NUR142Lecture_3.txt

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Author:
lwendt
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35440
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NUR142Lecture_3.txt
Updated:
2010-09-17 20:08:30
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nurse
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questions from lecture 3
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  1. What is the importance of Communication in Nursing?
    • Establish therapeutic relationships –
    • Essential element of nurse-patient relationship –
    • Critical skill –
    • Dynamic Process- constantly changing
  2. What do nurses use communication for?
    • 1. Gather information
    • 2. Teach, support, encourage-we do the teaching
    • 3. Express caring and comfort
  3. Three forms of communication:
    • Verbal
    • Nonverbal
    • Verbal Communication
  4. What is verbal communication?
    • Language
    • o Words
    • o Written
    • –Spoken
    • –Expressing and Receiving
  5. What is non verbal communication?
    • Body language
    • –Posture, gait, personal appearance
    • –Touch
    • –Facial expressions
    • –Gestures
    • Not always under our conscious control.
  6. What is the nursing process?
    • – Assessing
    • – Diagnosing
    • – Planning
    • – Implementing
    • – Evaluating
    • "ADPIE"
    • Therapeutic (helping) communication
  7. Nurse Patient Relationship can be described as:
    • Therapeutic-only reason why we are in a relationship with a patient
    • –Helping
    • –Interpersonal
    • –Professional
    • In the trenches! The nurse is constantly with the patient.
  8. Helping VS Social relationship:
    • Does not occur spontaneously
    • –Unequal sharing
    • –Based upon patient’s needs, not ours.
    • –PROFESSIONALISM
    • –Must permeate the relationship
    • –Be careful what you share personally. Stop and think.
    • –We are there for the patient and family
    • –What would a reasonable and prudent nurse do?
  9. Characteristics of Helping Relationship:
    • Dynamic-nonlinear
    • –Purposeful-what would be the best thing for this patient?
    • –Respects patient as individual-always try! A human being.
    • –Based upon trust-implicit trust in the nurse
  10. –Professional Accountability
    – Person providing assistance presents his/her helping abilities honestly and completely
  11. Goal of Helping Relationship:
    • Improved health and well-being
    • –Helps patients/families manage problems
    • –Help patients/families develop better ways to help themselves
  12. Phases of Therapeutic Relationship:
    • Orientation Phase
    • Working Phase
    • Termination Phase
  13. Orientation phase:
    • –Tone of relationship is established-when you first meet, could be a lot of different places
    • –Roles identified-introduce yourself, tell your role
    • –Agreement
    • o Goals-how are they feeling, what are their goals
    • o Duration, frequency, location
    • –Orientation
    • –TRUST BEGINS (Rapport)
  14. Working Phase:
    • Longest phase
    • –Nurse provides nursing assistance
    • –Nursing roles are performed:
    • – Teacher
    • – Counselor
    • – Advocate
    • – Leader
    • – Communicator!
  15. Termination phase:
    • Conclusion
    • –Can occur at various times
    • –Emotions associated-someone may be leaving to die, don’t make promises you can’t keep, don’t be offhand
    • –Honesty is critical
    • –Trust
  16. Dispositional Traits of a good nurse:
    • Warmth and friendliness-speak to person, introduce yourself
    • Openness/respect-do not judge, do not react to bad behavior
    • Empathy-some level of understanding of what a person may be going through, deeper level than sympathy
    • Competence-technical, interpersonal,
    • Caring-constant polishing of this skill
  17. Examples of good rapport builders:
    • Examples:
    • – Comfortable environment
    • – Privacy
    • – Confidentiality-what patient’s say to you stays within the appropriate realm. Do not say: I won’t tell anyone. Adult patients have a right to speak with you alone. Use intuition and observation skills.
    • –Patient focus
    • – Focus not on nurse or her activity
    • Observations
    • – Seeing and interpreting/communicates caring, “I noticed you aren’t very happy today……I noticed…” Be careful of cultural differences.
    • –Providing Personal space
    • – Be sensitive
    • – Nursing is an intimate profession!
  18. The importance of Unconditional Positive Regard
    • Must permeate the nurse patient relationship
    • – Recognize patient’s flaws as part of total picture
    • – Respect not dependent upon patient’s behavior
    • – Non-judgmental
    • – Accepting their humanness without ridicule…remove self if situation gets out of hand, explain to quit talking like that and that you are going to leave.
  19. Therapeutic Communication Skills:
    • Focuses on the patients concerns
    • 1. Takes time and practice to acquire!
    • 2. Does not occur quickly
    • 3. Mark of a competent professional
  20. Conversational Skills:
    • 1. Pacing-keep it steady
    • 2. Tone of voice-neutral demeanor, calming
    • 3. Clarity-try to be clear
    • 4. Brevity-to the point, simplicity, no jargon, use lay terms when necessary, do not assume a casual relationship with patient
  21. Listening:
    • 1. It is a SKILL
    • 2. Most important technique
    • 3. Basic to all other techniques
    • 4. Active process
    • 5. Requires concentration and energy
    • a. Silence
    • 6. Silence-it is GOLDEN!
    • 7. Different from social communication
    • 8. Its OK! Communicates acceptance.
    • – Do not have to fill as in a social dialogue
    • – Prevents too much talking on part of nurse
    • – Prevents filling in with social conversation
  22. Interviewing techniques:
    • Open ended question/comment
    • – Allows patient a range of possible responses
    • – Prevents a simple yes/no when trying to encourage verbalization
    • – “Tell me about….”
    • – “What do you think about…”
  23. Interviewing technique continued: Reflection
    • – Mirroring a statement or statement fragment with a questioning tone
    • – “Upset?”
    • – “Won’t be easy?” Using the patient’s own words
  24. Validating:
    • – Ensuring what was “heard” was correct
    • – What was the meaning of the words used
    • – “So, what I am hearing you say is….”
    • – “You are saying that you are worried about the test results?”
  25. Clarifying:
    • Make clear, more specific than validating
    • – Helps nurse to understand what was said
    • – “Are you taking your medicine every night, or just when you have trouble sleeping”
  26. Sequencing:
    • Places events, incidents in order
    • – “You had the argument with you son after you saw the social worker?”
  27. Directing:
    • Focusing on a topic
    • – “You were talking earlier about moving to assisted living”
  28. Other methods of communication:
    • Touch-for comfort and out of necessity
    • Humor-no sarcasm, or difficult to understand
  29. Communication blocks:
    • Happen when a nurse fails to view the patient as a human being
    • – Not a diagnosis
    • – Not a problem
    • – Not “work”
    • – Not the recipient of task
    • – Nurse focuses on the WHOLE PERSON -distinguishes nursing from other professions!

    Blocks-usually happens when we fail to look at the whole person
  30. Failure to listen
    LISTENING must occur throughout all interactions! Failure to do so may result in a communication block.
  31. Other reasons for communication blocks:
    • Clichés
    • – Trite response- “Boys will be boys” Conversation killers
    • Closed questions
    • – Can be answered with yes/no
    • Can be appropriate in certain situations when you need to glean information quickly
    • – Asking why
    • Can be intimidating or challenging, may put patient on defensive- “Why didn’t you discuss this with your doctor?”
    • Probing for information
    • –
  32. Interrogation techniques:
    • Aggressive approach vs assertive –
    • “What do you mean you don’t keep your appointments?” –
    • Using leading questions –
    • “You like the care you get here, don’t you?” –
    • Giving advice –
    • Nurse is an authority! –
    • Must be very aware of own influence –
    • People must be assisted and supported to make own decisions
  33. Making judgements:
    • – Imposing own standards upon others
    • – Does not convey acceptance
    • – “You know you are not going to get well until you grow up and face this”
  34. Changing the subject:
    • Conveys unacceptance
    • Shifts focus from patient centered dialogue to nurse controlled dialogue
  35. False reassurance:
    • Minimizes patients feelings/fears
    • – Belittling
    • – Conveys non interest on part of nurse
    • – Nurse may be the only one to whom patient can voice true fears and feelings
    • – “I am sure everything will turn out OK”
  36. Other helpful hints in communication:
    • Individualize for the patient with whom you are communicating
    • Vary the techniques used
    • Overuse of one technique will communicate that you are not listening
    • Use non verbal communication appropriately- body language, tone of voice etc
    • Hints
    • – Patient should be talking more than the nurse
    • – You will make mistakes, if genuine interest is expressed and the nurse is attempting to be therapeutic the relationship will be able to withstand an error or two!
    • – As a novice, RELAX, realize that most patients want very much to talk with you

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