NURSING 204 Communication Styles (1.2) – Flashcards
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examples of personal positive factors that affect communication
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eye contact, genuine respect for the client, and clear, concise message
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what are some negative barriers for the client
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Preoccupied with pain, discomfort, worry Unable to understand nurse's language/terminology Struggling with emotionally laden topic Feeling defensive, insecure, or judged Confused by complexity of the message Deprived of privacy Hearing or cognitive deficits
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what are some negative barriers for the nurse
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Preoccupied with personal agenda In a hurry to do physical care Making assumptions about client motivations Cultural stereotypes Defensive or personal insecurity about being able to help the client Thinking ahead to the next question Client emotionality or aggressiveness
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Self-awareness of personal ___ and ____ allows nurses to____________
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prejudices stereotypes;separate the person from the behavior or problem, and to maintain the patience, neutrality, and understanding needed for therapeutic communication.
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the three environmental factors
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privacy, space, and timing
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free from interruption and elimination of noise
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Privacy
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Personal Self Awareness consists of:
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know your own biases and values be aware of intimidating differences know your personal prejudices and stereotypes Resolved personal issues
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people require different amounts of personal _____ for conversation. Therapeutic conversations typically w/in a social distance (_____ feet optimal). .
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space, 3-4 ft,
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_____ will influence personal space needs.
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Culture, personal preferences, nature of the relationship, and the topic
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Clients with high anxiety - more ____ Clients with sudden physical injury or painful experience - require
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space, closer proximity
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patient needs to be able to participate physically and emotionally in both time-efficient and respectful of client's needs. They need enough time to absorb material, to share their impressions, and to ask questions
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time
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an interactive reciprocal exchange of ideas in which nurses try to understand what it is like to be:_____,_____,____
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client centered communication; this person in this situation with this illness
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What are the 6 functions of client centered communication
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1) foster healing relationships 2) exchange information 3) respond to emotions 4) manage uncertainty 5) make decisions 6) enable patient self-management
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The goal of client-centered communication is to find:
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find common grounds related to identification of client problems, priorities, and treatment goals.
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client centered communication concepts
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building a rapport observation open/closed ended questions communication patterns listening for themes intuitive feelings
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Building a Rapport in client centered communication begins with
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1st encounter open, welcoming relaxed introductions before conversation speak directly to client; include family provide relevant information and listen
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Building a rapport in client centered communication requires
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empathetic objectivity a here and now focus demonstration of respect authentic interest consider competing goals and alternative actions
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client centered communication observations:
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notice clients nonverbal cues be aware of environment cues use tentative inquiry (wondering what your feeling)
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nonverbal cues include:
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facial expressions, body movements, posture, breathing rate
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notice clients ___ cues to support or negate the meaning of the spoken word. could indicate discomfort with the message
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nonverbal
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examples of environmental cues:
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half-eaten lunch or noncompliance with treatment. Could mean distress.
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to inquire about your perceptions
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Tentative inquiry
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___ behaviors and signals are ______ bound - may mean different things in different cultures.
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culture; nonverbal cues
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Question type: encourage client to take initiative, open to interpretation and cannot be answered by yes or no or one word answers
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open-ended question
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___ Examples: Can you tell me what brought you to the clinic today? What has it been like for you since the accident? Where would you like to begin today? What can I do to help you? Is there anything else that is concerning you right now
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open-ended
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Question type:require more than a yes or no answer but place limitations on the topic to be addressed
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focused
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Question type:Good for emergencies or other circumstances requiring immediate answers.
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focused questions
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Question type:Can clarify the timing and sequence of symptoms, and concentrate on details Clients with limited verbal skills sometimes respond better to them b/c require less interpretation.
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focused questions
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Question type:Can be used to help clients prioritize immediate concerns
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focused questions
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___ examples Tell me more about the pain in your arm." "Can you give me a specific example of what you mean by...?"
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focused
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Question type:narrow the focus of the question to a single use yes, no, or simple phrase answer
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close ended
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___Examples: "Does the pain radiate down your left shoulder and arm?" "When was your last meal?"
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close ended
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Question type:your tray will be here soon. are you hungry?
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closed ended
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Question type:do you feel like taking medicine now or later
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closed ended
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Question type:tell me what brought you to see the doctor?
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focused
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Question type:what happened to you after you fell down?
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focused
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Question type:how are you
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open ended
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Question type:and then what did you think
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open ended
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seeing what an experience is for another person, not how it fits or relates to other experiences, not what causes it, why it exists, or what purposes it serves.
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Emotional objectivity
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An attempt to see attitudes and concepts, beliefs and values of an individual as they are to him at the moment he expresses them - not what they were or will become.
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Emotional objectivity
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allows you to experience clients as they are, not the way you would like them to be
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empathetic objectivity
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listening for themes (_______ process)
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interpersonal
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listening for themes include:
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underlying feelings or core ideas associated with the verbal message what theyre not telling you emotional objectivity is essential
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requires observing and understanding what the client is not saying and what they actually say
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listening for interpersonal processes
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the inner, subjectively expressed component.
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listening for interpersonal processes
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communication patterns of some clients:
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exaggerate leave out highly relevant detail talk alot (multiple examples) say very little
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communication patters reflected and influenced by:
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culture role ways of handling conflict ways of dealing with emotions
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a personal way of knowing,
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using intuitive feelings
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a body-centered way of listening to feelings about underlying issues and concerns
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using intuitive feelings
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be aware of behavioral reactions that feel out of proportion to the situation
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using intuitive feelings
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(Positive)Active listening responses
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minimal cues and leads clarification restatement paraphrasing reflection summarization silence touch
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show the client that the nurse is fully present as a professional partner in helping the client understand a change in health status and the best ways to cope with it.
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Active listening responses
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guide therapeutic interventions
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Active listening responses
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leads to fewer incidents of misunderstanding and more accurate information and stronger health relationships.
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Active listening
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active listening response: body actions): Smiling, nodding, leaning forward
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Minimal cues
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active listening response: words): "mm," "uh-huh, "oh really", "go on"
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Encouraging leads
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active listening response: "could you describe what happened in sequence?"
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clarification
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active listening response: "i'm not sure i understand what you mean? can you give me an example
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clarification
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active listening response: are you saying that....(repeat clients words)?"
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restatement
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active listening response: . "you mean...(repeat clients words)
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restatement
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active listening response: Client: I cant take this anymore. The chemo is worse than the cancer. I just want to die Nurse: it sounds as though you are saying you have had enough
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Paraphrasing
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active listening response: "it sounds as though you feel guilty because you weren't home at the time of the accident. "
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reflection
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active listening response: "you sound really frustrated because the treatment is taking longer than you thought it would. "
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reflection
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active listening response: "before moving on, i would like to go over with you what i think we've accomplished thus far"
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summarization
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active listening response: Briefly disconnecting but continuing to use atte.ding behaviors after an important idea, though or feeling
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silence
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active listening response: gently rubbing a persons arm during a painful procedure
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touch
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active listening response that Encourage the client to continue their story as they see it.
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Minimal Cues and Leads
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active listening response that Promote comfort in sharing intimate information.
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Minimal Cues and Leads
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active listening response that minimal cues-boy actions encouraging leads-words
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Minimal Cues and Leads
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active listening response that seeks to understand the message by asking for more information
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clarification
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active listening response that most useful when parts of communication are ambiguous
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clarification
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active listening response that expressed as a question or statement followed by a restatement or paraphrase of part of the messae
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clarification
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active listening response that neutral tone of voice
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clarification
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active listening response that used to broaden a client perspective
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restatement
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active listening response that give the nurse a sharper focus on a specific part of the communication
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restatement
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active listening response that repeat parts of the message in the form of a query (bracketing a phrase-"...")
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restatement
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active listening response that used to check the nurse translation of the clients words
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paraphrase
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active listening response that nurse transforms clients original message into own words
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paraphrase
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active listening response that is a shorter, more specific statement focusing on core elements
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paraphrase
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active listening response that focuses on the emotional implications of the message
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reflection
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active listening response that helps the client clarify important feelings and experience them with appropriate intensity
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reflection
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Ways to use reflection:
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reflect on vocal tones link feeling to content Link current feelings with past experiences
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active listening response that is used to review content and process
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summarization
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active listening response that pulls several ideas and feelings together, into a few succinct sentences followed by a comment seeking validation
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summarization
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active listening response that can bridge a change in topic or focus of the conversation
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summarization
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active listening response that is done before the end of conversation
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summarization
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active listening response that is an intentional short pause
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silence
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silence is an intentional short pause to:
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allow client to think let nurses process what was heard before responding
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active listening response that helps emphasize important points for client reflection
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silence
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active listening response "I can sense anger and frustration in your voice as you describe your accident."
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reflection
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It sounds like you feel _____ because _____."
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Link feelings with content
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It seems as if this experience reminds you of feelings you had with other health care providers where you didn't feel understood."
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Link current feelings with past experiences
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Tell me if my understanding of this agrees with yours."
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comment seeking validation
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active listening response not be delivered as the nurse leaves the room.
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summarization
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Be careful about overuse or prolonged periods of _____
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silence
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A brief disconnection followed by a verbal comment.
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silence
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Uses of for Silence:
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To assess your own level of anxiety. To assess the client's level of anxiety. To give the nurse an opportunity to concentrate on making observations of the client's nonverbal behavior. To encourages the client's verbal communication. To allow the client time to formulate a thoughtful reply to the nurse's interaction.
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Overuse leading to prolonged periods of silence can ____________
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discourage further communication.
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Prolonged periods of silence can increase client or nurse _____
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anxiety.