Study Guide for Fundamental chapter 20

Rewrite the following questions/statements to promote more effective communication with the patient: *Are you ready to try walking in that foot?"*

"Lets try walking on that foot now."

Rewrite the following questions/statements to promote more effective communication with the patient: *"Did you have a good night?"*

"Tell me about the night you had."

Rewrite the following questions/statements to promote more effective communication with the patient: *"You aren't afraid of taking that test, are you?"*

"Tell me what makes you afraid of taking the test."

Rewrite the following questions/statements to promote more effective communication with the patient: *"I can't believe you stopped taking your insulin!"*

"What things prompted you to stop taking your insulin?"

Rewrite the following questions/statements to promote more effective communication with the patient: *No one should be afraid of that procedure; it's been done a million times!"*

"Your procedure has been performed successfully every time here."

5 common blocks to communication and describe nursing's role in overcoming these obstacles

1. *Failure to perceive the patient as a human being*: The nurse should focus on the while person, not simply the illness or dysfunction. 2. *Failure to listen*: Nurses Should be open to opportunities for communication by keeping an open mind and focusing on the patient's needs instead of their own needs. 3.*Use of inappropriate comments or questions*: The nurse should avoid certain types of comments and questions (cliches, questions that probe for information, leading questions, comments that give advice, judgmental comments) that tend to impede communication. 4.*Changing the subject*: The nurse should avoid changing the subject; the patient may be ready to discuss something and may be frustrated if put off by a change in topic. 5. *Giving false assurance*: The nurse should not try to convince the patient that things are going to turn out well when knowing the chances are not good. False assurance may give patients the impression the nurse is not interested in their problems.

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Providing a comfortable environment*

A comfortable environment in which the patient and nurse are at ease helps to promote meaningful interactions. Relationships are enhanced when when the atmosphere is relaxed and unhurried.

A home care nurse discusses with a patient when visits will occur and how long they will last. In what phase of the helping relationship is this type of agreement established? A. Orientation B. Working phase C. Termination phase D.All of the above

A. Orientation

Briefly describe how you would alter your explanation of a surgical procedure to take into account the developmental considerations of all the following patients: *A 16 year old girl*

Adolescents are developing their ability to think abstractly and can understand fairly detailed descriptions of clinical procedures.

Briefly describe how you would alter your explanation of a surgical procedure to take into account the developmental considerations of all the following patients: *An 8 year old boy*

An 8 year old has limited understanding of surgical procedures. Therefore, the nurse must explain the procedure in simple terms so that the child will cooperate without being frightened.

"You say you've always been healthy and active; is this the first time you've been hospitalized?"

Clarifying question/comment

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Maintaining patient focus*

Communication in the nurse-patient relationship should focus on the patient and the patients needs, not on the nurse or an activity in which the nurse is engaged.

" You've been on your present medication for 3 years. Did you experience any side effects?''

Directing question/comment

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Providing privacy*

Every effort should be made to provide privacy during nurse-patient conversations

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Having specific objectives*

Having a purpose for an interaction guides the nurse toward achieving a meaningful encounter with the patient

When a nurse helps a patient achieve goal that allow his or her human needs to be satisfied, the nurse and patient are involved in a ______________________ relationship

Helping

Anger and aggression behavior between nurses, or nurse-to-nurse hostility, has been labeled __________________

Horizontal violence

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Developing therapeutic communication skills*

Nurses must train and practice using therapeutic skills by controlling the tone of their voices, being knowledgeable about the topic, being flexible, being clear and concise, avoiding words that may be interpreted differently, being truthful and open minded, and taking advantaged of opportunities for communicating.

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Providing personal space*

Nurses must try to determine each patients perception of personal space; invasion of this zone can evoke uncomfortable feelings.

What clues to a person's identity can sometimes be determined by knowing that person's occupation?

Occupations may reveal a person's abilities, talents, interests, and economic status

Explain the role that communication plays in the following steps of nursing process: *Diagnosing*

Once a nurse formulates a diagnosis, it must be communicated through the spoken and written word to other nurses as well as to the patient

When a nurse and patient meet and learn to identify each other by name and clarify their roles, they are in the __________________phase of the helping relationship

Orientation

A patient with anorexia will establish an agreement with her health care professional to return gradually to a normal eating pattern

Orientation phase

The patient will establish an agreement with the home health care worker about the frequency and length of contacts

Orientation phase

The patient will learn the name of the physical therapist and address him by his name

Orientation phase

"You expressed concern about your children at home..."

Reflective question/comment

"You've been upset about taking medication..."

Reflective question/comment

Rewrite the following questions/statements to promote more effective communication with the patient: *"Don't worry; everything will be all right."

SHOULD NOT BE SAID AT ALL

The patient will acknowledge the goals he has accomplished in physical therapy

Termination

The patient will express his desire to go home despite the excellent care he received at the agency

Termination

The patient will verbalize the goals set forth in his transition to a home health care setting

Termination

Explain the role that communication plays in the following steps of nursing process: *documenting*

The documentation of data promotes the continuity of care given by nurse and other health care providers

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Using silence as a tool*

The nurse can use silence appropriately by taking the time to wait for the patient to initiate or continue speaking. Nurses should be aware of the different possible meanings of silence (the patient is comfortable with the nurse, the patient is demonstrating stoicism or exploring inner thoughts, the patient may be fearful, etc.)

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Using optimal pacing*

The nurse must consider the pace of any conversation or encounter with a patient and let the patient set the pace.

Briefly describe how you would alter your explanation of a surgical procedure to take into account the developmental considerations of all the following patients: *A 65 year old with a hearing impairment*

The nurse should talk directly to the patient while facing him. When necessary, nonverbal communication should be used (e.g.:sign language or finger spelling, or by writing any ideas that cannot be conveyed in another manner)

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Maintaining confidentiality*

The patient should know his or her right to specify who may have access to clinical or personal information

Explain the role that communication plays in the following steps of nursing process: *Planning*

The patient, nurse, and other health care team members must communicate with each other as patient goal and outcomes are developed and interventions selected

A nurse is using a _____________ comment/question when she says to her patient, "You have been following a diet high in fiber at home. Are you continuing to get enough fiber in the foods you've been eating since you've been here?"

Validating

"At home you've been treating your ulcer with an antacid. Did you take any today?"

Validating question/comment

Explain the role that communication plays in the following steps of nursing process: *Implementing*

Verbal and nonverbal communication allows nurses to enhance basic care-giving measures and to teach, counsel, and support patients and their families

Explain the role that communication plays in the following steps of nursing process: *Assessing*

Verbal and nonverbal communication are essential nursing tools because the major focus of patient assessment is information gathering. Written words, patient records, spoken words, and observational skills are employed.

The patient will demonstrate ability to maneuver on crutches

Working phase

The patient will express his concerns about pending surgery to the nurse

Working phase

A nurse is attempting to communicate with a patient who speaks a different language and does not understand what is being communicated. Which nursing action would best facilitate the communication process? a. Speaking slowly and distinctly, but not loudly b. Repeating the message in the same manner many times until understood c. Using medical terms and abbreviations more frequently d. Avoiding using a dictionary to help maintain focus on patient

a. Speaking slowly and distinctly, but not loudly

A nurse is communicating the plan of care to a patient who is cognitively impaired. Which nursing actions facilitate this process? select all that apply a. The nurse maintains eye contact with the patient b. The nurse is patient and gives the patient time to respond c. The nurse communicates in a bust environment to hold the patients attention d. The nurse keeps communication simple and concrete e. The nurse gives lengthy explanations of the care that will be given f. If there is no response, the nurse does not repeat what is said and takes a break.

a. The nurse maintains eye contact with the patient b. The nurse is patient and gives the patient time to respond d. The nurse keeps communication simple and concrete

A female nurse states the following to another nurse who is constantly forgetting to was her hands between patients: "It looks like you keep forgetting to wash your hands between patients. It is really not safe for your patients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech? a. Aggressive b. Assertive c. Nonassertive d. Therapeutic

b. Assertive

A 36 yr.old who underwent a hysterectomy 4 days ago says to the nurse, "I wonder if i'll feel like a woman." Which response would most likely encourage the patient to expand on this and express her concerns in more specific terms? a. "Do you want more children?" b."Feel like a woman..." c. Remaining silent d. "when did you begin to wonder that?"

b."Feel like a woman..."

In a helping relationship, the nurse would most likely perform what action? a. Encourage the patient to independently explore goals that allow his or her human needs to be satisfied b. Set up a reciprocal relationship in which patient and nurse are both helper and person being helped c. Establish communication that is continuous and reciprocal d. Establish goals for the patient that are not set in a specific time frame.

c. Establish communication that is continuous and reciprocal

When attending a staff meeting, a nurse is participating in what type of communication? a. Intrapersonal b. interpersonal c.small-group d. organizational

c.small-group

A nurse who is caring for newborn infants delivers care by utilizing the sense that is most highly developed at birth. Which example of nursing care achieves this goal? a. The nurse plays "peek-a-boo" with the infant b. The nurse speaks to the infant in a loud voice to get attention c. The nurse wears colorful clothing to stimulate the infant d. The nurse gently strokes the baby's cheek to facilitate breastfeeding.

d. The nurse gently strokes the baby's cheek to facilitate breastfeeding.

A nurse who "unblocks" and "clears" congested areas of energy in a patient's body to promote comfort is applying the phenomenon know as: a. "unruffling" touch b. interpersonal touch c.Tactile manipulation d. Therapeutic touch

d. Therapeutic touch

A patient who verbally acknowledges understanding of discharge instructions is providing ________________ to the caregiver

feedback

The actual product of the encoder

message

Factors that distort the quality of the product

noise

A patient who expresses anger at a diagnosis by slamming a food tray on the table is using ________________ conversation

nonverbal

Explain why the following variables must be considered when establishing rapport between a nurse and patient *Using nursing observations*

observation is especially valuable in validating information and helping the nurse become aware of the patients nonverbal communication, it also demonstrates the nurses caring and interest in the patient.

He or she must translate and make a decision about the product

receiver

Verbal and nonverbal evidence that the patient received and understood the product

source

A nurse initiates the communication process by addressing a patient need. This patient need becomes a __________ for conversation

stimulus

The patient will attend a counseling session dealing with smoking

working phase

Explain the role that communication plays in the following steps of nursing process: *Evaluating*

Nurses often rely on the verbal and nonverbal clues they receive from their patients to determine whether patient objectives or goals have been achieved

Explain why the following variables must be considered when establishing rapport between a nurse and patient *developing listening skills*

Nurses should sit when communicating with a patient, be alert and relaxed, keep the conversation natural, maintain eye contact if culturally correct, indicate that they are paying attention, think before responding to the patient, and listen for themes in the patients comments.

"Your chest pain began after exercising on a bicycle?"

Sequencing question/comment

A nurse is communicating the plan of care for a patient who is unconscious. Which nursing actions best facilitate this process? select all that apply a. The nurse speaks to the patient in a louder than normal voice b. The nurse is careful what is said in the patient's presence since hearing is the last sense to go c. The nurse assumes the patient can hear and discusses things that would ordinarily be discussed d. The nurse raises environmental noises to help stimulate the patient e. The nurse does not use touch to communicate with the patient f. The nurse speaks with the patient before touching him or her.

b. The nurse is careful what is said in the patient's presence since hearing is the last sense to go c. The nurse assumes the patient can hear and discusses things that would ordinarily be discussed f. The nurse speaks with the patient before touching him or her.

Nurses must take into considerations factors that influence communication when communicating with patients. Which examples accurately reflect communication that considers these variables? select all that apply a. A female nurse communicates in the same manner to both male and female patients b. A nurse communicates in the same manner to patients of different cultures to avoid stereotyping patients c. A nurse uses simple language and demonstrations to explain a procedure to a pre-schooler d. A nurse uses the intimate zone when explaining painful procedure to young children e. A nurse checks a patient's occupation for clues on how this will affect communication but avoids stereotyping the person f. A nurse takes into consideration a patient's culture when planning how far away to sot when communicating

c. A nurse uses simple language and demonstrations to explain a procedure to a pre-schooler e. A nurse checks a patient's occupation for clues on how this will affect communication but avoids stereotyping the person f. A nurse takes into consideration a patient's culture when planning how far away to sot when communication

Which nursing actions help improve listening skills when conversing with patients? select all that apply a. The nurse sits with the patient in a comfortable environment with arms and legs crossed in a relaxed position b. The nurse always maintain eye contact with the patient in a face-to-face pose c. The nurse uses appropriate facial expressions and body gestures to indicate that he or she is paying attention to what the patient is saying d. The nurse thinks before responding to the patient, even if this creates a lull in the conversation e. The nurse listens for themes in the patient's comments f. If an action being performed does not allow for conversation, the nurse pretends to listen to the patient rather than interrupting the patient's conversation.

c. The nurse uses appropriate facial expressions and body gestures to indicate that he or she is paying attention to what the patient is saying d. The nurse thinks before responding to the patient, even if this creates a lull in the conversation e. The nurse listens for themes in the patient's comments

Which technique would a nurse employ when using listening skills appropriately? a. The nurse would try to avoid body gestures when listening to the patient. b. The nurse would not allow conversation to lapse into periods of silence. c. The nurse would listen to the themes in the patient's comments d. The nurse would stand close to the patient and maintain eye contact.

c. The nurse would listen to the themes in the patient's comments

The medium selected to convey the product

channel

When a doctor communicates with a nurse by telephone to prescribe pain medication for a patient, the telephone is considered to be the ____________ of this communication.

channel