Module 1: Communication

Defense Mechanism: Compensation

Using personal strengths or abilities to overcome feelings of inadequacy

voice inflection

-Second most significant form of nonverbal communication -Spoken words may be emphasized through tone, volume, and the rhythm or rate of speech.

Examples of Nontherapeutic Communication

-asking "why" questions -using closed-ended questions or comments (this limits elaboration or discussion of a topic) -changing the subject -giving false reassurance (discounts the patient's feelings) -giving advise -giving stereotypical or generalized responses -showing approval or disapproval -showing agreement/disagreement -Engaging in excessive self-disclosure or comparing the experiences of others -Comparing patient experiences -Using personal terms of endearment -Being defensive

Verbal Techniques for Initiating and Encouraging Communication

-offering self ("I'll sit with you for a while") -calling the patient by their name -sharing observations ("you look tense, seem frustrated, you are smiling" -giving information ("surgery is scheduled for 11 am") -using open-ended questions/comments ("what re some of your biggest concerns? tell me more... share some feelings") -using focused questions or comments ("when did you start noticing...? Can you point exactly to where it hurts?") -provide general leads ("go on, tell me more, and then?") -conveying acceptance ("yes, I follow what you're saying, uh huh", nodding) -using humor -verbalizing the implied -paraphrasing or restating communication content -reflecting feelings or emotions -seeking clarification -summarizing -validating "did I understand you correctly?")

SBAR Model of Communication

-standardized interprofessional communication tool that supports accurate transfer of information (hand-off communication) between care providers. It is best used in a quiet, face-to-face environment that allows the receiving caregiver to ask questions and clarify a patient's plan of care. -Situation: what is happening right now? -Background: what led to the current situation? -Assessment: what is the identified problem, concern, or need? -Recommendation: What actions or interventions should be initiated to alleviate the problem?

proxemics

-the study of spatial distances between individuals in different cultures and situations (in humans and animals) - theory developed by anthropologist Edward Hall (1966))

nonverbal communication

-wordless transmission of ideas in the form of body language, gestures, touch, attire, facial expressions, and eye contact. -consists of 93% of communication. -more accurate mode of conveying information

intimate space

0-1.5 feet

in small group dynamics, what are the five phases of group development/dynamics that may facilitate or hinder communication?

1) forming: the leader identifies the mission and goals of the group 2) storming: group leader works with members to resolve conflicts & build cohesion 3) norming: emergence of increased trust and openness which results in productivity and meaningful sharing of info. it is essential for the group leader to encourage participation of all group members. 4) performing: interdependence emerges. problem solving takes place within the group, collaboration is effective 5) adjourning: small group disperses. Group's goals have been achieved

what are the three phases of the nurse-patient helping relationship?

1) orientation/introductory 2) working 3) termination

five areas of nurse-patient relationship (nursing process)

1. building trust 2. demonstrating empathy 3. establishing boundaries 4. recognizing and respecting cultural influences 5. developing a comprehensive plan of care TEBRC (Terri Eliminated Ben's Red Car)

personal space

1.5-4 feet

public space

12 feet or more

social space

4-12 feet

therapeutic communication

A beneficial, positive interaction that focuses on the patient in a nurse-patient interaction.

Defense Mechanism: Introjection

Taking on certain characteristics of another individual's personality

Defense Mechanism: Projection

Attributing undesirable feelings to another person

Defense Mechanism: Suppression

Choosing not to think consciously about unpleasant feelings

intrapersonal communication

Communication that occurs within oneself, focuses on personal needs, and has the potential of having an impact on a person's well-being.

interpersonal communication

Communication that takes place between a minimum of two people; it may be formal or informal and conversational, and it may or may not have a stated goal or purpose.

Defense Mechanism: Rationalization

Denying true motives for an action by identifying a more socially acceptable explanation

What does HIPPA mean?

Health Insurance Portability and Accountability Act

social communication

Informal interactions among friends, neighbors, and acquaintances

what assessment techniques are performed one at a time for each body system? What is the exception?

Inspection, palpation, percussion, and auscultation (in that order) (Inspector Penny Pulls an All-nighter) during abdominal assessment, auscultation precedes palpation and percussion (this avoids stimulation of the bowel before auscultation of bowel sounds)

Nontherapeutic Communication

Negative, harmful interactions that are not focused on the patient's needs

Defense Mechanism: Repression

Storing painful or hostile feelings in the unconscious, causing them to be temporarily forgotten

Therapeutic Communication

Positive, beneficial interactions that focus on the patient

Defense Mechanism: Sublimation

Rechanneling unacceptable impulses into socially acceptable activities

Defense Mechanism: denial

Refusing to admit the reality of a situation or feeling

Defense Mechanism:Regression

Reverting to behaviors consistent with earlier stages of development

What does SOLER stand for in active listening?

S: sit (if possible) facing the patient O: maintain an open stance L: lean toward the speaker E: maintain eye contact R: relax. Demonstrating relaxation during a conversation encourages the person sharing to continue. It also conveys a sense of attention, interest, and comfort with the subject being shared

role boundaries

The limits and responsibilities of individuals within a given setting.

sender

The person who initiates and encodes the communication. Senders may be individuals or groups who have a message to share.

feedback

The receiver's response to a message. essential to avoid misinterpretation of a message.

encode

The translation of the sender's thoughts and feelings into communication with a receiver.

Defense Mechanism: Displacement

Transferring emotional energy away from an actual source of stress to an unrelated person or object

positive self-talk

internal conversation that provides motivation and encouragement; it may be used to build self-esteem and self-confidence.

the dynamic process of communication occurs when what six key elements interact?

a referent, a sender, a receiver, the message, the channel, and feedback RSRMCF

Which feature of the nurse-patient helping relationship is legally upheld by the Health Insurance Portability and Accountability Act (HIPAA)? a) Confidentiality b) Respect c) Caring d) Empathy

a) Confidentiality

Which statements are accurate about the communication process? Select all that apply. a) Feedback is important to ensure the correct interpretation of the message. b) A referent is what the receiver formulates when getting the message. c) Channels of communication can be delivered through all five senses. d) The message can be spoken, written, and/or nonverbal. e) The sender interprets the message

a) Feedback is important to ensure the correct interpretation of the message. c) Channels of communication can be delivered through all five senses. d) The message can be spoken, written, and/or nonverbal

Which nursing responses are considered nontherapeutic? a)Asking "why" questions b) Using open-ended questions c) Offering advice d) Agreeing with the patient e) providing general leads

a)Asking "why" questions c) Offering advice d) Agreeing with the patient

Which cue by a patient can be validated by laboratory and diagnostic test results? a. Deeply sighing with fatigue b. Bilateral crackles in the lungs c. Oxygen saturation of 98% on room air d. 2+ pitting edema of the ankles and feet

a. Deeply sighing with fatigue rationale: A cue is a behavioral hint of a potential disease process or concern. In this case, the only cue is a deep sigh indicating fatigue. The level of fatigue can be verified by evaluating the patient's hemoglobin and hematocrit levels for anemia. Crackles, oxygen saturation, and pitting edema are all physical assessment findings, not cues.

2. Which factors should be taken into consideration by the nurse before and during a patient interview? (Select all that apply.) a. Distance between the chairs in which the nurse and patient are sitting b. Traditional treatments typically used by the patient to treat disease c. Gender preference for primary care providers (PCPs) d. Physical condition of the patient e. Music preference of the patient

a. Distance between the chairs in which the nurse and patient are sitting b. Traditional treatments typically used by the patient to treat disease c. Gender preference for primary care providers (PCPs) d. Physical condition of the patient Rationale: The first four factors are important for the nurse to consider when initiating or conducting a patient interview. The distance that is comfortable for personal interaction and gender preferences for care providers are affected by cultural and age norms. During the interview, it is an important aspect of assessment to ask patients about the treatments that they traditionally use in response to illness. Preferred treatments sometimes can be incorporated into care plans. The physical condition of patients affects their ability to answer questions during an interview. It may be necessary to break the interview process into short periods to accommodate the patient who is seriously ill. Music preference is irrelevant. There should not be music playing during the interview because it would be a distraction.

What action by the nurse would most ensure accurate interpretation of patient communication? a. Providing feedback regarding the conveyed message b. Writing down the patient's conversational highlights c. Assuming significant cultural differences exist d. Verifying the patient's emotional state

a. Providing feedback regarding the conveyed message Reasoning: Feedback is the most effective way to avoid misinterpretation of a message. It helps ensure that the message sent is perceived by the receiver in a way that is consistent with the intention of the sender. Writing down conversational highlights is a form of documentation that can still be misinterpreted unless feedback is sought. Avoid making assumptions regarding cultural differences. Verifying a patient's emotional state provides insight into a patient's state of mind, but it does not ensure accurate interpretation of a conversation.

What strategy would be most effective in communicating with a highly anxious adult immediately before surgery? a. Providing specific, concise instructions b. Detailing likely causes of their anxiety c. Focusing on postoperative details d. Using instructional multimedia DVDs

a. Providing specific, concise instructions Only essential information supplied in short, succinct sentences can be comprehended by adults who are extremely anxious. The source of this patient's anxiety is already stated to be the surgery, so the nurse need not elaborate on it. Postoperative teaching is best completed well in advance of surgery and reinforced after completion of the procedure. Multimedia DVDs are not effective teaching tools immediately before surgery. They may be helpful for a patient to watch at least 24 hours before a scheduled procedure to allow time for elaboration on topics not totally understood by the patient. Nurses must always check with the patient to verify that critical information is understood regardless of what form of communication has been used.

Which factors influence whether a message is effectively communicated? (Select all that apply.) a. Timing of the conversation b. Educational level of participants c. Mode of communication used d. Physical environment of discussion

a. Timing of the conversation b. Educational level of participants c. Mode of communication used d. Physical environment of discussion Reasoning: Timing of a conversation dramatically influences the receptivity of the receiver. The educational level of those seeking to communicate has an impact on the type of language and technical terminology that can be used in conversation. Using more than one mode of communication can enhance the effectiveness of a message. Making sure the environment is devoid of excess noise and distraction can facilitate a greater understanding of shared information

what is the first step in the nursing process?

assessment

Which techniques promote therapeutic communication? a) Asking "yes" or "no" questions b) Conveying acceptance c) Using focused comments d) Using humor e) Offering generalized responses

b) Conveying acceptance c) Using focused comments d) Using humor

Which impairments may impede communication? a) Gustatory b) Hearing c) Visual d) Cognitive e) Olfactory f) Physical

b) Hearing c) Visual d) Cognitive f) Physical

Which behaviors would the nurse implement when using active listening? a) Lightly touching the patient's arm b) Maintaining eye level with the patient c) Keeping arms uncrossed d) Facing the patient e) Leaning toward the patient f) Allowing time for the patient to answer

b) Maintaining eye level with the patient c) Keeping arms uncrossed d) Facing the patient e) Leaning toward the patient

If a patient is grimacing, what assessment statement or question would be most beneficial in identifying the underlying cause of the nonverbal communication? a. "Did you lose something?" b. "You appear to be having pain." c. "I will turn off the lights and let you rest." d. "May I get you something to relieve your tension?"

b. "You appear to be having pain." Reasoning: Grimacing is a common nonverbal sign of pain. Sharing an observation encourages the patient to elaborate on nonverbal communication. Asking the patient whether something is lost indicates that the nurse has not attended to the nonverbal cues of the patient. It is important to do an assessment of the patient before initiating any interventions.

3. Which action by the nurse is most appropriate during the orientation phase of the patient interview? a. Always position patients in a comfortable reclined position to ensure their comfort during questioning. b. Ask which name a patient prefers to be called during care to show respect and build trust. c. Quickly conduct a review of systems to determine the need for a complete or focused assessment. d. Begin with questions about intimacy and sexuality to address sensitive issues first.

b. Ask which name a patient prefers to be called during care to show respect and build trust.

If a patient's verbal and nonverbal communications are inconsistent, which form of communication is most likely to convey the true feelings of the patient? a. Written notes b. Facial expressions c. Implied inferences d. Spoken words

b. Facial expressions Nonverbal communication is the more accurate mode of conveying feelings. When a patient's verbal and nonverbal cues are incongruent, it is important to explore observations made by the nurse to discern the true feelings of the patient. Written notes, implied inferences, and spoken words do not provide the opportunity for observing nonverbal cues.

4. Which activity by the nurse best demonstrates part of the working phase of a patient interview? a. Summarizing previously discussed key topics b. Including selected family members in care planning c. Transferring care responsibilities to the home health nurse d. Verifying the name by which a patient prefers to be addressed

b. Including selected family members in care planning rationale: Care planning takes place during the working phase of the nurse-patient interview. When a patient needs care assistance, it is important for family members who will be helping with the patient's care to be involved in the process. Verifying the name that a patient prefers to be called takes place during the orientation or introductory phase. Summarizing key topics covered in the interview and transferring care responsibilities take place in the termination

Which defense mechanism is being exhibited when a 27-year-old patient insists on having a parent present during routine care? a. Denial b. Regression c. Repression d. Displacement

b. Regression Young adults who require their parents' presence for routine care are exhibiting regression, which is behavior consistent with earlier stages of development. Patients in denial refuse to see the reality of their situation. Repression is storing painful feelings in the unconscious, causing them to be temporarily forgotten. Displacement transfers emotional energy away from the actual source of stress to an unrelated object or person.

A patient asks, "Can I eat after the test?" The nurse responds, "Yes, after you are fully awake." Which communication element is correctly correlated to its example? a) Referent: The patient b) Channel: Nurse saying "Yes, after you are fully awake." c) Message: Patient asking "Can I eat after the test?" d) Sender: The nurse

c) Message: Patient asking "Can I eat after the test?" -Referent: The patient In this scenario the patient is the sender, not the referent. The referent is the event that initiates the conversation. In this situation, the referent is the concern about eating after the test. -Channel: Nurse saying "Yes, after you are fully awake." In this scenario, the nurse saying "Yes, after you are fully awake" is the feedback, not the channel. The channel is the use of the five senses to convey the message. -Message: Patient asking "Can I eat after the test?" In this scenario, the patient asking "Can I eat after the test" is the message. -Sender: The nurse In this scenario, the nurse is the receiver, not the sender. The patient is the sender in this situation.

What would be the best therapeutic response to a patient who expresses indecision about recommended chemotherapy treatments? a. "Can you tell me why you are undecided?" b. "It's always a good idea to have chemotherapy." c. "What are you thinking about the treatments at this point?" d. "You should follow whatever your health care provider recommends."

c. "What are you thinking about the treatments at this point?" Asking open-ended questions allows patients to share freely on a subject. "Why" questions, using closed-ended questions, and giving advice are all nontherapeutic communication techniques that limit patient reflection and sharing on topics of concern.

When initiating a physical examination, which action should the nurse take first? a. Review of the patient's prior medical records b. Gather admission health history forms c. Assess the patient's vital signs d. Perform light and deep palpation for fluid

c. Assess the patient's vital signs

5. Which entry in a patient's electronic health record best indicates the need for a nurse to gather secondary rather than primary subjective data? a. Complaining of chest pain b. Apical pulse 110 c. Comatose d. Difficulty swallowing

c. Comatose rationale: Primary data are obtained from the patient directly. A patient who is comatose is unable to speak and therefore unable to share subjective, primary data. A patient complaining of chest pain has already shared primary, subjective data. A patient with an apical pulse of 110 who is alert or one who has difficulty swallowing may still be able to contribute subjective information to the data collection.

1. Which action by a patient marks the beginning of the physical assessment process? a. Redressing after a physical examination b. Breathing normally during auscultation c. Greeting the nurse in the examination room d. Sharing work environment information

c. Greeting the nurse in the examination room Rationale: Assessment begins at the moment the patient first interacts with the nurse. Redressing takes place at the end of the physical examination. Breathing during auscultation is part of the respiratory assessment, and sharing health history and demographic information takes place during the patient interview.

A hospitalized patient experiences a sharp, stabbing pain while visiting with his spouse. Both the patient and his wife become very concerned, and the patient's call light is activated. What referent initiated communication between the patient and the nurse? a. Interaction between the patient and his wife b. Concern on the part of the patient's spouse c. Pain experienced by the patient d. Activation of the call light

c. Pain experienced by the patient Reasoning: Pain is the referent that initiated the communication process. The interaction between the patient and his wife was the result of the patient's pain as was the concern of the patient's spouse. The call light could be considered a channel through which the patient's interaction with the nurse began.

What action should the nurse take if an alert and oriented patient asks the nurse for personal contact information? a. Ask the patient why the personal information is needed. b. Report the interaction to the nursing supervisor immediately. c. State that it would not be appropriate to share that information. d. Change the subject, and hope that the patient does not ask again.

c. State that it would not be appropriate to share that information It is important for the nurse to immediately communicate that sharing personal contact information with patients is inappropriate and violates professional role boundaries. Asking "why" questions and changing the subject are nontherapeutic. Neither action will discourage the patient from further infringing on the nurse's personal right to privacy. Reporting the interaction to a supervisor may be helpful for preventing other nurses from experiencing similar requests; however, the first action taken by the nurse should be to maintain professional role boundaries.

For which reason would the nurse avoid nontherapeutic communication in a nurse-patient helping (therapeutic) relationship? a) Focuses on patient's options b) Exhibits empathy to the patient c) Shifts the emphasis to the patient d) Requires justification of actions from the patient

d) Requires justification of actions from the patient

6. Which line of questioning by the nurse best represents an appropriate approach to the review of systems aspect of the assessment process? a. "What do you do for a living? Can you describe your work environment?" b. "Is there a family history of heart disease, cancer, high blood pressure, or stroke?" c. "When was your last annual physical? What immunizations did you receive at that time?" d. "Do you have any chest tightness, shortness of breath, or difficulty breathing while exercising?"

d. "Do you have any chest tightness, shortness of breath, or difficulty breathing while exercising?" It is appropriate to use direct questions to gather data when a yes or no answer is adequate. rationale: During a review of systems, the patient is asked questions about each body system to determine the level of functioning. Asking about work-related information, family history, and immunizations is accomplished during the collection of health history data before initiating the review of systems.

A patient discusses his job stress and family relationships with the nurse during his health history interview. In which organizational framework is this type of data likely to be recorded most extensively? a. Body systems model b. Physical assessment model c. Head-to-toe assessment model d. Functional health patterns model

d. Functional health patterns model

If the nurse discovers that a patient's right elbow is swollen and painful during a physical examination, which action should the nurse take next? a. Apply ice to decrease swelling and reduce pain b. Percuss the area to determine the presence of fluid c. Perform passive range of motion to promote flexibility d. Inspect the patient's left elbow to compare its appearance

d. Inspect the patient's left elbow to compare its appearance rationale: A major aspect of assessment is checking for symmetry. If an abnormality is observed on one side of a patient's body, the next step in the assessment is to compare that area with the other side. Applying ice is premature until the assessment is complete and an underlying cause of the swelling and pain is understood. Percussion is not indicated for assessment of a swollen elbow. Performing passive range of motion is not appropriate before identifying an injury or disease and determining its extent.

Which statement is most accurate regarding symbolic expression? a. Skills confidence can be shared most effectively by nurses through wearing distinctive clothing. b. Clothing choices by a hospitalized patient rarely reflects his or her economic resources. c. Make-up use by a patient is unnecessary for any reason during hospitalization. d. Nondramatic make-up use and minimal accessorizing by nurses demonstrates professionalism.

d. Nondramatic make-up use and minimal accessorizing by nurses demonstrates professionalism. Nurses demonstrate professionalism by adhering to institutional dress codes that require minimal accessorizing and cosmetic use. Wearing distinctive clothing is not linked to skills confidence. Clothing choices often reflect the economic resources of an individual, and make-up use by a hospitalized patient is a personal preference that should be honored.

what is obtained during a patient interview?

demographic information, data about current health concerns, and medical and surgical histories.

what is noted during the assessment phase of the nursing practice?

developmental, cultural, ethnic, and spiritual factors that may affect the patient.

What may be perceived as aggressive or impolite by individuals from Arab, Indo-Chinese, or American Indian cultures

direct eye contact

before touching a patient of the opposite sex, what may help communicate caring and alleviate anxiety in the patient?

eye contact

negative self-talk

harmful or destructive internal conversation that may damage the ability of an individual to achieve his or her greatest potential or to overcome adversity.

80% of preventable medical errors involve issues of what form of communication?

interpersonal

Referent

initiating event or thought that leads one person to interact with another, may be anything, including a sensation.

what are the four basic types of professional communication?

intrapersonal, interpersonal, small-group, and public communication

advocacy

involves defending the rights of others, especially those who are vulnerable or unable to make decisions independently

body language

nonverbal communication through posture, stance, gait, facial expressions, eye movements, touch, gestures, and symbolic expressions influencing personal appearance, such as jewelry and make-up, generally communicate a person's thoughts more accurately than simple verbal interactions.

what are the methods through which an assessment is conducted?

observation; the patient interview, including the completion of a health history and review of systems; and a physical examination.

interprofessional communication

open communication among various members of the interdisciplinary health care team

the patient interview consists of what three phases?

orientation (or introductory), working, and termination

what is often used as reference for vision impaired patients?

positions of numbers on an analog clock

what are the five essential components of professional nursing communication?

respect, assertiveness, collaboration, delegation, and advocacy

what might violate role boundaries?

sharing personal phone numbers with patients, agreeing to meet patients outside the health care setting, and inappropriate touching violate these boundaries. Ethical or legal action may be taken against nurses who ignore professional role boundaries.

assertiveness

the ability to express ideas and concerns clearly while respecting the thoughts of others. this communication by nurses demonstrates confidence and elicits respect from patients and colleagues.

message

the content transmitted during communication (through various forms: spoken, written, and nonverbal)

channel

the means by which a message is communicated. any of the five senses may be used

receiver

the person who decodes, or interprets, a message

decode

to interpret the meaning of the nonverbal behavior other people express, (such as deciding that a pat on the back was an expression of condescension and not kindness)

what are the two basic forms of communication?

verbal (spoken, written, or electronic) and nonverbal (body language, gestures, and eye contact)

How close should the nurse stand to a hearing impaired patient?

within 3-6 feet

Nonverbal techniques for facilitating communication: therapeutic touch

• Holding the hand of a patient • Providing a backrub • Touching a patient's arm lightly • Shaking hands with a patient in isolation

Phase of the Nurse-Patient Helping Relationship: Termination

• Alerting the patient to impending closure of the relationship • Evaluating the outcomes achieved during the interaction • Concluding the relationship and transitioning patient care to another caregiver, as needed

Nonverbal techniques for facilitating communication: silence

• Being present with a person without verbal communication • Provides the patient time to think or reflect • Communicates concern when there is really nothing adequate to say in difficult or challenging situations

Phase of the Nurse-Patient Helping Relationship: Working

• Development of a contract or plan of care to achieve identified patient goals • Implementation of the care plan or contract • Collaborative work among the nurse, patient, and other health care providers, as needed • Enhancement of trust and rapport between the nurse and the patient • Reflection by the patient on emotional aspects of illness • Use of therapeutic communication by the nurse to keep interactions focused on the patient

The International Classification for Nursing Practice (ICNP) nursing diagnoses commonly related to communication concerns include the following 6 elements

• Impaired Verbal Communication • Powerlessness • Risk for Powerlessness • Social Isolation • Situational Low Self Esteem • Anxiety • Fear

Nonverbal techniques for facilitating communication: active listening examples

• Maintaining intermittent eye contact • Matching eye levels • Attentive posturing • Facing the patient • Leaning toward the person who is speaking • Avoiding distracting body movement

Phase of the Nurse-Patient Helping Relationship: orientation/introductory

• Making introductions, establishing professional role boundaries (formally or informally) and expectations, and clarifying the role of the nurse • Observing, interviewing, and assessing the patient, followed by validation of perceptions • Identifying the needs and resources of the patient