STUDY GUIDE # 10

COMMUNICATING
Instructions:

a) Refer to the following pages for your answers: Pages 41, 413-418, 420-423, 431-434 of your book in a pdf file. If
you’re using an actual book, please be the one to identify from the pdf its corresponding pages in your book.
b) The number before each question is just for organization purposes because there are test items that will be merged
in iStudy, thus, only then a perfect score will be known.
c) The answers will be entered into iStudy and will close on May 4 , 11:59 PM

1. Communication is a critical skill for nursing and an integral part of the helping relationship.
2. The intent of every communication is to obtain a response, thus, it is a process.
3. Sometimes a client may say that a nurse is efficient but lacking in something called bedside manner.
Nurses who communicate effectively are better able to: (#s 4-8)
4. collect assessment data
5. initiate interventions
6. evaluate outcomes of interventions
7. initiate change that promotes health

8. prevent the safety and legal problems associated with

nursing practice
9. The communication process is built on a trusting relationship with a client and support people.
10. Effective communication is essential for the establishment of a nurse–client relationship.

11. Majority of communication is nonverbal, and learning about it is important for nurses in developing
effective communication patterns and relationships with clients.

12. A common form of electronic communication is e-mail

13. .

14. Verbal communication is largely conscious because people choose the words they use.

15. Speaking slowly and softly to an excited client may help calm the client.

Nurses need to learn to select appropriate, understandable, and simple terms based on the following of the client:
(#s 15 – 18)

15. age

16. knowledge

17. culture

18. education

19. A message that is direct and simple will be effective.

20. Clarity is saying precisely what is meant, and brevity is using the fewest words necessary.
21. To ensure clarity in communication, nurses also need to enunciate (pronounce) carefully.
22. Nurses need to be aware of both relevance and timing when communicating. No matter how clearly or simply
words are stated or written, the timing needs to be appropriate to ensure that words are heard.

23. The message need to relate to the person or the person’s interests and concerns.

24. In situations that client’s are fearful of the possibility of the disease and may not hear the nurse’s explanations
about the procedure to be performed, it is better for the nurse first to encourage the client to express
concerns, and then deal with those concerns.

25. The necessary explanations can be provided at another time when the client is better able to listen.

26. Another problem with timing is asking several questions at once.

27. By allowing the client to respond to the social talk or chat, the nurse develops a rapport with the client that can
help facilitate effective therapeutic communication.

28. What the nurse says and how it is said must be individualized and carefully considered.

29. It is important for the nurse to modify his or her tone of speech and express concern by facial expression while
moving toward the client.

Credibility may be the most important criterion of effective communication. Nurses foster this by being: (#s 30 -32)

30. consistent

31. dependable

32. honest

33. Nurses should convey confidence and certainty in what they are saying, while being able to acknowledge
their limitations.

34. The use of humor can be positive and powerful tool in the nurse-patient relationship, but must be used with care.

35. The physical act of laughter can be an emotional and physical release, reducing tension by providing a different
perspective and promoting a sense of well-being.

36. When using humor, it is important to consider the client’s perception of what is considered humorous.

37. Though humor and laughter can help reduce stress and anxiety, the feelings of the client need to be considered.

38. Nonverbal communication includes gestures, body movements, use of touch, and physical appearance , including
adornment.

39. Nonverbal communication either reinforces or contradicts what is said verbally.

40. Nonverbal communication sometimes conveys meaning more effectively than words.

41. Observing and interpreting the client’s nonverbal behavior is an essential skill for nurses to develop.

42. To observe nonverbal behavior efficiently requires a systematic assessment of the person’s overall physical
appearance, posture, gait, facial expressions, and gestures.

43. The nurse, needs to exercise caution in interpretation, always clarifying any observation with the client.
44. An attentive nurse who clarifies observations very often portrays caring and acceptance to the client.

45. Even for behaviors such smiling and handshaking, cultures differs.

46. When the symbolic meaning of an object is unfamiliar, the nurse can inquire about is significance, which
may foster rapport with the client.

47. When a person known for immaculate grooming becomes careless about appearance, the nurse must
validate these nonverbal data by asking the client.

48. For acutely ill clients in hospital or home care settings, a change in grooming habits may signal that the client is
feeling better.

49. Erect posture and an active, purposeful stride suggest a feeling of well-being.

50. Tense posture and a rapid, determined gait suggest anxiety or anger.

51. The nurse clarifies the meaning of the observed behavior by describing to the client what the nurse sees and
then asking what it means or whether the nurse’s interpretation is correct.

52. Although the face may express the person’s genuine emotions, it is also possible to control these muscles so
the emotion expressed does not reflect what the person is feeling.

53. When the message is not clear, it is important to get feedback to be sure of the intent of the expression.

54. Many facial expressions convey a universal meaning.

55. No single expression can be interpreted accurately.
56. Nurses need to be aware of their own expression and what they are communicating to others.
57. It is impossible to control all facial expression, but the nurse must learn to control expressions of feelings such
as fear or disgust in some circumstances.
58. Often a person initiates contact with another person with a glance, capturing the person’s attention prior to
communicating.
59. Hand and body gestures may emphasize and clarify the spoke word, or they may occur without words to
indicate a particular feeling or to give a sign.
60. For people with special communication problems, such as the deaf, the hands are invaluable in communication.
61. The client may be able to raise an index finger once for “yes” and twice for “no”.
62. Other signals often can be devised by the client and the nurse to denote other meanings.

63. E-mail promises better access, however, protection of client privacy remains an issue when transferring
information electronically.

64. Nurses need to know their agency’s guidelines about what can be sent to clients by e-mail.

65. Information sent to a client via e-mail is considered part of the client’s medical record, therefore, a copy of the e-
mail needs to be put in the client’s chart .

66. Nurses need to use their professional judgment about what form of communication(s) will best meet their
clients’ health needs.
67. It is important for the nurse to be aware of a client’s values and to validate or correct perceptions to avoid
creating barriers in the nurse-client relationship.

68. Nurses frequently use intimate distance.

69. When someone who wants to communicate steps into another person’s personal space, the receiver unconsciously
responds by stepping back a pace or two. In therapeutic relationships, nurses often are required to
violate this personal space.

70. Encroachment into another individual’s personal space creates tension.

71. Social distance is important in accomplishing the business of the day.

72. Although the faces and forms of people are seen at public distance, individuality is lost.

73. Health care workers must recognize the human tendency to claim territory.

74. Nurses need to obtain permission from clients to remove, rearrange, or borrow objects in their hospital area.

75. Environmental distraction can impair and distort communication.

76. Clients more readily trust the nurse when they perceive the nurse’s communication as congruent.

77. Nurses are taught to assess clients, but clients are often just as adept at reading a nurse’s expression
or body language.

78. People have a need to be different from others. Being too different can be isolating and threatening.

79. Nurses can learn new ways of approaching situations when they conscientiously listen to another person’s
perspective.

80. Health care providers may unknowingly use speech that they believe shows caring but the client perceives as
demeaning or patronizing.

81. Elderspeak does not communicate respect.

82. Acceptance emphasizes neither approval nor disapproval.

83. An accepting attitude allows clients to express personal feelings freely and to be themselves.

84. The nurse may need to restrict acceptance in situations where clients behaviors are harmful
to themselves or to others.

85. Helping the client to find appropriate behaviors for feelings is often part of client teaching.

86. For nurses, professional boundaries are crucial in the context of the nurse-client relationship.

87. To keep clear boundaries, the nurse keeps the focus on the client and avoids sharing personal information or
meeting his or her own needs through the nurse-client relationship.

88. If the client seeks friendship with the nurse or a relationship outside the work environment, the nurse affirms
his or her professional role and declines the invitation.

Some indicators that boundary issues need to be addressed include: (#s 89 – 91)

89. gift-giving by the nurse or client

90. spending more time than necessary with a client

 91. the nurse believing only he or she understands the client

92. Egan (2014) suggests specific nonverbal skills that a nurse can use to portray empathic presence through use
of acronym SOLER which means squarely, open, Lean, eye and relaxed.

By the end of the introductory phase, clients should begin to: (#s 93 – 100)

93. Develop trust in the nurse.

94. View the nurse as a competent professional capable of helping.

95. View the nurse as honest, open, and concerned about their welfare.

96. Believe the nurse will try to understand and respect their cultural values and beliefs.

97. Believe the nurse will respect client confidentiality.

98. Feel comfortable talking with the nurse about feelings and other sensitive issues.

99. Understand the purpose of the relationship and the roles.

100. Feel that they are active participants in developing a mutually agreeable plan of care.

In developing helping relationships, although special training in counseling techniques is advantageous, there are
many ways of helping clients that do not require special training: (#s 101 – 109)

101. Listen actively.

102. Help to identify what the person is feeling.
103. Put yourself in the other person’s shoes (i.e. empathize).
104. Be honest.
105. Be genuine and credible.
106. Use your ingenuity.
107. Be aware of cultural differences that may affect meaning and understanding.
108. Maintain client confidentiality.
109. Know your roles and your limitations.

110. Groups exist to help people achieve goals (outcomes) that would be unattainable by individual effort alone.

Types of Health Care Groups: (#s 111 – 116)

111. task groups
112. teaching groups
113. self-help groups
114. self-awareness/growth groups
115. therapy groups
116. work-related social support groups

117. Communication problems among health care personnel threaten client well-being and have contributed to
poor postoperative care, incorrect or delayed medication orders, and prolonged client suffering.
118. outrageous behavior is still common in health care facilities.

119. Besides undermining client care, disruptive behaviors also negatively affect staff morale.

120. The Joint Commission recognized workplace intimidation as a threat to client safety.

121. incivility as “rude or disruptive behavior that ma result in psychological or physiological distress for the
people involved and, if left unaddressed, may progress into threatening situations.”

122. In a stressful environment, it is imperative that nurses make civility a priority for their clients, colleagues,
and classmates.

123. Lateral violence also known as horizontal violence and horizontal hostility.

124. Horizontal violence is fairly widespread at 65% to 80% of nurses, a particularly vulnerable group is
nursing students during their clinical rotations.

125. Failing to address horizontal violence may cause students and new graduates to leave the profession.

126. In bullying, the perpetrator is usually at a higher level or power (actual or perceived) compared with the
victim.

127. A number of nursing organizations have issued statements regarding the harmful effect of disruptive behaviors
on both nurses and client safety.

128. Nurses must be as proficient in communication skills as they are in clinical skills.

129. Increase communication skills to intervene when others display disruptive behaviors.

130. Lack of guidelines or formal for verbal communication may contribute to medical errors
as a result of communication problems.

131. Physicians are trained to be concise, to the point, and focused on the problem, therefore, may become impatient
waiting for a nurse to come to the point.

Communication errors in the health care setting often have sever consequences that can lead to negative client
outcomes such as: (#s 132 – 134)

132. increased length of stay

133. client dissatisfaction

134. even death

In calling the primary care provider (physician) to report a client problem, the nurse will be using SBAR method.
However, the nurse also need to think about what information may be asked and be prepared to answer those
questions. This means knowing the most recent assessment data, including: (#s 135 – 137)

135. vital signs

136. laboratory data

137. other tests

138. In work environments, professionals can demonstrate emotional intelligence by accurately identifying their
own emotions and the emotions of others, managing those emotions and deciding how to interact with colleagues
constructively to achieve a positive outcome.

139. Assertive communication promotes client safety by minimizing miscommunication with colleagues.
 140. People who use assertive communication are honest, direct, and appropriate while being open to ideas, and
respecting the rights of others.

141. The “you” statement places blame and puts the listener in a defensive position.

142. The “I” statement encourages discussion.

143. It is important for the nurse to be clear, concise, organized, and fully informed when verbally
presenting the client concern.

144. Some experts believe that people who use the submissive behaviors or communication style are insecure and
try to maintain their self-esteem by avoiding conflict .

145. Aggressive communication, is directed toward what one wants without considering the feelings of others.

146. The effectiveness of nurse-client communication is best validated by:

A. Client feedback
B. Medical assessments
C. Health team conferences
D. Client’s physiologic adaptations

147. A client with history of hypertension is hospitalized with a transient ischemic attack (TIA). The client has been
told to stop smoking. The nurse discovers a pack of cigarettes in the client’s bathrobe. The best course of action
to take at this time is to:
A. Let the client know they were found
B. Discard them without making comments
C. Report the situation to the head nurse
D. Call the physician and request directions

148. After being medicated for anxiety a client who has congestive heart failure says to the nurse, “I guess you are too
busy to stay with me.” The best response in this circumstance is:
A. “I have to see other clients.”
B. “The medication will help you rest soon.”
C. “You will feel better; I will adjust your oxygen mask.”
D. “I have to go now, but I will come back in 10 minutes.”

149. When a physically ill client is being overtly verbally hostile, the most appropriate nursing response would be a:
A. Verbal defense of the staff’s actions
B. Reasonable exploration of the situation
C. Silent acceptance of the client’s behavior
D. Complete physical withdrawal from the client

150. A young man has recently begun experiencing forgetfulness, disorientation, and occasional lapses in memory.
The client was diagnosed with AIDS dementia. His family began sobbing on hearing the diagnosis. What would
be an appropriate response from the nurse?
A. “You must never give up hope.”
B. “He was in a high-risk group of AIDS.”
C. “I can understand your grief.”
D. “This must be very difficult for you
 Factors Influencing the Communication Process: Match the description to the factor
151. Personal space A. Distance people prefer in interactions with others.

152. VALUES AND PERCEPTIONS B. Each person has unique personality traits, values, and life experiences,
each will perceive and interpret messages and experiences differently.

153. DEVELOPMENT C. Nurse’s knowledge of a client’s developmental stage will allow the
nurse to modify the message accordingly.

154. GENDER D. Females and males communicate differently.

155. ROLES AND RELATIONSHIPS E. These between sender and receiver affect the communication
process.

156. ENVIRONMENT F. Temperature extremes, excessive noise, and poorl ventilation can all
interfere with communication.

157. Territoriality G. Space and things that an individual considers as belonging to self.

158. CONGRUENCE H. The verbal and the nonverbal aspects of the message match.

159. BOUNDARIES I. Limits of individuals, objects, or relationships.

160. INTERPERSONAL ATTITUDES J. It conveys beliefs, thoughts and feelings about people and events.

Identify the barriers to communication that a nurse is using for the following examples:
BARRIERS to Communication Examples
Client: “I feel as if I am dying.”
161. Challenging Nurse: “How can you feel that way when your pulse is 60?.”

161. Stereotyping “Men don’t cry.”

Client: “Those night nurse must just sit around and talk all night. They didn’t
162. Being defensive answer my light for over an hour.”
Nurse: “I’ll have you know we literally run around on nights. You’re not the
only client, you know.”
Client: “I don’t think Dr. Broad is a very good doctor. He doesn’t seem
164. Agreeing and disagreeing interested in his clients.”
Nurse: “Dr. Broad is head of the department of surgery and is an excellent
surgeon.”
“Don’t worry.”
165. Unwarranted reassurance

166. Testing “Who do you think you are?”

167. Passing judgment “That’s good (bad).”

168. Rejecting
169. Changing topics and subjects
Identify the therapeutic communication techniques that a nurse is using for the following examples:
THERAPEUTIC Communication
TECHNIQUES
170. Being specific and tentative
171. Using touch
172. Using open-ended question
173. Providing general leads
174. Restating or paraphrasing
175. Giving information
176. Seeking clarification
177. Offering self
178. Acknowledging
179. Clarifying time or sequence
180. Reflecting
181. Presenting reality
182. Summarizing and planning
183. Perception checking or seeking
consensual validation
Reference: Berman, A. & Synder, S. (2016) Kozier & Erb’s Fundamentals of Nursing. 10 ed. Pearson
Education, Inc.
“Let’s discuss other areas of interest to you rather than the two problems you
keep mentioning.”
Client: “I’m separated from my wife. Do you think I should have sexual
relations with another woman?”
Nurse: “I see that you are 36 and that you like gardening. This sunshine is
good for my roses. I have a beautiful rose garden.”
Examples
“You seem unconcerned about your diabetes
Placing your hand over the client’s hand
“How have you been feeling lately?”
“Perhaps you would like to talk about……”
Client: “I couldn’t manage to eat any dinner last night – not even the
dessert.”
Nurse: “You had difficulty eating yesterday.”
Client: “Yes, I was very upset after my family left.”
“You will feel a pulling sensation when the tube is removed from your
abdomen.”
“Would you please say that again?”
“I’ll stay with you until your daughter arrives.”
‘I notice you keep squinting your eyes. Are you having difficulty seeing?”
Client: ‘I vomited this morning.”
Nurse: “Was that after breakfast?”
Client: ‘What can I do?”
Nurse: “What do you think would be helpful?”
“Your magazine is here in the drawer. It has not been stolen.”
“In a few days I’ll review what you have learned about the actions and
effects of your insulin.”
Client: “My husband never gives me any presents.”
Nurse: ‘You mean he has never given you a present for your birthday or
Christmas?”
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