1. A nurse manager is reviewing verbal and nonverbal communication with staff members. List at least four examples of nonverbal communication and explain their effect on the communication. 1. Gestures: can be used along with verbal communication. They emphasize and add to verbal communication. Gestures can even negate what was said. Pay attention to nonverbal cues. A patient may not be able to tell you where their pain is, but they can use a gesture to point. 2. Facial Expressions: can indicate emotions and even show pain. However, some people have a flat affect, or their expressions do not match their verbal message. 3. Eye Contact: shows respect and indicates that one is listening. (Be careful of cultural beliefs regarding eye contact.) 4. Sounds: People use sounds to communicate feelings and pain. Be careful not to misinterpret. 5. Posture/Gait- The way a person carries themselves can tell a lot about them. Leaning forward conveys attention. Slumping over can mean illness or depression. 2. List and explain the levels of communication. Intrapersonal communication: Self-talk. Inner thoughts and inner conversations that can be positive or negative. A nurse should use positive intrapersonal communication Interpersonal communication- One on one communication. Usually face to face communication. Small-group communication- Group discussions or teachings. Usually goal oriented, organized, concise, and complete. Public communication- Interacting with an audience. Requires good eye contact, gestures, voice inflection, and accompanying materials. Used for presentations. Electronic communication- Using technology to create relationships with patients and healthcare teams. This will allow you to communicate and record data. Charting, patient portals, and emails are all examples of electronic communication. (Transpersonal Communication – mentioned in ATI book Communication that addresses spiritual needs.) 3. What does the active listening mnemonic SOLER mean? S - Sit Squarely facing the patient. O - Observe and open posture. L - Lean forward towards the client E - Establish eye contact. R - Relax 4. What is meant by Emotional Intelligence? Emotional intelligence is a technique that combines assessment and critical thinking. Self-awareness, self-management and empathy are integral parts of emotional intelligence. People react to situations based on their emotions. If you are emotionally intelligent, you will use positive emotions and critical thinking to solve problems. This will be beneficial to build a therapeutic relationship between nurses and patients. 5. Everyone bases his or her perceptions about information received through the five senses. What are the five senses? 1. Sight 2. Smell 3. Hearing 4. Taste 5. Touch 6. An individual’s thoughts and perception. 7. Critical thinking helps nurses overcome perceptual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others. 8. List 5 therapeutic communication techniques and why they work while communicating with patients. 1. Active listening - Listen intently to the what the patient is saying and watch their nonverbal cues. This will show that you are interested. 2. Silent- Allow the patient time to think things over. Constant talking will not allow the patient time to think. 3. Summarize- Summarize what the patient has just told you. This shows the patient you were listening. 4. Using touch- Touching is a powerful tool. Holding a patient’s hand or a putting your hand on their shoulder speaks volumes. 5. Validation- Acknowledging a patient’s feelings, thoughts, and needs will help the patient be more comfortable. This shows empathy and interest. 9. List 6 non-therapeutic communication techniques and why they do not work while communication with patients. 1. Asking personal questions- These kinds of questions are nosey and irrelevant. 2. Giving personal opinions- Do not offer your opinion. This takes away the decision from the patient or their family. Opinions can be construed as as medical advice. 3. Changing the subject – Changing the subject shows you are not interested in what the patient has to say. 4. Arguing- Challenging or arguing with a patient makes them feel as if you do not believe them. Keep your opinions to yourself. 5. False reassurance – You need to be direct and honest. Telling someone it will be okay will give them a false sense of hope. inner communications influence 6. Sympathy- This is not therapeutic. Sympathy shows that you feel sorry for someone. A patient does not need you to feel sorry for them. 10. Give an example of an open-ended question; give an example of a closed ended question. Which technique of communication is better to use with patients? Open ended question – How did you fall? Closed ended question – Did you fall down the stairs? Open ended questions are better because they allow the patient to give more information. 11. Explain the Elements of Professional Communication. Courtesy – Using your manners while communicating with others can help build relationships. Use of name – Be sure to introduce yourself and include your title. Always call your patient by their name never by their chart number or diagnosis. Trustworthiness – Be honest, do not gossip, and do not withhold information. Trust builds relationships. Autonomy and responsibility – Being self-directed and accepting responsibility for your actions. Be your own advocate. Assertiveness- Increases self-esteem and self-confidence. Being able to set limits and knowing it is okay to say no. 12. How do nurses work best with patients who have conditions that impair communication? The nursing process will help with this. Identify the mode of communication impairment. Develop a plan to help the patient use their other means of communication. Implement a form of communication that the patient will understand. Reassess and adjust as needed. Example: Patient is deaf. Find a qualified sign language interpreter and offer literature. 13. A nurse is caring for a patient who states, “I have to check with my wife and see if she thinks I am ready to go home.” The nurse replies, “How do you feel about going home today? Which clarifying technique is the nurse using to enhance communication with the patient? a. Pacing b. Reflecting c. Paraphrasing d. Restating Answer: b Which of the following actions should the nurse take when using the communicating techniques of active listening? (Select all that apply) e. Use an open posture. f. Write down what the patient says to avoid forgetting details. g. Establish and maintain eye contact. h. Nod in agreement with the patient throughout the conversation. i. Respond positively when giving feedback. Answer: e, g, i 15. A nurse is caring for a patient who is concerned about his impending discharge to home with a new colostomy (a bag used to catch bowels because the intestines has been rerouted to the stomach area) because he is an avid swimmer. Which of the following statements should the nurse make? (Select all that apply) a. “You will do great! You just have to get used to it.” b. “Why are you worried about going home?” c. “Your daily routines will be different when you get home.” d. “Tell me about your support system you’ll have after you leave the hospital.” e. “Let me tell you about a friend of mine with a colostomy who also enjoys swimming.” Answer: c, d, e 16. Which of the following strategies should a nurse use to establish a helping relationship with a patient? a. Make sure the communication is equally reciprocal between the nurse and the patient. b. Encourage the patient to communicate his thoughts and feelings. c. Give the nurse-patient communication no time limits. d. Allow communication to occur spontaneously throughout the nurse-patient relationship. Answer: b 17. A nurse is caring for a school-age child who is sitting in a chair. To facilitate effective communication, which of the following actions should the nurse take? a. Touch the child’s arm. b. Sit at eye level with the child. c. Stand facing the child. d. Stand with a relaxed posture. Answer: b 18. What does HCAHPS stand for and how it is used? Hospital Consumer Assessment of Healthcare Providers Systems. HCAHPS is a standardized survey used to measure patient’s perceptions of their hospital experience.