Nursing Chapter 26 Homework Facilitating And Taking Action The Nurse Plans

CHAPTER 26 / Communicating 145

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Describe the components of the communication process.

Concepts for Lecture

1. To some, communication is the interchange of information between

two or more individuals using methods such as talking and listening,

or writing and reading. Other methods of communication include

2. Face-to-face communication involves a sender, a message, a

receiver, and a response (feedback). In its simplest form, communi-

3. Encoding involves the selection of specific signs or symbols (codes)

4.

Communication is generally carried out in two different modes: verbal

and nonverbal.

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Discuss the various aspects that nurses need to consider when using the

different forms of communication.

Concepts for Lecture

1. Nurses need to consider the following when choosing words to say

or write: pace and intonation, simplicity, clarity and brevity, timing

and relevance, adaptability, credibility, and humor.

• The manner of speech, as in the rate or rhythm and tone, will

modify the feeling and impact of the message.

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behavioral cues from the client, referred to as adaptability.

• Credibility may be the most important criterion of effective

communication. Nurses foster credibility by being consistent,

dependable, and honest.

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Describe factors influencing the communication process.

Concepts for Lecture

1. Many factors influence the communication process. Some of these

include: development, gender, values and perceptions, personal

space, territoriality, roles and relationships, environment, congru-

ence, and attitudes.

From an early age, females and males communicate differently.

Girls tend to use language to seek confirmation, minimize differ-

ences, and establish intimacy. Boys use language to establish

independence and negotiate status within a group. These differences

can continue into adulthood, so the same communication may be

interpreted differently by a man and a woman.

Values are standards that influence behavior, and perceptions are

the personal view of an event. Because each individual has unique

personality traits, values, and life experiences, each will perceive and

Intimate distance is characterized by body contact, heightened

sensations of body heat and smell, and vocalizations that are low.

Vision is intense, restricted to a small body part, and may be

distorted. Examples of intimate distance include cuddling a baby,

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• Have each student find a partner. Have one

partner stand 12 to 15 feet away from the other;

then gradually move from public to social to

personal and then intimate space. As this is

occurring, ask the other individual to monitor the

feelings that he or she is experiencing. Reverse

the roles. Discuss findings.

• Move the notebook, books, or some personal

belongings of several students. Have the students

identify each emotion.

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• Have the students identify ways in which they

can control the environment in order to

facilitate communication with their clients.

• Have the students provide examples of situa-

tions in which they observed incongruence

between the verbal and nonverbal communica-

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Public distance requires loud, clear vocalizations with careful

enunciation. Although the faces and forms of individuals are seen at

public distance, individuality is lost. The perception is of the group

of individuals or the community. An example of this is when a nurse

speaks to a crowd at a conference.

Territoriality is the concept of the space and things that an indi-

vidual considers as belonging to the self. Territories marked off by

individuals may be visible to others. This human tendency to claim

territory must be recognized by health care providers. Clients often

relationship with the client.

Individuals usually communicate most effectively in a comfort-

able environment. Temperature extremes, excessive noise, and a

poorly ventilated environment can all interfere with communication,

as may lack of privacy and environmental distractions.

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Compare and contrast therapeutic communication techniques that facilitate

communication and focus on client concerns.

Concepts for Lecture

1. Therapeutic communication promotes understanding and can help

establish a constructive relationship between the nurse and the client.

3.

Attentive listening

is listening actively, using all the senses, as

opposed to listening passively with just the ears. It is probably the

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Recognize barriers to communication.

Concepts for Lecture

1. Barriers to communication (see Table 26–2) include:

• Stereotyping

• Agreeing and disagreeing

• Being defensive

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Describe the four phases of the helping relationship.

1. The helping relationship process can be described in terms of four

2. In the preinteraction phase, the nurse reviews pertinent assessment

3. The introductory phase consists of three stages: opening the relation-

ship, clarifying the problem, and structuring and formulating the

contract obligations to be met by both the nurse and the client.

•

Opening the relationship:

The nurse and client identify each other

by name. If the nurse initiates, it is important to give the client an

4. The working phase has two stages: exploring and understanding

thoughts and feelings, and facilitating and taking actions.

•

Exploring and understanding thoughts and feelings:

The nurse

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Divide the students into triads. Have two of

the students role-play the nurse and the client.

Have the third student observe the interaction

program), and have the “nurse” and “client”

work through the stages of the helping rela-

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• Assign students to perform admission

interviews, paying attention to the phases of

the helping relationship. Discuss outcomes in

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Discuss characteristics of an effectively functioning group.

Concepts for Lecture

1. Three main functions are required for any group to be effective: it

must maintain a degree of group unity, or cohesion; it needs to

develop and modify its structure to improve effectiveness; and it

must accomplish its goals.

be a shift in leadership from time to time depending on knowledge

and experience.

• Communication is open. Ideas and feelings are encouraged.

• Decisions are made by the group, although various decision–

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Identify types of groups helpful in promoting health and comfort.

Concepts for Lecture

1. Common types of health care groups include task groups, teaching

groups, self-help groups, self-awareness groups, therapy groups, and

work-related social support groups. Task groups are work-related

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Have the students identify a group of which

they are members. Have them discuss how

this group models or fails to model the

features of an effective group.

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• Have the students identify features of effective

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Have each student identify and write a short

report on a self-help group, including purpose,

group structure, and conduct of the group.

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• Discuss the types of groups that the clinical

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Discuss how nurses use communication skills in each phase of the nursing

process.

Concepts for Lecture

1. Communication is an integral part of the nursing process. Nurses use

2. Assessing: The nurse must determine communication impairments

or barriers and communication style, cultural influence, age, and

development.

3. Diagnosing: Impaired Verbal Communication may be used as a

nursing diagnosis when “an individual experiences a decreased,

delayed, or absent ability to receive, process, transmit, and use a

system of symbols—anything that has meaning (i.e., transmits mean-

4. Planning: The client and nurse determine outcomes and begin plan-

ning ways to promote effective communication. The overall outcome

is to reduce or resolve the factors impairing the communication.

5. Implementing: Interventions to facilitate communication with clients

6.

Evaluating: To establish whether outcomes have been met, the nurse

must listen actively, observe nonverbal cues, and use therapeutic

communication skills to determine that communication was effective.

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Divide the students into two groups. Provide

each group with a case study. One client case

study should provide evidence that the client

has Impaired Verbal Communication as a

nursing diagnosis, and the other case study

should provide evidence that Impaired Verbal

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State why effective communication is imperative among health professionals.

Concepts for Lecture

1. Effective communication among health professionals is imperative

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Describe the following disruptive behaviors and how they affect the health

care environment and client safety: incivility, lateral violence, and bullying.

Concepts for Lecture

1. Incivility is usually described as rude, discourteous, or disrespectful

behavior that reflects a lack of regard for others. Research literature

supports a relationship between workplace incivility and negative

health consequences, such as emotional exhaustion. The

2. Lateral violence

,

also known as horizontal violence and horizontal

3.

Bullying is an “repeated, unreasonable actions of individuals (or a group)

directed towards an employee (or a group of employees), which are in-

tended to intimidate, degrade, humiliate, or undermine; or which create a

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Discuss the difference between nurse and physician communication and how

to address these differences.

Concepts for Lecture

1. The differences between nurse and health care provider communica-

tion can make collaboration more difficult. In general, nurses have

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Have the students provide examples of

situations in which effective communication

could affect client outcomes and the ability to

maintain a positive working environment.

•

Discuss methods to improve communication

• Have the students observe communication

among various members of the health care

team. Discuss positive and negative examples

of the observed interactions. Have students

provide suggestions for improving communi-

cation.

2. One model, called SBAR (situation, background, assessment,

3. Interdisciplinary simulations can also enhance communication be-

tween nurses and health care providers.

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Differentiate the major characteristics of assertive and nonassertive commu-

nication.

Concepts for Lecture

1. Assertive communication promotes client safety by minimizing mis-

communication with colleagues. Individuals who are assertive are

2. Nonassertive communication includes two types of interpersonal

3. When individuals use a submissive communication style, they allow

their rights to be violated by others. They meet the demands and re-

4. There is a fine line between assertive and aggressive communication.

Assertive communication is an open expression of ideas and opin-

ions while respecting the rights and opinions of others. Aggressive

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Provide the students with a situation in which

there is a conflict. Have them role-play an

assertive and nonassertive approach to this

conflict. Have the students discuss feelings

experienced during this role play.

• Discuss examples of aggressive communica-

tion, methods to avoid this style of communi-