Chapter 8 - Communication

assertive behavior

ability to stand up for oneself and others using open, honest, and direct communication

A nurse finds that a client has infiltration around the IV line that needs to be removed. What explanation should the nurse give to reduce the client's anxiety?

"I know that you are anxious, but removal will be painless and the IV location needs to be changed."

A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?

"I think there is a better way to handle this."

A nurse is caring for a client experiencing biliary colic from uncomplicated cholelithiasis. The client asks, "My doctor says I should have surgery to remove my gallbladder. Do you think it is really necessary?" What is the nurse's best response?

"Share with me the advantages and disadvantages of your options as you see them."

A client is scheduled for thoracentesis. The nurse assesses that the client appears anxious about the procedure and needs honest support and reassurance. What is the most appropriate response by the nurse to this client?

"The needle causes discomfort or pain when it goes in, but I will be by your side throughout and will help you hold your position."

A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:

"Were you tired and depressed before starting the new medication?"

A 70-year-old female client had a cholecystectomy four days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask the client in order to assess the her orientation?

"What day of the week is it?"

A nurse is assessing a client's nutritional intake prior to admission based upon information that indicates the client has lost 10 lb (4.5 kg) over the last 2 months. Which therapeutic communication technique is appropriate to gain information?

"What factors have contributed to your weight loss over the last few months?"

-9kThe client is being discharged, and the nurse observes the client crying. What is the nurse's most appropriate response?

"Would you like to talk about anything before you go home?"

empathy

(1) objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting oneself in another person's circumstances and imagining what it would be like to share that person's feelings; (2) intellectually identifying with the way another person feels

The nurse is obtaining vital signs for a client and assesses a heart rate of 124 beats per minute. What additional assessment information would be important to obtain that would explain the tachycardia? Select all that apply

*The client has a temperature of 101.8°F (38.8°C) *The client just finished ambulating with physical therapy * The client has reports of pain of 8 on a scale of 0 to 10

Levels of Communication

- intrapersonal - interpersonal -Group

Intimate zone

0-18 inches

NANDA-I nursing Diagnosis for communication

1- impaired non-verbal communication 2- readiness for enhanced communication

ANA's Principles for Social Networking

1. not transmit or place online individually identifiable pt. information 2. must observe ethical prescribed professional pt. - nurse boundaries 3. understand the pts, colleagues, institutions, employers may view these postings 4. take advantage of personal settings and seek to separate personal and professional info online 5. bring content that could harm a pt's privacy, rights, or welfare to the attention of authorities 6. participate in developing institutional policies governing online conduct

Public Zone

12 feet or more

Personal zone

18 inches to 4 feet - friends of family

Social Zone

4-12 feet

3 ways to send a message

Auditory Visual Kinesthetic

A nurse is assessing the respirations of a 60-year-old female client and finds that the client's breaths are so shallow that the respirations cannot be counted. What would be the appropriate initial nursing intervention in this situation?

Auscultate the lung sounds and count respirations.

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?

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

therapeutic communication skills

Conversation skills, listening skills, silence, humor, touch.

Impaired verbal communication

Decreased, delayed, or absent ability to receive, process, transmit, and/or use a system of symbols

define working phase

During the working phase, the nurse and client explore and develop solutions that are enacted and evaluated in subsequent interactions.

Blocks to communication

False reassurance Giving advice False assumptions Defensiveness Arguing Asking for explanations Changing the subject

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?

Have you ever considered laser surgery

The nurse is preparing to assess the peripheral pulse of an adult client. Which action is correct?

Lightly compress the client's radial artery using the first, second, and third fingers.

electronic communication

Methods of communication via digital methods such as fax, email, voicemail, or by computer

interviewing 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

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?

Orientation phase

Phases of helping relationship

Orientation phase Working phase Termination phase

SBAR

Situation Background Assessment Recommendation

Rapport builders

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

A nurse has been caring for a client who suffered a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how he feels. Which scenario warrants further investigation?

The client stares at the floor and states, "I feel fine."

The student nurse is having difficulty feeling the pedal pulse of the client with a fractured leg. What should the nurse do next?

Use the Doppler ultrasound device.

A nurse needs to complete an assessment and vital signs on a client who has Alzheimer disease. How should the nurse approach this client to gain cooperation? Select all that apply.

Use the client's name. Smile and maintain eye contact. Approach the client from the front.

A nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:

allow the client to set the pace.

A nurse suspects that a client may have a hearing problem. The nurse should attempt to consult:

an audiologist.

horizontal violence

anger and aggressive behavior between nurses or nurse-to-nurse hostility

A client arrives at the emergency department after experiencing several black, tarry stools. The nurse will develop a cause and effect by:

asking the client if he or she has recently taken ferrous sulfate (iron) or bismuth subsalicylate.

How should you respond to disruptive behaviors

assertively and address the issue directly with those involved

During an assessment of a newly admitted client the nurse asks the client many questions. The nurse begins the assessment by asking, "How many times have you been hospitalized this year for your back pain?" This is an example of which type of question?

closed ended question

interpersonal communication

communication between two people

A nurse touches the client's hand while discussing his diagnosis. This action is a(an):

communication channel.

small group communication

communication occurring within small groups of three or more people

CUS (communication tool)

communication tool to assist in effective communication related to patient safety concerns; the acronym CUS stands for I'm Concerned, Uncomfortable, Safety issue

intrapersonal conflict

conflict that occurs within an individual

How are goals of a helping relationship determined?

cooperatively and are defined in terms of the patient's needs

Which quality in a nurse help the nurse to become effective in providing for a client's needs while remaining compassionately detached?

empathy

The nurse is visiting a hospice client in his home. He is explaining the difficulties he is having with his home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is utilizing which therapeutic nurse-client communication technique?

encouraging elaboration

What factors affect communication

environment (noise), developmental variations, gender, personal space, territoriality, sociocultural factors, roles and relationships

The nurse is beginning an assessment on a nonverbal client. The nurse must first:

establish eye contact prior to assessing, touching, and interacting with the client.

The client is an 18-month-old in the pediatric intensive care unit. He is scheduled to have a subgaleal shunt placed tomorrow, and his mother is quite nervous about the procedure. The nurse feels for the mother and tells her that the surgeon "has done this a million times. Your son will be fine." This is an example of what type of nontherapeutic communication?

false reassurance

rapport

feeling of mutual trust experienced by people in a satisfactory relationship

helping relationship

interaction that sets the climate of movement of the participants toward common goals

The nurse observing an interaction between a mother and her daughter appropriately identifies the interaction as which communication zone?

intimate

Receiver (decoder)

must translate and interpret the message sent and received

bullying

negative, often repetitive, disruptive behavior; also referred to as horizontal violence, lateral violence, and professional incivility

body language

nonverbal communication through gestures, facial expressions, behaviors, and posture

termination phase

occurs at the end of a relationship

organizational communication

process of communication that involves individuals and groups to achieve established goals

An experienced nurse has been working with a client with heart failure. The client's lungs were clear to auscultation during the morning assessment; however, the afternoon assessment revealed bibasilar crackles and tachypnea. The nurse calls to give SBAR report to the covering health care provider. In the final step of the report the nurse should:

recommend 40 mg of furosemide be administered because the client had improvement with past administration.

social relationships

relationships in which the specific people in a given role can be changed and the relationship would still occur

incivility

rude, intimidating, and undesirable behavior directed at another person

A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should:

sit at the bedside and allow the client to explain the statement.

aggressive behavior

standing up for one's rights in a negative manner that violates the rights of others

cliche

stereotyped expression

group dynamic

study of a group's characteristics and ways of functioning

semantics

study of the meaning of words

A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because she has not performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should:

tell herself to "remain calm" and remember that she was trained to perform this skill.

channel

term used in communication theory to denote the medium selected to convey the message; the channel may target any of the receiver's senses

orientation phase

the first phase of group interaction, in which members become adjusted to one another and to the group's task

A nurse is caring for an adult with fever. The nurse determines that which site is most ideal for obtaining the client's core body temperature?

the rectum

channel of communication

the way the message is delivered - whether face-to-face, in writing, on film, or in some other way

A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?

the working phase

2 types of feedback

verbal and nonverbal

working phase

when the nurse and the patient work together to solve problems and accomplish goals

Forms of Communication

•Verbal (language) •Nonverbal (body language) -Facial expressions, touch, eye contact -Posture, gait, gestures -General physical appearance -Mode of dress and grooming -Sounds, silence -Electronic communication