Communicating Chapter 26

Nursing Interventions directed towards improving communications in clients with specific needs and obtaining appropriate resources for clients...

-Make sure that assistive devices, glasses, and hearing aids are being used and are in good working order -Make referrals to appropriate resources, such as speech therapy -Make use of communications aids, such as communication boards, computers, or pictures, when possible -Keep environment distractions to a minimum -Speak in short, simple sentences, one subject at a time, reinforce or repeat what is said when necessary -Always face the person when speaking -Include family and friends in conversation -Use reminiscing, either in individual conversations or in groups, to maintain memory connections and to enhance self identity and self esteem in the older adult -When verbal expression and nonverbal expression are incongruent, believe the nonverbal. Clarification of this and attentiveness to their feelings will help promote a feeling of caring and acceptance. -Find out what has been important and has meaning to the person and try to maintain these things as much as possible. Even simple things such as bedtime rituals become important if they are lost in a hospital or extended care setting.

PCA Test (before publishing anything to a web-based social network site)

-Pause and Process -Choices (evaluate the situation and options) -Act accountably (professional conduct)

Some common physical or cognitive problems that necessitate nursing interventions to improve communication skills with OLDER ADULTS...

-Sensory deficits, such as vision and hearing -Cognitive impairment, as in dementia -Neurologic deficits from strokes or other neurologic conditions, such as aphasia and lack of movement -Psychosocial problems, such as depression

Barriers to Communication

-Stereotyping -Agreeing and disagreeing -Being defensive -Challenging -Probing -Testing -Rejecting -Changing topics and subjects -Unwarranted reassurance -Passing judgement -giving common advice

Therapeutic Communication Techniques

-Using silence -Providing general leads -Being specific and tentative -Using open-ended questions -Using touch -Restating or paraphrasing -Seeking clarification -Perception checking or seeking consensual validation -Offering self -Giving Information -Acknowledgement -Clarifying time or sequence -Presenting reality -Focusing -Reflecting -Summarizing and planning

The nurse who uses appropriate therapeutic listening skills will display which behaviors? Select all that apply. 1) Absorb both the content and the feeling the client is conveying 2) Presume and understanding of the client needs. 3) Adopt an open professional posture. 4) React quickly to the message. 5) Reassure the client that everything will be fine.

1) Absorb both the content and the feeling the client is conveying AND 3) Adopt an open professional posture.

The nurse asks the client, "What do you fear most about your surgery tomorrow?" This is an example of which communication techniques? 1) Providing general leads 2) Seeking clarification 3) Presenting reality 4) Summarizing

1) Providing general leads

A nurse tells a client who is struggling with cancer pain, "It is normal to feel frustrated about the discomfort." Which is MOST representative of the skills associated with the working phase of the helping relationship? 1) respect 2) genuineness 3) concreteness 4) confrontation

1) respect

Factors influencing the communication process...

1. Development 2. Gender 3. Values and Perceptions 4. Personal Space 5. Territoriality 6. Roles and Relationships 7.Environment 8. Congruence 9. Interpersonal Attitudes 10. Boundaries

When using VERBAL COMMUNICATIONS, nurses need to consider the following when choosing words to say or write...

1. Pace and Intonation 2. Simplicity 3. Clarity and Brevity 4. Timing and Relevance 5. Adaptability 6. Credibility 7. Humor

Blocks to listening that may prevent the nurse from hearing what the client is saying and hinder therapeutic communication...

1. REHEARSING - being too busy thinking about what you want to say . 2. BEING CONCERNED WITH YOURSELF - the focus should be on the client 3. JUDGING - framing what you hear or see in terms of your judgement about the client as being immature, depressed, etc. 4. IDENTIFYING - focusing on your own similar experiences, feelings, or beliefs. 5. GETTING OFF TRACK - changing the subject if you become uncomfortable, bored, or tired. 6. FILTERING - tuning out or only hearing certain things.

Nonverbal cues a nurse should be observing....

1.Personal Appearance 2. Posture and Gait 3. Facial Expression 4. Gestures

The nurse is communicating with a primary care provider about medical interventions prescribed for a client. Which statement is most representative of a collaborative relationship? 1) "That new medication you prescribed for Mr. Black is ineffective." 2) "I am worried about Mr. Black's blood pressure. It is not decreasing even with the new antihypertensive medication." 3) "Can we talk about Mr. Black?" 4) "Excuse me doctor. I think we need to talk about Mr. Black's blood pressure."

2) "I am worried about Mr. Black's blood pressure. It is not decreasing even with the new antihypertensive medication."

After being admitted for emergency surgery, an 80 year old client has just returned to the room from the PAR (postanestesia room). Which nursing interventions are most likely to facilitate effective communication with this client? Select all that apply. 1) Ask the client, "Do you know where you are?" 2) Ask the client or support person about visual or learning problems. 3) Inform the client and support person about events likely to occur during the next 24 hours. 4) Tell the client, "You will feel better soon."

2) Ask the client or support person about visual or learning problems. AND 3) Inform the client and support person about events likely to occur during the next 24 hours.

A depressed client who has not bathed or dressed in clean clothes today is reading the lunch menu but is unable to make a decision. Which would be the MOST appropriate nursing diagnosis for this client? 1) Anxiety 2) Powerlessness 3) Chronic Low Self-Esteem 4) Social Isolation

2) Powerlessness

The nurse is communicating with a well-oriented older adult in a long-term care setting. Which statement best reflects respectful and caring communication? 1) "Are we ready for our shower?" 2) "It's time to go to the dining room, honey." 3) "Are you comfortable, Mrs. Smith?" 4) "You would rather wear the slacks, wouldn't you?"

3) "Are you comfortable, Mrs. Smith?"

Place the following descriptions of the helping relationship phases in the correct sequence. 1) After introductions, the nurse asks, "What plans do you have for the upcoming holiday weekend?" 2) The nurse states, "It sounds like you are concerned about the possible complications of having diabetes. What would be the most helpful for you at this time?" 3)The nurse reads in the medical history that the client was diagnosed with diabetes 1 week ago. 4) The nurse states, "When we met, you knew very little about diabetes and now you are able to use your new information and apply it to your own personal situations."

3)The nurse reads in the medical history that the client was diagnosed with diabetes 1 week ago. 1) After introductions, the nurse asks, "What plans do you have for the upcoming holiday weekend?" 2) The nurse states, "It sounds like you are concerned about the possible complications of having diabetes. What would be the most helpful for you at this time?" 4) The nurse states, "When we met, you knew very little about diabetes and now you are able to use your new information and apply it to your own personal situations."

The client made the following statement to the nurse, "My doctor just told me that he cannot save my leg and that I need to have an above the knee amputation." Which response by the nurse is most appropriate? 1) "Dr. Jones is an excellent surgeon." 2) "Are you in pain?" 3) "If I were you, I'd get a second option." 4) "Tell me more..."

4) "Tell me more..."

Sender (First component in Communication Process)

A person or group who wishes to communicate a message to another (can be considered the source-encoder).

Toddlers and Preschoolers

Allow time for them to complete verbalizing their thoughts without interruptions.

A student nurse is caring for a 72 year old client with Alzheimer's disease who is very confused. Which is the MOST appropriate communication strategy to be used by the student nurse? A) Written directions for bathing B) Speaking very loudly C) Gentle touch while providing ADLs D) Flat facial expression

C) Gentle touch while providing ADLs : Nonverbal, gentle touch is an important tool; overstimulation may affect the client in a negative way.

MOST important criterion of effective communication

Credibility

Toddler and Preschoolers

Drawing a picture can provide another way for the child communicate.

Facial Expression (Nonverbal Communication)

Feelings of surprise, fear, anger, disgust, happiness, and sadness can be conveyed by facial expressions. Nurses need to be aware of their own expressions and what they are communicating to others.

Toddlers and Preschoolers

Gain skills in both expressive (telling others what they think, feel, want, care about) and receptive (hearing and understanding what others are communicating to them) language.

School-Age Children

Include the child in the conversation when communicating with the parents.

The majority of communication used is

Nonverbal

Working Phase

Nurse and client begin to view each other as unique individuals and begin to appreciate this uniqueness and care about each other.

Preinteraction Phase

Nurse has information about the client before the first face-to-face meeting. (Similar to the planning stage before an interview)

Nurse can identify the progress of a relationship by understanding these 4 phases.

Preinteraction Phase Introductory Phase Working Phase Termination Phase

Adolescents

Project a nonjudgemental attitude and nonreactive behaviors, even when they make disturbing remarks.

Toddlers and Preschoolers

Provide a simple response to questions because they have short attention spans.

Guidelines for Visibly Tuning in to Clients (SOLER)

S: Face the other squarely. O: Adopt an open posture. L: Lean toward the person. E: Maintain good eye contact. R: Try to be relatively relaxed or natural.

Communication Process

Sender, a message, a receiver, and a response or feedback

Introductory Phase (Orientation/Prehelping Phase)

Sets the tone for for the rest of the relationship. Client and nurse closely observe each other and form judgements about the other's behavior. (Nurse should develop trust and security within the nurse-client relationship)

Termination Phase

Summarizing or reviewing the process can produce a sense of accomplishment. Follow up phone calls or e-mails are other interventions that ease the client's transition to independence.

Adolescents

Take time to build rapport with them.

School-Age Children

Talk to the child at his/her eye level to help decrease intimidation.

Pace and Intonation

The manner of speech, as in the rate or rhythm and tone, will modify the feeling and impact of a message. (Verbal Communication)

Posture and Gait (Nonverbal Communication)

The way people walk and carry themselves are often reliable indicators of self-concept, current mood, and health.

Timing and Relevance

Timing needs to be appropriate to ensure that words are heard. (Verbal Communication)

Decode

To relate the message perceived to the receiver's storehouse of knowledge and experience and to sort out the meaning of the message.

Adolescents

Use active listening skills.

Feedback can be either _______ , _______ or _______.

Verbal, Nonverbal, or Both

Territoriality

a concept of the space and things that an individual considers as belonging to the self.

A nurse should _______ both relevance and timing when communicating with clients.

access

Adaptability

alter spoken messages in accordance with behavioral cues from the client. (Verbal Communication)

Humor

can be a positive and powerful tool BUT must be used with care. (Verbal Communication)

Infants

communicate nonverbally, often in response to body feelings rather than in a conscious effort to be expressive.

Encoding

involves the selection of specific signs or symbols (codes) to transmit the message, such as which language and words to use , how to arrange the words, and what tone of voice and gestures to use.

Elderspeak

is a speech style similar to baby talk that gives the message of dependence an incompetence and is seen as patronizing by older adults. It does not communicate respect.

Communication

is any means exchanging information or feelings between two or more people. Basic component of human relationships.

Intrapersonal Communication

is the communication that you have with yourself; another name is self-talk.

Visibly Tuning In

key nonverbal skill which is an expression of empathy that tells "clients that you are with them, and it puts you in a position to listen carefully to their concerns".

Attentive Listening

listening actively and with mindfulness, using all the senses, and paying attention to what the client says, does, and feels as opposed to listening passively with just the ear.

Personal Appearence (Nonverbal Communication)

may convey social and financial status, culture, religion, group association, and self-concept. How a person dresses is often an indicator of how that person feels.

Clarity and Brevity

message that is direct and simple will be effective. Clarity is saying precisely what is meant, and brevity is using the fewest words necessary. (Verbal Communication)

Nonverbal Communication

often tells others more about what a person is feeling that what is actually being said because this behavior is controlled less consciously.

Infants

perceptions are related to sensory stimuli, so gentle voice is soothing.

Therapeutic Communication

promotes understanding and can help establish a constructive relationship between the nurse and the client. It is client and goal directed.

The intent of any communication is to obtain a ________.

response

Receiver (Third component in Communication Process)

the listener, who must listen, observe, and attend. The decoder, who must perceive what the sender intended.

Response (Fourth component in Communication Process)

the message that the receiver returns to the sender. (also referred to as feedback)

Simplicity

use of commonly understood words, brevity, and completeness. (Verbal Communication)

Nonverbal Communication

uses gestures or facial expressions, and touch.

Verbal Communication

uses the spoken or written word.

Message (Second component in Communication Process)

what is actually said or written, the body language that accompanies the words, and how the message is transmitted.

Credibility

worthiness of belief, trustworthiness, and reliability. (Verbal Communication)