EKD-NRSG 2200 Unit 3 communication

Working Phase

nurse and patient work together to meet the patient's needs. Interaction is the essence of the working phase. The nursing roles of teacher and counselor are performed during this phase mostly.

Assessment

Collect, organize, and validate data

Potential errors in decision making

Bias, failure to consider the total situation, impatience

Triage priorities

1. Emergent Care 2. Urgent Care 3. Maintenance Care

Touch

A personal behavior and means different things to different people. Factors like age, gender, family experiences, culture, religion, class, etc play a role in how a person feels about touch. Touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, and excitement.

Listening

A skill that involves both hearing and interpreting what another person says. It requires attention and concentration to sort out, evaluate, and validate clues to better understand what is being said

What is Confidential

All information about patients written on paper, spoken aloud, or saved on the computer Name, address, phone number, social security number, reason the person is sick, treatments, past medical history

Clarifying question or comment

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

Open-ended question or comment

Allows the patient a wide range of possible responses. It allows patients to express what they understand to be true, yet is specific enough to prevent digressing from the issue at hand. It encourages free verbalization. It prevents a simple yes or no answer. Nurse: What did your physician tell you about your need for this hospitalization? Patient: He told me that my blood pressure is dangerously high and that I need some special tests done while I am here.

Verbal communication

An exchange of information using words

Humor

An important interpersonal skill for the nurse and a healing strategy for patients. Nurses can use humor to maintain a balanced perspective in their work and to encourage patients to do the same.

Diagnosis

Analyze data, identify problems, formulate nursing diagnosis

Major components of problem-oriented medical records

Defined database, problem list, care plans, progress notes, SOAP format

Factors Influencing Communication

Developmental level, gender, sociocultural differences, roles and responsibilities, space and territoriality, physical/mental/emotional state, values, environment

Evaluate

Did it work

The nursing process is interrelated, what does that mean?

Each step depends on the accuracy of the preceding steps.

Non-verbal communication

Exchange of information without the use of words

Examples of Nonverbal

Facial expression, touch, eye contact, posture, gait, gestures, physical appearance, silence

Blocks to Communication

Failure to perceive the patient as a human being Failure to listen Nontherapeutic questions/comments Using cliches Using closed questions Using how and why questions Using questions that probe for info 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

Tell whether the following statement is true or false. An open-ended question or comment serves to validate what the nurse believes is heard or observed.

False

Tell whether the following statement is true or false. Touch is a personal behavior that means the same thing to all persons.

False

Telephone/Telemedicine Reports

Identify yourself and the patient, and state your relationship to the patient Report concisely and accurately the change in the patient's condition and what has already been done in response to this condition Report the patient's current vital signs and clinical manifestation Have the patient's record at hand to make knowledgeable responses to physician's inquiries Concisely record time and date of the call, what was communicated, and the physician's response

Empathizing

Intellectually identifying with the way another person feels

Clinical Decision Making

Interpretation or conclusion about a patient's needs, concerns, or health problems, and/or the decision to take action (or not), use or modify standard approaches, or improvise new ones as deemed appropriate by the patient's response

Implement

Intervene and document progress

Aggressive Behavior

Involves asserting one's rights in a negative manner that violates the rights of others. It is marked by tension and anger.

Reflective question or comment

Involves repeating what the person has said or describing the person's feelings. It encourages them to elaborate. Patient: I've been really upset about my blood pressure and have to take these pills. Nurse: You've been upset... Patient: I guess I'm worried about what could happen if my blood pressure gets too bad.

Benner's Skills Acquisition

Moving from not having nursing experiences to relate to, to having concrete clinical experiences to relate to new situations requiring critical thinking

Interviewing Techniques

Open-ended, closed, validating, clarifying, reflective, sequencing, directing questions/comments

Benefits of Nursing Process for the Nurse

Opportunity to work collaboratively with other health care workers Satisfaction of making a difference in the lives of patients Opportunity to grow professionally

Phases of the helping relationship

Orientation, Working, Termination

Silence

Periods of time where no verbal communication is occurring. It is important to pay attention to nonverbal messages. Silence can indicate complete understanding, that both people are thinking, or that they are angry with each other.

Plan

Prioritize problems, formulate goals, write nursing interventions

Closed question or comment

Provides the receiver with limited choices of possible responses and is usually a yes or no answer. Closed questions are usually used to get specific information. Nurse: What medicines have you been taking at home? Patient: Let me see, my doctor gave me a water pill and a blood pressure pill to take every day.

Duties of RN receiving telephone order

Record the orders in patient's medical record Read orders back to verify accuracy Note date/time orders were issued Record telephone orders and the full name and title of the physician or NP who issued the orders Sign the orders with name and title

Benefits of Nursing Process for the Patient

Scientifically based, holistic individualized patient care Continuity of care Clear, efficient, cost-effective plan of action

Validating question or comment

Serves to validate what the nurse believes he/she heard or observed. Nurse: At home, you have been taking both a water pill and a blood pressure pill every day. Did you take them today? Patient: Yes, I took one of each with my breakfast.

Examples of communication tools used between team members

Shift report, telephone order, team care conference, SBAR

Methods of Documentation

Source-oriented records Problem-oriented medical records PIE charting (problem, intervention, evaluation) Focus charting Charting by exception Case management model Computerized documentation/electronic health record (EHR)

Assertive Behavior

The ability to stand up for yourself and others using open, honest, and direct communication.

How does a "nursing care plan" differ from "the nursing process"?

The nursing process is used to create a nursing care plan. The care plan is written down or documented in a charting system.

Common behaviors, attitudes, and characteristics of critical thinkers

They are guided by standards/policies/procedures/ethics, based on nursing process, identifies key problems, is driven by patient and family to give efficient care, calls for strategies that make the most of human potential and compensate for problems, find ways to prevent errors, use technology, re-evaluating, self-correcting, and striving to improve.

Tell whether the following statement is true or false. A nurse who fails to log off a computer after documenting patient care has breached patient confidentiality.

True

Directing question or comment

Used to obtain more info about a topic brought up earlier in the conversation. Nurse: You mentioned your dad earlier. Did he develop complications related to high blood pressure? Patient: Yes Nurse: What sort of complications? Patient: Kidney failure. He was on dialysis for years before getting a transplant. Nurse: Are you afraid this might happen to you?

Sequencing question or comment

Used to place events in a chronologic order or to investigate a cause and effect relationship. Patient: I don't feel like myself anymore since I've been taking my blood pressure medication. I'm tired and don't have any energy. Nurse: Your tiredness began after you started taking your medicine?

Forms of Communication

Verbal and Nonverbal

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.

a. An agreement or contract about the relationship is established.

Which step of the nursing process is a nurse using when analyzing patient data to determine a patient's strengths following a CVA? a. Assessing b. Diagnosing c. Planning d. Implementing e. Evaluating

b. Diagnosing

The mother of a toddler is deciding if she wants to allow her child to receive the recommended immunizations. The clinic nurse responds, "If you don't immunize your child you are jeopardizing the health of other children." What type of approach does this response indicate? a. advocacy or enforcing rights b. guilt inducement or approval/disapproval c. authoritarian or belittling d. dictatorial or bossing

b. guilt inducement or approval/disapproval

Collaborative/Critical Pathway

case management plan that is a detailed, standardized plan of care developed for a patient population with a designated diagnosis or procedure; it includes expected outcomes, a list of interventions to be performed, and the sequence and timing of those interventions.

Termination Phase

conclusion whether it is at shift change or the patient is discharged. Examine the goals and evaluate whether they were met.

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview, the client states, "I don't know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening? a. "Don't worry, I am sure your physician knows what he is doing." b. "I agree. If I were you, I would get a second opinion before the surgery." c. "I can see this interview is making you uncomfortable. We can continue later." d. "You seem unsure. Tell me your concerns about your surgery."

d. "You seem unsure. Tell me your concerns about your surgery."

A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse? a. "There are many good medications to decrease the pain; it will not be so bad." b. "Don't worry about labor, I have been through it and it is not so bad." c. "I would recommend keeping a positive attitude." d. "You're worried about how you will tolerate the pain associated with labor."

d. "You're worried about how you will tolerate the pain associated with labor."

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response? a. Stand and say, "I can see this interview is making you uncomfortable, so we can continue later." b. Nod and say, "I agree. If I were you, I would get a new doctor." c. Smile and say, "Don't worry, I am sure the physician is doing a good job." d. Be silent and allow the client to continue speaking when ready.

d. Be silent and allow the client to continue speaking when ready.

A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established? a. Working phase b. All of the above c. Termination phase d. Orientation phase

d. Orientation phase

The nursing instructor is discussing communication with a student. The student identifies that a contract is made with the client during which phase of the nurse-client relationship? a. Intimate phase b. Working phase c. Termination phase d. Orientation phase

d. Orientation phase

The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important? a. Ensure that family members are present. b. Have the interpreter write out all of the information listed in the unit brochure. c. Give all of the discharge instructions at once. d. Speak directly to the client.

d. Speak directly to the client.

A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to: a. pick a team leader who is not the dominant member. b. plan a meeting where the dominant person cannot attend. c. have group members issue a written warning to the dominant member. d. have group members confront the dominant member to promote the needed team work.

d. have group members confront the dominant member to promote the needed team work.

A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by: a. softly humming a song near the neonate. b. offering the neonate infant formula. c. staring into the neonate's eyes and smiling. d. swaddling the child and gently stroking its head.

d. swaddling the child and gently stroking its head.

Orientation Phase

roles are clarified, agreement about relationship is established, goals are set, patient is oriented to the facility, its services, routines, and any info that will decrease anxiety.