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1. Describe various modes of communication and justify when a specific mode of communication may be most useful (453)
- 1. Intrapersonal Communication
- I. Self talk, or communication within a person
- II. Affects nurse’s behavior and can enhance or detract from positive interactions with the patient and family
- 2. Interpersonal Communication
- I. Occurs between two or more people with a goal to exchange messages
- A. Communicate with patients, family members, and members of health care team
- II. Influences your sharing, problem solving, goal attainment, team build, and effectiveness in roles
- 3. Group Communication
- I. Small-Group Communication
- A. Interacting with two or more people
- a. Staff meetings, conferences, teaching sessions, and support groups
- B. Members of small group must communicate to achieve their goal
- II. Organizational Communication
- A. Within an organization communicate to achieve established goals
- III. Group Dynamics
- A. How individual group members r/t one another during the process of working toward goals
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2. Describe and give examples of barriers to successful communication and suggest strategies to reduce the risk of each barrier (470-471)
- 1. Failure to Perceive the Patient as a Human Being
- I. Nurses must focus on the patient as a whole and not just on the patient’s diagnosis
- 2. Failure to Listen
- I. Don’t miss valuable opportunities for important communication by approaching them with a closed mind or focusing on your own needs rather than on the patient’s needs
- 3. Nontherapeutic Comments and Questions
- I. Using Clichés
- A. They offer false reassurance
- “Everything will be alright.”
- “Don’t worry. You will be just fine in another day or two.”
- “Your doctor knows best.”
- “Cheer up. Tomorrow is another day.”
- 2. Tends to cut off communications and make people feels as thought they are insignificant
- “Men tolerate pain poorly. That must be why you’re complaining of severe pain.”
- “Everybody is afraid of surgery. Why should you be any different?”
- “You teenagers are all alike. You aren’t cooperative because you deny authority.”
- II. Using Questions Requiring a “Yes” or “No” Answer
- A. Questions that can be answered yes or no tend to cut off discussion
- “Did you have a good day?”
- II. It’s bad to ask a question to which a patient can say no when that can present a problem
- “Are you ready to get out of bed?”
- C. Problem arises when seeking more detailed information or when question might be difficult
- III. Using Questions Containing the Words Why and How
- A. Questions using the words why and how are intimidating to patients
- IV. Using Questions That Probe for Information
- V. Using Leading Questions
- A. Produces answers that might please the nurse
- B. Unlikely to encourage patient to respond honestly without feeling intimidated
- VI. Using Comments That Give Advice
- A. Often implies that the nurse knows what’s best for patients and denies them the right to make decisions and have feelings
- a. Tends to increase patient’s dependence on caregivers
- VII. Using Judgmental Comments
- A. Tend to impose the nurse’s standards on the patient
- VIII. Changing the Subject
- IX. Giving False Assurance
- A. Gives patients the impression that the nurse is not interested in their problems
- B. Use of clichés gives a patient false assurance
- C. Communication might be impeded when providing the patient and family false assurance
- X. Gossip and Rumor
- A. Can produce detrimental effects on relationships and group building
- B. Used to inform, influence others, entertain, or ventilate
- XI. Disruptive Interpersonal Behavior
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3. Compare and contrast different communication techniques aimed at preventing communication barriers (464-467)
- I. Conversation Skills
- A. Your tone should indicate interest rather than boredom
- B. Be knowledgeable about the topic of conversation and have accurate information
- C. Be flexible
- D. Be clear and concise
- E. Avoid words that might have different interpretations
- F. Be truthful
- G. Keep an open mind
- H. Take advantage of available opportunities
- II. Listening Skills
- A. Sit when communicating with a patient
- B. Don’t cross your arms and legs because that body language conveys a message of being closed
- C. Be alert and relaxed and take sufficient time so that the patient feels at ease
- D. Keep conversation as natural as possible
- E. Maintain eye contact with patient, without staring
- F. Be attentive to both your own and the patient’s verbal and nonverbal communication
- G. Think before responding to the patient
- H. Don’t pretend to listen
- I. Listen for themes in patient’s comments
- III. Silence
- A. Patient may be comfortable
- B. Patient may be trying to demonstrate stoicism and ability to cope without help
- C. May be exploring inner thoughts or feelings, and conversation would disrupt this
- D. Might be fearful and use silence as an escape from a threat
- E. Might be angry and use silence to display emotion
- IV. Touch
- A. It can connect people; provide affirmation, reassurance, and stimulation
- B. Decrease loneliness; increase self-esteem; and share warmth, intimacy, approval, and emo support
- C. Therapeutic touch involves clearing, congested areas of energy in the body and redirecting energy
- V. Humor
- A. Maintain a balanced perspective in their work and encourage patients to do the same
- B. Releases excess physical and psychological energy and reduces stress, anxiety, worry, frustration
- VI. Interviewing Techniques
- A. Open-Ended Question or Comment
- a. Allows patient a wide range of possible responses
- b. Encourages free verbalization
- c. It prevents patient from giving a simple yes or no answer
- B. Closed Question or Comment
- a. Used to gather specific information from a patient and to allow the nurse and patient to focus on a particular area
- C. Validating Question or Comment
- a. Validate what the nurse believes he or she has heard or observed
- b. Overusing may think nurse is not listening
- D. Clarifying Question or Comment
- a. Allows nurse to gain understanding of a patient’s comment
- E. Reflective Question or Comment
- a. Repeat what person has said or describe the person’s feelings
- b. Encourages patients to elaborate on their thoughts and feelings
- F. Sequencing Question or Comment
- a. Place events in a chronological order or to investigate a cause-and-effect relationship
- G. Directing Question or Comment
- a. Nurse can gain additional valuable information to consider in assessing patient’s health status and educational or counseling needs
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4. Diagram need for strong communication skills in each phase of nursing process
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5. Strategies nurse may implement to improve communication with a client who has communication deficits (474)
PICTURE
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6. Strategies nurse may implement to improve communication w/ limited English proficiency (474)
- 1. Use interpreter whenever possible
- 2. Use dictionary that translates words from one language to another
- 3. Speak in simple sentences and in normal tone of voice
- 4. Demonstrate or pantomime ideas you wish to convey, as appropriate
- 5. Be aware of nonverbal communication
- I. Nonverbal communication cues are universal
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7. Explore characteristics of an assertive communicator (468-469)
- I. Assertive behavior
- A. Ability to stand up for oneself and others using open, honest, and direct communication
- B. Focus is on the issue and not the person
- C. They express feelings and beliefs in a non-defensive manner
- D. Characteristics
- a. Confident, open body posture; eye contact; use of clear, concise “I” statements; ability to share effectively one’s thoughts, feelings, and emotions
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8. Predict the impact on client care when the nurse communicates assertively
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9. Identify types of difficult communications
10. Learner will be able to describe manifestations and consequences of difficult communications
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11. Learning will be able to describe strategies to use during difficult communications to improve patient safety
- 12. Describe the ISBARR form of communication and hand-off reporting (458)
- I. Involves process of accurate presentation and acceptance of patient-related info from one caregiver or team to another caregiver or team using effective communication
- II. SBAR
- A. Situation
- B. Background
- C. Assessment
- D. Recommendation
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