ULL Nursing 204 exam 1 with complete solutions.

Linear Model simplest form of communication. focuses only on the sending and receiving of a message. Useful in emergency situations 1. sender 2. message (verbal and nonverbal) 3. receiver 4. channels of CMCN 5. content Transactional Model define interpersonal communication as a reciprocal interaction in which the sender and the receiver influence each other's messages and responses as they converse. Employs system concepts Previous Play Next Rewind 10 seconds Move forward 10 seconds Unmute 0:00 / 0:15 Full screen Brainpower Read More systems theory concepts 1. human system (patient and providers) receives information from the environment (input) internally processes and interprets its meaning (throughput). The result is new information or behavior (output). Feedback loops provide information healthcare system all organizations, people and actions whose primary intent is to promote, restore or maintain health communication combination of verbal and nonverbal behaviors integrated for the purpose of sharing information Metacommunication broad term used to describe all factors that influence how the message is perceived. may be hidden within verbalizations or conveyed as nonverbal gestures and expressions communication style the manner in which one communicates denotative meaning generalized meaning of a word connotation personalized meaning of a work or phase Paralanguage vocalic behaviors that communicate meaning along with verbal behavior 6 verbal styles of communication 1. moderate pitch and tone in vocalization 2. vary vocalizations 3. encourage involvement 4. validate patient's worth 5. advocates for patient as necessary 6. provide needed information nonverbal communication communication using body movements, gestures, and facial expressions rather than speech. most of our person to person communication 6 nonverbal style of communication 1. allows therapeutic silences 2. use congruent nonverbal behaviors 3. use facilitative body language (kinetics) 4. use touch appropriately 5. proxemics (respect patient's space) 6. attend to nonverbal body cues body language nonverbal communication through gestures, facial expressions, behaviors, and posture Proxemics perception of what is a proper distance to be maintained between one's self and others Communication Accommodation Theory theory that people will adapt or adjust their speech, vocal patterns, dialect, word choice and gestures to accommodate others convergence adjusting one's speech to our conversational partners to help facilitate interaction, increase acceptance and improve trust and rapport divergence choice a different style of communication than partner sociocultural factors of communication 1. culture 2. age cohort and generational diversity 3. gender 4. location culture style factor communicating in a culturally competent manner age and cohort generational diversity members of different generations hold differing views regarding work motivation, person values and attitudes toward work; they also have differing communication styles interpersonal competence develops as the nurse comes to understand the complex cognitive, behavioral, and cultural factors that influence communication social cognitive competency the ability to interpret message content within interactions from the point of view of each of the participants message competency the ability to use language and nonverbal behaviors strategically in the intervention phase of the nursing process to achieve the goals of the interaction Style Factors that Influence Relationships Slang and Jargon Medical Jargon Responsiveness of Participants Roles of Participants Context of the Message Involvement in the Relationship Use of Humor professional communication complex interactive process used in clinical settings to help patients achieve health related goals outcomes of professional communication patient satisfaction, productive health changes, safety and better quality service basic assumptions of communication theory 1. all behavior is communication 2. every communication has content and a relationship aspect 3. we know about ourselves and others primarily through communications 4. faulty communication results in flawed feeling and acting 5. feedback is the only way we know that our perception about meanings are valid 6. silence is a form of communication 7. all parts of a communication system are interrelated and affect one another 8. people communicate through words, nonverbal behaviors and analog-verbal modalities Therapeutic communication A dynamic interactive process consisting of words and actions, and entered into by a clinician and client for the purpose of achieving identified health-related goals. patient centered communication skills lifeblood of clinical tasks such as obtaining a clinic history, explaining a diagnosis and providing competent nursing care with related health teaching interpersonal communication skills influence the completeness of diagnostic information, quality of shared decision making and patient motivation to achieve constructive clinical outcomes characteristics of patient centered communication 1. empathy 2. frame of reference or world view 3. defined interpersonal boundaries 4. health related purpose 5. nonverbal communication supports empathy being emotionally attuned to a patient's perceptive of a situation of a situation as well as to it's reality defined interpersonal boundaries conversations that focuses on patient and family health care needs health related purpose professional conversations take place within a defined health care format and terminate when the health related purpose is achieved or the patient is discharged nonverbal communication supports behavioral signals found in the tone of voice, inflections and intonations, facial expression and body language accompany verbal messages frame of reference or world view patient's perception active listening dynamically focused interpersonal process in which a nurse hears a patient's message, decodes it's meaning, asks questions for clarification and provides feedback to the patient. Transaction process with the goal to understand what the patient is trying to communicate. It includes metacommunications. Nurses need to be sensitive to what is left out of the message as well as what is included ANA Standards of Professional Performance Communication 1. assess communication format preferences 2. assess own communication skills 3. seeks continuous improvements 4. conveys information 5. questions decisions that do not appear to be in the best interest of the patient 6. discloses concerns related to hazards and error 7. maintain communication with other providers to minimize risk 8. contributes own professional perceptive personal factors that influence communication 1. eye contact, full attention on the patient, genuine respect and clear, concise messages 2. respect for a person's culture, spiritual and educational level 3. use of body language, gestures and minimal verbal cues to encourage further communication obstacles to effective communication within the patient 1. preoccupied with pain, physical discomfort, worry 2. unable to understand nurse's use of language 3. personal emotionally laden topic 4. insecurity 5. confusion 6. lack of privacy 7. sensory or cognitive deficits obstacles to effective communications within the patient 1. preoccupation with personal agenda 2. hurried 3. making assumptions 4. cultural stereotypes 5. defensiveness 6. thinking ahead to the next question 7. intense patient emotion or aggressiveness 8. weak language verbal responses 1. refer to spoken words in professional conversation 2. meaning making basic tools that enables organization data, explore options, resolve issues 3. meaning resides in the person using them 4. word choice matters 5. both verbal and nonverbal can be misinterpreted self awareness Nurses have an ethical and professional responsibility to resolve personal issues 1. know your goals 2. know your personal vulnerabilities and prejudices 3. nonverbal behaviors support your words environmental factors 1. privacy - free from interruptions and eliminate noise 2. space - Differs with culture, personal preferences, nature of relationship, topic 3. timing - Consider patient's ability to absorb material, share impressions, ask questions communication as a shared partnership 1.Patients need to be listened to, involved in own care, and supported. 2. An interactive reciprocal exchange of ideas in which the nurse tries to understand what it is like to be this person, in this situation, with this illness 6 core, overlapping functions of client- centered communication needed to achieve beneficial health outcomes: 1.Foster healing relationships 2.Exchange information 3.Respond to emotions 4.Manage uncertainty 5.Make decisions 6.Enable patient self-management communication applications engaging the patient 1. Begins with 1st encounter 2. Open, welcoming, relaxed 3. Introductions before conversation 4. Speak directly to patient; include family 5. Give relevant information & listen communication applications building rapport 1. Ask routine questions 2. Keep the conversation open with few interruptions 3. Ask questions from easy general to more complex 4. Be aware of personal characteristic, culture, experiences, education levels 5. Be attentive, sincere, genuine 6. Although starts with first encounter, continues throughout relationship communication applications developing a shared partnership 1. Empathetic objectivity 2. A "here and now" focus 3. Demonstration of respect 4. Authentic interest & confident manner 5. Consider competing goals & alternatives communications applications finding common ground 1. What is most important to patient & family? 2. What helps or hinders their capacity to self-manage? 3. Look for themes revealing fear, feelings, & level of engagement 4. Patients need to understand the full range of therapeutic choices communication applications observing cues 1. People are not always aware 2. Cues can support or contradict meaning of spoken message. 3. Look for environmental evidence 4. Comment on your perceptions 5. Like verbal communications, nonverbal behaviors & signals are culture bound emblems gestures or body motions have a common verbal interpretation (e.g. handshaking, baby waving bye) illustrators actions that accompany and emphasize the meaning of the verbal message (e.g. smiling, stern facial expression) affect displays facial presentation of emotion affect. have a larger range of meaning and act to support or contradict the meaning of the verbal message regulators nonverbal gestures such as nodding to stop conversation or to reinforce or modify what is being said adaptors patient specific, repetitive, nonverbal actions that are part of a patient's usual response to emotional issues (e.g. nervous foot tapping) physical characteristics information about the patient observed about the outward appearance of the patient (e.g. body odor, physical appearance) nonverbal cues active listening - Intentional form of listening - Requires extra effort - note feelings & look for underlying themes Goal: mutual understanding of facts & emotions Contributes to: 1. Fewer incidents of misunderstanding 2. Increase accuracy of data 3. Stronger health relationships Core clinical questions (open-ended): Encourage patient exploration, expand on ideas, voice confusion open-ended questions patient expresses problem in own words; open to interpretation & cannot be answered by "yes", "no", or one-word response. Focused questions require more than a yes or no answer, but place limitations on the topic. Good for prioritizing, details, limited verbal skills. circular question form of focused, look at other people within patient's support circle and identify difference in impact on each. closed-ended questions narrow the focus to a single (yes, no, or simple phrase) answer. Use when need to obtain information quickly & emotions come second. themes the underlying message, present, but not identified in the patient's words emotion objectivity Seeing what an experience is like for another person active listening responses 1. Minimal Cues and Leads 2. Clarification 3. Restatement 4. Paraphrasing 5. Reflection 6. Summarization 7. Silence minimal cues and leads 1. Encourage the patient to continue their story. 2. Promote comfort in sharing intimate information. 3. Minimal cues - body actions 4. Encouraging leads - words clarification 1. A brief question or a request for validation. 2. Used to better understand the message 3. Neutral tone of voice Ex. "Tell me more about..." or "I'm not sure I understand..." Restatement 1. Used to: broaden a patient's perspective or give the nurse a sharper focus on a specific part of the communication. 2. Repeat parts of the message in the form of a query -Ex. "Let me see if I have this right...", you [repeat the patient's words] 3. Effective when a patient overgeneralizes or seems stuck in a repetitive line of thinking paraphrase 1. Used to check the nurse's translation of the patient's words 2. Nurse transforms core elements of patient's original message 3. A shorter, more specific statement 4 .Objective: find a common understanding of the issues important to the patient. -Ex. Patient: "I can't take this anymore. The treatment is worse..." Nurse: "It sounds like you've had enough." reflection 1. Focuses on the emotional part of the message. 2. Lets the nurse "empathetically mirror" what they sense the patient may be emotionally experiencing 3. A simple observational comment, expressed tentatively. 4. Gives the patient an opportunity to validate or change the narrative. 5. Ways to use: -Reflect on vocal tones (i.e. anger or frustration in the voice) -Link feelings to content or with past experiences (reminds of feelings) summarization 1. Used to review content and process. 2. Pulls several ideas & feelings together, into a few succinct sentences. Followed by a comment seeking validation. 3. Can bridge a change in topic or focus of the conversation. 4. Do before the end of the conversation. false reassurance Using falsely comforting phrases in an attempt to offer reassurance. giving advice making a decision for a patient; offering personal opinions; telling a patient what to do false inference making an unsubstantiated assumption about what a patient means; interpreting the patients behavior without asking for validation, jumping to conclusions moralizing expressing your own values about what is right and wrong, especially on a topic that concerns the patient value judgment conveying your approval or disapproval about the patient's behavior or about what the patient has said using words such as "good", "bad" or "nice" silence - An intentional short pause to allow patient to think and let nurse process what was heard before responding - Helps emphasize important points for patient reflection mirroring communication patterns 1. Some patients, exaggerate, leave out highly relevant details, talk a lot (multiple examples) or say very little 2. Reflected and influenced by Culture, Role, Ways of handling conflict, Ways of dealing with emotions *Rule of Thumb - Start where patient is and mirror the patient's communication style. Fundamental themes patients look for "hear me," "touch me," "respond to me," feel my pain and experience my joys with me." Matching Responses responses that encourage a patient to explore feelings about limitations or strengths at a slightly deeper but related level of conversations are likely to meet with more success plain language use of clear cut, simple, easy to understand words to convey ideas, particularly those that are more abstract What the nurse listens for -Content themes -Communication patterns -Discrepancies in content, body language, and vocalization -Feelings revealed in voice, body, and facial expression -What is said; what is not being said -The client's representational system -The nurse's own inner responses -The effect communication produces in others involved with the client focusing What is most pressing topic? "I would like to hear more about...." You mentioned...I wonder if..." Presenting reality If patient is misinterpreting "I know you feel strongly about..., but I don't see it that way." giving feedback - A response to a question, verbal message, or observed behavior -Can focus on content, relationship, feelings generated, unclear parts of the message. "You seem____(angry, sad, happy, etc.) about______." effective feedback -Neutral mirror -Only addresses topic under discussion -Clear, honest, reflective -Specific - to the point, directed toward observed behaviors -Supported by realistic examples -Timing is critical - ASAP -Considers the patient's: readiness, need for privacy, available support system -Empathetic Use "how" or "what" questions instead of "why" questions *Benchmark: Does the feedback advance the goals of the relationship? Does it consider the individualized needs of the patient? validation -Special form of feedback -Used to ensure that both participants have the same basic understanding. -Not simply asking: "do you understand?" -Used to uncover the patient's reactions or questions about an issue. -Allows the nurse to frame comments that match the patient's needs. touch -First sense to develop; last to leave -Nurturing, comforting, powerful -Used when words might break a mood or fail to convey empathy -Stimulates security, sense of feeling valued -People vary in their comfort of touch Metaphor -Familiar images used to promote understanding. -Connecting new information with familiar images from ordinary life experiences. -Should be "nonthreatening" mental pictures - use with caution. humor -Recognizes incongruities in a situation -Lightens the mood and puts a tense situation into perspective "A good laugh bonds communicators" -Works best when rapport and trust established -Should focus on the idea, event, or situation; not the patient's personal characteristics. -Has a healing purpose factors that contribute to successful use of humor 1. knowledge of patient's response pattern 2. an overly intense situation 3. timing 4. situation lending itself to an imaginative or paradoxical solution 5. gearing the humor dynamics to the patient's development level and interests 6. focus on the humor in the situation or change in circumstances rather than the patient's personal characteristics ANA Standard of Culturally Congruent Practice The RN practices in a manner that is congruent with cultural diversity and inclusion principles Culture complex social concept consisting of family customs, beliefs and values, political systems, and ethnic identities •Helps explain how people approach shared decision making •A filter through which people "learn how to be in the world..." How culture is learned Learned through family and other social institutions *Children - Primary caregivers and schools *Immigrants -Two-step interpersonal process. Transitions from traditional culture to full adoption of new Subculture a smaller group of people living within the dominant culture with distinct lifestyle, shared beliefs and expectations that set them apart from the mainstream (e.g. Amish, Mormons) Acculturation How immigrants from a different culture learn and choose to adapt to the behavior and norms of a different, new culture, which holds different expectations. -A complicated process because it includes embracing new social, hierarchal, and kinship relationships -Creates stress due to competing pressures of reconciling a familiar cultural identity with the need to adopt new customs -People will have different levels of acculturation Assimilation When an individual from a different culture fully adopts the behaviors, customs, and values of the mainstream culture as part of his or her social identity. *A gradual process - can take 3 generations *Original culture virtually disappears. Cultural Patterns Describe the social customs, expected behaviors, cultural beliefs, values, and language passed down through generations. Transmitted informally or informally -An essential part of personal identity. -Dictate personal preferences -Influence how people process & interpret incoming information *Social factors (i.e. class and literacy level) further distinguish responses -Remainders from past culture can still influence behavior cultural diversity Describes the social variations between cultural groups. -Lack of exposure to and/or understanding of the normal patterns of people form other cultures decreases acceptance, reinforces stereotypes, and creates prejudice. -People more likely to notice differences in people of different cultures than within their own culture. -More differences occur among individuals within a culture than between cultural groups related to differences in educational and socioeconomic status, age, gender, and life experiences. 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