Therapeutic Communication/ Nurse-Client Relationship (Basics in Nursing) Flashcards

Terms Definitions

interchange of information, thoughts, or feelings

Communication consists of only verbal and conscious behavior.
False - communication consists of verbal, non-verbal, conscious, and unconscious behavior
What are the 4 elements of communication?
1. sender (encoder)
2. receiver (decoder)
3. message
4. feedback
Why is feedback so important?
it allows us to know if the message we are sending is understood
What is the purpose of communication?
to establish and maintain a harmonious and productive relationship among people

Communication can be both helpful and hurtful.
A patient asks you if s/he is dying. What do you think the patient is really seeking from you?
reassurance - they are looking for someone to talk to
What are the 2 main modes of communication?
- verbal
- nonverbal
Would a nurse's notes be considered a form of verbal or nonverbal communication?
You need to explain a complicated medical procedure to a patient. What is the most important method to guarantee that the patient will understand the procedure that s/he is receiving?
Keep it Simple!
A patient has just learned that s/he will need open heart surgery. You need to interview this patient. What should you do?
Return at a later time to interview the patient.
A patient asks you a question regarding an upcoming procedure and you do NOT know the answer. What should you do?
Be honest. Tell the patient that you don't know, but you will find out for them, get your instructor, or the staff nurse.

You should always give a patient a precise time for surgery.
FALSE - you should never give a precise time for surgeries or procedures. Complications do occur.
You tell a client that you will return in 15 minutes to check on them. Why is it so important that you return at that time?
to maintain credibility with the client
Why is clarity so important as a nurse?
to ensure that you are communicating clearly to the client

transmission of messages without using words
nonverbal communication
What are some methods of nonverbal communication?
- facial expressions
- posture
- personal appearance
- gestures
What are the 6 universal facial expressions?
- fear
- happiness
- sadness
- anger
- disgust
- surprise
Why is it so important to monitor your facial expressions while dealing with clients?
because your facial expressions can relay feelings that may damage your nurse-client relationship (ex. expressing shock when first seeing a burn patient)
How do you know if it is ok to touch a patient?
you ask permission, or look for nonverbal clues
Verbal and nonverbal communication must be _____________.

the process of becoming aware though our senses
A person's perception to their diagnosis will affect their _________.
A client is pressing the call light every 5 minutes. What is the best approach to dealing with this issue?
Talk to the client about the behavior, expressing that it is unacceptable but without passing judgment or displaying any negative emotions, thoughts, or feelings
You take a self-analysis of your strong and weak attributes. What is this also known as?
Therapeutic use of self
What are the 5 levels of communicational development?
- Cliche conversations
- reporting facts
- share personal feelings, ideas, judgments
- share feelings
- peak communication
What are some communication techniques?
- show interest and respect
- offering self
- acknowledging feelings
- giving information
What type of communication technique?

make yourself available to the client, show a desire to understand and be there
offering self
What type of communication technique?

let the patient know his feelings are understood and accepted
acknowledging feelings
What type of communication technique?

making available the facts the patient needs to know
giving information
What are 3 methods used to encourage patients to verbalize?
Silence (listening)
Broad Openings
General Leads
How does silence encourage a patient to talk?
gives the patient time to collect his thoughts and think about what they are going to say
What are some guidelines to being a good listener?
- maintain eye contact but don't stare
- never sit on the patient's bed (pull up a chair)
- lean forward slightly
- keep distractions to a minimum
- provide privacy
- remain relaxed
What type of communication technique?

open-ended questions
broad openers
What is the purpose of broad openers?
they encourage the patient to talk, determine the direction of the conversation, and elicit answers that are more than 1 or 2 words
What is the purpose of general leads?
lets the patient know you are listening and you want him to continue
What type of communication technique?

nodding your head and saying "go on"
general lead
What is reflecting?
you restate what the patient just stated (all or part is slightly rephrased)
What type of communication technique?

The patient says "I'm at the end of my ropes" and you say "you are at the end of your ropes?"
What is seeking clarification?
simply clarifying that which is vague
What is the purpose of sharing observations and perceptions?
to verbalize what is perceived and call it to the patients awareness
What type of communication technique?

Saying to the patient "You look really uncomfortable"
Sharing observations and perceptions
What are the 4 main types of questions?
- closed questions (yes/no)
- open-ended (broad openers)
- leading question (question that implies the answer desired)
- why questions (intimidating, puts people on the defensive)
What is summarizing?
to sum up everything you and client have spoken about
What is presenting reality?
giving true and accurate information to a patient; this is not disagreeing, just presenting the truth
Things that interfere with communication are known as what?
blocks to communication
What is false reassurance?
short, general cliches (ex. don't worry, everything will be fine)
Why is giving approval/disapproval considered a block to communication?
Nurses are supposed to non-judgmental - we are not supposed to tell the patient what is or is not best to do.
What is rejecting?
ignoring a client's request or statement because you disagree or feel uncomfortable
Why is agreeing/disagreeing considered a block to communication?
because we want the patient to come up with his own decisions without influence from us
Why is advising considered a block to communication?
because we are giving our opinion, which is not helpful to the client coming to a decision on his own, without influence
Why is probing a block to communication?
it is persistent questioning, which leads to making the patient feel violated
Why is challenging considered a block to communication?
it puts pressure on the patient, forcing him to analyze and explain his ideas
Why is defending considered a block to communication?
it shows weakness in the nurse's demeanor, focusing on the nurse's feelings rather than the patient's
Saying "You should be able to handle this diagnosis just and so did" is an example of what?
Saying "All teenagers are difficult!" is an example of what?
What is the biggest problem with stereotyping?
it places people in groups, taking away their individuality
In most cases, changing the subject is not recommended. What are 2 cases where changing the subject is okay?
- the conversation is inappropriate
- the client is asking personal questions

You should speak very loudly when communicating with a person who is hard of hearing.
False - speak slowly, facing the person (if they are deaf in one ear, speak into their good ear)

It is always fine to use family members as interpreters.
False- you have to call the hospital's interpreter for all important communication
What are a few techniques for communicating with people who speak another language when an interpreter is not available? (3)
- pictures
- flashcards
- facial expressions/hand signals
A person cannot speak because they have had a tracheotomy. What is a good technique for communicating with this client?
giving the client a slate (small chalkboard) to communicate
What are some things you need to know when interviewing a client?
Descriptions of how they are feeling, what brought them there, any desires/needs they have (focusing on emotionally charged areas)

an interpersonal process consisting of a series of interactions between a client and a nurse
therapeutic communication
What is the primary difference between social relationships and therapeutic relationships?
In a therapeutic relationship, the aim is to help the client. Social relationships are for companionship and aren't goal oriented.

Therapeutic relationships have mutual sharing.
False - Social relationships have mutual sharing.
What are 8 qualities of a nurse?
- concern for others and an active interest in them
- trust
- empathy
- sympathy
- genuineness
- unconditional positive regard
- involved objectivity

To have concern for a person, you have to like them.
False - concern means a genuine interest for a patient's well being and taking responsibility for him
What is unconditional positive regard?
caring for the patient as a person, not an object; requires belief in the values of another person regardless of what he believes
What is involved objectivity?
a conscious awareness of being able to see events without reacting in a highly personalized way

a particular way in which we perceive and relate to fellow human beings

a feeling of confidence in another
What are some things you can do to build trust with a client? (5)
- follow through on what you say
- keep promises
- be honest
- maintain confidentiality
- be available
What are the 2 types of empathy?
- accurate (true) empathy
- learned empathy
What is accurate empathy?
you yourself have been through a similar or like experience and can relate to what the patient is going through
What is learned empathy?
you have not personally experienced the situation, but you acknowledge what the patient is feeling because you have seen it many times before

being affected by another person's emotions; a basic urge to alleviate their distress

the ability to enter into or share in and comprehend the psychological state of another individual

Pity is a bad attribute to have in nursing.
For something to be genuine, it needs to be _____, ________, and ___-______.
real, spontaneous, and non-defensive
What is the basis of all other nursing qualities?

Nurses should express a non-judgmental and non-punitive attitude.
Nurses should avoid all ______ judgments.
What are the 4 phases of a therapeutic relationship?
- pre-interaction phase
- orientation phase
- working phase
- termination phase
During which phase of a therapeutic relationship should you tell the client when termination will be?
orientation phase

New material should be introduced during the termination phase.
False - NEVER introduce new information at the time of termination
A nurse is against abortion, however she is able to assist in performing an abortion without reacting in a personal way. What quality is this an example of?
avoiding all moral judgments; acting in a non-judgmental and non-punitive way
Why is being consistent as a nurse important to the client?
not knowing what to expect increases anxiety and fear
What goes on during the pre-interaction phase?
you read the patient's chart and familiarize yourself with him or receive a report from another nurse
What is the purpose of the pre-interaction phase?
allows you to prepare
What goes on during the orientation (introductory or initiating) phase?
You meet the patient, introduce yourself, review, ask questions, set goals, and tell the patient when termination will be.
What goes on during the working phase?
Striving to meet goals from the orientation phase, provide information, exploring, referrals, active problem solving
What goes on during the termination phase?
summarizing feelings, review of processes
During which phase of the Nurse-Client relationship?

The nurse will begin to think about the problems the patient will have
pre-interaction phase
During which phase of the Nurse-Client relationship?

The patient will demonstrate the ability to move on crutches
Working phase
During which phase of the Nurse-Client relationship?

The patient will acknowledge the goal he has accomplished in therapy.
During which phase of the Nurse-Client relationship?

The patient will learn the name of the nurse and become acquainted
Orientation Phase
During which phase of the Nurse-Client relationship?

An anorexic patient will establish an agreement with the healthcare professional to return gradually to a normal eating pattern.
Orientation Phase
During which phase of the Nurse-Client relationship?

The patient will express his desire to go home despite the excellent care he received at the agency.
During which phase of the Nurse-Client relationship?

The patient will attend a counseling session dealing with smoking.
Working Phase
During which phase of the Nurse-Client relationship?

The patient will verbalize the goals set forth in his transition to a home healthcare setting.
During which phase of the Nurse-Client relationship?

The patient will establish an agreement with the home healthcare worker about the frequency and length of contacts.
Orientation Phase
During which phase of the Nurse-Client relationship?

The patient will express his concern about a pending surgery to the nurse.
Working Phase

a feeling of sympathy for someone or something

The state of being responsible, accountable, or answerable; A duty, obligation or liability for which someone is held accountable

the state of being genuine

the state of NOT inflicting punishment upon another person
What therapeutic communication technique?

Sitting quietly until the client is able to put thoughts and feelings into words
Using Silence
What therapeutic communication technique?

"I'll stay with you until your daughter arrives"
Offering Self
What therapeutic communication technique?

"How have you been feeling lately?"
Open-Ended question (broad opening)
What therapeutic communication technique?

"Your surgery is scheduled for 11am tomorrow."
Giving Information
What therapeutic communication technique?

"Your magazine is here in the drawer. It has not been stolen."
Presenting Reality
What therapeutic communication technique?

Client: "Do you think I should tell my husband?"
Nurse: "You seem unsure about telling your husband"
What therapeutic communication technique?

"You seem upset today"
Making observations
What therapeutic communication technique?

"Perhaps you would like to talk about your fears."
Providing General Leads
What non-therapeutic communication technique?

"Don't worry, everything will be fine"
False Reassurance
What non-therapeutic communication technique?

"Yes, you should start jogging!"
Giving approval (Agreeing)
What non-therapeutic communication technique?

"You should think about having your wife take a part-time job."
What non-therapeutic communication technique?

"I can't talk now. I'm going on my coffee break"
What non-therapeutic communication technique?

Client: "The night nurse didn't answer my light for over an hour"
Nurse: "We literally run around at night. You aren't the only client!"
What non-therapeutic communication technique?

Client: "I felt nauseated after that red pill"
Nurse: "Surely you don't think I have you the wrong pill."
What non-therapeutic communication technique?

"Honestly, you can't be in that much pain over a sprain. Toughen up!"
____________ is a critical nursing skill used to gather assessment data for nursing diagnoses, to teach and persuade, and to express caring and comfort.
Which reveals more about a person's thoughts and feelings, verbal or non-verbal communication?
non-verbal communication
The effective nurse-client relationship is a helping relationship that facilitates _______ of the individual.
Assertive communication promotes client safety by minimizing miscommunication with colleagues. What is an important characteristic of assertive communication?
Using "I" statements
Nonassertive communication includes 2 types of interpersonal behaviors: What are they?
submissive and aggressive
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