Foundations in Nursing: Therapeutic Communication

A nurse goes online and posts about a patient by only refers to them by diagnosis is this still considered a breach of patient confidentiality?

Yes

If a nurse sends an email to the patient about their care, what should they also do?

1) Check to make sure email correspondence with patient is authorized by institution before sending email 2) Any emails sent to patient must be duplicated and become part of the medical record for that patient

What are some factors that can affect communication?

1) Language: can reveal aspects of a person's intellectual development, educational level, and geographic and cultural origin 2) Sociocultural differences: For example some cultures only speak to their spouses about personal issues 3) Developmental level: when speaking with patients of different age groups you should have different communication styles 4) Occupation of patient: can determine abilities, talents, interest and economic status of patient which can alter conversation 5) Space and territoriality: Understand personal space and be aware of non-verbal cues which indicate wanting to be closer or being too close 6) Physical, mental, and emotional state: For example a poor physical state (such as a full bladder) can negatively impact conversation) 7) Values influence communication and what is prioritized in conversation 8) Environment: Should be comfortable and have minimizing distractions in order to not be a barrier to communication

What are some differences between therapeutic and non-therapeutic communication?

1) Nurses focus on the whole patient and not just the diagnosis 2) Avoids cliches such as saying everything will be alright 3) Avoids questions which require only a yes or no answer (uses open ended questions) 4) Avoids questions containing the words why and how 5) Avoids questions that probe for information 6) Avoids giving advice and making judgemental comments

Describe ANA principles of social networking

1) Nurses must not transmit or place online individually identifiable patient information 2) Nurses must observe ethically prescribed professional patient-nurse boundaries 3) Nurses should understand that patients, colleagues, institutions, and employers may view postings 4) Nurses should take advantage of privacy settings and seek to separate personal and professional information online 5) Nurses should participate in developing institutional policies governing online contact

What are the three phases of a nurse-patient relationship?

1) Orientation phase: Patient and nurse introduce eachother and establish an agreement or contract on the goals of the relationship, duration, and location and frequency of contacts. Patient may also be provided orientation to services and facility. 2) Working phase: Interaction is orientated towards meeting goals or objectives and is the longest phase. Nurse also provides patient with daily assistance. Nurse at this phase should be motivating patient to learn and ability to execute nursing care plan. Patient can also express feedback to the nurse. 3) Termination phase: Initial agreement is acknowledged (may happen at end of shift, discharge from hospital). Evaluates patient's progress towards goals and whether they have been attained. Can prepare for termination (for example introducing patient to personnel to whom care is being transferred to).

What are some elements of positive non-verbal communication?

1) Touch 2) Eye contact (if culturally appropriate) 3) Positive facial expressions 4) Energetic gait 5) Good physical appearance and hygiene 6) Allowing for periods of silence 7) Using hand rub while talking to patient to convey that you care about safety

What are clarifying questions?

Allows nurse to gain understanding of the patient's comment. Can potentially lead to false diagnosis. "Is this the first health problem you have had?"

What are open-ended questions?

Allows a wide range of responses and the ability to obtain more information.

A nurse is caring for a client with depression. The nurse finds that the client is withdrawn and does not communicate with others. What is the most appropriate response by the nurse?

Avoid acting direct questions and use observation techniques which can help get the client's attention such as "is that a new shirt you're wearing today?"

When can SBAR or ISBARR technique be used?

Between nurses and other departments in the facility, during nurse to nurse report, or in nurse to physician/health care provider discussions

What would you do if a cognitively impaired patient would not respond to your questions?

First repeat question. If there is still no answer take a break and come back in order to avoid frustation

Describe the steps of SBAR/ISBARR

I: Initial identification of yourself and your patient S: Situation. Provide objective data. For example "the patient's code status is", "the problem I am calling about is" B: Background. Provides objective data which helps give a background/more information to the problem at hand. "The patient's mental health status is..." "patient is or is not on oxygen.." A: Assessment. Presentation of subjective information. "I believe the problem to be..." or "I am not sure about the problem..." R: Recommendations. Presentation of subjective information. "Order from physician is to transfer to critical care","talk to patient of family" R: Readback. Opportunity to ask and respond to questions. "Are any tests needed," "How often do you want vital signs checked"

What are reflective questions?

Involves repeating what the person has said or describing the person's feelings. "So you are worried about the pain associated with this injection?"

What are the elements of a nurse-patient relationship?

Is a helping and dynamic relationship. Both nurse and patient are active participants. Is also purposeful and time limited. Patient and nurse work together to establish specific goals which are to be met in a specific time frame. Nurse is professionally accountable for the outcomes of this relationship and goals should be set to patient needs.

A nurse is interviewing a client who has come to the clinic for a follow-up visit. The nurse notices the client does not make eye contact and speaks while looking down. How should the nurse respond?

Recognize that the patient is uncomfortable with eye contact so assume a position at eye level and continue with interview.

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?

Through the use of a clarifying question: "I understand you have four kids; how many times have you actually been pregnant?"

What are close-ended questions?

Used to gather specific info from a patient and to allow nurse to focus on particular area. Can usually be answered with yes or no or one word answers, therefore they are not usually effective in conversation.

What are directing questions?

Used to obtain more information about a topic brought up earlier in conversation. "You mentioned your dad earlier. Did he have complications related to high blood pressure?"

What are sequencing questions?

Used to place events in chronological order to potentially investigate a cause and effect relationship. "Your fatigue began after you started taking this medication?"

What are validating questions?

Validates what the nurse believes they have heard. Overuse can lead patient to believe nurse is not listening. "You have been taking a blood pressure pill everyday?"

Good ways to communicate with those who are visually impaired

▪ Acknowledge presence in room and introduce self by name ▪ Speak in a normal tone of voice ▪ Explain any reasoning for touching patient before you do so ▪ Indicate to patient when conversation has ended and when you are leaving room ▪ Keep a call light or bell within reach of patient ▪ Orient patient to surroundings of room ▪ Be sure patient's glasses are clean and intact or that contacts are in place

Good ways to communicate for those who are unconscious

▪ Be aware of what is said in patient's presence ▪ Talk in a normal tone of voice about things you would normally discuss (assume patient can hear you) ▪ Speak with patient before touching ▪ Keep environment noises as low as possible in order to help patient focus on communication

Good ways to communicate with those who are cognitively impaired

▪ Establish and maintain eye contact ▪ Communicate information in environment where there is little to no distractions ▪ Keep communication simple. Avoid lengthy explanations and break down instructions into simple tasks. Do not use abstract terms and use pictures or drawings when appropriate. ▪ Avoid open-ended questions ▪ Be patient and give time to respond. Take breaks from communication when patient response is difficult to initiate.

Good ways to communicate with those who are hearing imparied

▪ Orient patient to presence before conversation (can be done through touch or moving so that you can be seen) ▪ Talk directly to patient and if patient is able to lip read use simple sentences and speak in a natural manner. Be aware of non-verbal cues ▪ Do not chew gum or cover mouth ▪ Demonstrate or pantomime ideas you wish to express when appropriate ▪ Use sign language or finger spelling when appropriate ▪ Write any ideas that cannot be conveyed to the patient in another manner ▪ Be sure hearing aids are clean, functional, and inserted properly

Communicating with those who have a physical barrier such as laryngectomy or endotracheal tube

▪ Select forms of simple communication that patients are able to convey physically (flashcards, eye blinks or hand squeezes, sign language, communication boards with letters or pictures) ▪ Be sure that all who communicate with patient are able to use device selected ▪ Demonstrate patience with communication Ensure that patient has call bell or alarm

What are some elements of therapeutic communication?

▪ Should not block communication process ▪ Should allow patient to be able to verbalize concerns ▪ Nurse should provide patient with broad opening statements and patient goals to assist in planning and decision making ▪ Control tone of voice to indicate interest and that you are conveying exactly what you mean to say ▪ Be knowledgeable about topic of conversation and have accurate information ▪ If you do not have information regarding a certain subject, be honest with patient and assure them that you will get answers ▪ Follow patient's lead in conversation. For example, if a patient wants to talk about diet issues while you are administering a medication take time to talk with this patient about this issue ▪ Make statements as simple as possible to prevent confusion ▪ Avoid words that have different interpretations ▪ Be honest with patient. Admit when you don't know something ▪ Keep an open mind and respect autonomy of patient ▪ Take advantage of opportunities to show that you care and make routine tasks meaningful. For example while giving a bed bath to a patient ask about their day, present employment, and family ▪ Sit when communicating with patient and display open body language (don't cross arms or legs) ▪ Be alert and relaxed and take time to make sure the patient feels comfortable ▪ Avoid sounding overly eager ▪ Maintain eye contact (if culturally appropriate) ▪ Be attentive to your own and patient's verbal and non-verbal communication. Indicate that you are paying attention to what the patient is saying through facial expressions and body gestures

Good ways to communicate with those who do not speak english

▪ Use interpreter whenever possible ▪ Use dictionary or smartphone app to speak a few words to patients ▪ Speak in simple sentences and normal tone of voice Demonstrate or pantomime ideas you wish to convey ▪ Be aware of non-verbal cues