chapter 8
A client with a cardiac dysrhythmia was recently prescribed metoprolol and is at a follow-up appointment at the cardiologist's office. The client tells the nurse, "I feel depressed, tired, and I have no desire to exercise." To determine a cause-and-effect relationship, the nurse should ask:
"Were you tired and depressed before starting the new medication?" Sequencing is used to place events in a chronologic order or to investigate a possible cause-and-effect relationship between events. Nursing assessment is facilitated when events leading to a problem are placed in sequence. The symptoms the client is complaining of are common adverse effects of this drug. Sequencing can determine the cause and effect in this scenario. Clients taking metoprolol should check their blood pressure and pulse before taking their medication. Asking about the current diet or exercise regimen does not uncover the cause and effect.
A nurse is caring for a client who sustained head trauma. The client is in a medically induced coma and on mechanical ventilation. The client's parent is at the bedside in tears. The parent states, "I just want my child to know I am here." To address the needs of the parent and the client, what would be the nurse's most appropriate response?
Place a chair next to the bed and encourage the parent to hold the client's hand. Despite its individuality, touch is viewed as one of the most effective nonverbal ways to express feelings of comfort, love, affection, security, anger, frustration, aggression, excitement, and many others. The nurse may feel it is appropriate to place the client's hand on the parent's hand; however, the nurse should not provide false hope. The nurse should not leave the parent alone to grieve; the nurse should show the parent how to use comforting communication. The client is in a chemically induced coma and will not be able to see pictures that are displayed in the room.
The nurse is caring for a postoperative client who refuses a blood transfusion due to religious beliefs. The nurse is demonstrating trustworthiness when taking which action in response to the client's treatment wishes?
contacting the interprofessional care team to discuss alternative treatment options Nursing responsibilities in the nurse-client relationship entail advocating on the client's behalf. For a client who does not consent to a particular type of treatment, for which there may be alternative treatments available, the nurse can establish trust in the nurse-client relationship by advocating for the client's care needs to the client's interprofessional care team. Although it is part of the nurse's scope of practice to provide client education regarding treatment interventions, this is not the action the nurse would take to establish trust with the client. Speaking to the client's family about having this discussion potentially breaches client confidentiality and would serve to decrease trust in the nurse-client relationship. It is not within the nurse's scope to recommend that the client have the cognitive capacity assessed. While it is important to ensure the client has the capability to make informed decisions about treatment, the client's refusal for treatment stems from personal beliefs, not cognitive impairment.
Personal zone:
distance when interacting with close friends
verbal communication
exchange of information using words
noise
factors that distort the quality of a message and interfere with the communication process
rapport
feeling of mutual trust experienced by people in a satisfactory relationship
CUS
im concerned, im uncomfortable, this is unsafe( this is a safety issue) CUS offers a consistent method for health care team members to speak up about patient safety concerns in an assertive manner that is clear, structured, and easy to use. CUS can be used when the nurse feels there is an unsafe situation and needs to effectively communicate this concern to other health care providers.
A nurse is providing care to a 3-year-old child admitted with a diagnosis of infectious diarrhea. The nurse needs to insert an intravenous catheter in order to administer prescribed intravenous fluids. In an attempt to foster communication, the nurse should:
involve the child's stuffed animal in the educational session. Communication happens best when the environment facilitates an easy exchange of needed information. The environment most conducive to communication is one that is calm and nonthreatening. The goal is to minimize distractions and ensure privacy. The use of music, art, and interior decorations might help put the client at ease. A client with newly diagnosed human immunodeficiency virus (HIV) infection will find it difficult to discuss sexual history or genital warts in an area that lacks privacy. A toddler might find it easier to communicate if a parent, favorite stuffed animal, or blanket is nearby. The parent should not be asked to leave the room and this may cause panic or anxiety in the child. A 3-year-old child will not be able to read written materials. Showing the child the catheter may frighten the child.
when obtaining a nursing history
it is beast to use open ended question technique to allow the patient a wide range of possible responses
gait
manner of walking
targeted solutions tool (TST)
measure performance identify barriers to excellent performance implement proven solutions
bullying:
negative, often repetitive, disruptive behavior; also referred to as horizontal violence, lateral violence, and professional incivility
body language:
nonverbal communication
The S (Situation) and B (Background) provide
objective data,
Nurses must communicate with team members in a manner that promotes
open communication and mutual respect. Communication and collaboration between the nurse, patient, and other health care professionals results in quality person-centered care
language
prescribed way of using words; a means to express thoughts and feelings
organizational communication:
process of communication that involves individuals and groups to achieve established goals
communication:
process of sharing information; process of generating and transmitting meanings
The challenges of using social media include
protecting patient privacy and confidentiality and preventing unintended consequences for the employer or the nurse.
The American Association of Critical-Care Nurses (AACN)
provides standards for establishing and sustaining healthy work environments, and states the quality of the work environment is linked to excellent nursing practice and patient care outcomes (AACN, 2016).
incivility
rude, intimidating, and undesirable behavior directed at another person
tactile sense
sense of touch
why should you let a patient know at the beginning of the interaction if time is limited when going over his history?
so that the patient does not feel that you are rushing because of a lack of concern or personal interest.
Social zone:
space when interacting with acquaintances such as in a work or social setting
aggressive behavior:
standing up for one's rights in a negative manner that violates the rights of others
Semantics
study of the meaning of words
A nurse is attempting to calm an infant in the nursery. The nurse responds to the highest developed sense by:
swaddling the child and gently stroking its head. Touch is the most highly developed sense at birth. Tactile experiences of infants and young children appear essential for the normal development of self and awareness of others. It has also been found that many older people long for touch, especially when isolated from loved ones because of hospitalization or long-term care facility care. Vision, taste, and hearing are not as fully developed as touch in the neonate.
A nurse is preparing to enter a client's room to perform wound care. The shift report revealed that this client has a tunneling wound in the sacral area that cannot be staged. The wound was also documented as having a foul odor. The nurse is nervous because the nurse has not performed wound care on a complex wound in the past. Using effective intrapersonal communication, this nurse should
tell oneself to "remain calm" and remember that the nurse was trained to perform this skill. Intrapersonal communication, or self-talk, is communication within a person. This communication is crucial because it affects the nurse's behavior and can enhance or detract from positive interactions with the client and family. Understanding the importance of intrapersonal communication can also help the nurse work with clients and families whose negative self-talk affects their health and self-care abilities. Speaking directly to the client, a UAP, or charge nurse is interpersonal communication, not intrapersonal. This duty cannot be delegated to an UAP. The nurse should not ask the charge nurse to change the assignment but could ask for help in dealing with the complex wound.
message
term used in communication theory to denote the actual physical product of the source or encoder (e.g., a speech, interview, phone conversation, chart)
channel:
term used in communication theory to denote the medium selected to convey the message; the channel may target any of the receiver's senses
Proxemics is:
the study of how people use space and how the use relates to culture.
social media
web-based technologies that allow users to create, share, and participate in dialogue in virtual communities and networks
assertive behavior
ability to stand up for oneself and others using open, honest, and direct communication
The A (Assessment) and R (Recommendations) allow for
allow for presentation of subjective information.
A client was recently diagnosed with metastatic lung cancer. The nurse finds the client crying in the room. Which statement made by the nurse best demonstrates the use of empathy?
"I see you are upset. Would you like to talk?" Nurses use empathy, an intuitive awareness of what a client is experiencing, to perceive the client's emotional state and need for support. Acknowledging the client's state, "I see you are upset" and asking the open-ended question, "would you like to talk" best demonstrates the use of empathy and helps the nurse become effective at providing for the client's needs while remaining compassionately detached. Sympathy, such as saying sorry, is not supportive and asking a closed question does not allow the client to express his or her concerns or fears. An offer to call someone is an example of avoidance, and makes the nurse appear uncaring. Telling the client not to worry is an example of giving false reassurance and is nontherapeutic and can give the client false hopes and expectations.
A nurse is calling a physician to communicate a change in the client's condition. According to the ISBARR format for handoff communication among health care personnel, which is the most appropriate way to begin the conversation?
"My name is Sue Smith, RN, and I am calling regarding Mrs. Jones in room 356 at Jefferson Hospital." ISBARR was recently revised by the QSEN institute to include initial identification of the nurse and the client. The nurse should identify oneself and one's role during the initial conversation with the physician, as in the answer in which the nurse states the full name and degree. This allows the physician to understand the role of the nurse should the physician need to provide orders or instructions regarding the client. The other responses fail to identify the nurse in the beginning of the conversation or fail to adequately identify the client.
empathy:
(1) objective understanding of the way in which a patient sees his or her situation, identifying with the way another person feels, putting oneself in another person's circumstances and imagining what it would be like to share that person's feelings; (2) intellectually identifying with the way another person feels
The helping relationship (nurse-patient relationship) three phases
(1) the orientation phase, (2) the working phase, and (3) the termination phase.
Working Phase
-The patient will actively participate in the relationship. -The patient will cooperate in activities that work toward achieving mutually acceptable goals. -The patient will express feelings and concerns to the nurse.
orientation phase
-The patient will call the nurse by name. -The patient will accurately describe the roles of the participants in the relationship. -The patient and nurse will establish an agreement about: Goals of the relationship. Location, frequency, and length of the contacts -Duration of the relationship
Which is an open-ended question? "Why did the health care provider prescribe this medication for you?"
Open-ended questions (e.g., "Why was this medication prescribed for you?") give the client an opportunity to express what the client understands and prevent the client from answering with just "yes" or "no" or some other one-word response. The other three responses require only a one-word response (e.g., "yes" or "no") and so are closed-ended questions.
small group communication
: communication that occurs when two or more nurses interact with two or more individuals, allowing the members to achieve a goal through communication
nonverbal communication
: exchange of information without the use of words
group dynamics:
: study of a group's characteristics and ways of functioning
feedback
: verbal and nonverbal evidence that the message is received and understood
A nurse is completing a health history on a client who has a hearing impairment. Which action should the nurse take first to enhance communication?
Assess how the client would like to communicate Clients with hearing impairment pose unique challenges for communication. Assessing how the client communicates best is important. For example, if a deaf client can read and write, writing can facilitate communication. If the client knows sign language, the nurse could use a person trained in sign language. Using hand gestures and exaggerated facial movements does not allow for adequate acquisition of knowledge.
A family has lost a member who was treated for leukemia at a nursing unit. The nurse provides emotional support to the family and counsels them to cope with their loss. Which quality should the nurse use in this situation?
Empathy The nurse should empathize with the family for their loss. Empathy helps the nurse to provide effective care and support without being emotionally distraught by the family's condition. If the nurse becomes indifferent to the family's condition, the nurse may not be able to assess their needs. The nurse should not pity, or provide sympathy to, the family for their loss, as it would involve the nurse emotionally.
The helping relationship (nurse-patient relationship) three charateristics
It is dynamic. Both the person providing the assistance and the person being helped are active participants to the extent each is able. It is purposeful and time limited. This means there are specific goals that are intended to be met within a certain period. Although both parties in the helping relationship have responsibilities, the person providing the assistance is professionally accountable for the outcomes of the relationship and the means used to attain them. Helping persons should present their helping abilities as honestly as possible and not promise to provide more assistance than they can offer.
The nurse makes a contract with the client during which phase of the nurse-client relationship?
Orientation phase he orientation phase of the relationship represents the first phase of therapeutic work and involves signing of formal contracts. Formal contracts in this setting are a therapeutic tool to help a client develop more insight and control over the client's own behavior. The working phase is when the nurse assists clients in this process by helping them to describe and clarify their experiences, to plan courses of action and try out the plans, and to begin to evaluate the effectiveness of their new behavior. The termination phase is the final phase and the period when a client's goals are assessed and the relationship comes to an end. There is no intimate phase.
SBAR communication
Situation Background Assessment Recommendation /method to improve hand-off communication provides a consistent method for hand-off communication that is clear, structured, and easy to use.
The nurse meets with the client to teach self-administration of low molecular weight heparin. During the initial part of the training the client shakes the head and asks the nurse to repeat the instructions. What action demonstrates that the nurse has assessed the client's communication abilities?
The nurse faces the client, speaks slowly and clearly, and demonstrates the procedure using a needleless syringe.
Termination
The patient will participate in identifying the goals accomplished or the progress made toward goals. The patient will verbalize feelings about the termination of the relationship.
dispositional traits
a characteristic or customary way of behaving. Nurses who consistently demonstrate warmth and friendliness; openness and rapport; empathy, honesty, authenticity, and trust; caring; and competence are well disposed to communicate effectively.
cliché:
a stereotyped, trite, or pat answer
horizontal violence
anger and aggressive behavior between nurses or nurse-to-nurse hostility
what is the optimal distance to sit from a patient during an intake interview
anywhere from 18 in to 4 Feet
Describing a patient by using a room number or diagnosis rather than a name is still considered a
breach of confidentiality and a violation of patient privacy.
Each of the following facilitates a therapeutic nurse-client relationship except:
closed-ended questions.
intrapersonal communication
communication techniques or self-talk to enhance positive interaction with the patient and family
interpersonal communication:
communication that occurs between two or more people with a goal to exchange messages
CUS (communication tool):
communication tool to assist in effective communication related to patient safety concerns; the acronym CUS stands for I'm Concerned, I'm Uncomfortable, This is unSafe (or This is a Safety issue)
Public zone:
communication when speaking to an audience or small groups
SBAR communication tool
consistent, clear, structured, and easy-to-use method of communication between health care personnel; it organizes communication by the categories of: Situation, Background, Assessment, and Recommendations.
While communicating with a client who is hearing impaired, the nurse must take into account that the client's hearing serves as a:
filter. Sight, hearing, touch, taste, and smell are filters of the neurologic receptor system. Stimuli processed through these receptor systems enable the person to experience the outside world. Although the client's impaired hearing may make communication more challenging, the nurse should not view the impaired hearing as a handicap or communication blocker but as simply a factor the nurse must consider when communicating with the client. The client is the receiver, or receptor, of the message, not the client's hearing.
A unit-based infection control task force was developed in an attempt to reduce catheter-acquired infections. The group consists of 10 team members. During the past three meetings, one person dominated the meeting and did not allow other members ample time to speak. The best way to address the team dysfunction is to:
have group members confront the dominant member to promote the needed team work. Effective groups have members who are mutually respectful. If a group member dominates or thwarts the group process, then the leader or other group members must confront the member to promote the needed collegial.A written warning would be relationship. . A written warning would be inappropriate
Intimate zone:
interaction between parents and children or people who desire close personal contact
helping relationship:
interaction that sets the climate of movement of the participants toward common goals
The Quality and Safety Education for Nurses (QSEN) Institute identifies quality and safety competencies for nursing, with the goal of
preparing future nurses with the knowledge, skills, and attitudes necessary to improve the quality and safety of the health care systems within which they work (QSEN, 2014).
