Nursing Process Chapter 20: Communication

Touch

A powerful means of communication with multiple meanings. It can connect people, provide affirmation, reassurance, and stimulation, decreases loneliness, increase self-esteem, and share warmth, intimacy, approval, and emotional support. It can also communicate frustration, anger, aggression, and punishment, and invade personal space and privacy.

Changing the subject

A quick way to stop the conversation. The patient might be at a point of readiness to discuss something and will likely feel frustrated if put off by changing the topic of conversation. For example Patient: when can I expect to be told about my insulin? Nurse: let's discuss your diet now so that you will know what to eat when you get home. We can discuss your insulin some other time.

Listening skills

A skill that involves both hearing and interpreting what the other says. It requires attention and concentration to sort out, evaluate, and validate clues to better understand the true meaning of what is being said.

Cliche

A stereotype, trite, or Pat answer. Most healthcare clichés should just that there is no cause for anxiety or concern, or they offer a false assurance. Patients tend to interpret them as a lack of interest anyway that they have said.

Documenting communication

Continual assessment of the patients needs and conditions requires accurate documentation and appropriate place. It helps promote the continuity of care given by nurses and other healthcare providers. Because one nurse cannot provide 24 average coverage for patients, information must be passed on to others through nursing progress notes and care plans.

Incivility

Rude, intimidating, and undesirable behavior directed at another person. This behavior is recognized as a major concern among healthcare workers. It is considered by some as a precursor to bullying behavior or lateral violence and by others as a form of bullying.

Validating question or comment

Serves to validate what the nurse believes he or she has heard or observed. Might lead the patient to think the nurse is not listening.

SBAR

Stands for S situation, B background, A assessment, and R recommendations. Provides a consistent method for hand off communication that is clear, structure, and easy to use. This technique was originally developed by the U.S. Navy to accurately transmit critical information and initially adapted by Kaiser Permanente of Colorado to facilitate nurse and physician communication. The (s) situation, and B (background) provide objective data, where as the A (assessment) and R (recommendations) allow for presentation of subjective information. The SBAR format is widely used in and healthcare and can be modified to meet the specific situations related to shift reports, conversations with physicians, and transfers of patients. Using SBAR or another hand off tool enables nurses to communicate in a collegial, collaborative manner with a focus on patient safety.

Using leading questions

Suggest what response the speaker wishes to hear. Tend to produce answers that might please the nurse but are unlikely to encourage the patient to respond honestly without feeling intimidated. Example, nurse: you aren't going to smoke that cigarette, are you? Or you have been well cared for by your nurses, haven't you?

Using questions requiring only a yes or no answer

Tend to cut off discussion even when the person might wish to continue.

Using judgmental comments

Tend to impose the nurses standards on the patient. example: Nurse: you aren't acting very grown up. How do you think your husband would feel if he saw you crying like this? The nurse judges the patient as being immature, and the nurses apparent hostility could and effective communication. A better comment in the situation might be as follows: Nurse: I would like to help. Tell me, what is making you cry?

Assertive behavior

The ability to stand up for oneself and others using open, honest, and direct communication. The focus is on the issue and not the person. Are very different from aggressive behaviors.

The message.

The actual communication product from the source. It might be a speech, interview, conversation, chart, gesture, memorandum, or nursing note

Electronic communication

The challenges of using social media include protecting the patient privacy and confidentiality and preventing unintended consequences for the employer or the nurse.

Facial expressions

The face is the most expressive part of the body. Examples of the various messages sent are anger, joy, suspicion, sadness, fear, and contempt.

Assessing

The major focus of assessment is to gather information in both verbal and nonverbal communication forms. Before the assessment, the nurse should determine if the patient needs any assistive devices in order to communicate effectively and understand conversations. Identify the patients preferred language and secure an interpreter if one is needed. It is also the appropriate time to a certain from the patient if there are any additional challenges such as understanding healthcare information and participating in treatment. The data collected verbally and nonverbally are analyzed and then pass onto the appropriate people through oral and written communication.

The channel of communication

The medium the sender have selected to send the message. The message can be sent to their receiver through the following 1. Auditory-spoken words and cues 2. Visual-sight, observation, and perception 3. Kinesthetic-Touch

Silence

The nurse can use this to appropriately wait for the patient to initiate or continue speaking. During these periods, reflect on what has already been shared and observe the patient without having to concentrate simultaneously on the spoken word.

Diagnosing

The nurse communicates findings to other nursing professionals through the use of the written and spoken word. The written diagnosis becomes a permanent part of the patient's record.

A nurse enters the room of a patient with cancer. The patient is crying and states "I feel so alone." Which statement is the most therapeutic?

The nurse holds the patient's hand and asks, "what makes you feel so alone?"

Implementing

The patient's verbal and nonverbal messages are assessed during each nurse patient interaction. The implementation of the plan of care is then documented in the patient's record.

Outcome identification and planning

The planning step requires communication among the patient, nurse, and other team members as mutually agreed upon outcomes are developed and interventions are determined.

Communication

The process of exchanging information and generating and transmitting meanings between two or more people. It is the foundation of society and the most primary aspect of a nurse patient interaction. Without this, it will be impossible to share family experiences, gain knowledge, establish and maintain practice protocols, and enhance caregiving.

Interviewing

The purpose of this is to obtain accurate and thorough information. In nursing, is a major tool for collecting data during the assessment step of the nursing process. All interviews should begin with an explanation of the purpose of the interview.

Feedback

The receiver has understood the intended message

Semantics

The study of the meaning of words.

Nonverbal communication

The transmission of information without the use of words. Also known as body language. It often helps nurses to understand subtle and hidden meanings in what the patient is saying verbally.

A three year old child is being admitted to the medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents?

The use of clarifying questions

Clarifying question or comment

The use of this allows a nurse to gain an understanding of the patients comment. When used properly this technique can prevent possible misconceptions that could lead to inappropriate nursing diagnosis. However, overuse can lead to the patient to believe that the nurse is not listening or lacks appropriate knowledge.

Posture

The way a person holds the body carries nonverbal messages. It also often provides nonverbal clues concerning pain and physical limitations.

A nursing student is preparing to administer morning care to a patient. What is the most important question that the nursing student should ask the patient about personal hygiene?

-"May I help you with a bed bath now or later this morning?"

A 76 year old patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the most appropriate comment or question to elicit additional information?

"what specific complications of diabetes have you experienced?"

During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. When entering the room, what is the nurses best response?

"when your patient is safe and comfortable, meet me at the desk."

A nurse in the rehabilitation division states to her head nurse, mr. Tyler, "I need the day off and you didn't give it to me!" The head nurse replies, "well I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate." Instead of this exchange, what communication by the nurse would have been more effective?

"Mr. Tyler, I would like to discuss my schedule with you. I requested 8 August off for doctors appointment. Could I make an appointment?

Aggressive verbal statements

"do it my way" "that's just enough out of you" People speaking in aggressive manner may invade another personal space, speak loudly, and use gestures that are very and emphatic, or threatening. Aggressive people and enhance their self-esteem and prove their superiority through destructive comments directed at others.

Avoid the following common clichés

"everything will be alright" "don't worry. You will just be fine in another day or two" "your doctor knows best" "cheer up. Tomorrow is another day"

A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states," how is she doing, since the babies father is no help?" What is a nurses best response to the neighbor?

"mothers need support"

A nurse enters a patient's room and examines the patient IV fluid and cardiac monitor. The patient states "well, I haven't seen you before. Who are you?" What is the nurses best response?

"my name is John Smith, I am your nurse and will be caring for you until 11 PM"

Ways to improve conversation skills

-Control the tone of your voice so that you are conveying exactly what you mean to say and not a hidden message. Your told should indicate interest rather than boredom, patience rather than anger, acceptance rather than hostility, and so forth. -be knowledgeable about the topic of conversation and have accurate information. And possible, be familiar with the subject of conversation before discussing it with the patient. If the topic is unfamiliar to you, admit that to the patient and family and direct them to other resources. Convey confidence and honesty to the patient. -be flexible. You might want to discuss a certain subject but learned that the patient wishes to discuss something else. -be clear and concise, and make statements as simple as possible. Patients often are anxious and fail to understand the message unless the patient understands the language used. Stay on one subject at a time. This helps prevent confusion. -avoid using words that might have different interpretations. Even went to people speak the same language, some words such as love, hate, freedom, and health might have a different meanings to different people. -be truthful. A patient who is given false information will soon distrust The nurse. If you're not sure about something admit you don't know and seek an answer rather than make a comment that maybe an error. -keep an open mind. An attitude of " I know better than the patient" is quickly discerned by the patient. Patients can make valuable contributions to their own healthcare. -take advantage of available opportunities. During most caregiving situations you can facilitate conversation that makes even the most routine tasks meaningful.

During an interaction with the patient diagnosed with epilepsy, the nurse notes that the patient is silent after she communicates the plan of care. What would be appropriate nurse responses in this situation?

-Discuss the silence with the patient to ascertain its meaning. -allow the patient time to think and explore inner thoughts -determine if the patient's culture requires pauses between conversations.

During the nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessments. This is an example of which characteristics of effective communication?

-Group decision making -Group identity -Group patterns of interaction -Group cohesiveness

Patients with a physical barrier (laryngectomy or endotracheal tube)

-Options include eye blinks or hand squeeze this to communicate yes or no -be sure that everyone communicating with the patient family, friends, and caregivers understands and is able to use the communication devices selected -demonstrate patience with the time needed to communicate effectively, and reinforce the patient's efforts -ensure that the patient has an effective means of signaling need for assistance, such as a call bell or an alarm.

Periods of silence meanings

-The patient might be comfortable and content in the nurse patient relationship. Continuous talking is unnecessary. -the patient might be trying to demonstrate stoicism and the ability to cope without help. -the patient might be exploring inner thoughts or feelings, and conversation will disrupt this. -the patient might be fearful and use silence as an escape from a threat -the patient might be angry and use silence to display this emotion -the patients culture may require longer pauses between verbal communication

Patients who are visually impaired

-acknowledge your presence in the patient's room -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 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 eyeglasses are clean and intact or the contacts are in place

Patients who are unconscious

-be careful of what is said in the patient's presence. Hearing is believed to be the last sense lost therefore the unconscious patient is often likely to hear even though there is no apparent response. -assume that the patient can hear you. Talking in normal tone of voice about things you would ordinarily discuss. -speak with a patient before touching. Remember that touch can be an effective means of communication with the unconscious patient -keep environment noises at low level as possible. This helps the patient focus on the 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 patients attention -keep communication simple and concrete. Breakdown instructions into simple task and avoid lengthy explanations. Use pictures or drawings when appropriate -be patient and gives the patient time to respond. If the patient does not respond after two 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.

Patients who are hearing-impaired

-orient patient to your presence before initiating the conversation -talk directly to the patient while facing him or her. If the patient is unable 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 fingerspelling that's appropriate -write any ideas that you cannot convey to the patient in another manner -be sure that hearing aids are clean, functioning, and entered it properly

Patients who do not speak English

-use an interpreter whenever possible -use a dictionary that translates words from one language to another so that you can speak at least some words in the patient's language -speak in a simple sentence and in a normal tone of voice -demonstrate or pantomime ideas you wish to convey, as appropriate -be aware of nonverbal communication. Remember that many nonverbal communication cues are universal.

Characteristics of aggressive behavior

-using an angry tone of voice -making accusations -demonstrating the belligerence and intolerance.

Recommended techniques to improve listening skills

-when possible, sit when communicating with the patient. Do not cross your arms or legs because that body language conveys a message of being closed to the patients comments. -be alert and relaxed and take sufficient time so that the patient feels at ease during the conversation. -keep the conversation as natural as possible, and avoid sounding overly eager. -if culturally appropriate, maintain eye contact with the patient, without staring, in a face-to-face pose. This technique conveys interest in the conversation and willingness to listen. -indicate that you're paying attention to what the patient is saying by using appropriate facial expressions and body gestures. Be attentive to both your own and the patient's verbal and nonverbal communication. -Think before responding to the patient. Responding impulsively tents to disrupt communication and listening. -do not pretend to listen. Most patients are sensitive to an attitude of feigned attention or to boredom and apathy. -listen for themes in the patient's comments. What are the repeated themes in the person speech and behavior? What topics does the patient tend to avoid? What subjects tend to make the patient shift the conversation to other subjects? What inconsistencies and gaps appear in the patient's conversations?

Dispositional traits

A characteristic or customary way of behaving. Nurses who constantly demonstrate warmth, and friendliness, openness and rapport, empathy, honesty, authenticity, and trust, carrying, and competence are well disposed to communicate effectively.

Characteristics of the assertive nurse's self presentation

A confident, open body posture, eye contact, use of clear, concise "I" statements, and the ability to share effectively one's thoughts, feelings, and emotions.

Rapport

A feeling of mutual trust experienced by people in a satisfactory relationship. Facilitates open communication. Can be achieved by paying attention to the following variables: Specific objectives, comfortable environment, privacy, confidentiality, patient versus task focus, using nursing observations, optimal pacing.

Eye contact

A glance is often an attention-getting method to open conversation. The eyes carry other nonverbal messages in addition to the messages sent by eye contact.

The sender or source (encoder)

A person or group who initiates or begins the communication process.

Touch

A personal behavior and means different things to different people. Familial, regional, class, and cultural influences largely shape tactile experiences. Factors such as age and sex also plays a key role in meaning associated with touch. It is viewed as one of the most effective non-verbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others.

Open ended question or comment

Allows a patient with 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. The greatest advantage of this technique is that it prevents the patient from giving a simple yes or no answer that has the effect of limiting the patient response.

Intrapersonal communication

Also known as a self talk, is communication within a person. This communication is crucial because it affects the nurses behavior and enhance or detract from positive interactions with the patient and family.

Verbal communication

An exchange of information using words, including both the spoken and written word. It depends on language, or a prescribed way of using words so that people can share information effectively. Language includes a common definition of words and a method of arranging the words in a certain order.

Bullying

Anger and aggressive behavior between nurses, or nurse-to-nurse hostility, also known as label horizontal violence, lateral violence, and professional incivility. It often occurs repetitively, whereas horizontal or lateral violence can occur as a single event.

Phases of the helping relationship

Ordinarily described as having three phases: 1. The orientation phase 2. The working phase 3. The termination phase

A nurse sees a patient walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. It is important that the nurse assesses the patient for..

Pain

Sequencing question or comment example

Patient: I don't feel like myself anymore since I've been taking my blood pressure medicine. I'm tired and don't have any energy. Nurse: your tiredness begin after you started taking your medicine?

Goals of the helping relationship

Are determined cooperatively and are defined in terms of the patients needs. Common goals might include increased independence for the patient, greater feelings of worth, and improved health and well-being.

Email and text messages

Are efficient means to communicate with staff members and, in some cases, patients. These messages should be concise and avoid text abbreviations.

Gestures

Are often used extensively when two people speaking in different languages attempt to communicate with each other. For example thumbs-up means victory, kicking an object often expresses anger, wringing the hands or tapping a foot usually indicates anxiety or anger, and waving a hand serves to beckon someone to come on.

Gait

Associated with illnesses

Impaired verbal communication

Can affect every aspect of a persons life. It is an approved North American nursing diagnoses Association international (NANDA-I) nursing diagnosis. According to NANDA-I is defined as decreased, and delayed, or absent ability to receive, process, transmit, and or use a system of symbols.

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

Gossip and rumor

Common forms of communication, particularly in the health care settings, sometimes referred to as "the grapevine" can produce detrimental effects on relationships and group building. Might be used to inform, influence others, entertaining, or ventilate. It can be harmless but can also damage the reputation of others. Might cause blocks to team building and damage the reputation of the people who are the subject of the information.

Environment

Communication happens best when the environment facilitates an easy exchange of needed information. The most effective for Communication is one that is calm and nonthreatening.

Values

Communication is influenced by the way people value themselves, one another, and the purpose of any human interaction.

Stimulus

Communication process is initiated by this.

Social cultural differences

Culture refers to the common lifestyles, languages, behavior patterns, traditions, and believes that are learned and passed from one generation to the next. Understanding a patient's culture helps you understand nonverbal communication and deliver accurate nursing care to the patient and family.

A nurse caring for a patient who was hospitalized following a double mastectomy is preparing to discharge plan for the patient. Which action should be the focus for this termination phase of the helping relationship?

Determining the progress made in achieving a established goals

Example of effective use of clarifying question or comment

Patient: I have never needed to take medicine before in my life. Nurse: is this the first health problem that you have had? Patient: yes, I've always been healthy.

A nursing student is nervous and concerned about the work she is about to do at the clinical facility. To Allay anxiety and be successful in her provision of care, it is most important for her to:

Engage in self talk to plan her day and decrease her fear.

Helping relationship

Exsist among people who provide and receive assistance in meeting human needs. It sets the climate for participants to move towards common goals. Therefore, the patients needs are met as a result of a successful helping relationship.

Noise

Factors that distort the quality of a message. Can interfere with communication at any point in the process.

Disruptive interpersonal behavior

Has a negative effect on clinical outcomes and interpersonal relationships. These events occur when communication between healthcare professionals is ineffective, abusive, or negative. This behavior compromises patient safety, influences satisfaction with care, and contributes to medical errors.

Example of reflective question or comment technique

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

Helping relationship vs social relationships

Helping relationships contain many of the qualities of a social relationship but they have in common the components of care, concern, trust, and growth. -the helping relationship does not occur spontaneously, as do the most social relationships. It occurs for a specific purpose with a specific person. -the helping relationship is characterized by an unequal sharing of information. The patient shares information related to personal health problems, whereas the nurse shares information in terms of a professional role. In a friendship, information sharing is more likely to be similar in quality and type. -the helping relationship is built on the patients needs, not on those of the helping person. In a friendship, needs of both participants are generally considered. A friendship might grow out of a helping relationship, but this is separate from the purposeful, time-limited interaction described as a helping relationship.

Orientation Phase

Ideally begins between the nurse and patient during the data gathering part of the nursing process. It can also be initiated at other times during the nurse patient relationship. -the patient will call the nurse by name -the patient will accurately describe the roles of participants in the relationship -the patient and nurse will establish an agreement about: goals of their relationship, location, frequency, and length of the contacts, duration of the relationship.

Empathy

Identifying with the way another person feels. By retaining this quality, you can establish successful helping relationships without appearing cold or stern.

Group communication

Includes a small group and organizational group communication.

Humor

Increasingly valued as both an interpersonal skill for the nurse and a healing strategy for patients. Nurses can use it effectively to maintain a balance perspective in their work and to encourage patients to do the same.

A nurse is providing instruction to her patient regarding the procedure to change his colostomy bag. During the teaching session he asks "what type of food should I avoid to prevent gas?" The patient's question allows for what type of communication?

Information clarification

Group dynamics .

Involve how individual group members relate to one another during the process of working toward group goals

Using Hand-off Communication: SBAR Technique

Involves a process of accurate presentation and acceptance of patient related information from one caregiver or team to another caregiver or team using effective communication. Can occur with other hospital departments, nurse to nurse report, or nurse to physician discussions.

Aggressive behavior

Involves asserting one's rights in a negative manner that violates the rights of others. Aggression can be verbal or physical. It is communication that is marked by tension and anger, and it inhibits the formation of good relationships and collaboration. It is rude and threatening.

Reflective question or comment

Involves repeating what the person has said or describing the person's feelings. It encourages patients to elaborate on their thoughts and feelings.

Characteristics of the helping relationship

It is intangible and, therefore, difficult to describe. It has at least the following three basic characteristics: 1. It is dynamic. Both the person providing the assistant and the person being helped are active participants to the extent each is able. 2. It is purposeful and time-limited. This means there are specific goals that are intended to be met within a certain period. 3. Although both parties in the helping relationship have responsibilities, the person providing the assistant is professionally accountable for the outcomes of that relationship and the means used to attain them. Helping persons should present their helping abilities as honestly as possible and not promise to provide more assistance than they can offer.

Directing question or comment

It may become necessary at times to obtain more information about a topic brought up earlier in the interview or to introduce a new aspect of the current topic. And this way, the nurse can gain additional valuable information to consider In assessing the patient health status and educational or counseling needs.

Closed question or comment

Provides the receiver with limited choices of possible responses and might often be answered by one or two words, "yes" or "no." Are used to gather specific information from patient and to allow the nurse and patient to focus on a particular area. Are often a barrier to effective communication.

Factors influencing communication

Level of development, gender, social cultural differences, roles and responsibilities, space and territoriality, physical, mental, and emotional state, and environment.

Gender

Men and women have differing communication styles and might get different interpretations of the same conversation. Tannen (1990) believes that this is because boys and girls grew up communicating differently.

Validating the patient's reply example

Nurse: at home, you have been taking both a water pill and a blood pressure pill everyday. Did you take them today? Patient: yes, I took one of each with my breakfast.

Example of an open-ended question and the response

Nurse: what did your physician tell you about you're 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.

Example of an appropriate use of a closed question

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 everyday.

Example of directing question or comment technique

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?

Giving false assurance

Nurses might try to convince the patient that things are going to turn out well even when knowing the chances are not good. Might give patients the impression that the nurse is not interested in their problems. The use of clichés gives a patient false assurance.

Evaluating

Nurses often rely on verbal and nonverbal cues from patients to verify whether patient objectives or goals have been achieved.

Interpersonal communication

Occurs between two or more people with a goal to exchange messages.

Small group communication

Occurs when nurses interact with two or more people. Examples include staff meetings, patient care conferences, teaching sessions, and support groups.

Organizational communication

Occurs when people and groups within an organization communicate to achieve established goals.

Termination phase

Occurs when the conclusion of the initial agreement is acknowledged. This might happen at change of shift time, when the patient is discharged, or when a nurse leaves on vacation or for employment elsewhere. At this point, you will examine with the patient the goals of the helping relationship for indications of their attainment or for evidence of progress toward them. Ordinarily emotions are associated with the termination of a helping relationship. If the goals have been met, there is often regret about ending a satisfying relationship, even though a sense of accomplishment persist. -the patient will participate in identifying the goals accomplished or the progress made towards goals. -the patient will verbalize feelings about the termination of the relationship.

Using comments that give advice

Often implies that the nurse knows what is best for patients and denies them the right to make decisions and have feelings. It also tends to increase the patients dependence on caregivers.

Using questions containing the words why and how

These questions are intimidating to many patients

Using questions that probe for information

These type of questions might cut off communication.

Forms of Nonverbal communications

Touch, eye contact, facial expressions, posture, gait, gestures, General physical appearance, mode of dress and grooming, sounds, silence.

Interviewing techniques

Used to obtain needed information while remaining flexible in approach. The interview itself as a therapeutic interaction I might be an essential part of the orientation phase of the helping relationship.

Sequencing question or comment

Used to place an event in a chronological order or to investigate a possible cause and effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed any sequence.

Working phase

Usually the longest phase of the helping relationship. During this phase the nurse work together with the patient to meet the patients physical and psychosocial needs. -the patient Will actively participate in their relationship -the patient will cooperate in activities that work toward achieving mutual acceptable goals -the patient will express feelings and concerns to the nurse.

Social media

Web based technologies that allow users to create, share, and participate in dialogue in virtual communities and networks.