NURS 212: Exam 2

communication

process of exchanging information and generating meanings

source (encoder)

person/group that begins communication process

message

actual communication product from the source

channel

medium the source has selected to send the message

receiver (decoder)

person who receives the message and interprets it

auditory channel

spoken words and cues

visual channel

sight, observations, and perception

kinesthetic

touch

noise

factors that distort the quality of the message (ex. tv, roommates, visitors, pain/discomfort)

physical barriers

hearing, sight, and cognitive distractors

interpersonal

self-talk, communication within a person (can be positive or negative)

intrapersonal

talk between two or more people, goal is to exchange messages

small group

nurses interact with two or more people (ex. staff meeting)

organizational group

people within groups and organizations communicate to achieve established goals (ANA, etc.)

group dynamics

how well group members work with each other towards a goal, determines effectiveness of a group

task oriented roles

getting the work done

group building/maintenance roles

focusing on the well being of the people doing the work

self serving roles

advance the needs of individual members at the groups expense

ground rules

identify goals, set direction, ensure group cohesiveness

verbal communication

exchange of info using words, depends on the language

spoken/written

reveals aspects of the patient's intellectual development, educational level, and geographic/cultural origin

nonverbal communication

help nurses understand subtle and hidden meanings in what the person is feeling

body language

communication via the movements or attitudes of the body

touch

personal behavior, express affection, anger, etc

eye contact

willingness to listen, anxiety, avoidance

facial expressions

can read what the person is feeling by their face, some people can mask feelings

posture

depressed/tired = slouch, positive/good health = sits upright, can give clues to pain

gait

the way someone walks can indicate well being; bouncy, shuffling, slowly, limping

gestures

thumbs up, kicking, tapping foot, waving hand

general physical appearance

paleness, sunken eyes, dry skin, fullness of cheeks

dressing and grooming

interest in physical appearance can vary depending on health (depression may equal lack of keeping up w/ appearance)

sounds

crying, moaning, gasping, sighing

silence

many meanings, understanding, anger, dying

factors influencing communication

developmental level, biological sex, sociocultural responsibilities, space and territory, physical/emotional/mental state, values, environment

helping relationship

relationship between caregiver/nurse and patient

a helping relationship...

does not occur spontaneously, has unequal sharing of info, and is built on the client's needs

characteristics of helping relationship

dynamic, purposeful, time limited, professional accountability

orientation phase

identify each other by name, agreement is established, data gathered

working phase

longest phase, meet patient's physical and psychosocial needs, nurse provides assistance, nurse is teacher and counselor

termination phase

conclusion of agreement, patient is discharged or nurse leaves, evaluation of outcomes, patient verbalizes feelings about termination

dispositional traits

characteristics/way of behaving that affects relationship: warmth and friendliness, openness and respect, empathy, honesty/authenticity and trust, caring, competence

rapport

feeling of mutual trust in a relationship that facilitates open communication

rapport builders

specific objectiveness (having a purpose for interaction), comfortable environment, privacy, confidentiality, patient vs. task focus (focus on patient and their needs), using nursing observations (ex. nonverbal messages), optimal pacing, respecting personal space

different cultures

release personal bias, learn about client's cultures/beliefs, adjust your care to meet their needs, use interpreters when necessary

therapeutic communication

focusing on the patient's needs

non-therapeutic communication

not making the patient feel comfortable

conversation skills

tone of voice, knowledgeable, flexible, concise, avoid slang, truthful, open-minded, facilitate conversation at optimal times

listening skills

sit and be conscious about body language, be alert and relaxed, keep conversation natural, maintain eye contact, think before responding, listen and identify themes

silence technique

allows patients to gather their thoughts and proceed at their own pace

touch technique

express comfort and affection

humor technique

accept failures, lighten situation, maintain balanced perspective in work

openended questions

allows for wide range of response

close ended questions

limited to yes/no/short answers, gather specific info

validating question

validate what nurse believes they've heard/observed (do not overuse)

clarifying question

gain understanding of patient's comment

reflective question

repeating what the patient said or describing patient's feeling

sequencing question

place events in chronological order or investigate a possible cause and effect relationship in events

direct question

obtain more info about a topic brought up earlier or introduce new aspect

assertive behaviors

empathy, describing feelings and situations, clarifying expectations, anticipating consequences

communication blockers

changing subject, false assurance, gossip/rumors, disruptive interpersonal behavior and communication, failure to perceive the patient as a human being, failure to listen, non therapeutic comments and questions

visually impaired communication

acknowledge presence, identify yourself

hearing impaired communication

face patient, keep mouth clear, use gestures

physical barrier communication

eye blink, hand squeezes

cognitively impaired communication

maintain eye contact for attention, talk simple and concrete

unconscious

assume patient can hear you

non-english speaking

speak in simple sentences, find interpreter, universal nonverbal cues

maintain/promote health (aims)

helps patients value health and develop specific health practices (ex. passive exercise, making safe exercise program)

preventing illness (aims)

teach patients how to prevent illness (ex. screening)

restoring health (aims)

counseling someone who is already ill, practice self-care, improve health (ex. teach someone w/ STI to use condoms)

facilitating coping (aims)

help come to terms w/ changes and cope

promoting outcomes

high-level wellness, self-care practices, recovery from trauma, enhanced ability to adjust to developmental lifestyle

T

tune into patient

E

edit patient info

A

act on every teaching moment

C

clarify often

H

honor the patient as a partner in the education process

ADPIE

Assess, Diagnose, Plan, Implement, Evaluate

factors affecting patient learning

age (emotional maturity and moral/spiritual dev.), developmental level (degree of understanding), adult learners, family support and financial resources, cultural influence, language deficits, health literacy

pedagogy

child learning

andragogy

adult learning

cognitive learning

storing/recalling new knowledge int he brain, comprehension

psychomotor learning

learning a physical skill

affective learning

changes in attitudes, values, and feelings

effective communication techniques

sincerity, honesty, stick to the basics (avoid giving too much detail), simple words, clear and concise, vary tone of voice, listen (do not interrupt the patient), environment is free of interruptions

assessing

patients are considered primary sources of info, review medical records, assess learning readiness, motivation, compliance, and patient strenghts

diagnosing

nursing diagnosis is not a medical diagnosis (ex. ineffective breathing, risk for infection, risk for falls, pain)

outcome identification and planning

goals of patient, time line, teaching strategy/learner activity, goal met or not met, teacher content

role modeling

actions speak louder than words

lecture

present info, but be interactive and collaborate with patient

discussion

exchange info, ideas, feelings

panel discussion

presentation of info by two or more people, debate, share experiences and emotions

demonstration and return demonstration

evaluate patient learning by having them teach back what they've learned

discovery

offer info (like a pamphlet) to patient and let them conduct their own research

role playing

give learner a chance to experience, relive, or anticipate event

contractual agreements

pact between two people setting out mutually agreed on goals

time constraints

set priorities for essential content

scheduling

plan shorter, more frequent teaching sessions

group vs. individual

depends on skill being taught (ex. getting dressed would be individual, while expressing feelings may be done in a group)

formal vs. informal

informal (unplanned) deals w/ immediate concerns while formal is planned sessions for anticipated outcomes

implementing

prepare and organize teaching aids, make it fun and creative, have a positive attitude, review patient expectations and role functions as learner to avoid misunderstandings, consider environment, assess comfort level