Chapter 3 - Communications, Question and Answer Homework

One-way communication is highly structured; the sender is in control and expects and gets very little response from the receiver. A lecture to a large audience is an example of one-way communication. A one-way communication has a very little place in the nurse-patient relationship

Two-way communication requires that both the sender and the receiver participate in the interaction. It allows for exchange between you and the patient, and its purpose is to meet the needs of both of you and to establish a trusting relationship. Rather than just talking to the patient, seek and accept the patient's inpute and feedback (page 37)

1) Voice - tone, volume, pitch, rate of speech;

2) Eye contact - Extended (longer than 6 sec), brief but direct (2-6 sec), absent or fleeing;

3) Physical appearance - size, color of skin, dress, grooming, body carriage, sex, age;

4) Gestures - distinct movement of hands, head and body;

5) Posture - (a) Open: relaxed stance, facing receiver, uncrossed arms and legs, direct eye contact, smile
(b) Closed: formal, distant stance, arms and possible legs tightly crossed.

(from page 38, Table 3-1)

Assertives is the ability to confidently and comfortable express thoughts and feelings while still respecting the legitimate rights of the patient. An assertive communication style is interaction that takes into account the feelings and the needs of the patient, yet honors your rights as an individual. It makes interactions more even -sided and has positive benefits for all involved.

Aggressive communication is when you interact with another in an overpowering and forceful manner to meet your own personal needs at the expense of the other. Aggressive communication is destructive, often highly so.

An unassertive communication style is when a nurse agrees to do what the patient requests even if doing so will create additional problems for the nurse. Use of this style sacrifices your legitimate personal rights to the needs of the patient and the price to pay is resentment ( Page 39 )

(1) Make the patient the focus of each inteaction
(2) Upon entering a patient's room, look and address hte patient before assessing or adjusting any eqqipment
(3) Be diligent in following through with commitments
(4 ) Trust is essential for an effective nuirse-patient interaction.
(5) Always give top priority in maintaining confidentiality. (page 40)

(1) Active listening
(2) Maintaining silence (often used in conjunction with touch)
(3) Miminal encouragement by nodding occasionally and maintaining eye contact.
(4) Touch - Conveying acceptance (usually involves a verbal component. (page 40)

A closed question is focused and seeks a particular answer. For example, when interviewing a newly admitted patient with diabetes, you ask: "What time do you usually take your insulin? It is a specific question with a specific answer, useful if this type of information is desired.

Open-ended questions do not require a specific response and allow the patient to elaborate freely on a subject. This type of question is useful in assessing feelings.

The closed question requires only a "yes" or "no". The open ended question requires elaboration in whatever direction the patient chooses. (page 44)

If an interpreter is not available, do the following:

a) Use a translator

b) Determine if there is a third language that both of you and the patient speak. In many cultures, it is common for patients to speak several languages.

c) Remember that nonverbal communication is more important than verbal communication.

d) Be attentive to both your own and the patient's nonverbal messages.

e) Pantomime simple words and actions

f) Remember that a picture is worth a thousand words. Use paper and pencil.

g) Talk with tran your institution's administration about the importance of using trained medical interpreters when caring for non-English speaking patients.

h) Until medical interpreters are available, use both formal and informal networking to locate suitable interpreters or translators. (page 48, Box 3-3)

The most therapeutic posture and positioning is the same position and level as the patient, or as close to it as possible. If a patient is lying on bed, sit on a chair at the bedside facing the patient. If you sit in a comfortable position, with neither arms nor legs crossed, and lean slightly forward toward the patient, you convey a message of interest and openness. (page 46)

1) Reduce environmental distractions while conversing
2) Get patient's attention before speaking.
3) Use simple sentences and avoid long explanations.
4) Ask one question at a time.
5) Allow time for patient to respond.
6) Be an attentive listener
7) Include family and friends in conversations, especially in subjects known to patient. (page 49, Box 3-5)

1) VENTILATOR-DEPENDENT PATIENTS
Patients who receive mechanical ventilation via endotracheal tube or tracheostomy will experience an inability to speak because the trachea is obstructed by the tube. Patients will find this devastating and will affect their sense of well-being and control. Use alternative methods of communication.

2) APHASIC PATIENTS
Aphasia is a deficient or absent language function resulting from ischemic insult to the brain, such as stroke (brain attack), brain trauma or anoxia.

3) UNRESPONSIVE PATIENTS
It is not certain if, or how much, the unresponsive patient is able to hear or interpret verbal stimuli. Because of this, it is important for anyone interacting with the unresponsive patient to assume that all sound and verbal stimuli have the potential of being heard by the patient. Caution people nearby about making negative or anxiety-producing statements.
(pages 52-53)