NUR168: CONCEPTS 3: CHAPTER 8: COMMUNICATION:

Levels Of Communication: Group: Small-Group:

- Occurs when nurses interact with two or more people. - To be functional, members of the small group must communicate to achieve their goal. - Examples of small-group communication include staff meetings, patient care conferences, teaching sessions, and support groups. - The more people involved in the communication process, the more complex it becomes.

Levels Of Communication: Group: Organizational:

- Occurs when people and groups within an organization communicate to achieve established goals. - Nurses on a practice council meeting to review unit policies, or nurses working with interdisciplinary groups on strategic planning or quality assurance, use organizational communication to achieve their aims.

Interview Techniques:

- Open-ended questions or comments - Closed questions or comments - Validating questions or comments - Clarifying questions or comments - Reflective questions or comments - Sequencing questions or comments - Directing questions or comments

Aggressive Behavior:

- Involves asserting one's rights in a negative manner that violates the rights of others - Can be verbal or physical - Communication is marked by tension and anger, inhibiting the formation of good relationships and collaboration. - Characteristics include using an angry tone of voice, making accusations, and demonstrating belligerence and intolerance. - Focus is usually "winning at all costs."

Reflective Question Or Comment:

- Involves repeating what the person has said or describing the person's feelings. - Encourages patients to elaborate on their thoughts/feelings. - Ex: Patient says, "I've been really upset about my blood pressure and have to take these pills" Nurse says, "You've been upset..." Patient says, "I guess I'm worried about what could happen if my blood pressure gets too bad".

Forms Of Communication: Verbal:

- Language - an exchange of information using words, including both the spoken and written word

Directing Question Or Comment:

- Might become necessary at times to obtain more information about a topic brought up earlier in the interview or to introduce a new aspect of the current topic. This way, the nurse can gain additional valuable information to consider in assessing the patient's health status and educational or counseling needs. - Ex: Nurse says, "You mentioned your dad earlier. Did he develop complications related to high blood pressure?" Patient says, "Yes" Nurse says, "What sort of complications?" Patient says, "Kidney failure. He was on dialysis for years before getting a transplant." Nurse says, "Are you afraid this ight happen to you?"

2. A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's BEST response to the neighbor? A) "New mothers need support." B) "The lack of a father is difficult." C) "How are you today?" D) "It is a very sad situation."

A) "New mothers need support."

13. When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of what type of inappropriate communication technique? A) Cliché B) Giving advice C) Being judgmental D) Changing the subject

A) Cliché

6. A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of the helping relationship? A) Determining the progress made in achieving established goals B) Clarifying when the patient should take medications C) Reporting the progress made in teaching to the staff D) Including all family members in the teaching session

A) Determining the progress made in achieving established goals

Levels Of Communication: Intrapersonal:

Self-talk; communication within a person

Communication:

the process of exchanging information and generating and transmitting meanings between two or more people.

Blocks To Communication:

- Failure to perceive the patient as a human being - Failure to listen - Nontherapeutic comments and questions - Using clichés - Using closed questions - Using questions containing the words "why" and "how" - Using questions that probe for information - Using leading questions - Using comments that give advice - Using judgmental comments - Changing the subject - Giving false assurance - Using gossip and rumors - Using disruptive interpersonal behavior

Characteristics of Effective and Ineffective Groups:

- Group identity - Cohesiveness - Patterns of interaction - Decision making - Responsibility - Leadership - Power

Characteristics of the Helping Relationship:

- Dynamic: both RN & patient active participants to extent each is able - Purposeful and time limited: Goals met in specific period - Person providing assistance is professionally accountable for the outcomes and the means used to attain them - Helping relationship is another way of saying nurse-patient relationship - Goals determined cooperatively and defined in terms of patient's needs. Patient needs first

Nonverbal Communication: Gait:

- A bouncy, purposeful walk usually carries a message of well-being. A less purposeful, shuffling gait often means the person is sad or discouraged. - Certain gaits are associated with illness. - For example, patients recovering from recent abdominal surgery usually walk slightly bent over and slowly and might need the assistance of handrails or a helping person.

Clarifying Question Or Comment:

- Allows nurse to gain understanding of a patient's comment. - When used properly, this can prevent possible misconceptions that could lead to an inappropriate nursing diagnosis - Overusing can lead the patient to believe that the nurse is not listening or lacks appropriate knowledge - Ex: Patient says, "I have never needed to take medicine before in my life" Nurse says, "Is this the first health problem you have had?" Patient says, "Yes, I've always been healthy"

Relating To Different Cultures:

- Assess own beliefs: set aside own views, biases, and values. - Assess communication variables from cultural perspective: Use patient as source of info, assess what my hinder helping relationship - Learn as much as can about culture and how patient preserves health in their culture. - Modify communication approach. Look for signs of fear, anxiety or confusion. Be aware that some groups find discussion of patient in some situations can be offensive. - Respect of patient & communicated needs is essential for positive relationship: active listening, being flexible & bridging barriers - Communicate in non-threatening manner, unhurried manner, social or intrapersonal distance, giving full attention - Be alert patient may not understand, reluctance to talk re: sexual matters. - Use caring tone, speak slowly, clearly, not loudly though, repeat frequently, avoid medical terms, keep it simple - Culturally sensitive interpreter to translate the message, obtain feedback of understanding.

Importance Of Communication In Nursing:

- Communication must be heard - Limit distractions so message is not misunderstood - Communication is nurse's primary focus in client-nurse relationship, as we are caring for client and their needs - Developing nurse-client relationship is critical for patient outcomes - Trust helps us build good communication in relationships - As nurses, we convey (communicate) patient care, through documentation.

Characteristics of the Assertive Nurse's Self-Presentation:

- Confident; open body posture - Use of clear, concise "I" statements - Ability to share effectively one's thoughts, feelings, and emotions - Working to capacity with or without supervision - Remaining calm under supervision - Asking for help when necessary - Giving and accepting compliments - Admitting mistakes and taking responsibility for them

Developing Conversation Skills:

- Control the tone of your voice. - Be knowledgeable about the topic of conversation. - Be flexible. - Be clear and concise. - Avoid words that might have different interpretations. - Be truthful. - Keep an open mind. - Take advantage of available opportunities.

Factors Influencing Communication:

- Developmental level: Young age making little or no understanding of illness or disease - Gender: Women and men communicate differently - Sociocultural differences: Become aware of your own personal cultural beliefs, identify prejudices or attitudes that could effect the care you give - Roles and responsibilities: Don't stereotype a person by their occupation. It could be misleading. Particularly, don't assume someone in healthcare, knows everything about their disease or illness. Be careful of the "take charge" kind of person, make sure you ask if they have any questions even if seem well vs.& the pts that are quiet or reserved, don't assume they don't have questions either. - Space and territoriality: People most comfortable in own space, people act differently when on "home turf" then in new or unfamiliar space. - Physical, mental, and emotional state: full bladder, headache, cognitive impairment. Provide touch as communication - Values: influences communication by how they value themselves or one another. Nurses who believe teaching is important when caring for patients, will provide it more. - Environment: best when calm & nonthreatening, minimal distractions and privacy is obtained.

Factors That Promote Effective Communication:

- Dispositional traits - Rapport builders

The Helping Relationship:

- Does not occur spontaneously - Characterized by an unequal sharing of information - Built on the patient's needs - The nurse is the helper, and the patient is the person being helped. - Communication is the means used to establish rapport and helping-trust relationships. - When the nurse uses a helping relationship, it helps the patient identify and achieve goals. PROFESSIONAL RELATIONSHIPS

Phases Of The Helping Relationship:

- Orientation phase: Data-gathering part of nursing process. 1. Roles in the in the relationship are clarified. 2. Agreement or contract about relationship established, whether verbally for short-term or written for long-term. - Working phase: Longest phase of relationship. 1. Requires active participation from patient. 2. Patient will cooperate in activities that have been mutually agreed upon, to reach goals. 3. The patient will express feelings and concerns to nurse. - Termination phase: Occurs when the conclusion of the initial agreement is acknowledged. It might happen with change-of-shift or discharge, nurse takes vacation or other employment. 1. Examination of goals to see if they were attained or progress has been made towards them. 2. The patient verbalizes expression of feelings towards relationship ending.

Closed Question Or Comment:

- Provides the receiver with limited choices of possible responses and might be answered by one or two words "yes" or "no" - Used to gather specific information from a patient and to allow nurse and patient to focus on a particular area. - Barrier to effective communication - Ex: Nurse asks, "what medicines have you been taking at home? Patient says, "Let me see, my doctor gave me a water pill and a blood pressure pill to take every day".

Validating Question Or Comment:

- Serves to validate what the nurse believes they have heard/observed. - Overusing this might lead to patient to think nurse is not listening - Ex: Nurse says, "at home, you have been taking both a water pill and a blood pressure pill every day. Did you take them today?" Patient says, "Yes, I took one of each with my breakfast"

Developing Listening Skills:

- Sit when communicating with a patient. - Be alert and relaxed and take your time. - Keep the conversation as natural as possible. - Maintain eye contact if appropriate. - Use appropriate facial expressions and body gestures. - Think before responding to the patient. - Do not pretend to listen. - Listen for themes in the patient's comments. - Use silence, therapeutic touch, and humor appropriately.

Factors That Promote Effective Communication: Rapport Builders:

- Specific objectives - Comfortable environment - Privacy - Confidentiality - Patient vs. task focus - Utilization of nursing observations - Optimal pacing

The Channel In Communication:

- The medium the sender has selected to send the message. The channel might target any of the receiver's senses. - The message can be sent to the receiver through the following channels: Auditory, Visual, Kinesthetic Auditory: spoken words and cues Visual: sight, observation, perception Kinesthetic: touch - The receiver (decoder) must translate and interpret the message sent and received. - Through the translation of the message, the receiver must then make a decision about an accurate response. To be an effective communicator, the nurse needs to be considerate of the receiver, and select a message that appeals to the patient's interests and that requires minimal effort and time to decode.

Goals Of The Working Phase:

- The patient will actively participate in the relationship. - The patient will cooperate in activities that work toward achieving mutually acceptable goals. - The patient will express feelings and concerns to the nurse.

Goals Of The Termination Phase:

- The patient will participate in identifying the goals accomplished or the progress made toward goals. - The patient will verbalize feelings about the termination of the relationship.

Nonverbal Communication: Touch:

- Touch is a personal behavior and means different things to different people. - Familial, regional, class, and cultural influences largely shape tactile experiences. - Factors such as age and sex also play a key role in meanings associated with touch. - Touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others.

Sequencing Question Or Comment:

- Used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events - Nursing assessment is facilitated when events leading to a problem are placed in sequence - Ex: Patient says, "I don't feel like myself anymore since I've been taking my blood pressure medicine. I'm tired and don't have any energy." Nurse says, "Your tiredness began after you started taking your medicine?"

Factors That Promote Effective Communication: Dispositional Trait:

- Warmth and friendliness: help facilitate helping relationship - Openness and respect: key factor in effective communication, open, accepting, frank, respectful, and without prejudice. - Empathy: sensitive to feeling but remaining objective so you can help achieve positive outcomes - Honesty, authenticity, trust: trusting professional helpers, providing all resources available within their level of expertise - Caring: a way of being a counselor as a nurse - Competence: skilled in all aspects of basic nursing. Evaluating your own strengthens and weaknesses

Level Of Communication: Group: Group Dynamics:

- When determining the effectiveness or ineffectiveness of a group, one studies the group dynamics. Group dynamics involve how individual group members relate to one another during the process of working toward group goals. - Although effective leadership facilitates a group's achievement of its goals, success or failure largely results from members' behavior and associated communication. - Ideally, all group members use their talents and interpersonal strengths to help the group to accomplish its goals. - The group's ability to function at a high level depends on each member's sensitivity to the needs of the group and its individual members. - Effective groups have members who are mutually respectful. - If a group member dominates or thwarts the group process, then the leader or other group members must confront that member to promote the needed collegial relationship.

Open-Ended Questions Or Comments:

- When obtaining nursing history, use this to allow the patient a wide range of possible responses. - Prevents patients from giving a simple "yes" or "no" answer that has the effect of limiting the patient's response. - Ex: Nurse asks "what did your health care provider tell you about your need for this hospitalization?" Patient says, "He told me that my blood pressure is high and that I need some special tests done while I'm here."

Levels Of Communication: Group:

-Small-group -Organizational communication -Group dynamics

Electronic Communication: Emails & Text Messages:

-The risk for violating patient privacy and confidentiality exists any time a message is sent electronically. -Health care agencies usually have security measures in place to safeguard e-mail and text communications.

4 Levels Of Communication:

1. Intrapersonal communication 2. Interpersonal communication Group Communication: Group communication includes small-group and organizational group communication. To determine the effectiveness or ineffectiveness of a group, one studies the group dynamics. 3. Small-group communication 4. Organizational communication

5 Parts Of The Communication Process (BERLO):

1. Stimulus or referent: patient's needs, what needs addressing 2. Sender or source of message (encoder): who begins communication 3. Message itself: speech, verbal, non-verbal, nursing note 4. Medium or channel of communication: might target any of receiver's senses(auditory, visual, kinesthetic)use of interpreter for non-English, touch, hand holding, for an unconscious pt 5. Receiver (decoder): the individual who is getting message, pt receiving d/c instructions from nurse

9. During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply. A) Group decision making B) Group leadership C) Group power D) Group identity E) Group patterns of interaction F) Group cohesiveness

A) Group decision making D) Group identity E) Group patterns of interaction F) Group cohesiveness

10. A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. Based on these nonverbal clues, for which condition would the nurse assess? A) Pain B) Anxiety C) Depression D) Fluid volume deficit

A) Pain

Which activity generally occurs during the orientation phase of the helping relationship? A. An agreement or contract about the relationship is established. B. The nurse provides any assistance needed to achieve patient goals. C. The nurse provides patient counseling and teaching. D. The patient and nurse examine the goals of the helping relationship for indications of attainment.

Answer: A. An agreement or contract about the relationship is established. Rationale: In the orientation phase a contract is made defining the goals of the relationship, frequency, location, length of contacts, and duration of the relationship. The nurse provides assistance needed to achieve patient goals, counseling, and teaching in the working phase. The patient and nurse examine the goals of the helping relationship for indications of attainment in the terminations phase.

A nurse reassuring oneself of being prepared to speak in front of a peer group is using which of the following types of communication? A. Intrapersonal B. Interpersonal C. Group D. Organizational

Answer: A. Intrapersonal

An open-ended question or comment serves to validate what the nurse believes is heard or observed. A. True B. False

Answer: B. False Rationale: A validating question or comment serves to validate what the nurse believes is heard or observed.

Touch is a personal behavior that means the same thing to all persons. A. True B. False

Answer: B. False Rationale: Touch is a personal behavior that means different things to different people.

8. A nurse in the rehabilitation division states to the head nurse: "I need the day off and you didn't give it to me!" The head nurse replies, "Well, I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate." Instead of this exchange, what communication by the nurse would have been more effective? A) "I placed a request to have 8th of August off, but I'm working and I have a doctor's appointment." B) "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?" C) "I will need to call in on the 8th of August because I have a doctor's appointment." D) "Since you didn't give me the 8th of August off, will I need to find someone to work for me?"

B) "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?"

11. A nursing student is preparing to administer morning care to a patient. What is the MOST important question that the nursing student should ask the patient about personal hygiene? A) "Would you prefer a bath or a shower?" B) "May I help you with a bed bath now or later this morning?" C) "I will be giving you your bath. Do you use soap or shower gel?" D) "I prefer a shower in the evening. When would you like your bath?"

B) "May I help you with a bed bath now or later this morning?"

12. A nurse is providing instruction to a patient regarding the procedure to change a colostomy bag. During the teaching session, the patient asks, "What type of foods should I avoid to prevent gas?" The patient's question allows for what type of communication on the nurse's part? A) A closed-ended answer B) Information clarification C) The nurse to give advice D) Assertive behavior

B) Information clarification

Forms Of Communication: Nonverbal

BODY LANGUAGE -Facial expressions, touch, eye contact -Posture, gait, gestures -General physical appearance -Mode of dress and grooming -Sounds, silence -Electronic communication

Electronic Communication: Social Media:

Both the American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) have issued guidelines for RNs regarding use of social media.

15. During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after communicating the nursing care plan. What would be appropriate nurse responses in this situation? Select all that apply. A) Fill the silence with lighter conversation directed at the patient. B) Use the time to perform the care that is needed uninterrupted. C) Discuss the silence with the patient to ascertain its meaning. D) Allow the patient time to think and explore inner thoughts. E) Determine if the patient's culture requires pauses between conversation. F) Arrange for a counselor to help the patient cope with emotional issues.

C) Discuss the silence with the patient to ascertain its meaning. D) Allow the patient time to think and explore inner thoughts. E) Determine if the patient's culture requires pauses between conversation.

7. A nursing student is nervous and concerned about working at a clinical facility. Which action would BEST decrease anxiety and ensure success in the student's provision of patient care? A) Determining the established goals of the institution B) Ensuring that verbal and nonverbal communication is congruent C) Engaging in self-talk to plan the day and decrease fear D) Speaking with fellow colleagues about how they feel

C) Engaging in self-talk to plan the day and decrease fear

4. A nurse enters a patient's room and examines the patient's IV fluids and cardiac monitor. The patient states, "Well, I haven't seen you before. Who are you?" What is the nurse's BEST response? A) "I'm just the IV therapist checking your IV." B) "I've been transferred to this division and will be caring for you." C) "I'm sorry, my name is John Smith and I am your nurse." D) "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."

D) "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."

14. A patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the MOST appropriate comment or question to elicit additional information? A) "Do you take two injections of insulin to decrease the complications?" B) "Most health care providers recommend diet and exercise to regulate blood sugar." C) "Most complications of diabetes are related to neuropathy." D) "What specific complications have you experienced?"

D) "What specific complications have you experienced?"

1. During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. Upon entering the room, what is the nurse's BEST response? A) "You need to speak to the patient quietly so you don't disturb the other patients." B) "Let me help you with your transfer technique." C) "When you are finished, be sure to apologize for your rough demeanor." D) "When your patient is safe and comfortable, meet me at the desk."

D) "When your patient is safe and comfortable, meet me at the desk."

5. A nurse enters the room of a patient with cancer. The patient is crying and states, "I feel so alone." Which response by the nurse is the most therapeutic action? A) The nurse stands at the patient's bedside and states, "I understand how you feel. My mother said the same thing when she was ill." B) The nurse places a hand on the patient's arm and states, "You feel so alone." C) The nurse stands in the patient's room and asks, "Why do you feel so alone? Your wife has been here every day." D) The nurse holds the patient's hand and asks, "What makes you feel so alone?"

D) The nurse holds the patient's hand and asks, "What makes you feel so alone?"

3. A 3-year-old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents? A) The use of reflective questions B) The use of closed questions C) The use of assertive questions D) The use of clarifying questions

D) The use of clarifying questions

Handoff Communication: ISBAR:

Introduction Situation Background Assessment Recommendation

Levels Of Communication: Interpersonal:

Occurs between two or more people with a goal to exchange messages

The Message:

the actual communication product from the source. It might be a speech, interview, conversation, chart, gesture, memorandum, or nursing note

Disruptive Interpersonal Behavior:

•Incivility: Rude, disruptive, intimidating, undesirable behavior directed at another person. Also includes failing to act when action is warranted (such as refusing to assist a coworker/share important information about a patient's care. •Bullying: Occurs when a person is subjected to intimidating behaviors that have a negative effect on them -Horizontal violence: Anger and aggressive behavior between nurses or nurse-to-nurse hostility -Nurse bullying -Negative communication between nurse and physician •Organizational response to disruptive behaviors

Goals Of Orientation Phase:

•The patient will call the nurse by name. •The patient will accurately describe the roles of the participants in the relationship. •The patient and nurse will establish an agreement about: -Goals of the relationship -Location, frequency, and length of the contacts -Duration of the relationship.