Chapter 10 - Communicating Effectively

An employee is sabotaging the work of a newly oriented charge nurse, and the charge nurse has not been successful in addressing the problem. When the nurse manager addresses the issue, which is the most appropriate statement? 1. "I know it must be frustrating working with a new charge nurse, but how can we make this situation better?" 2. "This is not professional behavior, and you need to stop it or you will lose your job the next time I hear about it." 3. "I know the charge nurse is new to the role, but you should get used to it or there will be more changes." 4. "I know the new charge nurse is difficult to work with, but please help make the job easier to do."

*Answer: 1* *Explanation:* 1. Acknowledging the person's frustration validates his or her feelings, and asking for input helps make him or her part of the solution. 2. This statement is confrontational and is unlikely to result in a positive response from the employee. 3. Threatening the employee, no matter how veiled the threat, is confrontational and is unlikely to result in a positive response. 4. Patronizing remarks are condescending and are not likely to result in a positive employee response.

In the morning care conference, the nurse instructs the assistant to feed breakfast to the clients in beds 2234, 2230, and 2241. The assistant indicates understanding of the assignment and repeats the bed numbers back to the nurse. What is the nurse's next step? 1. Check with the assistant to see how the assignment is going during the time breakfast is served. 2. Check the client's breakfast trays before they are returned to dietary. 3. Check with the clients to see if they had breakfast. 4. At the end of the shift, ask the assistant how the clients ate.

*Answer: 1* *Explanation:* 1. Checking with the assistant while the tasks are being done is the best plan. If there is a misunderstanding or problem, this is the best time for the nurse to intervene. 2. Simply seeing an empty breakfast tray does not guarantee that the instructions were carried out correctly. 3. Checking with the clients does not allow for the nurse to amend the instruction or correct the actions being taken. 4. Waiting until the end of the shift does not allow the nurse to amend the instruction or correct actions being taken.

The staff nurse is unsure of the correct protocol for calling in sick to work. The nursing supervisor told the nurse to call the nursing office; however, the nurse manager told the nurse to call the unit. This issue is likely the result of which distorted communication? 1. Intersender conflict 2. Intrasender conflict 3. Metacommunication 4. Downward communication

*Answer: 1* *Explanation:* 1. Intersender conflict occurs when a person receives two conflicting messages from different sources. 2. Intrasender conflict occurs when a verbal message differs from the nonverbal message; the recipient has difficulty interpreting the intended meaning. 3. Metacommunication is the combination of oral messages with nonverbal messages. 4. Downward communication occurs from manager to staff and is often directive.

The person who has just been promoted to nurse manager is male. If this nurse communicates in a way that is considered typical for men, what can the staff expect? 1. He will focus more on the issue than on personal experience. 2. He will strive to reach consensus within the group. 3. He will strive to avoid conflict within the group. 4. He will prefer to ask questions rather than make statements.

*Answer: 1* *Explanation:* 1. Men have been socialized to remain focused on the issue and avoid self-disclosure about personal experiences. 2. Men can tolerate disagreement within the group. 3. Men may be more apt to tolerate conflict than women are. 4. Women are more apt to ask questions to seek input.

During an evaluation conference, the nurse manager observes nonverbal messages, including nodding in agreement and smiling. These behaviors are examples of which aspect of communication? 1. Metacommunication 2. Intrasender conflict 3. Fogging 4. Intersender conflict

*Answer: 1* *Explanation:* 1. Metacommunications are nonverbal messages conveyed by body language and environmental factors. 2. Intrasender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between verbal and nonverbal communication. 3. Fogging is a communication technique in which one partially agrees with what was said. 4. Intersender conflict occurs when there is a difficulty in the interpretation of an intended message due to disparity between different sources.

The nurse manager has determined that two staff nurses need to be hired. Which factor is most critical as the nurse manager prepares to submit the request to administration? 1. Timing of the request 2. Negative inquiry 3. Compromise 4. Persistence

*Answer: 1* *Explanation:* 1. The nurse manager should plan to meet with administration when there is sufficient time and the supervisor seems receptive. 2. Negative inquiry is used after a request has been denied. 3. Compromise occurs after a request has been denied. 4. Persistence and repetition are used after a request has been denied.

A nurse manager is aware that there is a strong "grapevine" communication system on the unit. The manager elects to use this grapevine to distribute information about an upcoming change in unit policy. In making this decision, the manager should consider which possibilities? Select all that apply. 1. The information may be rapidly disseminated. 2. The information may be altered as it moves across the grapevine. 3. Most people try to spread information accurately. 4. Most people do not pay any attention to the grapevine. 5. Professional nurses do not participate in grapevine communication.

*Answer: 1, 2* *Explanation:* 1. Grapevine communication is often rapid and complete. 2. Grapevine communication is often altered as is goes from person to person. 3. The grapevine is very prone to distortion-sometimes significant distortion. 4. Most people do believe or at least attend to the grapevine. 5. Grapevine communication crosses all levels of professionalism.

Which directions given by the nurse to the assistant are most likely to be understood and completed correctly? Select all that apply. 1. "Here are your directions for this morning. Please give the clients in rooms 2156, 2158, and 2159 total bed baths." 2. "Go to the diet kitchen and get a cup of apple juice for the client in room 2112." 3. "Ambulate the clients on the south wing." 4. "Do you think you'll have time to do shampoos today?" 5. "It might be a good idea to get the client in room 2110 up in the chair this morning. Or maybe it would be better to wait until this afternoon."

*Answer: 1, 2* *Explanation:* 1. Saying "Here are your directions" alerts the assistant that an important statement is going to be made. The instructions are clear and concise. 2. This is a clear and concise set of instructions. 3. This direction is not clear. Does the nurse want the clients whose rooms are on the south wing ambulated? Or does the nurse want all ambulation to occur on the south wing today? 4. This instruction is ambiguous. If the nurse would like for certain clients to have their hair shampooed today, the nurse should indicate that more clearly. 5. The nurse should be clear regarding what should be done before instruction is provided.

A nurse manager approaches the nursing supervisor with a request for approval to incorporate 12-hour shifts into scheduling. The supervisor denies the request, stating this staffing pattern was used previously with poor outcomes. Which responses by the nurse manager may positively influence the supervisor? Select all that apply. 1. "I agree it was not effective years ago, but other units have now had success with it." 2. "What were your specific concerns about the 12-hour shifts?" 3. "I think it is unfair to refuse my unit this opportunity based on the past." 4. "Why are you always so opposed to change on my unit?" 5. "If we don't offer alternative staffing patterns, we aren't going to be able to attract new hires."

*Answer: 1, 2* *Explanation:* 1. This is an example of using "fogging," or agreeing with part of what is said. This technique may make the supervisor rethink the decision by offering some new information. 2. Asking about previous concerns is a type of negative inquiry. It helps the nurse manager understand the supervisor's position, but also requires the supervisor to rethink the issue. 3. Telling the supervisor it is unfair is the same as calling the supervisor unfair and is confrontational. 4. This approach is confrontational. 5. Threats, even veiled threats, are confrontational and should not be used.

The nurse manager has asked that another staff nurse position be funded for the unit. The supervisor denies the request. Which statements by the manager are examples of negative assertion? Select all that apply. 1. "I know I haven't been too careful in keeping personnel costs low, but we are really going to need another position." 2. "I don't see why another position cannot be funded. We have met our budget each year for the last 3 years." 3. "I realize that my staff is not always positive about organizational changes, but having this extra staff member might reduce some of their stress." 4. "I can understand what you said about budget being tight, but we still need the position." 5. "Do you not understand how hard my nurses are working?"

*Answer: 1, 3* *Explanation:* 1. Negative assertion occurs when the speaker accepts some of the blame for the situation. 2. This is an example of negative inquiry. 3. Negative assertion is accepting some of the blame. 4. This is an example of fogging. 5. This is a confrontational statement and should be avoided.

A nurse often has difficulty explaining and getting a clear message through to the receiver. Which communication skills will help the nurse to improve communication. Select all that apply. 1. Check timing 2. Expect respect 3. Consider relationship to receiver 4. Find an interpreter 5. Reply appropriately

*Answer: 1, 3, 5* *Explanation:* 1. Check timing is a communication skill that will help the nurse to improve communication. 2. Expect respect is not a communication skill that will help the nurse to improve communication. 3. Consider relationship to receiver is a communication skill that will help the nurse to improve communication. 4. Find an interpreter is not a communication skill that will help the nurse to improve communication. 5. Reply appropriately is a communication skill that will help the nurse to improve communication.

The nurse manager works at a rural hospital and is in charge of a medical unit. Another nurse manager is in charge of the adjacent surgical unit. Equipment is shared between the two units. The surgical unit manager frequently confronts and intimidates the manager of the medical unit regarding the use of the equipment. Which strategies could the manager of the medical unit use to generate feelings of personal power? Select all that apply. 1. Body language 2. Power plays 3. Arguing 4. Word choices 5. Listening

*Answer: 1, 4, 5* *Explanation:* 1. Body language is a strategy used to generate feeling of personal power. 2. Power play is not a strategy used to generate feeling of personal power. 3. Arguing is not a strategy used to generate feeling of personal power. 4. Word choice is a strategy used to generate feeling of personal power. 5. Listening is a strategy used to generate feeling of personal power.

What is the most important reason that excellent communication skills are essential for nurses? 1. Nurses must communicate with all disciplines. 2. All nursing activities occur in relationships. 3. Interpersonal skills get the work done. 4. Good communication ensures no problems occur.

*Answer: 2* *Explanation:* 1. Although nurses do communicate with all disciplines, the correct reason is broader. 2. Nursing activities occur in relationships, making communication skills essential. 3. Excellent communication skills can get the work done more quickly and effectively, but the correct reason is broader. 4. Excellent communication skills do not keep problems from occurring.

The nurse manager is counseling a male nurse about several recent incidents in which female nurses complained that he was abrupt and condescending. What advice should the manager give this nurse? 1. "Make sure that anything you say is clear and concise." 2. "Don't feel as if you are responsible for fixing every problem." 3. "Avoid using phrases such as 'sort of' when talking to females." 4. "Don't personalize everything."

*Answer: 2* *Explanation:* 1. Males tend to communicate clearly and concisely, especially in professional relationships. 2. There are many gender differences in communication. Males tend to take responsibility and feel the need to "fix" things. 3. Using phrases such as "sort of" is a more common trait of female conversation than of male conversation. 4. Women tend to personalize, whereas men are more focused on the issues.

When the nurse manager orders supplies for the unit, which communication mode is best? 1. Telephone 2. Email 3. In person 4. Voice mail

*Answer: 2* *Explanation:* 1. Telephoning an order leaves room for misinterpretation or inaccuracy in recording what was ordered. 2. To avoid misunderstanding what supplies are needed, a written request is the most appropriate choice. It avoids misunderstanding because the items can be checked off a list. 3. A verbal order in person may still result in double orders because there is no written record of what was ordered. 4. Voice mail may result in a mistake because there is no written record of what was ordered.

The nurse manager should be most careful not to hold preconceived beliefs when listening to which person? 1. The hospital administrator discussing next year's budget 2. A staff nurse the manager has worked with for 25 years 3. A newly licensed nurse who is hesitant to address the manager 4. A physician discussing prognosis with the client and family

*Answer: 2* *Explanation:* 1. The manager will probably pay close attention to the hospital administrator because of the position. 2. When there is a long-term relationship, the listener sometimes thinks they know what the other person is going to say. Careful listening is necessary in these situations. 3. The manager would be attuned to someone who is new to the organization and who might be hesitant to speak. This is not a common situation in which the manager would have preconceived beliefs. 4. The nurse manager will likely to listen very closely to this conversation without preconceived beliefs.

The nurse has a concern regarding the quality of care being provided in the hospital. What should the nurse consider first before communicating this concern? 1. The medium of the message 2. The relationship between the nurse and the receiver of the message 3. The timing of the message 4. What to include in the message

*Answer: 2* *Explanation:* 1. The medium of the message is not the first consideration. 2. The first consideration is the relationship with the receiver of the message. This will guide the remainder of the choices the nurse will make. 3. Timing is essential, but it is not the first consideration. 4. In this situation, the nurse likely has numerous points to express. It might not be the best plan to include them all in the initial conversation.

2) A nurse plans to seek employment in an acute-care setting after graduation. Which form of communication would be most effective in applying for a position? 1. Send an email to the nurse manager, requesting a job interview. 2. Send a written letter and résumé in the mail. 3. Call the nurse manager to ask if any jobs are open. 4. Drop into the nurse manager's office to discuss employment options.

*Answer: 2* *Explanation:* 1. This approach is too informal. 2. Applying for a job requires a high level of formality. A written cover letter and résumé are expected by most organizations offering employment opportunities. This submission would be done by email only if that is the organization's specific request. 3. This approach is too informal. 4. "Dropping in" to the manager's office is not professional. Any meetings generally occur at the request of the potential employer and would occur after the résumé and cover letter are sent.

A problem has arisen on a unit with primarily Generation X nursing staff. Which strategies should the nurse manager employ to get staff input into solving this problem? Select all that apply. 1. Schedule a staff meeting for discussion of the problem and its possible solutions. 2. Post a notice on the bulletin board explaining the issue. 3. Ask nurses individually for input. 4. Develop a possible solution and share it with nurses in a formal meeting. 5. Ask for input in text message and promise to respond to texts immediately.

*Answer: 2, 3* *Explanation:* 1. Generation X members do not like group problem solving and decision making. This is more the style of Baby Boomers. 2. Generation X members would be more likely to read the information, formulate an opinion, and share it with the manager. They like decisions to be made without unnecessary discussion. 3. Generation X members do not like unnecessary discussion, so asking for input individually would be a good strategy. 4. Traditionalists are more likely to respond to a suggestion from someone higher in the chain of command. They also tend to be more formal. 5. Generation Y is more likely to want immediate feedback from emails or text messages.

The nursing supervisor is planning an education session on collaborative communication between nurses and physicians. Which topics should be on this agenda? Select all that apply. 1. Interdisciplinary respect 2. Understanding the role of the physician 3. Understanding the role of the nurse 4. Communication across disciplines 5. Active listening skills

*Answer: 2, 3, 4, 5* *Explanation:* 1. This topic is diffuse and hard to understand. More precise topics should be used. 2. Understanding roles is essential to collaboration. It must include both roles. 3. Understanding roles is essential to collaboration. It must include both roles. 4. Communication is the key to collaboration. 5. Listening is an essential part of communication.

The nurse asks the nurse manager if he can go home early because the census is low. When the request is denied, the nurse states, "I don't understand why I can't leave early. I will use vacation time, and this will help minimize personnel costs for the shift." This statement is an example of which technique of influencing the supervisor? 1. Fogging 2. Negative assertion 3. Negative inquiry 4. Compromise

*Answer: 3* *Explanation:* 1. Fogging is a technique used when the person is in partial agreement with what was said. 2. Negative assertion involves some acceptance of blame for what was said. 3. Negative inquiry is a statement of "I don't understand." Negative inquiry is an effective technique, provided the person to whom it is directed does not become defensive or distraught. 4. Compromise implies that an agreement has occurred between the nurse manager and the nurse.

The hospital chief operating officer holds monthly focus groups with the purpose of gaining ideas and insights from nursing administration and staff nurses. Which type of communication does this indicate? 1. Lateral communication 2. Downward communication 3. Diagonal communication 4. Grapevine communication

*Answer: 3* *Explanation:* 1. Lateral communication involves discussion among individuals at the same hierarchical level (e.g., all nurse supervisors). 2. Downward communication involves direction given by management to the staff. 3. Diagonal communication involves dialogue among individuals at different hierarchical levels (e.g., staff nurses to chief executive officer of nursing). 4. Grapevine communication is an informal channel among individuals at all hierarchical levels and has the potential to generate misinformation.

The nurse manager has instituted a policy of sending information to the staff in emails. Many misunderstandings have occurred since this policy was implemented. What technique should the manager use to reduce this miscommunication? 1. Use text messaging instead of email. 2. Require a return email from everyone reading the information. 3. Be certain that emails go only to the intended recipients. 4. Send all emails with a message line that says "Important."

*Answer: 3* *Explanation:* 1. Text messaging can make the problem worse because it implies the need to respond quickly. 2. Having everyone send a return email will set the nurse manager up for an onslaught of messages that really are not important. 3. Email communication is fraught with difficulties. The best of these options is to be certain that emails go only to the intended recipients. The use of "reply to all" or distribution lists is convenient, but it can result in sending the email to people that it does not affect. When this happens, people begin to ignore email. 4. Sending the message line "Important" with each email is much like crying wolf, and recipients will soon realize that the term Important is meaningless.

Which example represents a qualifier that may interfere with the message being communicated? 1. "Please notify me when this task is complete." 2. "Are you satisfied with the care you are receiving?" 3. "I hate to bother you with this, but we have a problem." 4. "How can I help you solve your issues with this physician?"

*Answer: 3* *Explanation:* 1. This is a direct command or request and does not contain a qualifier. 2. This is a valid inquiry that does not include a qualifier. 3. Qualifiers are often used as "entry statements" into important discussions, but they can interfere with the message being communicated. This qualifier ("I hate to bother you") sets up the receiver of the message to feel bothered. Qualifiers also reveal a lack of confidence in the sender. 4. This is a valid inquiry and does not include a qualifier.

After several near-incidents during procedures, the nurse manager is increasingly concerned about how nursing staff members communicate with physician staff. Which advice from the manager would be most beneficial to the nursing staff? 1. "Don't forget, you are just as good as they are." 2. "Physicians just don't listen as well as nurses." 3. "Let's review the steps of the procedures that we know are the biggest problems." 4. "I'm going to listen to the physicians, but I think most of the problem is with the physicians, not the nurses."

*Answer: 3* *Explanation:* 1. This statement sets up an "us against them" mentality. This mindset does not support respect for the physicians and could make communication more difficult. 2. This statement sets up an "us against them" mentality. This mindset does not support communication. 3. The nurse manager should ensure that the nursing staff is competent in the procedures that are causing problems by reviewing the steps of the procedures with them. 4. The preconceived notion that the problems are the fault of the physicians would make open and honest communication more difficult.

A nurse has made several "near errors" in client care in the last 2 months. The nurse manager says, "These are simple errors. You just aren't listening." How could the nurse improve listening skills in this situation? Select all that apply. 1. The nurse should try to think ahead about what the person talking is going to say. 2. The nurse should hold eye contact with the speaker at all times. 3. When listening to instructions, the nurse should ask anyone who interrupts to wait a moment. 4. The nurse should get sufficient time away from work to rest. 5. The nurse should be careful not to prejudge what the speaker is going to say.

*Answer: 3, 4, 5* *Explanation:* 1. Thinking ahead in the conversation interferes with the ability to listen and comprehend. 2. Eye contact does not mean the nurse is listening. 3. When many people are talking at one time, it is difficult to listen and comprehend. 4. Being tired and stressed from too much time at work can cause energy to flag, resulting in difficulty listening. 5. Preconceived beliefs about what the speaker is going to say makes it more likely that the nurse is not going to listen effectively.

The nurse is always intimidated when asking a physician to clarify orders. Which statements should the nurse use to help counteract this feeling? Select all that apply. 1. "I'm sorry, doctor, but I need for you to repeat the dosage on that medication order." 2. "Doctor, what was the dosage on that medication you ordered, and do you want the client up in a chair today?" 3. "How often did you want the furosemide given?" 4. "Uh, can you tell me if you need for this client to be NPO today?" 5. "Doctor, what rate did you want for the IV?"

*Answer: 3, 5* *Explanation:* 1. Saying "I'm sorry" discounts the message. 2. The nurse should focus on one point at a time. 3. This is a direct statement. 4. This statement is weak. Avoid "uh" and "um." 5. This is a direct statement, and it starts with a "name" that gets the physician's attention.

The staff nurse would like to improve personal communication with peers, patients, and the medical staff. Which strategy would be most effective for this nurse? 1. Plan to be more assertive in all communication. 2. Work to manage fear of conflict. 3. First learn to delegate clearly to others. 4. Attend the hospital-based communication training.

*Answer: 4* *Explanation:* 1. Although being more assertive in communication could help this nurse, this is not the most complete option. 2. Working to manage fear of conflict is not the most complete option. 3. Learning to delegate clearly would help the nurse learn to communicate better, but this is not the most effective strategy. 4. Attending training on communication would be the best plan for this nurse. The strategies described in the other options would likely be included in this training.

An inexperienced speaker is practicing delivering a speech. Which statement indicates a lack of understanding about how easily communication is distorted? 1. "I know I can better connect with my audience with good eye contact." 2. "If I repeat a complicated section in another way, comprehension is improved." 3. "If I know the background of the audience, it can help with tailoring the content." 4. "The topic is not complicated, so I don't have to worry about misunderstanding."

*Answer: 4* *Explanation:* 1. Eye contact can assist in keeping the message clear. 2. Repeating the message can assist in keeping the message clear. 3. Tailoring the message can assist in keeping it clear. 4. It does not matter how uncomplicated the topic is; misunderstandings and distortions can still occur.

In which situation should the nurse be most concerned that communication was distorted? 1. The nurse obtains an admission history from the parents of an adopted child. 2. The nurse gives discharge instructions to a couple in their early 80s. 3. The nurse manager hires a new nurse originally from the Philippines. 4. The emergency nurse receives a confused client who was transferred in an ambulance.

*Answer: 4* *Explanation:* 1. Just because this child is adopted does not mean that the admission history will not be correct or that communication with the child or parents will be impaired. 2. Just because a person is older does not mean that communication is impaired. 3. Just because the person is from another country does not mean that communication will be distorted. 4. Communication will be most affected by the confusion of the client because the nurse cannot be sure of anything the client said or that the client understood anything the nurse tried to communicate.

The nurse manager is concerned about a family member's complaint regarding the professional behavior of a nurse on the unit. Which is the most effective method to address this issue? 1. Post a memo to the nursing staff about expected professional behavior. 2. Send an email to the nursing staff about expected professional behavior. 3. Address the complaint with the individual nurse in a telephone conversation. 4. Discuss the complaint with the individual nurse face-to-face.

*Answer: 4* *Explanation:* 1. The purpose of a memo is to convey general information to a group; it has a low level of personal intimacy. 2. The purpose of email is to broadcast information to large groups; it has a low level of personal intimacy. 3. A telephone conversation is less intimate than face-to-face communication, and the individual's response cannot be seen. 4. More important or difficult issues should be communicated face-to-face to the nurse involved so that the individual's response can be seen and questions can be answered appropriately.

The nurse has been concentrating on improving personal communication skills. Which option represents the final step in this nurse's work to improve communication? 1. Think about the goals of the communication. 2. Develop an appropriate and thoughtful response. 3. Decide how to say what you want conveyed. 4. Ensure the communication is understood.

*Answer: 4* *Explanation:* 1. Thinking about the goals is assessment. 2. Developing an appropriate response is an implementation. 3. Deciding how to say what you want conveyed or how to deliver your response is an implementation or plan. 4. Ensuring all parties understand the communication is the last step as it involves evaluation.