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Linear Model correct answerssimplest form of communication. focuses only on the sending and receiving of a message. Useful in emergency situations
- sender
- message (verbal and nonverbal)
- receiver
- channels of CMCN
- content Transactional Model correct answersdefine interpersonal communication as a reciprocal interaction in which the sender and the receiver influence each other's messages and responses as they converse. Employs system concepts systems theory concepts correct answers1. human system (patient and providers) receives information from the environment (input) internally processes and interprets its meaning (throughput). The result is new information or behavior (output). Feedback loops provide information healthcare system correct answersall organizations, people and actions whose primary intent is to promote, restore or maintain health communication correct answerscombination of verbal and nonverbal behaviors integrated for the purpose of sharing information Metacommunication correct answersbroad term used to describe all factors that influence how the message is perceived. may be hidden within verbalizations or conveyed as nonverbal gestures and expressions communication style correct answersthe manner in which one communicates denotative meaning correct answersgeneralized meaning of a word
connotation correct answerspersonalized meaning of a work or phase Paralanguage correct answersvocalic behaviors that communicate meaning along with verbal behavior 6 verbal styles of communication correct answers1. moderate pitch and tone in vocalization
- vary vocalizations
- encourage involvement
- validate patient's worth
- advocates for patient as necessary
- provide needed information nonverbal communication correct answerscommunication using body movements, gestures, and facial expressions rather than speech. most of our person to person communication 6 nonverbal style of communication correct answers1. allows therapeutic silences
- use congruent nonverbal behaviors
- use facilitative body language (kinetics)
- use touch appropriately
- proxemics (respect patient's space)
- attend to nonverbal body cues body language correct answersnonverbal communication through gestures, facial expressions, behaviors, and posture Proxemics correct answersperception of what is a proper distance to be maintained between one's self and others Communication Accommodation Theory correct answerstheory that people will adapt or adjust their speech, vocal patterns, dialect, word choice and gestures to accommodate others
Involvement in the Relationship Use of Humor professional communication correct answerscomplex interactive process used in clinical settings to help patients achieve health related goals outcomes of professional communication correct answerspatient satisfaction, productive health changes, safety and better quality service basic assumptions of communication theory correct answers1. all behavior is communication
- every communication has content and a relationship aspect
- we know about ourselves and others primarily through communications
- faulty communication results in flawed feeling and acting
- feedback is the only way we know that our perception about meanings are valid
- silence is a form of communication
- all parts of a communication system are interrelated and affect one another
- people communicate through words, nonverbal behaviors and analog-verbal modalities Therapeutic communication correct answersA dynamic interactive process consisting of words and actions, and entered into by a clinician and client for the purpose of achieving identified health-related goals. patient centered communication skills correct answerslifeblood of clinical tasks such as obtaining a clinic history, explaining a diagnosis and providing competent nursing care with related health teaching interpersonal communication skills correct answersinfluence the completeness of diagnostic information, quality of shared decision making and patient motivation to achieve constructive clinical outcomes characteristics of patient centered communication correct answers1. empathy
- frame of reference or world view
- defined interpersonal boundaries
- health related purpose
- nonverbal communication supports empathy correct answersbeing emotionally attuned to a patient's perceptive of a situation of a situation as well as to it's reality defined interpersonal boundaries correct answersconversations that focuses on patient and family health care needs health related purpose correct answersprofessional conversations take place within a defined health care format and terminate when the health related purpose is achieved or the patient is discharged nonverbal communication supports correct answersbehavioral signals found in the tone of voice, inflections and intonations, facial expression and body language accompany verbal messages frame of reference or world view correct answerspatient's perception active listening correct answersdynamically focused interpersonal process in which a nurse hears a patient's message, decodes it's meaning, asks questions for clarification and provides feedback to the patient. Transaction process with the goal to understand what the patient is trying to communicate. It includes metacommunications. Nurses need to be sensitive to what is left out of the message as well as what is included ANA Standards of Professional Performance Communication correct answers1. assess communication format preferences
- assess own communication skills
- seeks continuous improvements
- conveys information
- questions decisions that do not appear to be in the best interest of the patient
- discloses concerns related to hazards and error
- maintain communication with other providers to minimize risk
- both verbal and nonverbal can be misinterpreted self awareness correct answersNurses have an ethical and professional responsibility to resolve personal issues
- know your goals
- know your personal vulnerabilities and prejudices
- nonverbal behaviors support your words environmental factors correct answers1. privacy - free from interruptions and eliminate noise
- space - Differs with culture, personal preferences, nature of relationship, topic
- timing - Consider patient's ability to absorb material, share impressions, ask questions communication as a shared partnership correct answers1.Patients need to be listened to, involved in own care, and supported.
- An interactive reciprocal exchange of ideas in which the nurse tries to understand what it is like to be this person, in this situation, with this illness 6 core, overlapping functions of client- centered communication needed to achieve beneficial health outcomes: correct answers1.Foster healing relationships 2.Exchange information 3.Respond to emotions 4.Manage uncertainty 5.Make decisions 6.Enable patient self-management communication applications engaging the patient correct answers1. Begins with 1st encounter
- Open, welcoming, relaxed
- Introductions before conversation
- Speak directly to patient; include family
- Give relevant information & listen
communication applications building rapport correct answers1. Ask routine questions
- Keep the conversation open with few interruptions
- Ask questions from easy general to more complex
- Be aware of personal characteristic, culture, experiences, education levels
- Be attentive, sincere, genuine
- Although starts with first encounter, continues throughout relationship communication applications developing a shared partnership correct answers1. Empathetic objectivity
- A "here and now" focus
- Demonstration of respect
- Authentic interest & confident manner
- Consider competing goals & alternatives communications applications finding common ground correct answers1. What is most important to patient & family?
- What helps or hinders their capacity to self-manage?
- Look for themes revealing fear, feelings, & level of engagement
- Patients need to understand the full range of therapeutic choices communication applications observing cues correct answers1. People are not always aware
- Cues can support or contradict meaning of spoken message.
- Look for environmental evidence
- Comment on your perceptions
- Like verbal communications, nonverbal behaviors & signals are culture bound emblems correct answersgestures or body motions have a common verbal interpretation (e.g. handshaking, baby waving bye)
circular question correct answersform of focused, look at other people within patient's support circle and identify difference in impact on each. closed-ended questions correct answersnarrow the focus to a single (yes, no, or simple phrase) answer. Use when need to obtain information quickly & emotions come second. themes correct answersthe underlying message, present, but not identified in the patient's words emotion objectivity correct answersSeeing what an experience is like for another person active listening responses correct answers1. Minimal Cues and Leads
- Clarification
- Restatement
- Paraphrasing
- Reflection
- Summarization
- Silence minimal cues and leads correct answers1. Encourage the patient to continue their story.
- Promote comfort in sharing intimate information.
- Minimal cues - body actions
- Encouraging leads - words clarification correct answers1. A brief question or a request for validation.
- Used to better understand the message
- Neutral tone of voice Ex. "Tell me more about..." or "I'm not sure I understand..."
Restatement correct answers1. Used to: broaden a patient's perspective or give the nurse a sharper focus on a specific part of the communication.
- Repeat parts of the message in the form of a query -Ex. "Let me see if I have this right...", you [repeat the patient's words]
- Effective when a patient overgeneralizes or seems stuck in a repetitive line of thinking paraphrase correct answers1. Used to check the nurse's translation of the patient's words
- Nurse transforms core elements of patient's original message
- A shorter, more specific statement 4 .Objective: find a common understanding of the issues important to the patient. -Ex. Patient: "I can't take this anymore. The treatment is worse..." Nurse: "It sounds like you've had enough." reflection correct answers1. Focuses on the emotional part of the message.
- Lets the nurse "empathetically mirror" what they sense the patient may be emotionally experiencing
- A simple observational comment, expressed tentatively.
- Gives the patient an opportunity to validate or change the narrative.
- Ways to use: -Reflect on vocal tones (i.e. anger or frustration in the voice) -Link feelings to content or with past experiences (reminds of feelings) summarization correct answers1. Used to review content and process.
- Pulls several ideas & feelings together, into a few succinct sentences. Followed by a comment seeking validation.
- Can bridge a change in topic or focus of the conversation.
- Do before the end of the conversation. false reassurance correct answersUsing falsely comforting phrases in an attempt to offer reassurance.
-Communication patterns -Discrepancies in content, body language, and vocalization -Feelings revealed in voice, body, and facial expression -What is said; what is not being said -The client's representational system -The nurse's own inner responses -The effect communication produces in others involved with the client focusing correct answersWhat is most pressing topic? "I would like to hear more about...." You mentioned...I wonder if..." Presenting reality correct answersIf patient is misinterpreting "I know you feel strongly about..., but I don't see it that way." giving feedback correct answers- A response to a question, verbal message, or observed behavior -Can focus on content, relationship, feelings generated, unclear parts of the message. "You seem____(angry, sad, happy, etc.) about______." effective feedback correct answers-Neutral mirror -Only addresses topic under discussion -Clear, honest, reflective -Specific - to the point, directed toward observed behaviors -Supported by realistic examples -Timing is critical - ASAP -Considers the patient's: readiness, need for privacy, available support system -Empathetic Use "how" or "what" questions instead of "why" questions *Benchmark: Does the feedback advance the goals of the relationship? Does it consider the individualized needs of the patient?
validation correct answers-Special form of feedback -Used to ensure that both participants have the same basic understanding. -Not simply asking: "do you understand?" -Used to uncover the patient's reactions or questions about an issue. -Allows the nurse to frame comments that match the patient's needs. touch correct answers-First sense to develop; last to leave -Nurturing, comforting, powerful -Used when words might break a mood or fail to convey empathy -Stimulates security, sense of feeling valued -People vary in their comfort of touch Metaphor correct answers-Familiar images used to promote understanding. -Connecting new information with familiar images from ordinary life experiences. -Should be "nonthreatening" mental pictures - use with caution. humor correct answers-Recognizes incongruities in a situation -Lightens the mood and puts a tense situation into perspective "A good laugh bonds communicators" -Works best when rapport and trust established -Should focus on the idea, event, or situation; not the patient's personal characteristics. -Has a healing purpose factors that contribute to successful use of humor correct answers1. knowledge of patient's response pattern
- an overly intense situation
- timing
- situation lending itself to an imaginative or paradoxical solution
Cultural Patterns correct answersDescribe the social customs, expected behaviors, cultural beliefs, values, and language passed down through generations. Transmitted informally or informally -An essential part of personal identity. -Dictate personal preferences -Influence how people process & interpret incoming information *Social factors (i.e. class and literacy level) further distinguish responses -Remainders from past culture can still influence behavior cultural diversity correct answersDescribes the social variations between cultural groups. -Lack of exposure to and/or understanding of the normal patterns of people form other cultures decreases acceptance, reinforces stereotypes, and creates prejudice. -People more likely to notice differences in people of different cultures than within their own culture. -More differences occur among individuals within a culture than between cultural groups related to differences in educational and socioeconomic status, age, gender, and life experiences. Points of Cultural Diversity in Health Care correct answers1. people's feelings, attitudes and behavioral standards
- ways of living, language and habits
- how people related to others
- nutrition and diet
- personal views on right and wrong
- perspectives on health, illness and death, including rituals
- hearing and discussing negative health information
- decisional authority, role relationships and truth telling practices
- child-rearing practices
- use of advance directives, informed consent and patient autonomy Worldview correct answersthe way people tend to look out upon their world or universe to form a picture or value stance about life or the world around them
- An individual's point of view or perspective about the larger social culture
Personal Heritage correct answerscountry of origin, reasons for migration, politics, class distinctions, education, social and economic status communication correct answersdominate language and dialects, personal space, body language and touch, time relationships, greeting, eye contact Family Roles and Organization correct answersgender roles, roles of extended family, elders, head of household, family goals, priorities and expectations and lifestyle differences workforce issues correct answersacculturation and assimilation, gender roles, temporality, current and previous jobs, variance in salary and status associated with job changes bioecology correct answersgenetics, hereditary factors, ethnic physical characteristics, drug metabolism high risk behaviors correct answersdrugs, nicotine and alcohol use, sexual behaviors Nutrition correct answersmeaning of food, availability and food preferences, taboos associated with food, use of food in illness pregnancy and childrearing correct answersrituals and constraints during pregnancy, labor and delivery practices, newborn and postpartum care death rituals correct answershow death is viewed, death rituals, preparation of the body, care after death, use of advance directives, bereavement practices Spirituality correct answersreligious practices, spiritual meanings, use of prayer healthcare practices correct answerstraditional practices, religious health care beliefs, individual versus collective responsibility for heath, how pain is expressed, transplantation, mental health barriers health care practitioners correct answersuse of traditional and/or folk practitioners, gender role preferences in health care
-Embraces differences in perceptions, language, & nonverbal behaviors -Sharing meaning and developing relationships between people of different cultures cultural language competence correct answersrequires "knowing what to say, and how, when, where, and why to say it." -Words can have different meanings -Idioms - nonliteral expression of idea -Nonverbal behaviors - gestures, eye contact -English as a second language high context communication correct answers1. Prefer indirect communication style
- Collectivist cultures
- "We" consciousness & strong emphasis on group loyalty and harmony
- Relationships before task
- Trust is critical
- Tone of voice before words
- Asia, Africa, South America, parts of Middle East low context communication correct answers1. Individualistic cultures
- Task before relationships
- Information is reality based & explicitly conveyed.
- Precise words taken literally & lead to mutually determined actions
- North American & Western European cultures health disparity evidence correct answers1. 2002 IOM Report - people of color and minorities receive lower quality of care
- National Healthcare Quality and Disparities Report confirms IOM report (DHHS, 2007)
- National Center for Health Statistics - ethnic & racial minorities make up 30% US adult pop. & almost 40% < 18 have greater mortality & morbidity rates
- 2050 - ethnic minority expect to be numerical majority
National Culturally and Linguistically Appropriate Service Standards (CLAS) correct answers2017 Office of Minority Health of the DHHS published revised CLAS policies and practices for providing quality care and services to diverse cultures -Five identified populations:
- disabilities
- low health literacy
- limited english proficiency
- racial and ethnic minorities
- sexual and gender minorities cultural competence correct answersA set of cultural behaviors & attitudes integrating into practice methods of a system, agency, or its professionals that enables them to work effectively in cross-cultural situations. *A process, NOT an event *An essential skill set required for professional nurses and other healthcare providers. (IOM and AACN) cultural humility correct answersProcess of openness, self-awareness, being egoless, & incorporating self-reflection & critique after willingly interacting with diverse individuals. Cultural Sensitivity correct answersAbility to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common & distinctive racial, national, religions, linguistic, or cultural heritage. self-awareness cultural assessment correct answersDiscuss the following questions regarding your own culture.
- Where did my family originate?
- What is important to me that I consider a cultural value?
- What are my beliefs about gender roles? Different from parent's beliefs?
- How much physical distance do I need in social interactions?
- Who are the decision makers in my family?
- If I need health care, how would I respond to this need and what would be my expectations?
