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HS Unit 3 Exam- Ch4 Communication

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icorojo's version from 2018-04-07 13:54

OVERVIEW

Question Answer
Communicationis a reciprocal process in which messages are sent and received between people
Senderis the one who conveys the message
Recieveris the person or people to whom the message is conveyed
One-way communicationhas very little place in the nurse-PT relationship; BUT can be appropriate for PT who might be impaired cognitively, concerning safety issues
Two-way communicationrequires that both the sender and the receiver participate in the interaction
Two-way communication allows for exchange between the nurse and PT, and its purpose is to meet the needs of both the nurse and PT and establish a trusting relationship
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VERBAL

Question Answer
Verbal communicationinvolves the use of spoken or written words or symbols
Connotative meaningof a word is subjective and reflects the individual's perception or interpretation; in context "slang"
Denotative meaningrefers to the commonly accepted definition of a particular word; literal meaning
Jargonis commonplace "language" or terminology unique to people in a particular work setting, such as a hospital, or to a specific type of work, such as nursing; "professional terms"
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NONVERBAL

Question Answer
Nonverbal communicationmessages transmitted without the use of words (either oral or written)
Nonverbal: cues includetone and rate of voice, volume of speech, eye contact, physical appearance, and use of touch
Voice varies depending emotions, familiarity with a situation, confidence, and geographic and cultural influences
Meaning cannotbe accurately interpreted on the basis of tone, rate, and volume alone
Nurses should consider thevoice characteristics in the context of the situation as a whole so that interpretation of the message is accurate
Eye Contactcommunicates an intention to interact
Extended eye contact(longer than 6 sec) sometimes implies aggression and arouses anxiety; brief, but direct (2-6 sec) interest, respect, caring
Absence of eye contactshyness, lack of confidence, disinterest, embarrassment, or hurt, or in contrast, deference and respect (culture-specific)
Physical appearance includes attributesof size, color of skin, dress, grooming, posture, and facial expression
A professional appearancecoveys pride and competence
Physical appearance: interpretationsprofessional or nonprofessional, trust or distrust, respect or disrespect, comfort or intimidation, interest or disinterest, competence or incompetence
Gesturesare movements people use to emphasize the idea they are attempting to communicate
Gestures may alsoplay a useful role in clarifying
Posturethe way that an individual sits, stands, and moves
Open posturewhen taking a relaxed stance with uncrossed arms and legs while facing the other individual
Open posture: interpretationswarmth, acceptance, caring
Closed posturea more formal, distant stance, generally with the arms, and possibly the legs tightly crossed
Closed posture: interpretationsdisinterest, coldness, nonacceptance, authority, control, intimidation, condescension
Nonverbal communication is often more accurateand makes up the largest percentage of our communication
IF nonverbal cues are inconsistentor incongruent with the verbal message, the nonverbal message is most likely the one received
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STYLES

Question Answer
Assertivenessone's ability to confidently and comfortably express thoughts and feelings while still respecting the legitimate rights of the PT
Assertive communication styleinteraction that takes into account the feelings and needs of the PT, yet honors the nurse's rights as an individual
Assertive communication interactions are even-sided
Aggressive communicationoccurs when an individual interacts with another in an overpowering and forceful manner to meet one's own personal needs at the expense of the other
Aggressive communication is destructive and non-therapeutic
Unassertive communication stylenurse agrees to do what the PT requests, even though doing so creates additional problems for the nurse
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THERAPEUTIC RELATIONSHIP

Question Answer
Therapeutic nurse-PT interactionis one in which the nurse demonstrates caring, sincerity, empathy, and trustworthiness
LPN/LVN must ensure thatthe PT is the focus of each interaction, not the equipment or the task
Trust is essential to effective nurse-PT interaction
Be careful to maintain professional boundaries in nurse-PT relationships
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TECHNIQUES

Question Answer
Therapeutic communicationis the ideal; facilitates formation of positive nurse-PT relationship and actively involves PT
Non-therapeutic communicationusually blocks the development of a trusting and therapeutic relationship
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NONVERBAL TECHNIQUES

Question Answer
Listeningis an acquires skill that is vitally important to the nurse-PT relationship
Active listening requiresfull attention to what the PT is saying
Active listening: benefitsconveys interest and caring; gives PT full attention; allows feedback to verify understanding of the message
Passive listeninglistening to the speaker is indicated either nonverbally via eye contact and nodding, or verbally via encouraging phrases such as "Uh-huh"and "I see"
Silenceallows time to organize thoughts and formulate an appropriate response
Silence conveysrespect, understanding, caring, and support; allows observation of PT nonverbal response
Touch conveyswarmth, caring, comfort, support, and understanding
Touch is often highlypersonal or intimate in nature (ex. giving a bed bath, assisting a PT on or off a bedpan, inserting a urine catheter); must be used with great discretion
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VERBAL TECHNIQUES

Question Answer
Conveying acceptancePT hesitant to give complete info; often due to fear of disapproval from the nurse; nurse needs acceptance and willingness to listen and respond without being judgmental
Nurse must be carefulnot to relay nonverbal disapproval through gestures or facial expressions
Closed questionsis focused and seeks a particular answer
Open-ended questionsdo not require a specific response and allow the PT to elaborate freely on a subject when replying; useful in assessing PT feelings
Restatingnurse repeats to the PT what is BELIEVED to be the main point that PT is trying to convey
Paraphrasingthe restatement of the PT message in the NURSE'S OWN WORDS in an attempt to verify that the nurse has correctly INTERPRETED the PT message
Clarifyingnurse suggests his/her OWN IDEAS about what PT is trying to communicate back to the PT
Clarifying: is usefulwhen PT message is incomplete or confusing or does not go deeply enough into the area being explored
Clarifying: preventsmisinterpretation of PT comments
Focusingused when more specific info is needed to accurately understand PT message
Focusing: allows the nurseto gather more specific info when PT message is too vague; focuses on specific data
Reflectingused to assist PT to explore their own feelings, often about a choice that lies before them, rather than seeking answers or advice from someone else
Reflecting: allows PTto see that their ideas and thoughts are important and have worth
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CONTINUED

Question Answer
Stating Observationscommunicating the nurse's observations to PT
Stating Observations: benefitsuseful in validating the accuracy of observation; helpful when PT verbal message does not match the nonverbal behavior witnessed by nurse
Offering Informationpreparing PT for what to expect before, during, and after an invasive diagnostic procedure
Offering Information: benefitsuseful for PT teaching; promotes informed decision making
Summarizingproviding a REVIEW of the MAIN POINTS covered in an interaction
Summarizing: benefitsuseful when interaction has been lengthy or has covered several topics
Using humorcan help put both nurse and PT at ease; BUT important for nurse to know when humor is appropriate and when it is inappropriate; never appropriate to laugh AT PT, only appropriate to laugh WITH PT
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FACTORS THAT AFFECT COMMUNICATION:

Question Answer
Therapeutic posture and positioningis the SAME POSITION and SAME LEVEL as the PT, or as close to it as feasible
Space and Territoriality: intimate spacefrom the FACE to about 18 inches away
Space and Territoriality: personal spacearea from 18 inches to 4ft away from a person
Space and Territoriality: social space4ft to 12ft from a person
Space and Territoriality: public spacebeyond 12ft from a person
Environmentkey elements to a successful interaction are a calm relaxed atmosphere and privacy
Level of Trustessential to an effective nurse-PT interaction
Level of Trust: is buildby demonstrating confidence and competence
Language Barrierscan pose a major threat to effective communication and development of a therapeutic nurse-PT relationship
Cultureis a significant component of PT psychological well-being
Culture: nurse mustmake an effort to seek specific info regarding cultural practices and beliefs of PT being cared for, especially when PT is of a different culture
Age and Gender: barriersignificant age difference between nurse and PT may raise a barrier; (ex. teenagers use of slang)
Age and Gender: male and femalecommunication are closely related to cultural, familial, and lifestyle patterns
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PSYSIOLOGIC

Question Answer
When a PT is experiencing painall available energy is focused on coping with the pain; it is difficult for PT to communicate about anything else
Altered cognitionanother physiologic factor that frequently hinders effective communication
Altered cognition: carefulassessment of PT level of cognitive function is important when beginning any interaction
Impaired hearinganother physiological factor that impedes communication
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PSYCHOLOGICAL

Question Answer
Stresscan lead to problems with communication between PT and nurse
While experiencing increased stress, PTmay respond to nurse with anger, impatience, or even withdrawal; nurse may need to modify communication methods
Stress: nurse may find it helpful to let PT direct the conversation; being supportive of PT aids in keeping the lines of communication open and effective
Grieving a result of actual or perceived loss
Nurses often feel uncomfortable interacting with a grieving PT for fear of not knowing what to say or saying the wrong thing
Grieving: nurse-PT interactiona silent presence is often all that is necessary; may be facilitated by therapeutic touch, displaying warmth and caring behaviors, and using open-ended statements to listen
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RESPONSES THAT BLOCK COMMUNICATION (BOX 4-4 p73)

Question Answer
False reassuranceusing falsely comforting phrases in an attempt to offer reassurance
False reassurance: outcomeyou promise something that will not occur or is unrealistic
Giving advice or personal opinions: outcomestakes decision making away from PT
Giving advice or personal opinionsmaking a decision for a PT; offering personal opinions; telling a PT what to do with phrases such as "should do"
False assumptionsmaking an assumption without validation; jumping to conclusions
False assumptions: outcomeeasily leads to a wrong conclusion; often viewed as accusatory or argumentative
Approval or disapprovaltrying to impose the nurse's own attitudes, values, beliefs, moral standards on PT about what is right and wrong
Approval or disapproval: outcomeeasily leads PT to doubt personal values; creates feelings of guilt and resentment; causes friction between nurse and PT
Automatic responsestereotyped or superficial comments that do not focus on what PT is feeling or trying to say
Automatic response: outcometends to belittle individual feelings and minimize the importance of the message; communicates the message nurse is not taking PT concerns seriously
Defensivenessresponding negatively to criticism; often in response to feelings of anger or hurt on your part; usually involves making excuses
Arguingchallenging or arguing against PT statements or perceptions
Defensiveness: outcomeimplies PT has no right to an opinion; often nurse ends up ignoring or minimizing PT concerns
Arguing: outcomedenies that PT perception are real and valid; implies that PT is lying, misinformed, or uneducated
Asking for explanationsasks the PT to explain their actions, beliefs, or feelings with "why" questions
Asking for explanations: outcomefrequently viewed by PT as accusatory; PT often thinks you know the answer and are testing them; risk causing resentment, insecurity, mistrust
Changing the subjectinappropriately focusing the discussion on something other than PT concerns
Changing the subject: outcomerude and shows lack of empathy; blocks further communication, and sometimes makes PT feel uncomfortable about expressing feelings; interrupts thoughts, and often inhibits the sharing of important information
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VENTILATOR DEPENDENCE

Question Answer
Ventilator-dependent PTasses PT ability to use an alternative method of communication
Ventilator-dependent PT: communication boardincludes the alphabet, commonly used phrases, pictures, or a combination of all three
Ventilator-dependent PT: blinkingsetting up a "signal" system such as one blink for "yes" and two blinks for "no"; slow and cumbersome process for communicating that requires patience from both PT and nurse
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APHASIA

Question Answer
Aphasiaa deficient or absent language function that results from ischemic insult to the brain, such as stroke (cerebrovascular accident), brain trauma, or anoxia
Expressive aphasiaPT unable to SEND the desired verbal message
Receptive aphasiaan inability to recognize or interpret the verbal message being RECEIVED
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UNRESPONSIVE

Question Answer
Unresponsive PT: interactionall sound and verbal stimuli has the potential of being heard
Encouragehealth care providers, family, friends to speak to PT
Alwaysexplain any procedure or activity
KeepPT at the center of conversations
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ALTERNATIVE METHODS (BOX 4-7 p75)

Question Answer
Lip readingPT mouth words to be interpreted by the receiver
Sign languageHand and finger signals used to indicate letters
Paper and Pencil or magic slatePT writes message to communicate needs
Picture boardPT points to pictures on a board or poster of typical PT needs
Word or picture cards3 x 5 cards with words or pictures on them; PT picks appropriate card or sorts cards into short phrases or sentences
Magnetic boards with plastic lettersPT moves letters around on board to spell words or phrases
Eye blinkspredetermined system in which the number of times a PT blinks in response to a question indicates yes or no
Computer-assisted communicationPT uses keyboard to type messages
Clock face communicatorMessages placed at intervals around the clock face; clock hand scans the messages, and PT presses a button to stop the hand on the desired message
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