NURS 311 Clinical Nursing Skills Exam 4 2025

Goal of therapeutic communication - -•to promote wellness and personal growth in patients Therapeutic communication - -is patient centered, purposeful, and time limited. This differs from social communication that is casual and comfortable. In this kind of relationship, the nurse recognizes the patient as a unique individual and establishes a goal to help the patient. One does not form a social relationship with the patient, such as dating, confiding personal information, etc. Phases of the therapeutic relationship - -•Pre-interactive phase - Here the nurse gathers information about the Patient prior to having direct contact. • Orientation phase - The goal of this phase is to develop rapport and trust. It begins with an introduction and ends when the relationship has been defined. • Working phase - During this phase, caring is communicated, thoughts and feelings are expressed, mutual respect is maintained, and honest verbal and nonverbal expression occurs. The key goal is to help the patient to clarify feelings and concerns. A professional relationship is courteous, trustworthy, and confidential and accomplished by active listening and the use of therapeutic communication techniques. • Termination phase - concludes the relationship. This could occur at the end of a shift or discharge from the facility, etc. Note that therapeutic relations have an end. Pre-interactive phase - --1st phase of the therapeutic relationship - Here the nurse gathers information about the patient prior to having direct contact. Orientation phase - --2nd phase of the therapeutic relationship - The goal of this phase is to develop rapport and trust. It begins with an introduction and ends when the relationship has been defined. Working phase - --3rd phase of the therapeutic relationship - During this phase, caring is communicated, thoughts and feelings are expressed, mutual respect is maintained, and honest verbal and nonverbal expression occurs. The key goal is to help the patient to clarify feelings and concerns. A professional relationship is courteous, trustworthy, and confidential and accomplished by active listening and the use of therapeutic communication techniques. Termination phase - --4th phase of the therapeutic relationship NURSING NURSING - concludes the relationship. This could occur at the end of a shift or discharge from the facility, etc. Note that therapeutic relations have an end. Characteristics of Therapeutic Communication - -• Empathy - Empathy is the desire to understand and be sensitive to the feelings, beliefs and situations of another person (Put yourself in the other's place.) • Respect for the patient • Genuineness - Be honest. Be authentic. • Concreteness and Confrontation - Offer understandable responses to a client's questions or concerns. Construct messages in a manner that is suitable for the patient. Conversely, if a patient is unable to express thoughts clearly, be willing and able to request clarification or to confront the patient, as needed. Empathy - --Characteristic of therapeutic communication -Is the desire to understand and be sensitive to the feelings, beliefs and situations of another person (Put yourself in the other's place.) Genuineness - --Characteristic of therapeutic communication - Be honest. Be authentic Concreteness and Confrontation - --Characteristic of therapeutic communication - Offer understandable responses to a client's questions or concerns. Construct messages in a manner that is suitable for the patient. Conversely, if a patient is unable to express thoughts clearly, be willing and able to request clarification or to ____________ the patient, as needed. Active listening - --Part of therapeutic communication - The active listener focuses on the sender and attends to both verbal and non-verbal communication. This requires full attention and the use of all senses. This type of comunication begins conversations with open ended questions such as "What brings you to the hospital" and seeks clarification through more direct (closed) and probing questions. Establish Trust - --Part of therapeutic communication -Good communication originates with a trusting relationship. Can be enhanced through the use of active listening, honesty, and the provision of competent, compassionate care. Be Assertive - - -Part of therapeutic communication -Is the expression of beliefs or feelings without infringing on another's right. - Make "I" statements - State facts, avoid judgments - Ask directly for what you need; don't make another guess as what you want. NURSING NURSING - Use body language (eye contact and speak clearly) -____________ people look for win-win solutions. Some confuse being __________ with being aggressive. An aggressive person looks for a win- lose solution. -Commonly, nurses begin early in their career by being passive (not speaking up) and move over time towards becoming passive-aggressive (quietly sabotage). Beware, don't fall prey to these type behaviors. Restate/Reflection - --Part of therapeutic communication - Use patient's own words to ask for the patient to elaborate. Clarify - --Part of therapeutic communication - Use when a patient's words or messages are ambiguous or confusing. "Do I understand you correctly when you say...." Use silence - --Part of therapeutic communication -Very uncomfortable for most, but respectful and highly effective in promoting communication Verbal communication - --The conscious use of spoken or written word. Choice of words can reflect age, education, developmental level, or culture. Feelings can be expressed through the tone and pace of words. This means that the emotional meaning of words are altered by how things are said. Nurses need to remember this important message when giving or receiving information. -The most effective messages consist of: • Clearly selected wording • The use of a few words, not dissertations • Relevant information • Appropriate timing • Truthful • Humor Relevant information - --Part of verbal communication - Extraneous information blurs the intended message Appropriate timing - --Part of verbal communication - When information is sent while the receiver is distracted, the receiver may either not hear the message or may received a distorted version of the message. Truthful - --Part of verbal communication - A response such as "I don't know but I'll find out is far more credible than providing incorrect information." Furthermore, a nurse should never lie to a patient; lying destroys trust. For example, when a nurse tells a patient she will be right back with pain NURSING NURSING medication and fails to return until later reminded, the patient loses confidence in the nurse. Humor - --Part of verbal communication - can be positive and contribute to a patient's well being. However, humor must be used cautiously. The patient should never be left feeling like the brunt of a joke. Furthermore, the use of humor at the wrong time conveys a lack of caring and concern. Non-verbal communication - --Includes personal appearance and body language such as facial expression, posture and gait, gestures and touch. -It is important that nurses recognize that this behavior accounts for 85% of communication. These messages are more likely to convey how someone truly feels. -If there is incongruence between the spoken and non-spoken message, the non spoken message is heard loudest. • Nurses must be aware of personal style and how their non-spoken behavior affects messages sent. • When interpreting messages from others, it is important to watch for both verbal and non-spoken cues. When there is a discrepancy, between what is said and what is seen, the nurse seeks clarification before assigning judgment. It is careless to make a quick assumption as to the meaning of the behavior. Remember, cultural beliefs are strongly reflected in behavior. For example, when a Chinese female does not make eye contact, one may misinterpret the behavior as reflecting a poor self concept or perhaps see the behavior as representing dishonesty; however, in the Chinese culture, direct eye contact is considered rude behavior. The response of the female may simply be a courteous or respectful social act. To make clinical inferences about discrepancies, nurses must have an understanding of cultural variations and be willing to ask probing questions to validate speculations. • Touch Touch - --Part of non-verbal communication -Can be highly therapeutic. Can convey caring, concern, and encouragement. Is particularly comforting to the elderly or those who are grief stricken. However, one must carefully consider how another may interpret touch before using this therapeutic skill. -Instances when it may be inappropriate include when interacting with an: • Angry person • Mentally ill person Also, it is not appropriate if another may possibly infer the act as a sexual gesture. Along those same lines, some cultures prohibit an individual of the opposite sex to be alone with another. Sensitivity to these situations are essential to avoid misinterpretations or ______________. SBAR - --Is an effective tool for all types of communication handoffs •is a simple method to help standardize communication •Allows all parties to have common expectations: -What is going to be communicated NURSING NURSING -How the communication is structured -Required elements •Focuses on the problem, not the people Situation - --Part of SBAR - The problem • State: your name and unit • I am calling about:: (Patient Name & Room Number) • The problem: The reason I am calling ..... Background - --Part of SBAR - Brief, related, to the point • State the admission diagnosis and date of admission • State the pertinent medical history • A Brief Synopsis of the treatment to date Assessment - --Part of SBAR - what you found, what you think • Pertinent objective & subjective information - Most recent vitals - Mental status - Respiratory rate and quality - B/P, pulse rate & quality - Pain - Neuro changes - Skin color - Rhythm changes Recommendation - --Part of SBAR - what you want • State what you would like to see done: