NR 222 Exam 3

What are the three forms of communication?

1)verbal 2)nonverbal 3)metacommunication

Steps in Promoting Problem Solving

1. Describe the experience or event of concern 2. Analyze the parts of the experience and see relationships to other events 3. Formulate the problem 4.Validate the Formulation 5. Use the formulation to identify ways to solve or manage the difficulty 6. Try out the solutions, judge the outcomes, and adjust the plan accordingly

Four Zones of Space

1. Intimate- 0- 18 inches; high interpersonal communication like performing physical assessment. 2. Personal- 18 inches- 4 feet; close relationships; might include touching; like sitting at a patients bedside. 3. Social-consultative- 9-12 feet; less intimate; requires louder verbal communication; like giving directions in the hallway. 4. Public- 12 feet; used for formal gatherings like giving a lecture to a class of students.

Sharing Humor

A coping strategy that can reduce anxiety and promote positive feelings; provides emotional support to patients and professional colleagues and humanizes the illness experience; release tension, cope with fear related to pain and suffering, communicate a fear or need, or cope with an uncomfortable or embarrassing situation.

Help the individual to describe and clarify content and meaning

A crucial step in using the therapeutic relationship effectively is to assist the individual to describe a particular experience or concern; the nurse should avoid threatening, detective-like questions; a problem solving approach by the nurse assists the person to describe and clarify the content and meaning of experience; the nurse's primary goal is helping their person to describe the problem and formulate solutions in partnership.

Rapport

A harmony and an affinity between people in a relationship; be genuine, open, and concerned.

Symmetrical Role

A more equal relationship in communicating.

Helping or Therapeutic Relationship

A process through which one person promotes the development of another person by fostering the latter's maturation, adaptation, integrating openness and ability to find meaning in the present situation; emerges from purposeful encounters characterized by effective communication; nurse respects the individuals values, attends to concerns, and promotes positive change by encouraging self-expression, exploring behavior patterns and outcomes, and promoting self help; is the foundation of clinical nursing practice.

Motivational Interview

A technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing behavior.

Pacing

Conversing at an appropriate speed; think before speaking and develop an awareness of the rhythm of your speech to improve pacing.

Intrapersonal Communication

AKA self-talk; people's thoughts and inner communications; influences perceptions, feelings, behavior, and self-esteem; can help develop self-awareness and a positive self esteem through positive self-talk.

Elements of Professional Communication

Courtesy, use of names, trustworthiness, autonomy and responsibility, and assertiveness.

Emotional Intelligence

An assessment and communication technique that allows nurses to better understand and perceive the emotions of themselves and others; enables a nurse to use self-awareness, motivation, empathy, and social skills to build a therapeutic relationship with a patient.

Timing and Relevance

Critical in communication; best time for interaction is when a patient expresses an interest in communicating.

Resistance

Arises from anxiety when a person feels threatened; most common form is avoidance.

Abilities the nurse must have to be able to relate to others

Ability to take initiative in establishing and maintaining communication; be authentic (one's self); respond appropriately to the other person; have a sense of mutuality; believe that the nurse patient relationship is a partnership and bother are equal participants.

AIDET

Acknowledge, Introduce, Duration, Explain, Thank you.

Perceptual Biases

Aka stereotypes; interfere with accurately perceiving and interpreting messages from others; tend to distort or ignore information that goes against their expectations, preconceptions, or stereotypes.

Silence

Allows individuals to reflect on what is being discussed or experienced; lets patient know that the nurse is willing to wait until they are ready to say more; provides them with comfort and support; allows person time to decide when to comment; nurse should make brief comments that do not demand answers.

Assertiveness

Allows you to express feelings and ideas without judging or hurting others.

Autonomy

Being self-directed and independent in accomplishing goals and advocating for others.

Attitudes

Biases and stereotypes that can limit the nurse's and individuals ability to communicate.

Gaps between nurse and individual

Block functional communication between the nurse and individual; can block mutual understanding.

Flexibility

Balance between control and permissiveness; overcontrol- every message is monitored; exaggerated permissiveness- anything can be communicated in any way; rules are needed about what is appropriate without rigid prescriptions that inhibit meaningful interchange.

Assessment

Be careful of a patient's values, preferences, and cultural, ethnic, and social backgrounds; look at the psychophysiological factors that might influence or limit communication like speech barriers, neurological deficits, hearing impairments, and medications; take into account the person's age and adjust how you speak to them by their developmental level (e.g. how you speak to an adult vs. a child); men and women handle communication differently (men are less verbal but more direct and more likely to engage you in communication; women are more likely to disclose personal information and will ask questions to continue conversation.

Preinteraction Phase

Before meeting the patient; review available data; talking to other caregivers; anticipate health concerns; identify a location and setting that fosters communication; plan enough time.

Orientation or Introductory Phase

Begins when individual and nurse meet; typically involves some feeling of anxiety; establishes a contract or pact that involves the mutual understanding of the parameters of the relationship; assess the patients health status; prioritize the patients problems and identify their goals.

Active Listening

Being attentive to what a patient is saying both verbally and nonverbally; facilitates patient communication; enhances trust because you communicate acceptance; SOLER (Sit facing the patient, Open position, Lean towards the patient, Eye contact, Relax).

Setting

Can affect the goals and the nature of the communication; most important aspect is that the nurse and individual are able to attend to each other; the nurse assesses the influence of factors such as lighting, noise, temperature, comfort, physical distance, and privacy.

Ethical Interpersonal Communication

Communicating information accurately; sharing responsibility from consequences; recognizing multicultural context of all communication; avoiding coercion and use of power; facilitating accurate and open communication.

Anxiety

During an interaction in which one has anxiety perception is altered and ability to communicate effectively is curtailed sharply; distorts reality and leads to disordered communication.

Clarity and Brevity

Effective communication is simple, brief, and direct.

Listening

Effective listening is actively focusing attention on the message; ask questions to explore what is meant; nonverbal communications like eye contact, nodding, maintaining interpersonal closeness or leaning forward can convey listening; reciprocity is the patterning of similar activities with in same interval by two people.

Working Phase

Emerges when the nurse and individual collaborate as partners in promoting the person's health; goals are set and the patient and nurse work mutually toward their accomplishment; solving problems, coping with stressors, and gaining insight are all part of this phase; trust is the first step; encourage and help the patient with self-exploration.

Sharing Feelings

Emotions are subjective feelings that result from one's thoughts and perceptions; if individuals do not do this their illness or stress could worsen; help patients do this by making observations, acknowledging feelings, encouraging communication, giving permission to express negative feelings, and modeling healthy emotional self-expression.

Gestures and Sounds

Emphasize, punctuate, and clarify the spoken word; sighs moans, groans, or sobs also communicate feelings and thoughts.

Nonverbal Communication

Encompasses all messages that are not spoken or written; use the five senses (movement, facial and eye expressions, gestures, touch, appearance, & vocalization or paralanguage); subject to misunderstanding (do not always reflect the senders conscious intent); no specific beginning or ending; culturally and situationally bound; careful observation is needed; more accurately indicates a person's intended meaning.

Sharing Hope

Essential for healing and learn to communicate a sense of possibility to others; encouragement and positive feedback are important.

Interpersonal Values

Factors within both the sender and the receiver that influence communication; provides a uniquely personal view of reality formed by an individual's culture, expectations, and experiences.

Focus on the Individual

First step to therapeutic communication is focusing the individual and the reason for the interaction; a useful rule of thumb is to answer or respond to obvious questions and to switch the focus back to clinical concerns when other questions are asked; keep the focus on the person's concerns.

Nursing Diagnosis

For patients with limited or no ability to communicate verbally it's Impaired Verbal Communication; defining characteristics are: inability to articulate words, inappropriate verbalization, difficulty forming words, and difficulty comprehending; related factors are: physiological, mechanical, anatomical, psychological, cultural, or developmental.

Touch

Form of nonverbal communication; can be expressed by a gentle or soothing application; evaluation of the context and meaning of touch to the individual is based on knowledge of that person and the interpretation of feedback.

Posture and Gait

Forms of self-expression; the way people sit, stand, and move reflects attitudes, emotions, self-concept and health status.

Complementary Role

Function with one person holding an elevated position over the other person.

Goal Direction

Helping relationship exists solely to meet some need or to promote the growth of the recipient; relationship is centered on the recipient; goals are formulated as desired individual behaviors; short term goals are any that last from 10 days to 2 weeks anything longer is long term.

Sharing Observations

Helps a patient communicate without the need for extensive questioning, focusing, or clarification.

Use Silence

Helps the individual to talk at his or her own pace; allows time for reflection.

Personal Appearance

Includes physical characteristics, facial expression, and manner of dress and grooming; communicates physical well-being, personality, social status, occupation, religion, culture, and self-concept; patients prefer nurses to have their hair back and off their shoulders and to not have long fingernails.

Circular Transactional Model

Includes several elements: the referent, the sender and receiver, message, channels, context or environment in which the communication process occurs, feedback, and interpersonal variables; each person in the communication interaction is both a speaker and a listener; communication becomes a continuous and interactive activity; feedback from the receiver or environment enables the communicator to correct or validate the communication; two roles: complementary or symmetrical.

Small-Group Communication

Interaction that occurs when a small number of people meet; usually goal directed and requires an understanding of group dynamics; should be organized, concise, and complete; encourage all to contribute and provide feedback.

Public Communication

Interaction with an audience; speaking with groups of consumers, present scholarly work, or leading classroom discussions; increase audience knowledge about health related topics, health issues, or other issues.

Psychophysiological Context

Internal factors; physiological status; emotional status; growth and development status; unmet needs; attitudes, values, and beliefs; perceptions and personality; self-concept and self-esteem.

Planning

Involve the patient and family in decisions; allow adequate time for practice; once a diagnosis has been identified select a goal like: patient initiates conversation about diagnosis or health care problem, patient is able to attend to appropriate stimuli, patient conveys a clear and understandable message with health care team, or patient expresses increase satisfaction with the communication process; always maintain an open line of communication; collaborate with other health care team members who have expertise in communication strategies.

Communication

Is the key to nurse patient relationships and the ability to deliver patient centered care; help reduces the risk of errors; promote improved patient outcomes and increased patient satisfaction; essential to ensure patent safety and optimum patient care.

Factors of Effective Communication

Listening, flexibility, silence, humor, touch, and space.

Improved Communication with Older Adults

Make sure patient knows you are talking to them; face the patient and be sure that they can see your mouth and don't chew gum; speak clearly but don't exaggerate lip movement or shout; speak a little more slowly; check if a patient uses hearing aids, glasses, or other adaptive equipment; choose a quiet, well-lit environment; allow time for the patient to respond; give the patient a chance to ask questions; keep communication short and to the point.

Termination Phase

Marks the end of the relationship; can cause anxiety; represents a loss; can trigger feelings of sadness, frustration, and anger; can also reawaken feelings of previously unresolved losses; working through any feelings related to termination is important; evaluate goal achievement.

Sensory Barriers

May need to use extra skills in communicating; might need to use other senses.

Channels

Means of sending and receiving messages through the senses; may understand the message more clearly when the sender uses multiple of these to send it.

Failure to address concerns or needs

Most serious barrier; can rise from: inadequate assessment, lack of knowledge, inability to separate the nurses needs from the individuals, and confusion between friendship and a helping relationship.

Referent

Motivates one person to communicate with another; sights, sounds, sensations, perceptions, and ideas are examples of cues; knowing the stimulus allows you to develop and organize messages more efficiently.

Relational Context

Nature of the relationship; social, helping, or working; level of trust among participants; level of caring expressed; level of self-disclosure among participants; shared history of participants; balance of power and control.

Brief Interactions

Nurses can structure these interactions to achieve specific clinical outcomes; feasible if nurses plan to introduce themself, state the purpose of the meeting, validate understanding, clarify parameters, and elicit individual/family data; goals must be realistic and clearly defined.

Lateral Violence or Workplace Bullying

Occurs between colleagues and includes behaviors such as withholding information, backbiting, making snide remarks or put downs, and nonverbal expressions of disapproval such as raising eyebrows or making faces; some techniques to use when experiencing it are: address the behavior when it occurs, describe how it affects your functioning, ask for it to stop, tell the manager, make a plan, and document the incident.

Using Touch

One of the most potent and personal forms of communication; expresses concern or caring to establish a feeling of connection; ask permission.

Interpersonal Communication

One-on-one interactions between a nurse and another person that occurs face-to-face; most frequently used; takes place within a social context; results in an exchange of ideas, problem solving, expression of feelings, decision making, goal accomplishment, team building and personal growth.

SBAR

Situation, Background, Assessment, and Recommendation.

Challenging Communication Situations

People who are silent, withdrawn, have difficulty expressing their feelings or needs; people who are sad or depresses; people who require assistance with visual or speech disabilities; people who are angry or confrontation and cannot listen to explanations; people who are uncooperative and resent being asked to help others; people who are talkative or lonely and want someone to be with them all the time; people who are demanding and expect others to meet their requests; people who are frightened, anxious, and have difficulty coping; people who are confused or disoriented; people who speak and/or understand little English; people who are flirtatious or sexually inappropriate.

Environmental Context

Physical surroundings; privacy level; noise level; comfort and safety level; distraction level.

Unethical Communication

Purposefully deceiving; intentionally blocking communication; scapegoating or unnecessarily condemning others; lying or deceiving; verbally "hitting below the belt".

Transference and Countertransference

Reacting to another person in an exchange as though that person were someone from the past; the same phenomenon but is experienced by the health care professional rather than the person.

Situational Context

Reason; information exchange; goal achievement; problem resolution; expression of feelings.

Metacommunication

Refers to all factors that influence communication; the impossibility of not communicating; one cannot communicate; persons transmit a message about what is being communicated even when words are not spoken; relationship aspect of communication; reading between the lines; interpreting communication accurately may be difficult; in group settings may be called group process; all communication has content and process (content- what is said; process- the relationship aspect of what is communicated); occurs during every group encounter.

Humor

Relieves tension, reduces aggression and creates a climate of sharing; can also block communication when it is used to avoid subjects; can also inflict emotional pain and communicate negative views and stereotypes through teasing and jokes.

Eye Contact

Signals readiness to communicate; shows respect and willingness to listen; allows people to closely observe one another; some cultures consider it intrusive, threatening, or harmful and minimize or avoid its use.

Cultural Context

Sociocultural elements; educational level of participants; language and self-expression patterns; customs and expectations.

Effectiveness of Communication

Steps include: firmly stating the case (make the content and metacommunication congruent), clarifying the message (must give a complete message, use "I" statements, and open ended questions), seek feedback (consensual validation), and being receptive to feedback when receiving it.

Sharing Empathy

The ability to understand and accept another person's reality, accurately perceive feelings, and communicate this understanding to the other; enables you to understand a patients situation, feelings, and concerns.

Empathy

The ability to understand another's feelings without losing personal identity and perspective; draw on emotions and experiences that enable them to place themselves in the other person's situation; use clinical and personal experience; don't shift focus onto yourself (e.g. "I know exactly how you feel; that happened to me once"); enables the listener to share human experiences as the basis for providing care.

Health Literacy

The capacity to read, comprehend, and follow through on health information; to combat low health literacy nurses can encourage individuals to ask three essential questions, create a safe and comfortable environment, sit to establish eye contact rather than stand, use visual aids and models, and verify understanding by using teach back technique.

Message

The content of the communication; contains verbal and nonverbal expressions; effective ones clear, direct, and understandable; personal perceptions may distort the receiver's interpretation.

Facial Expression

The face is the most expressive part of the body; conveys emotions such as surprise, fear, anger, happiness, and sadness.

Feedback

The message the receiver receives from the sender; indicates whether the receiver understood the meaning of the senders message; occurs continuously.

Purposeful Communication

The nurse focuses communication toward a particular goal; there should be some purpose to the communication; goals guide the nurse in focusing communication.

Use of Nouns and Pronouns Correctly

The nurse must be careful to use separate pronouns when speaking of himself or herself and the individual.

Use Construction Confrontation

The nurse points out a specific behavior and then helps the person to examine the meaning or consequences of the behavior; a purposeful way of helping the person examine personal actions and their meaning.

Sender

The person who encodes and delivers a message; their message acts as a referent for the receiver.

Receiver

The person who receives and decodes the message; includes the person interpreting the meaning of the word symbols.

Trust

The reliance on a person to carry out responsibilities and promises; based on a sense of safety, honesty, and reliability; promote trust by modeling and structuring the relationship appropriately; strategies: be consistent, and clearly define relationship.

Use Reflection

The restatement of what the individual has said in the same or different words; can involve paraphrasing or summarizing the person's main points; not parrot-like repetition; ask the person to restate what has been communicated.

Environment

The setting for the sender-receiver interaction; noise, temperature extremes, distractions, and lack of privacy or space create confusion, tension, or discomfort.

Narrative Interaction

The sharing of personal stories.

Intonation

Tone of voice.

Verbal Communication

Transmission of messages using words, spoken or written; a code that conveys specific meaning through a combination of words; words impart meaning defined by a specific language; sign language, braille, and touch also work; importance of language development is apparent in its 3 functions- informing the person of others' thoughts and feelings, stimulating the receiver of a message by triggering a response, & serving a descriptive function by imparting information and sharing observation, ideas, inferences, and memories; ability to fulfill these functions is influenced by many factors including communicator's social class, culture, age, milieu, and ability to receive and interpret messages.

Communication with non-English speakers

Understand your own cultural values and beliefs; assess the patient's primary language and level of fluency; provide a professional interpreter; speak directly to the patient; nodding or saying OK doesn't mean they understand; provide written information in both English and their primary language; learn about other cultures; incorporate the patients communication methods into plan of care.

Vocabulary

Unsuccessful communication happens if senders and receives cannot translate one another's words and phrases; limit use of medical jargon.

Electronic Communication

Use of technology to create ongoing relationships with patients and their health care team; provides an opportunity for timely communication with a patients physician or nurse; enables patients to stay engaged and informed.

Implementation

Use therapeutic communication techniques (active listening, sharing observations, sharing empathy, sharing hope, sharing humor, sharing feelings, using touch, using silence, providing information, clarifying, focusing, paraphrasing, asking relevant questions, summarizing, self-disclosure, confrontation, and validation); refrain from using non-therapeutic communication techniques (asking personal questions, giving personal opinions, changing the subject, automatic responses, false reassurance, sympathy, asking for explanations, approval or disapproval, defensive responses, passive responses, and arguing); be sure that the patient is physically able to use the chosen method and that it does not cause frustration by being too complicated or difficult.

Space

Vary depending on type of communication; proxemics- use of space between communicators; recognition of differences in culture helps the nurse adjust the distance and interpret the meaning of this nonverbal communication.

Denotative an Connotative Meaning

Words may have the same or different meanings depending on who you are speaking to; the shade or interpretation of the meaning of a word influenced by the thoughts, feelings, or ideas that people have about the word.