NU140- Chapter 8 Communication
Social media
web-based technologies that allow users to create, share, and participate in dialogue in virtual communities and networks
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)
A nurse caring for a patient who is hospitalized following a double mastectomy is preparing a discharge plan for the patient. Which action should be the focus of this termination phase of the helping relationship? a. Determining the progress made in achieving established goals b. Clarifying when the patient should take medications c. Reporting the progress made in teaching to the staff d. Including all family members in the teaching session
a. Determining the progress made in achieving established goals
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
Paramedics arrive in the emergency department with a client who was in a motor vehicle collision. The paramedic reports that the driver was restrained, the car was traveling about 30 miles per hour (48 km/hr), and the air bags were not deployed. The paramedic continues to report that the car was struck from behind and that all individuals in the car were able to self-extricate. Which statement made by the nurse is verifying the report from the paramedic?
"All of the people got themselves out of the car?"
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?"
The nurse is performing an admission interview with a new client diagnosed with acute coronary syndrome. For the nurse to obtain information and allow the client free verbalization, which question would elicit the most information?
"Could you tell me more about how you are feeling right now?"
A nurse finds that a client has infiltration around the IV line that needs to be removed. What explanation should the nurse give to reduce the client's anxiety?
"I know that you are anxious, but the IV location needs to be changed."
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?"
The nurse has arranged to start an IV line for a client with pancreatitis. The nurse notes that the client appears anxious about the procedure. What is the most appropriate response by the nurse to decrease the client's anxiety?
"I will start an IV that will add fluids directly to the blood stream."
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."
A client is reluctant to undergo surgery and is discussing it with the nurse. Which response by the nurse would reflect an authoritarian approach?
"Surgery is your only option. You need this operation."
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 day of the week is it?"
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?"
Which is an open-ended question?
"Why did the health care provider prescribe this medication for you?"
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."
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
What nursing care behavior by the nurse engenders a client to trust 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.
In which situation would the SBAR technique of communication be most appropriate?
A nurse is calling a physician to report a client's new onset of chest pain.
Nurses use social media to share ideas, develop professional connections, access educational offerings and forums, receive support, and investigate evidence-based practices. Which is an example of the proper use of social media by a nurse?
A nurse uses a disclaimer to verify that any views the nurse expresses on Facebook are the nurse's alone and not the employer's.
The nurse is caring for a client who is a victim of sexual assault. Which action would the nurse take to develop a trusting rapport with the client?
Approach the client with empathy and understanding and allow the client to share feelings without being judged.
A nurse states the following to another nurse who is constantly forgetting to wash hands between clients: "It looks like you keep forgetting to wash your hands between clients. It's really not safe for your clients. Let's think of some type of reminder we can use to help you remember." This communication is an example of what type of speech?
Assertive
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
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 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.
Which is a skill appropriate to use in therapeutic communication?
Control the tone of the voice to avoid hidden messages.
Four communication zones
Intimate zone: interaction between parents and children or people who desire close personal contact Personal zone: distance when interacting with close friends Social zone: space when interacting with acquaintances such as in a work or social setting Public zone: communication when speaking to an audience or small groups
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 nurse who has been caring for a client for the past few days is preparing the client for discharge and termination of the nurse-client relationship. Which activity would the nurse be carrying out during this phase of the relationship?
Reviewing health changes
Several nurses on the same hospital unit communicate on the same social networking site. A nurse posts the following statement to the social networking page, "The lady in room 34 with heart failure was a train wreck!" In which manner has the nurse failed to apply the principles of confidentiality?
Sharing information about a client beyond the area of client care is unacceptable and breaches the client's confidentiality rights.
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 maintains eye contact with the client. The nurse shows patience with the client and gives the client time to respond. The nurse keeps communication simple and concrete.
A dialysis nurse is educating a client on caring for the dialysis access that was inserted into the client's right arm. The nurse assesses the client's fears and concerns related to dialysis, the dialysis access, and care of the access. This information is taught over several sessions during the course of the client's hospitalization. Which phase of the working relationship is best described in this scenario?
The working phase
To provide effective nursing care, the nurse should engage in what type of communication with the client and significant others?
Therapeutic communication
Care provided to a client following surgery and until discharge represents which phase of the nurse-client relationship?
Working phase
A nurse notices a patient is walking to the bathroom with a stooped gait, facial grimacing, and gasping sounds. Based on these nonverbal clues, for which condition would the nurse assess? a. Pain b. Anxiety c. Depression d. Fluid volume deficit
a. Pain
Assertive behavior
ability to stand up for oneself and others using open, honest, and direct communication
Verbal communication
exchange of information using words
Nonverbal communication
exchange of information without the use of 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
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.
Aggressive behavior
standing up for one's rights in a negative manner that violates the rights of others
Group dynamics
study of a group's characteristics and ways of functioning
Semantics
study of the meaning of words
A nurse is discharging a client and thus terminating the nurse-client relationship. Which action should the nurse perform in this phase?
Examine goals of the relationship to determine whether they were achieved
When assessing a client's nonverbal communication, the nurse should assess which aspect as being the most expressive?
Facial expressions
A nurse is preparing to provide discharge instructions to a postpartum client regarding infant care. Before beginning the education session, the nurse should:
eliminate as many distractions as possible.
A nurse is caring for a client who presents with a skin infection. While obtaining the client's medical history, it is determined that the client is an intravenous drug user. To foster effective communication, the nurse should:
remain honest, open, and frank.
Incivility
rude, intimidating, and undesirable behavior directed at another person
Horizontal violence
anger and aggressive behavior between nurses or nurse-to-nurse hostility
A nurse is on lunch break in the hospital cafeteria and sits at a table near a group of physicians eating their lunch. One of the physicians, who is in charge of the nurse's clients, points at the nurse and states, "That guy needs to get fired." The best response by the nurse would be to:
ask to speak to the physician in private and address the disrespectful remark.
A nurse enters the client's room and begins the process of establishing a nurse-client relationship. The nurse introduces oneself and informs the client how long the nurse will be caring for the client. What additional statement does the nurse need to communicate with the client?
"Let me know if you have concerns regarding your care."
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
A nurse who is preparing to administer an injection to the client states, "This injection will not be painful." The nurse has used which communication technique?
Giving false reassurance
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 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."
A nurse and client are in the working phase of the helping relationship. What outcome statement developed by the nurse and client correlates with this phase?
The client will express feelings and concerns to the nurse.
For which purposes would observing silence be appropriate? Select all that apply.
To allow the client time to reflect on the client's thoughts To allow the client time to reflect on communication that has occurred To allow the client time to formulate an answer after asking the client a question To allow the client time to compose oneself when the client is upset
A nurse touches the client's hand while discussing the client's diagnosis. This action is:
a communication channel.
A public health nurse is leaving the home of a young mother who has a special needs baby. The neighbor states, "How is she doing, since the baby's father is no help?" What is the nurse's BEST response to the neighbor? a. "New mothers need support." b. "The lack of a father is difficult." c. "How are you today?" d. "It is a very sad situation."
a. "New mothers need support."
When interacting with a patient, the nurse answers, "I am sure everything will be fine. You have nothing to worry about." This is an example of what type of inappropriate communication technique? a. Cliché b. Giving advice c. Being judgmental d. Changing the subject
a. Cliche
During a nursing staff meeting, the nurses resolve a problem of delayed documentation by agreeing unanimously that they will make sure all vital signs are reported and charted within 15 minutes following assessment. This is an example of which characteristics of effective communication? Select all that apply. a. Group decision making b. Group leadership c. Group power d. Group identity e. Group patterns of interaction f. Group cohesiveness
a. Group decision making d. Group identity e. Group patterns of interaction f. Group cohesiveness
A nurse in the rehabilitation division states to the head nurse: "I need the day off and you didn't give it to me!" The head nurse replies, "Well, I wasn't aware you needed the day off, and it isn't possible since staffing is so inadequate." Instead of this exchange, what communication by the nurse would have been more effective? a. "I placed a request to have 8th of August off, but I'm working and I have a doctor's appointment." b. "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I make an appointment?" c. "I will need to call in on the 8th of August because I have a doctor's appointment." d. "Since you didn't give me the 8th of August off, will I need to find someone to work for me?"
b. "I would like to discuss my schedule with you. I requested the 8th of August off for a doctor's appointment. Could I made an appointment?"
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.
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
A nurse enters a patient's room and examines the patient's IV fluids and cardiac monitor. The patient states, "Well, I haven't seen you before. Who are you?" What is the nurse's BEST response? a. "I'm just the IV therapist checking your IV." b. "I've been transferred to this division and will be caring for you." c. "I'm sorry, my name is John Smith and I am your nurse." d. "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."
d. "My name is John Smith, I am your nurse and I'll be caring for you until 11 PM."
A patient states, "I have been experiencing complications of diabetes." The nurse needs to direct the patient to gain more information. What is the MOST appropriate comment or question to elicit additional information? a. "Do you take two injections of insulin to decrease the complications?" b. "Most health care providers recommend diet and exercise to regulate blood sugar." c. "Most complications of diabetes are related to neuropathy." d. "What specific complications have you experienced?"
d. "What specific complications have you experienced?"
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.
Helping relationship
interaction that sets the climate of movement of the participants toward common goals
Body language
nonverbal communication
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
Cliche
process of sharing information; process of generating and transmitting meanings
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.
Feedback
verbal and nonverbal evidence that the message is received and understood
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 nurse is attempting to complete an admission database. While taking the history, the nurse notices the client appears uncomfortable and slightly tachypneic. The nurse should:
allow the client to set the pace.
Carl Rogers (1961) studied the process of therapeutic communication. Through his research, the elements of a "helpful" person were described. They include all of the following except which choice?
analysis
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 afraid of waking up during surgery. The best response by the nurse is to:
ask why the client thinks the client will wake up during surgery.
A nursing student is preparing to administer morning care to a patient. What is the MOST important question that the nursing student should ask the patient about personal hygiene? a. "Would you prefer a bath or a shower?" b. "May I help you with a bed bath now or later this morning?" c. "I will be giving you your bath. Do you use soap or shower gel?" d. "I prefer a shower in the evening. When would you like your bath?"
b. "May I help you with a bed bath now or later this morning?"
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
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
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)
When communicating with clients, nurses need to be very careful in their approach. This is particularly true when communicating using:
medical terminology.
Bullying
negative, often repetitive, disruptive behavior; also referred to as horizontal violence, lateral violence, and professional incivility
A nurse is providing instruction to a patient regarding the procedure to change a colostomy bag. During the teaching session, the patient asks, "What type of foods should I avoid to prevent gas?" The patient's question allows for what type of communication on the nurse's part? a. A closed-ended answer b. Information clarification c. The nurse to give advice d. Assertive behavior
b. Information clarification
During an interaction with a patient diagnosed with epilepsy, a nurse notes that the patient is silent after communicating the nursing care plan. What would be appropriate nurse responses in this situation? Select all that apply. a. Fill the silence with lighter conversation directed at the patient. b. Use the time to perform the care that is needed uninterrupted. c. Discuss the silence with the patient to ascertain its meaning. d. Allow the patient time to think and explore inner thoughts. e. Determine if the patient's culture requires pauses between conversation. f. Arrange for a counselor to help the patient cope with emotional issues.
c. Discuss the silence with the patient to ascertain its meaning d. Allow the patient time to think and explore inner thoughts e. Determine if the patient's culture requires pauses between conversation
A nursing student is nervous and concerned about working at a clinical facility. Which action would BEST decrease anxiety and ensure success in the student's provision of patient care? a. Determining the established goals of the institution b. Ensuring that verbal and nonverbal communication is congruent c. Engaging in self-talk to plan the day and decrease fear d. Speaking with fellow colleagues about how they feel
c. Engaging in self-talk to plan the day and decrease fear
During rounds, a charge nurse hears the patient care technician yelling loudly to a patient regarding a transfer from the bed to chair. Upon entering the room, what is the nurse's BEST response? a. "You need to speak to the patient quietly so you don't disturb the other patients." b. "Let me help you with your transfer technique." c. "When you are finished, be sure to apologize for your rough demeanor." d. "When your patient is safe and comfortable, meet me at the desk."
d. "When your patient is safe and comfortable, meet me at the desk."
A nurse enters the room of a patient with cancer. The patient is crying and states, "I feel so alone." Which response by the nurse is the most therapeutic action? a. The nurse stands at the patient's bedside and states, "I understand how you feel. My mother said the same thing when she was ill." b. The nurse places a hand on the patient's arm and states, "You feel so alone." c. The nurse stands in the patient's room and asks, "Why do you feel so alone? Your wife has been here every day." d. The nurse holds the patient's hand and asks, "What makes you feel so alone?"
d. The nurse holds the patient's hand and asks, "What makes you feel so alone?"
A 3-year-old child is being admitted to a medical division for vomiting, diarrhea, and dehydration. During the admission interview, the nurse should implement which communication techniques to elicit the most information from the parents? a. The use of reflective questions b. The use of closed questions c. The use of assertive questions d. The use of clarifying questions
d. The use of clarifying questions
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.
