Client Education, Therapeutic Communication & Coping

Question 1

Nursing and Education

Answer 1

Nurses provide health education to individuals, families, and communities.

Clients’ educational needs are influenced by
- health, education level, socioeconomic status, and cultural and family influences. (emotional status, spiritual factors, health perception, willingness to participate,)

Give pt information and skills to:
Maintain and promote health and prevent illness (immunizations, lifestyle changes, prenatal care).

Restore health (self‑administration of insulin).

Adapt to permanent illness or injury (ostomy care, swallowing techniques, speech therapy).

Question 2

Domains of Learning Cognitive:

Answer 2

Cognitive learning
Requires intellectual behaviors and focuses on thinking. It involves….
-Knowledge (learning the new information)
-Application
-Analysis (organizing the new information),
-Synthesis (using the knowledge for a new outcome),
-Evaluation (determining the effectiveness of learning the new information).

Question 3

What are the Domains of learning

Answer 3

Cognitive, Affective, Psychomotor

Question 4

Domain of learning

Answer 4

Affective learning
Involves feelings, beliefs, and values.
-verbally and nonverbally,
-valuing the content or believing that it is worth learning,
- creating a method for identifying values and resolving differences, and employing values consistently in decision-making

Question 5

Psychomotor learning

Answer 5

Psychomotor learning
Is gaining skills that require mental and physical activity. Psychomotor learning relies on perception (or sensory awareness),
Set (willing to learn)
Guided response (task performance with an instructor), Mechanism (increased confidence )
Adaptation (when problems arise),
Origination (use of skills to perform complex tasks that require creating new skills)

Question 6

Adult Learners

Answer 6

Plan to teach adult clients in a different manner from children because learning usually occurs in different ways.
Adults are often able to identify what they need to learn.
Adults learn well by building on prior information and life experiences.
Adults’ learning abilities can be influenced by other life factors. The nurse might need to help resolve issues (employment concerns, finances) so the client is ready to learn.
Learning for adults is enhanced when the nurse works with the client to set mutual goals

Question 7

Teaching in Groups

Answer 7

Teaching in small groups (six people or fewer) often increases learning and learner satisfaction.
The nurse is able to teach more than one client or family at a time.
The nurse can use several types of learning strategies at once.
Learners can interact and learn from each other.
Group settings do not work for all clients, especially if physical or emotional barriers are present

Question 8

Assessing learning needs

Answer 8

Assess/monitor learning needs.
Evaluate the learning environment.
Identify learning style (auditory, visual, kinesthetic).
Identify areas of concern (low literacy levels, pain, distractions).
Identify available resources (financial, social, community).
Identify developmental level.
Determine physical and cognitive ability.
Identify specific needs (visual impairment, decreased manual dexterity, learning challenges).
Determine motivation and readiness to learn.
Consider the client’s culture or personal values, and how that will affect the client’s willingness to learn.
Assess the client’s ability to make health decisions by basic understanding of health (health literacy), and what the client believes affects health and illness (health beliefs).

Question 9

Planning learning

Answer 9

Avoid using ALL CAP letters, minimal white space, and small type in print materials.

Speak and write in active voice (“take the medication,” not “the medication should be taken”).

Provide electronic educational resources (CDs, DVDs, software programs, mobile applications).

Use reliable Internet sources to access information and support services.

Organize learning activities to move from simple to more complex tasks and known to unknown concepts.

Incorporate active participation in the learning process.

Schedule teaching sessions at optimal times for learning (teaching ostomy care while replacing the pouch).

Question 10

Planning teaching/learning

Answer 10

Identify mutually agreeable outcomes.
Prioritize the learning objectives with clients’ needs in mind.
Use methods that emphasize the learning style. Strategies include demonstration, lecture, role-playing, simulation, visual aids (charts, graphs, images, objects equipment), and media resources (audio, video).
Select age‑appropriate teaching methods and materials.
Speak and provide print materials at the sixth‑ to eighth-grade reading level.
Avoid nursing terminology (administer, monitor, implement, assess).
Speak and write in the second person, not the third (“your leg,” not “the leg”).

Question 11

Iplementation of patient learning

Answer 11

Create an environment that promotes learning (minimal distractions and interruptions, privacy).

Use therapeutic communication (active listening, empathy) to develop trust and promote sharing of concerns.

Consider the client’s values, and help the client understand why the information is relevant or important.

Review previous knowledge and experiences.

Explain the therapeutic regimen or procedure.

Present steps that build toward more complex tasks.

Demonstrate psychomotor skills.***

Allow time for return demonstrations.***

Provide positive reinforcement**

Teach back demonstration the return demonstration**

Question 12

Evaluation of patient learning

Answer 12

Ask clients to explain the information in their own words.**

Observe return demonstrations (psychomotor learning).

Use written tools to measure the accuracy of information.

Evaluate the client’s progress without appearing judgmental.

Continue to provide support and encouragement.

Ask clients to evaluate their own progress.

Observe nonverbal communication.

Reevaluate learning during follow‑up telephone calls or contacts (home health visits or appointments with the provider).

Revise the care plan accordingly. Teaching sessions might need to be repeated, or the client might need to practice to demonstrate adequate learning.

Question 13

Factors that impact learning and barriers

Answer 13

FACTORS THAT ENHANCE LEARNING
Perceived benefit**
Cognitive and physical ability*
Active participation*
Age‑ and education level‑appropriate methods

BARRIERS TO LEARNING
Fear, anxiety, depression “what are you anxious about’
Physical discomfort, pain, fatigue
Environmental distractions
Sensory and perceptual deficits
Psychomotor deficits

Question 14

Levels of Communication

Answer 14

1. Intrapersonal communication: “self‑talk,”
2. Interpersonal communication: Communication between two people. .
3. Public communication: Communication to, within, or between large groups of people.
4. Small group communication: Communication within a group of people, often working toward a mutual goal (in committees, research teams, and support groups

Question 15

Components of communication

Answer 15

1. Referent: The reason for communication
2. Sender: The person who transmits the message
3. Receiver: The person who interprets the sender’s message
4. Message: The verbal and nonverbal information
5. Channel: The method of transmitting and receiving (verbal/nonverbal)
   Environment:
6. Feedback: Can be verbal, nonverbal, positive, negative

-An essential component of ongoing communication
Interpersonal variables: Factors that influence communication between the sender and the receiver (educational and developmental levels)

Question 16

Verbal Communication

Answer 16

Vocabulary
1. Limited vocabulary or speaking a different language can make it difficult to communicate
medical jargon can decrease understanding. Children and adolescents use words differently than adults
2. Credibility
3. Trustworthiness and reliability of the individual.
- Nurses must be knowledgeable, consistent, honest, confident, and dependable.
Lack of credibility creates a sense of uncertainty for clients
4. Denotative and connotative meaning
When communicating, participants must share meanings.
Words that have multiple meanings can be misinterpreted
5. Clarity and brevity
* Concise

Question 17

Verbal Communication

Answer 17

6. Timing and relevance
   Knowing when to communicate
   When clients are uncomfortable or distracted, it can be difficult to convey the message.
7. Pacing
   Speaking rapidly can suggest not having time for the clients.
   Intonation
8. The tone of voice can communicate a variety of feelings.
   Nurses communicate feelings (acceptance, judgment, and dislike)

Question 18

Nonverbal communication

Answer 18

1. Appearance, posture, gait: Physical characteristics can convey professionalism. Body language and posture can demonstrate comfort and ease in the situation. The first
   impression is very important.
2. Facial expressions, eye contact, gestures: Facial expressions can be misinterpreted. Eye contact can convey interest and respect but varies with culture and the situation. Gestures can enhance verbal communication or create their own messages.
3. Sounds: Crying or moaning can have multiple meanings, especially when other nonverbal communication accompanies it.
4. Territoriality, personal space: Lack of awareness of territoriality (right to space) and personal space (the area around an individual) can make clients perceive a threat and react defensively.

Question 19

Therapeutic Communication

Answer 19

Therapeutic communication is the purposeful use of communication to build and maintain helping relationships with clients, families, and significant others.

Elicit and attend to clients’ thoughts, feelings, concerns, and needs.
Express empathy and genuine concern

Obtain information and give feedback about clients’ status.

Intervene to promote functional behavior and effective interpersonal relationships.

Evaluate clients’ progress toward desired goals and outcomes.

Question 20

Components to therapeutic communication

Answer 20

1. Time: adequate time to communicate.
2. Attentive behavior or active listening: convey interest, trust, and acceptance.
3. Caring attitude: Show concern/ an emotional connection to all.
4. Honesty: Be open, direct, truthful, and sincere.
5. Trust: Demonstrate to clients, families, and significant others that they can rely on nurses without doubt, question, or judgment.
6. Empathy: Convey an objective awareness and understanding of all
7. Nonjudgmental attitude: A display of acceptance of all

Question 21

Assessment for children and older adults

Answer 21

CHILDREN
Use simple, straightforward language.
Be aware of nonverbal messages because children are especially sensitive to nonverbal communication.
Enhance communication by being at the child’s eye level.
Incorporate play in interactions.

OLDER ADULT CLIENTS
Recognize that many older adults require amplification of sound.
Make sure of assistive devices (glasses and hearing aids)
Minimize distractions, and face clients when speaking.
Speak in short and simple sentences.
Allow plenty of time for clients to respond.
Ask for input from caregivers or family to determine the extent of any communication deficits and how best to communicate.

Question 22

Planning

Answer 22

Minimize distractions.
Provide privacy.
Identify mutually agreed‑upon outcomes.
Set priorities according to the clients’ needs.
Collaborate with other health care professionals when necessary.
Plan adequate time for interventions.

Question 23

Implementation

Answer 23

Establish a trusting nurse‑client relationship.
-Clients feel more at ease during the implementation phase when nurses establish a helping relationship.

Provide empathetic responses and explanations by using observations, giving information, conveying hope, and using humor.

Manipulate the environment to decrease distractions.

Verbal communication and nonverbal communication have the same message

Demonstrate an empathic presence by appearing relaxed and comfortable, facing the client, having an open posture, leaning toward the client, and maintaining good eye contact unless cultural norms discourage it

Question 24

Effective Skill and Technique

Answer 24

1. Silence: This allows time for meaningful reflection.
2. Presenting reality: This helps the client distinguish what is real from what is not and to dispel delusions, hallucinations, and faulty beliefs.
3. Active listening: This helps the nurse hear, observe, and understand what the client communicates and provide feedback.

Asking questions: This is a way to seek additional information.
4. Open‑ended questions: It encourages the client to explore feelings and thoughts and avoids yes or no answers.

5. Clarifying techniques: This helps the nurse determine whether the message the client received was accurate:
6. Restating: Uses the client’s exact words
7. Reflecting: Directs the focus back to the client for them to examine their feelings
8. Paraphrasing: Restates the client’s feelings and thoughts for them to confirm what they have communicated
9. Exploring: Allows the nurse to gather more information about important topics the client mentioned

Question 25

Effective Skill and Technique

Answer 25

1. Offering general leads, broad opening statements: This encourages the client to start and to continue talking.
2. Showing acceptance and recognition: nonjudgmental attitude.
3. Focusing: client concentrates on what is important.
4. Giving information: factual details needed for decision‑making.
5. Summarizing: This emphasizes important points

Question 26

Effective skill and tech

Answer 26

1. Offering self: This demonstrates a willingness to spend time with the client.
   -The nurse can share limited personal information, but the focus should return to the client as soon as possible.
   -Relevant self‑disclosure by the nurse helps the client see that others share their experience and understand
2. Touch: If appropriate, touch can communicate caring and provide comfort.
3. Sharing feelings: Ask clients to express feelings and help them identify their feelings. Plan to discuss negative or angry feelings with peers or other support persons rather than the client. The nurse can also share feelings of caring and concern with the client, which can promote rapport with the client.

Question 27

Barriers to effective communication

Answer 27

Asking irrelevant personal questions
Offering personal opinions
Stereotyping
Giving advice or false reassurance
Minimizing feelings or changing the topic
Asking “why” questions or explanations
Challenging
Asking questions excessively (probing)
Responding approvingly or disapprovingly (refusing)
-dont constantly nod
Being defensive
Testing, Judging or arguing
Offering sympathy
Making automatic responses or with passive or aggressive responses

Question 28

Stress

Answer 28

Stress describes changes in an individual’s state or balance in response to stressors, the internal and external forces that disrupt that state of balance.
-Both “good” or “bad,” produces a similar biological response
-Stress can be situational (adjusting to a chronic disease or a stressful job).
-Stress can be developmental (varying with life stage). Adult stressors can include losing parents, having a baby, and getting married.
-Stress can be caused by sociocultural factors, including substance use, lack of education, and prolonged poverty.
-***Stress impairs the immune system and is a factor in numerous health conditions.

The presence of stressors delays a client’s return to health in the same way that the presence of a foreign body or infection delays the healing of a wound.

Question 29

Coping

Answer 29

Coping describes how an individual deals with the problem
-the behavioral and cognitive efforts of an individual to manage stress.

Factors influencing an individual’s ability to cope include…
-the number, duration, and intensity of stressors;
-individual’s past experiences; the current support system; and available resources.

Coping strategies are unique to an individual and can vary greatly with each stressor.

Ego defense mechanisms: assist a person during a stressful situation or crisis by regulating emotional distress

Question 30

General Adaptation System:
Stress syndrome

Answer 30

Hans Selye developed a theory of adaptation

1. Alarm stage:
   Body functions are heightened to respond to stressors, also called fight-or-flight.
   Hormones (epinephrine, norepinephrine, cortisone)
   - elevated blood pressure and heart rate, heightened mental alertness,
   - increased secretion of epinephrine and norepinephrine, and increased blood flow to muscles.
2. Resistance stage:
   Body functions normalize while responding to the stressor.
   The body attempts to cope with the stressor and return to homeostasis.
   Stabilization of blood pressure, heart rate, and hormones will occur.
3. Exhaustion stage:
   Body functions are no longer able to maintain a response to the stressor and the client cannot adapt. **
   The end of this stage results in recovery or death*

Question 31

Adherence:
The commitment and ability of the client and family to follow a given treatment regimen.

Answer 31

Commitment to the regimen increases adherence.

Complicated regimen interferes with adherence.

Involvement of the client and significant support people in the planning stage increases adherence.

Adverse effects of medications diminish adherence
.
Negative coping mechanisms (denial) can cause nonadherence; positive coping mechanisms can increase adherence.

Available resources increase adherence.

Question 32

Assessment of stress

Answer 32

Ask the client questions related to:
Current stress, perception of stressors, and ability to cope
Support systems

Adherence to healthy behaviors and/or the treatment regimen

Sleep patterns

Altered elimination patterns, changes in appetite, and weight loss or gain

Observe the client’s appearance and eye contact, verbal, motor, and cognitive status during the assessment.

Measure vital signs.

Observe for irritability, anxiety, and tension.

Question 33

Nursing Care and Stress

Answer 33

Encourage health promotion strategies (exercise diet, sleep and rest).
Assist with time management and determining priority tasks.

Encourage appropriate relaxation techniques, (breathing exercises, massage, imagery, yoga, meditation).

Listen attentively, and take the time to understand pt

Control the environment to reduce external stressors, (noise and breaks in the continuity of care.
Identify available support systems)

Educate the client on available training to manage stress (journal writing, assertiveness training, stress management in the workplace, mindfulness-based stress reduction).

The optimal time to teach a client about stress-management skills is after coping with crisis successfully.
Use effective communication techniques to foster the expression of feelings.

Question 34

Nursing Care: Coping

Answer 34

Be empathetic in communication, and encourage the client to verbalize feelings.

Identify the client’s and family’s strengths and abilities.

Encourage client’s autonomy with decision‑making.

Discuss the client’s and family’s abilities to deal with the current situation.

Encourage the client to describe coping skills used effectively in the past.

Identify available community resources, and refer the client for counseling if needed.

Question 34

Nursing Care: Coping

Answer 34

Be empathetic in communication, and encourage the client to verbalize feelings.

Identify the client’s and family’s strengths and abilities.

Encourage client’s autonomy with decision‑making.

Discuss the client’s and family’s abilities to deal with the current situation.

Encourage the client to describe coping skills used effectively in the past.

Identify available community resources, and refer the client for counseling if needed.

Question 35

nursing and adherence

Answer 35

Put instructions in writing.
Allow the client to give input into the treatment regimen.
Simplify treatment regimens as much as possible.
Follow up with the client to address any questions or problems

Question 36

Family Systems & Family Dynamics

Answer 36

Family is defined by the client, and it consists of the individual structures and roles.
It is typically two or more people whose relationships create a bond and influence their mutual development, support, goals, and resources.
Consider five realms of processes involved in family function during a family assessment:
interactive, developmental, coping, integrity, and health.

Families and clients are not mutually exclusive; family‑centered care creates a holistic approach to nursing care.
Family dynamics are constantly evolving due to the processes of family life and developmental stages of the family members.

Question 37

trends

Answer 37

FASTEST‑GROWING POPULATION: Those older than 65 years, leading to caregiver issues

DECLINING ECONOMIC STATUS OF FAMILIES (increased unemployment)

FAMILY VIOLENCE and its cycle

ANY ACUTE OR CHRONIC ILLNESS THAT DISRUPTS THE
FAMILY UNIT (can include end‑of‑life care issues)

HOMELESSNESS: Lack of stable environment, financial issues, inadequate access to health care (fastest‑growing homeless population is families with children). The homeless population is increasing due to lack of affordable housing.

Question 38

family attributes

Answer 38

Structure dictates the family’s ability to cope.

Rigid structure is dictatorial and strict.

Open structure includes few or no boundaries, consistent behavior, or consequences.

Either structure can provide positive or negative outcomes.

Function describes the course of action the family uses to reach its goals, including members’ communication skills,
problem‑solving abilities, and available resources

Question 39

family assessment

Answer 39

Assess all clients within the context of the family.

Assess a family by looking at its structure and function.

Assessment of a family can focus on family as a context, a client, or a system.

Identify who is a family member, what role each family member has, and the dynamic interactions within the family.
Listen attentively, and use the therapeutic communication techniques of reflection and restatement to clarify the family’s concerns.

Cultural variables: all of which can differ between and within generations

Perception of events
Rites and rituals
Health beliefs

Question 40

Role changes

Answer 40

A role is the function a person adopts within their life. Seldom is it limited to one role, but rather is multidimensional and is often relative to the role of others.
Grandparent Parent Dependent child Employee/employer Committee member Community activist

Stress affects roles in many ways.
Illness causes role stress by creating a situation in which roles can change simply due to the effect and progression of the illness.

Nurses must be aware of a client’s roles in life, as well as how the situation of illness might change these roles, either temporarily or permanently.
A basic assumption is that a client can either advance or regress in the face of a situational role change

Question 41

*****Types of role conflict

Answer 41

1. Role conflict:
   This develops when a person must assume opposing roles with incompatible expectations. Role conflicts can be interpersonal (when parents expect adolescents to participate in sports and perform household tasks) or inter‑role (when a mother wants to stay at home with her infant, but family finances require her to work).
2. Sick role:
   Expectations of others and society regarding how one should behave when sick (caring for self while sick and continuing to provide childcare to grandchildren).
3. Role ambiguity:
   Uncertainty about what is expected when assuming a role; creates confusion.
4. Role strain:
   The frustration and anxiety that occurs when a person feels inadequate for assuming a role (caring for a parent with dementia).
5. Role overload:
   More responsibility and roles than are manageable; very common

Question 42

Assess five realms of family life

Answer 42

interactive processes, developmental processes, coping processes, integrity processes, health processes

Question 43

Nursing care

Answer 43

Educate family members on potential stressors (social isolation, physical demands) and the resources available
Provide short‑term care to provide relief for the family caregiver.
Provide encouragement during times of stress.
Seek congruence among perceived roles.
Prepare the client for the anticipated situational crisis.
Anticipate role conflict or overload on the client’s part.
Improve relationships by supplementing specific role behaviors.
Explore which roles the client can relinquish.
Help the client improve personal judgment of self‑worth given the current situational role change.
Provide counseling about roles that are permanently altered.
Make referrals to community services for outpatient adaptation to lost or new roles.
Make referrals to social services for assistance in some roles.
Evaluate the client after acceptance of the role change(s) to assess adaptation