Chapter 8

Nonassertive Communication (Passive)

> Allowing one's own rights to be violated by others > meeting the demands and requests of others without regard to own feelings and needs > Believing own feelings are not important > Being insecure and trying to maintain self-esteem by avoiding conflict

A nurse is planning care for an adult client with severe hearing impairment who uses sign language and lip reading for communication and who has a new diagnosis of cancer. Which nursing action is most appropriate when establishing the plan of care for this client?

Arrange for a sign language interpreter when discussing treatment.

Accurate documentation for a patient given Diovan, 10 mg, once daily is: "Diovan, 10 mg, Q.D."

False

Attentive Listening

> Active listening, mindfully > Listen for key themes

Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?

Working phase

A nurse is asking a colleague about a situation. Which statement demonstrates assertive communication?

"I think there is a better way to handle this."

Electronic Communication

> Social Media > E-mail > Text messages

A nurse is communicating the plan of care for a client who is unconscious. Which nursing actions best facilitate this process? Select all that apply.

> The nurse is careful what is said in the patient's presence since hearing is the last sense to go > The nurse assumes the client can hear and discusses things that would ordinarily be discussed. > The nurse speaks with the client before touching the client.

An example of a helpful and accurate nursing note is: "The patient appears to be resting more comfortably today than yesterday."

False

Carrying out a physician-initiated order is an example of an independent nursing action.

False

Clearly identifying patient strengths and actual and potential problems is a part of the nursing process known as assessing.

False

During the implementation step of the nursing process, patient outcomes are identified.

False

Three Phases of Helping Relationships

1. orientation 2. working 3. termination

A data _______________ is a grouping of patient data or cues that point to the existence of a patient health problem.

Cluster

Subjective data are observable and measurable data that can be seen, heard, or felt by someone other than the person experiencing it.

False

A nurse is obtaining a history from an adult female client. When the nurse asks how many times the client has been pregnant, the client answers, "I have four kids." Which statement, made by the nurse, seeks clarification of the original question?

"I understand you have four kids; how many times have you actually been pregnant?"

Offering Self

"I will stay with you until your daughter arrives"

Direct

"Rate your pain on a scale of zero to ten"

Sequencing

"Tell me about what happened first"

During an admission intake assessment, a nurse uses open-ended questions to gather information. An example of an open-ended question is:

"What did your health care provider tell you about your need to be admitted?"

A 70-year-old client had a cholecystectomy 4 days ago. The client's daughter tells the nurse, "My mother seems confused today." Which question would be best for the nurse to ask to assess the client's orientation?

"What is your name?"

Providing Leads

"Would you like to talk about..." "And then what?"

Three Goals of Helping Relationships

1. increased client independence 2. Greater feelings of worth 3. Improved health/well-being

Personal

1.5-4 ft

Public

12 to 15 ft

Social

4-12 FT

2020: Social Distancing

6 to - ft.

An evening shift nurse is caring for a client scheduled for a colon resection in the morning. The client tells the nurse that the client is nervous about the surgery. The best response by the nurse is to:

Ask the client "Can you tell me more about what is worrying you?"

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

Quality process review recognizes that ____________ is the primary source of evidence used to continuously measure performance outcomes against predetermined standards.

Documentation

The following would be considered an example of a psychomotor outcome: "Before discharge, patient will verbalize the need to quit smoking cigarettes."

False

The phase expected outcomes is used to refer to the less-specific, hard-to-measure criteria for measuring whether a goal has been met.

False

Therapeutic Communication

Foundational to the nurse-client relationship

The __________ record is a form used to record specific patient variables such as pulse, respiratory rate, blood pressure readings, body temperature, weight, fluid intake and output, bowel movements, and other patient characteristics.

Graphic

Most schools of nursing and health care institutions establish a _________________ data set that specifies the information that must be collected from every patient.

Minimum

Adaptability

Modifying tone to match the mood, atmosphere of the client

The client recently immigrated from Mumbai, India. The client was just admitted to the nurse's unit postoperatively following gallstone removal. The client does not speak the dominant language. When using the hospital's interpretive services, which is most important?

Speak directly to the client

A ___________ or a norm is a generally accepted rule, measure, pattern, or model to which data can be compared in the same class or category.

Standard

Public Communication

Teaching, community presentations, writing about nursing or health care topics

When the relationship between the carer and the cared for is used for promoting or restoring the health and well-being of people within the relationship, it becomes a _____________relationship.

Therapeutic

Intimate

Touching to 1.5 feet

A comprehensive care plan specifies any routine nursing assistance that the patient needs to meet basic human needs and describes appropriate nursing responsibilities for fulfilling the collaborative and medical care plan.

True

It is critical that every nursing intervention is supported by a sound scientific rationale, as demanded by _______________-based practice.

evidence

Verbal and Nonverbal Communication

Both are necessary to build trust and rapport

A __________________ nursing diagnosis is a clinical judgment concerning an undesirable human response to a health condition/life process that exists in an individual, family, group, or community..

Problem-focused

Top 3 Disruptive Behaviors

> Incivility > Lateral Violence > Bullying

Effective Communication

A skill nurses must develop

An _____________ is a set of steps, typically embedded in a branching flow chart, that approximates the decision-making process of an expert clinician.

Algorithm

Humor

Help client adjust to difficult painful situation

The nursing _________________ identifies the patient's health status, strengths, health problems, health risks, and need for nursing care.

History

Bullying

Offensive, abusive, intimidating, insulting behavior or abuse of power

A national study of more than 1,700 health care professionals found that the majority of physicians and nurses surveyed had seen coworkers take shortcuts that could have been dangerous to patients.

True

The evaluation of one staff member by another staff member on the same level in the hierarchy of an organization is known as ___________ review.

Peer

Patient safety and transparency of information are two principles of ___________-centered care that can be used by every organization.

Person

You statements

Place blame and put the listener in a defensive position

Verbal Communication

Vocabulary, credibility, shared meaning, clarity and brevity (simple, clear), timing and relevance, pace and intonation, humor

A nurse is caring for a client who is newly diagnosed with terminal cancer. The nurse enters the client's room and finds the client sitting in the dark crying. Which statement conveys empathy by the nurse?

"I know this is hard for you. Is there any way I can help?"

The nurse completes the admission process of a client to an acute care facility. Which statement by the nurse demonstrates the communication technique of focusing?

"You are hoping to figure out the cause of your extreme fatigue during this hospital stay."

A nurse is assessing vital signs on a pregnant client during a routine prenatal visit. The client states, "I know labor will be so painful, it sounds awful. I am sure I will not be able to stand the pain; I really dread going into labor." What is the best response from the nurse?

"You're worried about how you will tolerate the pain associated with labor."

Factors Influencing Communication

> Development > Gender > Values and perception

Lateral Violence

Abusive words or actions of peers (gossip, exclusion of information, threat of harm, actual harm)

Culture

Affects interpretation

A nurse is completing a health history with a newly admitted client. During the interview, the client presents with an angry affect and states, "If my doctor did a good job, I would not be here right now!" What is the nurse's best response?

Be silent and allow the client to continue speaking when ready

A nurse and an older adult client with chronic back pain are beginning to communicate. What activity should the nurse focus on at this point?

Being sensitive to the client's emotional barriers

Which quality in a nurse helps the nurse to become effective in providing for a client's needs while remaining compassionately detached?

Empathy

In a helping relationship, the nurse would most likely perform what action?

Encourage the client to independently explore goals that allow the client's human needs to be satisfied.

Interpersonal Communication

Exchange of information between two or more people

Assertive Communication

Promotes client safety by minimizing miscommunication with colleagues > Honest, direct, appropriate; open to ideas > Respects rights of others > I statements, not you

Actual or potential health problems that can be prevented or resolved by independent nursing interventions are termed nursing diagnoses.

True

Critical thinking is defined as "a systematic way to form and shape one's thinking."

True

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.

Nonverbal Communication

> Physical appearance > Posture > Gait > Eye contact > Gestures > Sounds > Touch

Therapeutic Communication

> Promotes understanding > Establishes constructive relationship > Attentive listening > Visibly tuning in

Communication Strategies

> SBAR > Closed loop > Handoff

Closed Loop

> Sender initiates message > receiver accepts message, provides feedback confirmation > Sender verifies message was received

Avoiding information contrary to one's opinion is an example of _____, an approach that leads to potential errors in clinical decision making.

Bias

Interventions performed jointly or interdependently by nurses and other members of the health care team are called ___________ interventions.

Collaborative

Using physician-prescribed and nursing-prescribed interventions are examples of _____________ problems that are managed by nurses to minimize the complications of an event.

Collaborative

Communication

Complex process of sending, receiving, and comprehending messages between two or more people

The Nursing Interventions Classification (NIC) project defines an indirect care intervention as any nursing activity.

False

The chief purpose of ongoing planning is to teach the patient to competently carry out necessary self-care behaviors at home.

False

Root Cause of Nearly 66% Sentinel Events

Ineffective communication

Problem solving that is ____________ refers to a direct understanding of a situation based on a background of experience, knowledge, and skill that makes expert decision making possible.

Intuitive

Pace and Intonation

Manner of speech, rate, rhythm, and tone that modify the impact and feeling of a message

A home care nurse discusses with a client when visits will occur and how long they will last. In what phase of the nurse-client relationship is this type of agreement established?

Orientation Phase

The nurse makes a contract with the client during which phase of the nurse-client relationship?

Orientation phase

A patient ___________ is an expected conclusion to a patient's health expectation.

Outcome

In the nursing process, evaluative criteria are the patient _____________ developed during the planning step.

Outcomes

Levels of Basic Communication

Public Small

Clarifying Questions

Restating, reflecting, paraphrasing, exploring

Incivility

Rude dialogue or actions (Sarcasm, eye rolling)

Timing and Relevance

Sensitivity to the client's needs

Sentinel Event

Signal need for immediate investigation and response; A patient safety event that reaches a patient and results in any of the following: > Death > Serious physical/psychological injury or risk

Silence

Sitting quietly, waiting until client can pull thoughts together

Self-Talk

The inner speech that includes the questions and comments you make to yourself. Use it when you: > Think things through > Interpret events > Interpret messages of others > Respond to your own experiences > Respond to your interactions with others

In most facilities, the only circumstance in which orders may be issued verbally is in a medical emergency.

True

Credibility

Trustworthiness, reliability; nurse should convey confidence

Open-Ended Questions

Who, what, where, when, why

A nurse is completing a health history with a client being admitted for a mastectomy. During the interview the client states, "I do not know what to do. I am not sure if I really need this surgery." Which response by the nurse demonstrates active listening?

"You seem unsure. Tell me your concerns about your surgery."

A nurse is communicating the plan of care to a client who is cognitively impaired. Which nursing actions facilitate this process? Select all that apply.

> The nurse shows patience with the client and gives the client time to respond. > The nurse maintains eye contact with the client. > The nurse keeps communication simple and concrete.

A nurse during orientation notices that the preceptor gives all subcutaneous injections on a 45-degree angle. When the new nurse asks the preceptor the rationale for the practice the preceptors states, "This is how I do it, and this is how you will do it." The new nurse recognizes this behavior to be:

Aggressive

A client is diagnosed with diabetes. The client's adult child offers to serve as an interpreter, because the client does not speak the dominant language. Which is the best action for the nurse to take?

Contact a professional interpreter.

Charting by __________ is a shorthand documentation method in which only deviations from well-defined standards of practice are documented in narrative notes.

Exception

Most experienced nurses begin the work of interpreting and analyzing data after they have finished collecting it.

False

Nursing assessments have the same components as medical assessments, but with less detail.

False

Quality by inspection focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork.

False

A key nursing skill when performing both the nursing history and the physical examination is _________________ , the conscious and deliberate use of the five senses to gather data.

Observation

Initial _______________ addresses each problem listed in the prioritized list of nursing diagnoses and identifies appropriate patient goals and related nursing care.

Planning

A health ___________ is a condition that necessitates intervention to prevent or resolve disease or illness, or to promote coping and wellness.

Problem

Which technique would a nurse employ when using listening skills appropriately when interviewing a client?

The nurse would listen to the themes in the client's comments.

A focused assessment is conducted to gather data about a specific problem that has already been identified.

True

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 often performed wound care on a complex wound. Using effective intrapersonal communication, this nurse should:

tell oneself to "remain calm" and remember that the nurse was trained to perform this skill.

A client arrives at a crisis center in a state of bipolar mania. The client has a flight of ideas and it is difficult for the nurse to obtain an adequate intake assessment. Which statement or question will elicit the most specific information?

"Are you allergic to any medications?"

The nurse is collecting health data and avoids using closed-ended questions. Which are examples of closed-ended questions? Select all that apply.

"Are you ready to get out of bed?" "Do you smoke cigarettes?" "Is there any chance you might be pregnant?" "Does it hurt when I touch you here?"

Prevent Communication Errors

> Listen closely > Write down > Read back > Confirm

Examples of Sentinel Events

> Loss of limb or function > Patient on suicide watch commits suicide > Unexpected death of full-term infant > Infant abduction > Infant discharged to wrong family > Rape > Reaction to mismatched blood > Surgery on wrong patient/wrong body part

Visibly Tuning In

> Manner of being present to another > Face the client, open posture, lean to person, maintain eye contact, relax

Essential Components of Communication

> Time > Attentive behavior > Caring attitude > Honesty > Trust > Empathy > Nonjudgemental attitude

Aggressive Communication

Can be blaming and delivered in a rushed manner; becomes ineffective and leads to frustration for the nurse and physician

Evaluation that is conducted by using direct observation of nursing care, patient interviews, and chart review to determine whether the specified evaluative criteria are met is known as ______________ evaluation.

Concurrent

Computer-based records, or ____________ health records (EHRs), allow data to be distributed among many caregivers in a standardized format.

Electronic

The nurse is visiting a hospice client in the client's home. The client is explaining difficulties with a home infusion pump. By making statements such as "I see" and "go on" during the conversation, the nurse is using which therapeutic nurse-client communication technique?

Encouraging elaboration

The documentation of a judgment summarizing data interpretation and patient outcome achievement is an ____________ statement.

Evaluative

Twentieth-century health care in the United States has finally focused more on the needs of the patient rather than on the disease process affecting the patient.

False

A nurse is discussing cataract treatment with a client. Which statement by the nurse would be most therapeutic?

Have you ever thought of laser eye surgery?

The outcome of critical thinking or clinical reasoning is known as clinical ____________, the conclusion, decision, or opinion the nurse makes.

Judgment

Clarity and Brevity

Message direct and simple; say what you mean

A ______________-initiated intervention is an autonomous action based on scientific rationale that a nurse executes to benefit the patient in a predictable way.

Nurse

Written plans, known as _______________ , detail the nursing activities to be executed in specific situations.

Protocols

When preparing for data collection, identify the __________ of the nursing assessment first, then gather the appropriate data.

Purpose

A nurse is at the end of a busy shift on a medical-surgical unit. The nurse enters a room to empty the client's urinary catheter and the client says, "I feel like you ignored me today." In response to the statement, the nurse should:

Sit at the bedside and allow the client to explain the statement

SBAR

Situation Background Assessment Recommendation

A ________________-oriented patient record is one in which each health care group keeps data on its own separate form.

Source

A ____________ of nursing practice is established by authority, custom, or consent, and reflects a level of performance accepted by and expected of nursing staff.

Standard

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

A nurse has been caring for a client who had a myocardial infarction 2 days ago. During the morning assessment, the nurse asks the client how the client feels. Which scenario warrants further investigation?

The client stares at the floor and states, "I feel fine."

Handoff

The transfer of information (along with authority and responsibility) during transitions in care > Shift change > Client transfer > Transfer of responsibility between and among: CNA, RN, NP's, physicians

A health promotion nursing diagnosis is a clinical judgment concerning motivation and desire to increase well-being and to actualize human health potential.

True

An example of a cognitive outcome is: "Within one day after teaching, the patient will list three benefits of quitting smoking."

True

Concept mapping---an instructional strategy to identify, graphically display and link key concepts---is an example of a critical-thinking approach to care planning.

True

Critical pathways or care maps, used in the case management model, specify the care plan that is linked to expected outcomes projected along a timeline.

True

Delegation is the transfer of responsibility for the performance of an activity to another person while retaining accountability for the outcome.

True

Evaluative criteria are measurable qualities, attributes, or characteristics that specify skills, knowledge, or health status.

True

Hypothesis formation and testing are two steps in the scientific problem-solving method used by health care professionals as they work with patients.

True

Maslow's Human Needs Model can be used to organize or cluster data.

True

Nurse-initiated interventions do not require a health care provider's (or other team member's) order.

True

Nursing diagnoses focus on unhealthy responses to health and illness.

True

Risk nursing diagnoses are statements that an individual, family, or community is more vulnerable to develop the problem than others in the same or similar situation.

True

Standing orders empower the nurse to initiate actions that ordinarily require the order or supervision of a physician.

True

The focus of a process evaluation is the nature and sequence of activities carried out by nurses who are implementing the nursing process.

True

The patient record is the only permanent legal document that details the nurse's interactions with the patient.

True

Unless specified otherwise, the data recorded in the nursing history are assumed to have been collected from the patient.

True

Staff who are trained to function in an assistive role to the registered nurse (RN) in the provision of patient activities, as delegated by and under the supervision of the RN, are called ______________ assistive personnel.

Unlicensed

The purpose of _________________ data is to keep information, an important part of assessment, free from error, bias, and misinterpretation as much as possible.

Validating

Methods of Communication

Verbal and Nonverbal Electronic

A pregnant client presents to the emergency department with vaginal bleeding. A transvaginal ultrasound is performed, and the health care provider informs the client that there are normal fetal heart tones noted. The client begins to tear-up and has a worried appearance. To facilitate therapeutic communication, what statement would the nurse make after observing the client's nonverbal communication?

"Take your time and tell me how you are feeling. I have plenty of time to answer your questions and discuss any thoughts or feelings with you."

Small Group Communication

A group of people working toward a mutual goal (childbirth education, research teams, support groups)

What nursing care behavior by the nurse engenders a client's trust in the nurse?

A nurse answers the client's questions about an upcoming test in a calm gentle voice while making eye contact with the client

The process of _______________ occurs when two or more people with varying degrees of experience and expertise discuss a problem and its solution.

Consultation

The nurse takes into consideration factors that influence communication when communicating with clients. Which situations accurately reflect communication that considers these variables? Select all that apply.

> A nurse uses simple language and demonstrations to explain a procedure to a preschooler > A nurse checks a client's occupation for clues on how this will affect communication but avoids stereotyping > A nurse takes into consideration a client's culture when planning how far away to sit when communicating

Barriers to Effective Communication

> Asking irrelevant personal questions > Offering personal opinions > Giving advice > Giving false reassurance > Minimizing feelings > Changing the topic > Asking "why" questions > Challenging > Being defensive > Judging > Arguing > Cliches > Excessive questioning

The Nursing Interventions Classification (NIC) report of research provides a ___________ structure of nursing interventions.

taxonomy