Ch. 24 Communication

The nurse demonstrates active listening by: A) Agreeing with the client B) Repeating everything the client says to clarify C) Assuming a relaxed posture and leaning toward the client D) Smiling and nodding continuously throughout the interview

Assuming a relaxed posture and leaning toward the client

"Forbidden Phrases"

"You should..." "Why...?" "If it were me, I'd ..." "Don't worry..." "Why don't you ..."

PHASES OF THE HELPING RELATIONSHIP

1.Pre-interaction phase - planning 2.Orientation phase ◦Introduction & purpose ◦Climate SOLER ◦Discuss time frame for relationship 3.Working phase ◦Implement communication techniques 4.Termination phase ◦Summarize ◦Closure

Your patient has just been told that she has cancer, and she is crying. Which actions facilitate therapeutic communication? Select all that apply 1. Turning on the TV to her favorite show 2. Pulling the curtain to provide privacy 3. Offering to discuss information about her condition. 4. Asking her why she is crying 5. Sit quietly by her bed and hold her hand

2. Pulling the curtain to provide privacy 3. Offering to discuss information about her condition. 5. Sit quietly by her bed and hold her hand

Communication and Nursing Practice

A lifelong learning process for nurses An essential attribute of professional nursing practice Builds relationships with: ◦ clients ◦ families ◦ multidisciplinary team members

If the nurse is working with a client who has expressive aphasia, it would be most helpful for the nurse to: A) Ask open-ended questions. B) Speak loudly and use simple sentences. C) Allow extra time for the client to respond. D) Encourage a family member to answer for the client.

Allow extra time for the client to respond.

THERAPEUTIC COMMUNICATION TECHNIQUES part 1

Active Listening = SOLER ◦Sit facing client ◦Open posture ◦Lean toward client ◦Establish & maintain eye contact ◦Relax

Which of the following statements by the nurse would be non-therapeutic and tend to block communication? (Select all that apply.) A) "You look sad today." B) "Why are you so nervous?" C) "If I were you, I'd have the surgery." D) "I'm sure the test results will come out fine." E) "Tell me what it's like to live with dizziness."

B) "Why are you so nervous?" C) "If I were you, I'd have the surgery." D) "I'm sure the test results will come out fine."

The nurse tells the client, "I'm not sure I understand what you mean by 'sicker than usual.' What is different now?" The nurse is using the therapeutic technique of: A) Focusing B) Clarifying C) Paraphrasing D) Providing information

Clarifying

NON-VERBAL COMMUNICATION

Includes all 5 senses & everything that does NOT involve spoken or written word Researchers indicate meaning transmitted by: ◦7% from words ◦38% from vocal cues ◦55% body cues A nurse's nonverbal communication may be more important than his/her verbal communication.

ZONES OF PERSONAL SPACE

Intimate Zone: 0-18 inches: Personal zone: 18 inches - 4 feet Social zone: 4 - 12 feet Public Zone: ≥ 12 feet

THERAPEUTIC COMMUNICATION TECHNIQUES part 2

Sharing Observations ◦"You look tired...," "you seem different today..." or "I see you haven't eaten anything" Sharing Empathy (not sympathy) ◦"It must be very frustrating to know what you want & not be able to do it." Sharing Hope ◦"I believe you will find a way to face your situation, because I have seen your courage and creativity in the past." Using Touch- Gentle but firm, Comforting, non-threatening Using Silence- prompts people to talk, ◦Allows time to think Paraphrasing or restating ◦Client-"I've been overweight all my life and never had any problems." ◦Nurse-"You're not convinced that you need to be on a diet because you've stayed healthy." Asking Relevant Questions (Open -ended questions/General leads) ◦"How has pain affected your life at home." ◦"tell me about ......" Summarizing ◦Brings closure & clarifies expectations & a good beginning of next interaction ◦"During the past hour we have talked about ......."

ZONES OF TOUCH

Social- (permission not needed) Consent- (permission needed) Vulnerable- (special care needed) Intimate- (great sensitivity needed)

Modes of Communication

Verbal ◦Uses spoken or written word Nonverbal ◦Uses gestures, facial expressions, touch, and other forms ◦Makes up majority of communication Electronic ◦E-mail

CULTURAL CONSIDERATIONS

◦Eye contact ◦Personal space ◦Gestures ◦Loudness of voice ◦Pace of speech ◦Touch ◦Silence ◦Meanings of language

Zone of touch - Vulnerable (special care needed)

◦Face, neck, front of body

Zone of touch - Intimate (great sensitivity needed)

◦Genitalia, rectum

Zone of touch - Social (permission not needed)

◦Hands, arms, shoulders, back

Intimate Zone: 0-18 inches:

◦Holding a crying infant ◦Performing a physical assessment

Zone of touch - Consent (permission needed)

◦Mouth, wrist, feet

Social zone: 4 - 12 feet

◦Rounds with Dr ◦Conference table discussion

Personal zone: 18 inches - 4 feet

◦Sitting at a client's bedside ◦Taking a client's nursing history

Public Zone: ≥ 12 feet

◦Speaking/lecturing to large group

VERBAL COMMUNICATION

◦Vocabulary ◦Denotative and connotative meaning ◦Pacing ◦Intonation ◦Clarity and brevity ◦Timing and relevance

Developing communication skills requires understanding of :

◦the communication process ◦ one's own communication experience.