Communication

Patients Who are Cognitively Impaired

Establish and maintain eye contact with the patient to hold attention. Communicate important information in a quiet environment where there is little to distract the patient's attention. Keep communication simple and concrete. Break down instructions into simple tasks and avoid lengthy explanations. Do not use pronouns or abstract terms. Use pictures or drawings when appropriate. Whenever possible, avoid open-ended questions. Ask "Would you like to wear the brown pants or the gray pants?" instead of "What would you like to wear?" Be patient and give the patient time to respond. If the patient does not respond after 2 minutes, repeat what you said. If there is still no response, take a break before continuing the conversation so that neither you nor the patient becomes frustrated.

rapport

feeling of mutual trust experienced by people in a satisfactory relationship

The client is talking to the nurse about recent health problems of immediate family members and the strain the client has been under trying to care for them. The client begins to cry. What response by the nurse demonstrates the most empathy?

"Just take your time. I am listening."

intimate zone

0-18"

public zone

12 feet or more

personal zone

18 inches to 4 feet

social zone

4-12 feet

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?

Cliché

A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process?

The nurse maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete.

assertive behavior

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

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:

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

Patients Who are Visually Impaired

Acknowledge your presence in the patient's room. Identify yourself by name. Remember that the visually impaired patient will be unable to pick up most nonverbal cues during communication. Speak in a normal tone of voice. Explain the reason for touching the patient before doing so. Indicate to the patient when the conversation has ended and when you are leaving the room. Keep a call light or bell within easy reach of the patient. Orient the patient to the sounds in the environment and to the arrangement of the room and its furnishings. Be sure the patient's eyeglasses are clean and intact or that contacts are in place.

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 D E

Patients Who are Hearing Impaired

Orient the patient to your presence before initiating conversation. This may be done by gently touching the patient or moving so that you can be seen. Talk directly to the patient while facing him or her. If the patient is able to lip read, use simple sentences and speak in a quiet, natural manner and pace. Be aware of nonverbal communication. Do not chew gum or cover your mouth when talking with the patient. Demonstrate or pantomime ideas you wish to express, as appropriate. Use sign language or finger spelling, as appropriate. Write any ideas that you cannot convey to the patient in another manner. Be sure that hearing aids are clean, functioning, and inserted properly.