Chapter 18 - Communication&Therapeutic Relationships (Week 5 Quiz) Flashcards
(42 cards)
T or F: The Joint commision National Pt Safety goal is to improve patient safety by improving communication among caregivers.
True. Perf standards also state the pt has the right to receive effective, understandable information.
Communication is….
Box 18-1
Sharing or transmitting thoughts or feelings
A way to meet physical, psycho-social, emotional and spiritual needs.
A process - the act of sending receiving interpreting and reacting to a message.
Content - actual subject matter words gestures and substance of the message.
It may be verbal or non verbal
Forms the basis for sharing meaning and building effective working relationships among individuals, families, and the healthcare team.
It involves talking and listening.
Communication occurs on three levels (p.352)
- __________ communication - conscious internal dialogue aka self-talk.
- _______ communication - between 2 or more people.
- _____ communication - you engage in exchange of ideas with two or more individuals at the same time.
- _____ ______ - when a speaker addresses a large group.
- INTRApersonal (can be negative or positive). Can affect your ability to perform a task - like taking a test….
* *INTRA means on the inside - INTERpersonal (inter = intersection = between you and others) - usually between 2 or more people. This is the form of communication used by us to complete a pt interview/assessment.
- Group - you may be thinking interpersonal and group seem like the same thing. The difference is the way in which communication takes place. Interpersonal is more “personal” whereas group is more formal.
http: //www.positionignition.com/blog/2014/2/27/differences-between-interpersonal-skills-and-communication-s.html - Public speaking
Communication involves content and process. Content of communcation is the actual subject matter/words/ gestures/and substance of a message. The Process refers to the act of sending/receiving/interpreting and reacting to a message. Why are both of these necessary?
Example:
Content: A patient (the message SENDER) says, “I slept through lunch.”
What does the pt mean by this???? What encoding (tone, gestures, symbols) did the patient use to transmit the message?
You must process the information (receive and decode) by paying attention to all forms of communication (verbal and non verbal) plus have an understanding of the person’s nature to get WHY the patient said this and WHAT they mean by it.
Was he mad about? Surprised? What does his face say? Did he yell it? etc.
This is the process….. encoding and decoding what the purpose/point is in the statement by the pt.
Effective messages are…..
complete, clear, concise, organized, timely, and expressed in a manner that the receiver can understand. (To the point!)
The _____ is the medium used to send the message.
Channel
Can be face to face Written pamphlets audiovisual aids recordings telephone and text messages Touch (touching someone's hand and sitting quietly may convey caring more than words)
The ______ of a message is the listener, observer, interpreter.
receiver (you when someone speak to you)
To avoid miscommunication, confusion and misinterpretation you should give the sender (the person speaking to you) ________.
Feedback - it validates that you (the receiver) received the message and understood it as the sender intended it. In other words, “so what I think you are saying it…..” etc.
When speaking to others, what should you take into consideration about them?
education level (if the person has a limited vocab, you should not speak over their head. They may feel too embarrassed to ask questions. Make sure you speak on their level without being condescending. Always ask if they have questions and encourage them to ask questions!)
culture
language (if the person is not fluent in English, get a translator. Again, they may be intimidated and too fearful to ask for help)
age (would you speak to a child the same as a 45 year old adult?)
etc.
Denotation is the _____ meaning of a word.
Connotation is the ______ or _____ meaning of the word.
denotation = literal meaning (Baby, don’t cry. Mama is here)
connotation = implied or emotional meaning. You know the old saying, it’s not what you said it’s how you said it?
Ex:”Don’t cry baby! Grow up!” < baby is meant as an insult. “Hey baby, you look hot!”
Why is pacing important?
Pacing is the speed/rhythm of the convo. If you don’t pause in between ideas/statements, you don’t allow the other person to add to the convo nor interpret what you are saying.
“God gave us two ears and one mouth so we can listen twice as much as we speak.”
If someone talks to me endlessly I drift off. Conversations should be like volleyball or tennis….ball goes back and forth!
p.354-355
T or F: Clarity and brevity creates a clear and concise conversation that holds the interest of all parties and conveys the intended message.
True.
Clarity forces you to use words that convey intended meaning; ensure that your body language and words match!
Brevity keeps it brief and to the point.
My English professor calls it word economy. Don’t use fluffy words to “sound” a type of way….just say what you mean and be direct.
Why is timing and relevance so important?
Timing/relevance:
If someone just told you that your house is on fire, will you be able to process a conversation about your car payment being due?
Timing
If a patient has just been told they have stage IV cancer, will they be ready to discuss their treatment options? Maybe, maybe not. It is your job to assess the scene?
T or F: Communication is more effective when both parties value the interaction and find the discussion relevant.
True
Your ______ depends on a pattern of honest and timely response to patient concerns, as well as congruence between your verbal and nonverbal communication.
credibility
If you make empty promises, lie, do not produce what you say…no one will have faith in you or believe in you…
Do not say things to make yourself or pt feel better. Telling them they results may be wrong, and they are not going to die, gives them false hope. It’s better to offer up counseling or the chaplain to speak with them about the diagnosis.
Why is humor important? Why must you use it with caution?
- Humor and laughter can have a positive influence on attitude and healing; can create physiologic changes that contribute to well-being and provide emotional release.
- Humor is subjective. What is funny to some may be offensive to others. Never make mean jokes, if you have to hurt others to make the joke it’s not funny. Do not joke about the disease, treatment or direct the joke at the patient.
Body language is a form of ______ communication. When we speak we (attempt to anyway) consciously choose the words and how we say them. Body language shows how we actually feel.
Nonverbal
It is important to make sure yours is appropriate (no making stink face when you are cleaning up feces) and that you pay attention to the patient’s!
List forms of nonverbal communication and describe each…
- Facial expression (frowning, smiling, raised eyebrows)
- Posture and Gait - someone with pep in their step may be happy or may be in a hurry. Someone with slouched posture may have low self esteem. etc
- Personal appearance - tells about a persons, socieconomic status, culture and religion. Depressed person may lack attention to personal appearance and/or hygiene
- Gestures - is your patient’s arms folded? is their head in their hands?
- Touch - use it consciously and cautiously. Some people may interpret it to be inappropriate (for cultural reasons). Patients with dementia or mental disease may be confused/scared or react violently. Some women may not be comfortable with men.
What action should you take when there is a discrepancy between the client’s spoken word and nonverbal body language?
Answer:
You must discuss the communication discrepancy with the patient.
What are the major factors that affect communication?
Answer:
Communication is affected by the following major factors:
● Environment - quiet private free of unpleasant smells with a comfy temp is optimum
● Lifespan variations - speak to people on their level! (A patient who requires frequent hospitalization may surprise you on how much they do know for their age!)
● Gender - women communicate to form connections and est relationships. Men want to maintain independence and favorable position in hierarchy. A female nurse may interpret “I feel lousy” as an invitation to talk whereas a male nurse may discuss pain control.
● Personal space - varies per person/culture. (intimate,personal, social and public distance to be discussed next card)
● Territoriality- “Mine” “my stuff” “my space”…refers to space and things a person identifies with; ask before touching a pt’s belongings.
● Sociocultural factors- Doctors and patients may view themselves as higher or lower than each other. NUrses are the middle road and approachable. Patients may as you questions they didn’t dare “embarassingly” ask the doc. Docs may treat impoverished patients with less respect than wealthy ones.
● Roles and relationships - You would never talk to your grandma the way you do your childhood best friend. Be approachable so patients can open up to you.
● Attitudes
People vary in the amount of physical space they are comfortable with when communicating.
- ______ distance is the area most immediately surround a person (within about 18 inches). So close you can feel their body heat, smell their breath/body, but can hear a whisper.
- ______ distance is 18 inches to 4 feet away. This is typical space we keep with coworkers, pt families, etc.
- ________ distance is 4ft to 12 ft. This is typical for a presenter from the crowd. It is impersonal.
- ______ distance is considered beyond 12 feet
- Intimate - we will invade this space during assessments/procedures. Remember to ask for permission and explain yourself before touching!
- Personal (allows you to be personal and keep it personal without getting intimate).
- Social (if you stand at the door and ask a pt a question, you may not get a great response).
- public (group community focused)
In what distance(s) do most nurse–client interactions occur?
Answer:
Most nurse–client interactions occur in either the intimate or personal distances.
There are a few difference communication styles used:
- _______ communication avoids conflict and allows other to take the lead. This is submissive, helpless, indecisive, apologetic or whining.
- ______ communication is the expression of a wide range of positive and negative thoughts and feelings in a style that is direct, open, honest, spontaneous, responsible and non judgmental. Recognizes your rights as well as the rights of others.
- _______ communication forces a person to lose. The goal is to win the conversation. This type is bossy, arrogant, opinionated, sarcastic, manipulative intolerant or overbearing.
- passive - You cannot advocate for a patient if you are unwilling to assert yourself on their behalf.
- Assertive - use I statments, focus on the issue and not participatnts, etc. READ pg 360 It’s so important!
No one wins when It’s a wrong or right conversation. Winning is finding a harmonious way to work together to provide care for our patients. - Aggressive
What is a therapeutic relationship? What is therapeutic communication?
focuses on improving the health of the patient. The patient gains info and knowledge and works though issues concerns and problems as related to health status Tx, and nursing care.
Uses therapeutic communication - patient centered communication directed at achieving goals. Used to build relationship with patient and family, used to express interest and concern.
