. d. Collaboration

ANS: D Collaboration is a solution-oriented response in which individuals work together cooperatively to problem solve. To manage a conflict, those involved commit to finding a mutually satisfying solution. This involves directly confronting the issue, acknowledging feelings, and using open communication to solve the problem. Steps for productive confrontation include: identifying concerns of each party; clarifying assumptions; communicating honestly to identify the real issue; and working collaboratively to find a solution that satisfies everyone. This is considered to be the most effective style for genuine resolution. This is a win-win situation. Accommodation is a lose-win situation. Avoidance can turn into a lose-lose situation. Competition can lead to a lose-lose situation.

When working in situations that involve conflict, the nurse recognizes that which of the following is true in relation to conflict? a. Conflict always leads to impaired relationships. b. Conflict arises from compatible goals and needs. c. Most people experience conflict as a lack of discomfort. d. Conflict serves as a warning that something in the relationship needs closer attention

ANS: D Conflict has been defined as tension arising from incompatible goals or needs, in which the actions of one frustrate the ability of the other to achieve a goal, resulting in stress or tension. Conflicts in any relationship are inevitable: they serve as warning that something in the relationship needs closer attention. Conflict can lead to improved relationships. Most people experience conflict as discomfort.

Which of the following is a violation of client confidentiality? a. Sharing of information about a communicable disease b. Stating client's diagnosis during change of shift report c. Photographing a client's wound to monitor the healing process d. Discussing private information about the client casually with others

ANS: D Discussing private information casually with others is an abuse of confidentiality. It is legal to share information about public health issues such as a communicable disease. Information can be shared with the health care team. Photographing a client's wound is not a breach of confidentiality; the pictures stay with the client's record and are used for the benefit of the client.

The nurse demonstrates an understanding of mutuality when stating to the client, a. Mr. Jones, I think you should go to bed now. b. Mr. Jones, I would like you to go to bed now. c. Mr. Jones, I don't think you should sit in the chair. d. Mr. Jones, I thought we agreed that you would return to bed at this time.

ANS: D Mutuality basically means that the nurse and the client agree on the client's health problems and the means for resolving them and that both parties are committed to enhancing the client's well-being. When the nurse instructs the client what to do, it represents the nurse's goals for the client and does not demonstrate mutuality.

Which of the following is true about trust? a. The sender feels it. b. It is difficult to demonstrate professionally. c. It is an intuitive process. d. The trusting client feels comfortable revealing needs.

ANS: D The development of a sense of interpersonal trust, a sense of feeling safe, is the keystone in the nurse-client relationship. Trust provides a nonthreatening interpersonal climate in which the client feels comfortable revealing his needs. The sender promotes a trusting relationship. Trust is demonstrated professionally in the nurse-client relationship. The development of trust is based on past experiences, not intuition.

Which of the following is true regarding personal space? a. Individuals living in a Western culture need 40 square feet of personal space. b. Direct eye contact causes a need for less space. c. People need less space when they are anxious. d. The elderly need more control over their personal space.

ANS: D The elderly need control over personal space because they can become profoundly disoriented in unfamiliar environments. Individuals living in a Western culture need 86-108 square feet of personal space. Direct eye contact causes a need for more space. People need more space when they are anxious.

A patient on a psychiatric unit is found pacing the halls and angrily punching at the wall. The nurse's primary goal should be to a. Assertively tell the patient to stop the behavior. b. Suggest that the patient write in a journal to help relieve anxiety. c. Speak in a loud voice in order to alert other staff members. d. Maintain safety while helping the patient.

ANS: D The nurse should help the patient own the angry feelings by getting the patient to verbalize things that make him or her angry. Acknowledging a patient's anger may prevent an Expression of abusive ranting. It is essential that the nurse use empathetic statements or active listening to acknowledge the patient's anger and maintain a non threatening demeanor before moving on to try to discuss the issue. The goal is to maintain safety while helping the patient.Psychiatric patients can be unpredictable and at this point would not be likely to respond positively to a suggestion such as writing in a journal. Speaking assertively or in a loud voice may escalate the situation, and the patient is already out of control.