Nurs 226 communication and assessment lecture test 1

the nurse explains to a client that he will have to have a bowel prep before going to his esophagogastroscopy. what should the nurse focus on to improve communication skills?

simplicity

a client who has been sullen and withdrawn since receiving the news of having cancer asks for assistance with a shower. which comment by the nurse is the most appropriate?

"this is a positive sign, ill be right back with your shower supplies"

the nurse is working in a pediatric clinic and has to explain a nebulizer treatment to a child. which approach should the nurse use?

let the child handle the equipment first, then demonstrate on a doll

the nurse is giving a demonstration of new equipment to the rest of the staff. which level of proxemics should the nurse use?

social

the nurse is preparing to explain a dressing change to a client. which statement indicated the fourth component of the communication process?

"i dont understand when i should do this at home"

A client grimaces and responds "I'm fine" when asked by the nurse to describe a level of pain. Which communication factor is the client struggling with?

congruence

verbal connection

pace, intonation, simplicity, clarity, brevity, timing, relevance, adaptability, flexibility, humor

example of verbal connection-

simply saying spouses heart stopped- the code team is trying to get it to start

non-verbal connection

body language, appearance, posture, facial expression, gestures, emotions

non-verbal connection example

while listening to a pt, a nurse nods and says uh-huh

use of technology or other equipment example-

if a client is unable to speak use white boards, paper/pen/picture board

use of technology or other equipment example 2-

using dolls/ games to explain a procedure to a child

4 elements of communication

sender, message, medium, receiver

4 key components of the communication process

encoding, channel, decoding, feedback

feedback-

response from the receiver- could be verbal/nonverbal and reveals if the audience understands the message

personal space proxemics

intimate, personal, social, and public

intimate proxemics

touching- 1 foot

-personal care given to client

personal proxemics

1.5 to 4 feet

social proxemics

4-12 feet

-nurse demo of a new IV pump to nursing unit

public proxemics

12-15 feet

factors that influence communication

roles and relationships, environment, congruence, interpersonal attitudes, boundaries

roles and relationships

recognize the uniqueness of the individual

environment

-most effective communication happens in a comfortable environment using open ended questions - "tell me more", "what brings you to the hospital"

-provide privacy

congruence

facial expressions and tone of voice match

What are some components of interpersonal attitudes?

Caring, warmth, respect

How should one communicate in heightened situations according to interpersonal attitudes?

Be brief, factual, and to the point while showing empathy

What is 'elder speak' in the context of interpersonal attitudes?

Similar to baby talk, it patronizes older adults

what are the benefits of therapeutic communication?

-promotes understanding

-attentive listening

manner of being present to another, appropriate head nods, and offering use of self

what does good therapuetic communication result in?

knowing what the client values, nurse can reduce vulnerability and enhance quality of life

example of good therapeutic communication

asking pt. if they feel safe; intently listening

-providing client with favorite magazine, book, or treat

communication barriers

language differences, cultural diversities, speech or hearing impairments, developmental or cognitive disorders, etc.

pre-interaction phase:

become familiar with clients social history- name address, medical and social history

introductory phase- opening relationship

develop trust and security- getting to know each other, keeping promises to return and visit

-clarifying problem

-formulating the contract

working phase

convey respect, explore and understand thoughts and feelings

-respect wish to be left alone

termination phase

nurse and client accept feelings of loss, the client accepts the end of the relationship without feelings of anxiety or dependence

What is OARS used for?

open-ended questions

affirmations

reflective listening

summarizing

what is the SOLER approach when interviewing a client?

S- sit squarely facing client

O- open your posture

L-lean toward person

E-eye contact

R- relax while listening

process recording

-verbatim account of conversation

-verbal and non verbal info

-evaluates effectiveness of teaching

interprofessional teams

two or more professionals work together to improve access to and coordination of health care services

-important factor in health care

what is SBAR

Situation,

Background,

Assessment, Recommendations

what causes the most client errors

communication problems

what are communication styles

passive: avoidance of conflict

assertive: honest and clear- uses I statements

aggressive: verbally and sometimes physically abusive

passive aggressive: demonstrating anger in subtle or indirect way

what is emotional intelligence

-being approachable and easy going

-displaying maturity in a variety of situations

-resolving conflicts while taking others emotions into consideration

what is assertive communication

"I" statements not "you" statements

what is a consult?

refers to a request for a referral to transfer care

what is a barrier?

an interruption, misunderstanding, language barrier, and hesitation to speak up to authority figures

what can a barrier to communication, team work, and collaboration do?

can jeopardize client and staff safety, and create a hostile work environment which can take a mental and physical toll on those effected

what are some disruptive behaviors?

incivility, lateral violence, and bullying- worker on worker

what is incivility?

rudeness, discourtesy, and disrespect

what is bullying- worker on worker

offensive, abusive, intimidating, insulting behavior or abuse of power

-recipient feels upset, threatened, humilliated, and vulnerable

-occurs repeatedly for 6 months

what is an example of worker on worker bullying

giving a new grad RN assignments that are beyond their knowledge and then threatening to fire them if they refuse an assignment

how should one respond to disruptive behaviors?

model respectful, ethical behavior

what does ISBAR stand for?

introduction

situation

background

assessment

recommendations

readback

what should you do when receiving a prescription?

record it

read it

don't just repeat it

read it back as written

verify

a health care provider asks the nurse what school was attended because "mickey mouse is a better nurse". in which way should the nurse categorize this example of workplace violence?

worker- on- worker

the nurse is creating a teaching tool about emotional intelligence, which personal skills should the nurse identify that are essential when using this framework?

self control, self awareness, and self motivation

the nurse is using the situation, background, assessment and recommendation model to report a change in a clients health status. for which category should the nurse describe the clients current condition?

assessment

a health care provider confronts a staff nurse for being contacted early in the morning for a client issue. in which way will the health care providers behavior impact client care in the future?

client information will not be shared and will jeopardize safety

the nurse is assessing a client with an exacerbation of a chronic illness. which statement provides unwarranted/ false reassurance to the client

you will feel better soon

the nurse educator assigns students an activity to implement socratic questioning in their daily lives. which question provided by a student demonstrates this reasoning technique?

what makes you think cramming for a test is an ineffective way to study.

a client is experiencing a productive cough, audible coarse crackles, elevated temperature of 102.3, chills, and body aches. what did the nurse use to determine that this patient is experiencing respiratory compromise?

deductive reasoning

the nurse enters the room of a critically ill child after sensing that "something" isnt right and finds the last IV solution hung by the previous nurse was nor the correct solution. which problem-solving method did this nurse use?

intuition

the nurse is creating an inner concept map to explain relationships between concepts and associated attributes. what are the benefits of using a concept map?

quicker than taking notes, visual aid to critical thinking process, graphic description of connections. linear and nonlinear relationships

the nurse completes collecting data from a client and determines a list of problems. which step in the nursing process should the nurse preform next?

diagnose

what is the nursing process key in helping nurses do?

making clinical judgements that are appropriate for clients

what are the steps of the nursing processs?

assessment

analysis

planning

implementation

evaluation

what occurs during assessment?

assess subjective and objective data

-recognize cues

what happens during analysis?

determine client problems

- prioritize hypotheses

what happens during planning?

creates a plan to address client problems

- generates solutions

what happens during implementation?

take action

what occurs during critical thinking?

compare and contrast data

-includes questioning, analysis, synthesis, interpretation, inference, inductive reasoning, etc.

why is nursing critical thinking important?

high pt. acuity, care is only as good as the nurse, health care costs are high so nurses are expected to keep costs doen, and care of pts. with new illnesses

critical thinking is...

purposeful, reasoned, solution seeking, goal directs, active, orderly, and well thought out

during the critical thinking process you must:

suspend all judgement

what is ADPIE

Assessing,

diagnosing,

planning,

implementing,

and evaluation

family of a client demonstrating confusion state that this is not the clients usual behavior. how should the nurse document this data?

secondary subjective data

during the initial interview, the client says "i dont understand why i have to have surgery; im really not that sick or in pain right now". how should the nurse respond?

what kind of questions do you have about your surgery?

during an assessment interview, the client stated the elective surgical procedure will not be done because it does not fit into their life goals. which of gordons functional health patterns does this fit into?

value and belief pattern

while preparing a client for a procedure, the nurse notes that the client has become unresponsive, and respirations have become shallow. what type of assessment should the nurse complete?

emergency assessment

a nurse is preforming an initial assessment on a new admission. what information should the nurse consider as being a part of the database?

reports for PT the client received as an outpatient, documentation of the nurses physical assessment, a list of current medications, and information about the clients cultural preferences

exp. of assessing and recognizing clues

a nurse notes a new area of skin break down caused by the tape when changing a dressing on a wound

diagnosing and analyzing clues

develop a list of problems, identify client strengths, identify problems that can be prevented

implementation and taking action exp.

giving a patient a back rub

evaluating and evaluating outcomes

identifying outcomes in between diagnosing and planning

what are the 4 types of assessments?

initial assessment, problem focused assessment, emergency assessment, and ongoing assessment

what is COLDSPA

character, onset, location, duration, severity, pattern, associated factors

what is included in the initial assessment?

health history, physical exam (assesses exact location of problem; when symptoms began)

when is the initial assessment preformed

within 24 hours of admission

effective communication guidelines

-looking directly at the client to ensure good eye contact

- sitting in a chair next to the client who is in bed

-keeping arms unfolded and in a relaxed position

primary source

client

secondary source

parents, caregivers, and children of older clients

subjective data

symptoms, apparent only to person affected; sensations, feelings, values, and beliefs

objective data

signs or overt data, detectable by an observer, can be seen, heard, felt, or smelled; obtained through observation or physical exam

client source

best source

support people

family members, friends, and caregivers

components of a database

-documentation of a nurses physical assessment

-current meds

-family history

-lifestyle

-past medical history

-demographics

interview settings-

time (after client is settled)

place (private and comfortable)

seating arrangement

distance (sit next to; few feet apart)

comfortable

language

examination

carefully assesses each area for normal and abnormal findings

components of general survey

physical appearance, body structure, mobility, behavior, vital signs

gordons functional health pattern framework

health perception and management; nutrition, elimination, activity

self perception/ self concept

role relationship

coping/ stress

value/ belief