Communicating

Face-to-face communication involves

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

A patient has entered a smoking cessation program to quit smoking. He tells the nurse he has not smoked a cigarette for 3 weeks, but is afraid he will slip up and smoke because of current job pressures. What would be the most appropriate reply for the nurse to make in response to the patient's comments? "Don't worry about it. Everyone has difficulty quitting smoking and you should expect to as well" "If you increase your self-control, I am sure you will be able to avoid smoking" "It is good that you can talk about your concerns. Try calling a friend when you want to smoke" "Try taking a couple of days of vacation to relieve the stress of your job"

"It is good that you can talk about your concerns. Try calling a friend when you want to smoke"

Factors influencing the communication process

- Development - Gender - Values and perceptions - Personal space - Territoriality - Roles and relationships - Environment - Congruence: the verbal and nonverbal aspects of the message match - Interpersonal attitudes: caring and warmth, respect, acceptance - Elderspeech - speech like baby and patronizing - Boundaries: nurse should avoid sharing personal information or meeting his or her own need through the nurse-client relationship

Verbal communication considerations:

- Pace and intonation: manner of speech as in the rate or rhythm and tone - Simplicity - Clarity and brevity: clarity a message that is direct and simple and brevity using the fewest words necessary - Timing and relevance - Adaptability: altering spoken messages in accordance with behavioral cues from the client - Credibility: might be the most important criterion of effective communication - Humor

Nonverbal communication considerations:

- Personal appearance - Posture and gait - Facial expression - Gestures

Communication

- any means of exchanging information or feelings between two or more people

Attentive listening

- listening actively and with mindfulness using all the sense, and paying attention to what the client says, does, and feels as opposed to listening passively with just the ear - Is an active process requires energy and concentration - Involves paying attention to the total message, both verbal and nonverbal and noting if they are the same - Put aside own judgments - Highly developed skill

Therapeutic communication

- promotes understanding and can help establish a constructive relationship between the nurse and the client - Unlike a social relationship where there may not be a specific purpose or direction the therapeutic helping relationship is client and goal directed

Patient centered-care includes which of the following? (Select all that apply) Speak to patients and families using medical terms Assess patient preferences Actively listen to the patient Encourage family to participate in care Using facial expressions to convey feelings

Assess patient preferences Actively listen to the patient Encourage family to participate in care

Barriers to communication

Barriers to communication - Stereotyping: generalized and oversimplified beliefs, these categorize clients and negate their uniqueness as individuals - Agreeing and disagreeing: implies the client is either right or wrong and nurse is not in a position to judge - Being defensive: prevent client from expressing true concerns - Challenging: making clients prove their statement or point of view - Probing: usually "why" - Testing - Rejecting - Changing topics and subjects - Unwarranted reassurance - Passing judgment - Giving common advice: telling the client what to do

Identify the barrier to communication in the following interaction. Patient: "When can I expect to be told about how to take my insulin?" Nurse: "Let's discuss your diet now so that you will know what to eat when you get home. We can discuss insulin some other time." Presenting reality Giving information Stereotyping Changing the subject

Changing the subject

What is the root cause for 82% of sentinel events? Incorrect diagnoses Increased health care provider workload Administration of wrong meds Communication breakdown

Communication breakdown

Which of the following is the most crucial goal of therapeutic communication when helping patients deal with personal issues and painful feelings? Mutual sharing of information, spontaneity, emotions, and intimacy Conveying respect and acceptance even if all of the patient's behaviors are not tolerated Guaranteeing total confidentiality and anonymity for the patient Communicating empathy through maintaining gentle touching of the client

Conveying respect and acceptance even if all of the patient's behaviors are not tolerated

Two days after an ileostomy, the patient refuses nursing care and requests to be left alone. What should be the nurse's first action? Allow the client the privacy he requests Encourage the client to verbalize his feelings Invite a member of the ostomy association for a visit Tell the client that he must begin to deal with the situation

Encourage the client to verbalize his feelings

The nurse has asked the unlicensed assistive personnel (UAP) to help with admitting a patient. Which of the following activities can be delegated to the UAP? Assess the patient's lung sounds Obtain the patient's height and weight Collect nursing history and assessment data Administer scheduled medications

Obtain the patient's height and weight

What therapeutic communication technique does this interaction demonstrate? Nurse: "Tell me more about that." Open ended questions Restating/paraphrasing Giving information Changing subject

Open ended questions

In what phase of the helping relationship does the nurse review patient assessment data and develops a plan of action? Preinteraction phase Termination phase Introductory phase Working phase

Preinteraction phase

Which of the following are correct guidelines for charting in the patient record? Chart at the end of the shift only Always use abbreviated terminology Use initials for signing chart Record the time of each entry

Record the time of each entry

A patient states "I am dying." The nurse responds "You believe that you are dying?" which therapeutic approach did the nurse use? Giving information Focusing Summarizing Reflecting

Reflecting

Which communication technique is used in this interaction? Patient: "I have been really upset about my blood pressure and having to take these pills." Nurse: "You've been upset about your blood pressure and taking pills." Patient: "I guess I'm worried about what could happen if my blood pressure gets too bad." Summarizing Restating Using humor Informing

Restating

Therapeutic communication techniques

Therapeutic communication techniques - Using silence: letting client put thoughts and words together - Providing general leads: facilitating - Being specific and tentative: making specific statements rather than general and tentative rather than absolute - Using open-ended questions - Using touch - Restating or paraphrasing: repeating in similar words - Seeking clarification - Perception checking or seeking consensual validation: verifies the meaning of specific words - Offering self: ex. I'll stay with you until your daughter comes - Giving information - Acknowledging - Clarifying time or sequence: help to clarify an event, situation, or happening in relation to time - Presenting reality: helping to differentiate the real from the unreal - Focusing - Reflecting: directing ideas, feelings, questions, or content back to clients to enable then to explore their own ideas and feelings - Summarizing and planning