Flashcards in Exam 1 Deck (69):
What is the effective communication cycle?
Feedback to Sender.
When is there potential for a communication breakdown in healthcare?
Anytime there is a communication happening.
What are the categories of risk factors for distorted messages?
What are examples of physical risk factors for distortion of messages?
Distractions from the external environment - background noise or unfamiliar surroundings
What are psychological or physiological risk factors for distorted communication?
Psychological - emotional state of communicators
Physiological - Illness, fatigue, cognitive impairment
What would semantic risk factors be?
Language/literacy issues, illegible handwriting or unknown abbreviations
What is the health belief model?
Start by understanding the patient’s beliefs about their health.
Understand what factors contribute to those beliefs.
Use the model to gear your education style/recommendations/interventions based on what works for them.
What does Orlando’s theory of Deliberative nursing process say?
Effective nursing communication comes from:
Pt communicating to nurse, nurse thinking internally, then nurse communicates those thoughts to the patient for validation BEFORE moving on with the activity the nurse had thought about/decided upon.
What does Carl Rogers Rogerian model say about communication?
The interaction between client and patient is therapeutic and patient-centered.
The provider must communicate with empathy, respect and genuineness in order to help the patient adjust and get better.
What is the model of social information processing?
Nurses learn to develop their communication skills by regulating their own internal reactions, developing confidence, deciding on a response that will help both the patient and the nurse achieve their goals.
What are the six roles Peplau described?
Stranger (pt. Arrives as a stranger - nurse accepts in a way that promotes trust)
Resource (nurse gives info, answers questions, interprets some clinical information)
Teaching (Nurse teaches pt with instruction/training)
Counseling: (Nurse guides and encourages pt to integrate this new experience into their current life)
Surrogate (Nurse advocates for pt and helps patient clarify what roles are independent, dependent and interdependent)
Active leadership (helps pt gain a sense of responsibility for goals of treatment)
What are Peplau’s three (five) phases? (Theory of Self)
Orientation phase: beginning of relationship, nurse and pt are strangers. Pt seeks help and nurse helps pt identify problem and how much help he/she needs.
Identification: nurse assures pt that he/she understands.
Exploitation: pt uses nurse’s services. Nurse helps with strategies to resolve issue.
Resolution: Pt’s old needs are resolved - more mature goals emerge.
Termination phase: Nurse and pt evaluate progress, end relationship. Nurse gives referrals for continuing care.
Define “ego defense mechanisms”
Ways that people protect themselves during situations that create anxiety within them.
When you project someone else’s emotions or your own emotions from the past and project them onto the present situation.
Feelings that someone develops in response to a current situation that is rooted in the feeler’s past experiences.
What should we know about genuineness
Being oneself while still working as a nurse can help to put a patient at ease - laughing, being humble.
It can even include self-revelations, but we have to use these carefully so that communication remains patient-focused. (This is not the same as disclosing personal problems - which the notes say NO to)
What should we know about Erikson’s research?
Erickson developed a series of stages about personality development that continue throughout the lifespan. Understanding these helps us to understand where others are in their own personal journey.
(Ie, adolescence and being one’s self; 60+ years and coming to terms with being and not being).
What should we know about Maslow’s hierarchy of needs?
Basic needs are at the bottom (food, water, etc), then through love/belonging, self-esteem, with self-actualization at the top. Can’t happen until you’ve met all your other needs.
What are some ways the text says nurses can be genuine?
You still have to hold back judgments, but you can acknowledge their struggles, offer encouragement, and show interest in pt’s family, work, and personal stories.
Define Open Self
Behaviors/thoughts/feelings known by you and others
Define Blind self
Things people know about you that you don’t know about yourself
Define Hidden self
All that you know about yourself but you hide from others
Define unknown self
Truths about yourself that neither you nor others know about.
What are the three times you can breach confidentiality?
Suspicion of abuse of elders/minors
Commission of a crime (?)
Threat of harm to oneself or others
Understanding the experience of another involving self-sacrifice
Unselfish regard and/or devotion to others
Sharing the feelings of another and actually feeling the same experience.
Can impair the nurse’s ability to care for the pt - can cloud judgment
Deep sympathy or desire to understand another’s experience, accompanied by a desire to relieve suffering.
Educated compassion, or the intellectual understanding of the emotional state of another person.
The desire to understand what’s happening from the patient’s experience WITHOUT experiencing the emotional content.
Why is it important to clarify the purpose and nature (+ goals) of the nurse-pt relationship?
It’s fundamental both for the delivery of care and for the evaluation of relationship+outcomes during termination phase.
Anxiety levels decrease when the pt knows what to expect.
What happens during the orientation phase
Nurse introduces him/herself, establishes rapport/trust.
Lays foundation for therapeutic relationship.
Clarifies purpose and nature of relationship.
Collects data for nursing assessment with active participation from pt. Listen well here so that all issues - needs and expectations - are addressed.
Orientation ends with a therapeutic (verbal) contract, where the roles of nurse and patient are explained and the goals are clarified.
What happens during the identification phase?
Collaboration between nurse and patient to identify problems and set problem-oriented goals.
Nurse might help patient explore feelings about their situation and direct their energies toward actions.
Identify personal strengths and resources to help cope and participate.
Using health services.
Interventions (for the afore-mentioned goals).
Might even review and re-assess goals.
Pt’s old needs are resolved. New goals emerge.
Nurse summarizes the progress of interventions towards intended goals.
Allows for a sense of accomplishment.
Any unmet goals are identified and potentially referred for follow-up care.
Can bring about big feelings. Okay to talk about them with the patient.
If you disagree with advice being given by another nurse, what should you do?
Don’t correct in front of the patient - discuss the issue in private with the coworker.
How do you navigate questions about yourself?
Pts often use questions to find out about common ground (do you have children? Where are you from?).
Prior to this point, nurse needs to establish that the patient is the focus.
Sharing of non-intimate information may be appropriate depending on the circumstance.
When faces with inappropriate questions, you can say “I don’t think that question is relevant to your care. Let’s focus on you...”
What does active listening entail?
Carefully hearing the patient’s message
Understanding the meaning of the words
Observing verbal and nonverbal messages
Suspending own thoughts and feelings
Listening to what patients are saying AND NOT SAYING about their experience
Allow for silence - patient guides conversation at comfortable pace
What are some barriers to active listening
(Private setting. Ask if the pt feels comfortable talking there)
(If pt is not ready to talk, wait until an appropriate time)
(About diagnosis or other things. Increased anxiety decreases information processing.)
(With angry patients, patients with cancer, challenging conversations, or during tense situations. Know that listening/judgment can be impeded)
When/Why is silence important?
Allows the verbal message to sink in
Allows adequate time for composing a thoughtful response
Allows for emotion to dissipate
After intense content, it shows respect for pt’s processing.
What should you do if you think the patient is silent to avoid discussion?
Something like “you seem quiet... would you like to share your thoughts?”
What should you do if the patient seems to be silent to protect him/herself?
What should you do if the patient seems quiet because they don’t want to disclose private information
Reassure the pt that you’ll keep the info confidential.
You can allow more time to establish trust.
What should you do if the pt is silent to regroup after intense emotions
Give the patient time to gather him/herself.
Resist the urge to fill the silence with talk.
What is restatement?
Paraphrasing what was said.
Acknowledges that the listener has heard and allows patient to clarify.
Restating what was said AND reflecting the emotional undertones.
Simplification and summarization of pt’s words to boil it down to clear statements (facilitates understanding)
What does it mean to distinguish between the patient’s interpretation and the actual symptoms?
Patients might misinterpret symptoms.
The patient might think their chest pain is related to grief, while it’s actually related to a heart attack.
What’s an open-ended way to ask about pain?
Can you tell me about any pain you have today?
How would you describe your pain?
How might you respond to a patient asking if you’ve ever had pain this bad?
“Let’s stay focused on your needs... tell me more about this pain in your belly.”
What are the different components of body language?
Hand and arm gestures
Is asking questions the same thing as listening?
No, they’re actually two different strategies.
What are some risk factors for poor listening?
-Hearing/cognitive impairment, anxiety, fatigue, pain, sedation
-Brain processing (planning what to say while the other is speaking)
-External distractions (setting, sounds, etc).
What is “identifying” and why is it an impediment to the listening process
Identification is when it triggers memories of your own similar experiences. It takes the conversation away from being patient-focused
What might it mean to “encourage expression”?
Asking the patient to talk about the quality of their experience:
“What are your feelings with regard to _____?”
What might it mean to encourage comparison?
Asking that similarities and differences be noted between this and other experiences:
“Have you had similar experiences? Was it something like _____?”
What might it look like to formulate a plan of action with a patient?
Ask the patient to consider what kinds of behavior might be appropriate in future situations:
“Next time this comes up, what might you do to handle it?”
What does it mean to “place an event in time or sequence”?
Clarify the relationship of events in the patient’s story - “What seemed to lead up to that? Was this before or after ____?”
What does “focusing” mean in communication?
Asking patient to hone in on a single point: “Of all the concerns you’ve mentioned, which is the most troublesome?”
What are tag questions?
A phrase with a question at the end that encourages the listener to express a particular opinion.
Don’t do it. Make statements or ask direct questions instead.
When there is an incongruence between verbal and non-verbal communication, which should you believe?
Non-verbal communications -
You can point out the non-verbal body language that you notice:
“Mr. X, you said that everything is okay, but you frowned as you spoke.”
What’s the science behind crying/stress relief?
The initial release of catecholamines increases your heart rate and blood pressure, but your parasympathetic response generates systemic relaxation.
What do you do if your patient is raging and crying?
Keep silent and accept their response. Let them regain control and blow off steam.
What are scenarios in which you shouldn’t touch a patient.
-anyone who withdraws from touch!
-anyone who has been abused
-anyone who is angry
-careful with panic or pain - touch can increase these.
Why might it be a bad idea to express approval about a patient’s decision? “It’s great that you made that decision”
Because it comes with a flip side - the disapproval. Being moralistic is a communication block.
Why shouldn’t you request an explanation from a patient? “Can you tell me why you don’t want to go to that group?”
It puts people on the defensive.
What could you say instead of “everything will be alright”?
“We will work on that together”
What could you do instead of giving advice?
“What do you think you should do?” or “What do you think would be the best way to solve this problem?”
What to say if you want to ask why a client did something?
“Describe what you were doing/feeling right before that happened”