Nursing Chapter 24: Communication

Questions and Answers

What is the primary role of caring relationships in nursing?

To establish a therapeutic communication with patients (correct)

To overcome perceptual biases or stereotypes

To maintain effective relationships within the entire sphere of professional practice

To ensure compliance with legal standards of care

What is essential for nurses to become the best communicators?

Acquiring technical skills in patient care

Maintaining effective relationships within the entire sphere of professional practice

Developing critical thinking skills and clinical judgment (correct)

Following ethical standards of care

What is the outcome of competent communication in nursing practice?

Establishing therapeutic relationships with patients

Overcoming perceptual biases or stereotypes

Maintaining effective relationships within the entire sphere of professional practice

Meeting legal, ethical, and clinical standards of care (correct)

What is the core of nursing, according to the described nursing practice?

Caring relationships Signup and view all the answers

What is the primary goal of developing communication skills in nursing?

To establish therapeutic relationships with patients Signup and view all the answers

What is the relationship between critical thinking skills and communication in nursing?

Critical thinking skills are crucial for effective communication in nursing Signup and view all the answers

What is the scope of competent communication in nursing practice?

Within the entire sphere of professional practice Signup and view all the answers

What is the term for the process of conveying information and ideas through facial expressions, body language, and tone of voice?

Nonverbal communication Signup and view all the answers

What is the role of interpersonal relationships in nursing?

To establish therapeutic relationships with patients Signup and view all the answers

Why is communication a lifelong learning process in nursing?

Because it requires continuous development of critical thinking skills and clinical judgment Signup and view all the answers

Which of the following is an example of therapeutic communication technique?

Sharing empathy Signup and view all the answers

What is the relationship between critical thinking skills and perceptual biases or stereotypes in nursing?

Critical thinking skills overcome perceptual biases or stereotypes Signup and view all the answers

What is the primary goal of the assessment phase in the nursing process?

To identify patient problems Signup and view all the answers

Which of the following is a barrier to effective communication in nursing practice?

Lateral violence Signup and view all the answers

What is the term for the communication that occurs between two or more people in a small group?

Small-group communication Signup and view all the answers

Which of the following is an element of the communication process?

All of the above Signup and view all the answers

What is the term for the process of conveying information through written or spoken words?

Verbal communication Signup and view all the answers

Which of the following is an example of a nontherapeutic communication technique?

Asking personal questions Signup and view all the answers

What is the term for the process of interacting with patients, families, and communities to promote health outcomes?

Professional nursing relationships Signup and view all the answers

Which of the following is an element of professional communication in nursing practice?

All of the above Signup and view all the answers

Which leadership style is most likely to empower teams in a nursing organization?

Transformational leadership Signup and view all the answers

What is the primary focus of the Magnet Recognition Program?

All of the above Signup and view all the answers

What is the main goal of shared decision making in a nursing team?

To enhance patient-centered care Signup and view all the answers

Which nursing care delivery model emphasizes collaboration between patients, families, and healthcare providers?

Patient- and family-centered care Signup and view all the answers

What is the primary role of a nurse manager in supporting staff involvement?

To establish nursing practice through problem-solving committees Signup and view all the answers

What is the primary focus of interprofessional rounding in a nursing team?

To promote communication among healthcare providers Signup and view all the answers

What is the primary goal of staff communication in a nursing team?

To facilitate collaboration and shared decision making Signup and view all the answers

What is the primary focus of professional shared governance councils?

To establish nursing practice through problem-solving committees Signup and view all the answers

What is the primary role of nurse executives in building a strong nursing team?

To establish transformational leadership Signup and view all the answers

What is the primary goal of staff education in a nursing team?

To enhance patient-centered care Signup and view all the answers

What is the primary distinction between clinical decision making and clinical judgment?

Clinical judgment is an observed outcome of critical thinking and decision making. Signup and view all the answers

What is the main purpose of a model for clinical judgment?

To explain the many variables involved in making decisions and clinical judgments about patients. Signup and view all the answers

What is the primary goal of critical thinking in nursing?

To make decisions that produce desired patient outcomes. Signup and view all the answers

What is the characteristic of critical thinking?

The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process. Signup and view all the answers

What separates professional nurses from technicians or assistive personnel?

Clinical decision making. Signup and view all the answers

What is the relationship between critical thinking and clinical judgment?

Clinical judgment is an observed outcome of critical thinking and decision making. Signup and view all the answers

What is the primary focus of models for clinical judgment?

Describing the many variables involved in making decisions and clinical judgments about patients. Signup and view all the answers

What is the primary characteristic of critical thinking in nursing practice?

Systematic and logical thinking with openness to question and reflect on the reasoning process. Signup and view all the answers

What is the primary role of clinical judgment in nursing practice?

To make accurate and appropriate clinical decisions. Signup and view all the answers

What is the purpose of reflection in the evaluation of clinical judgments?

To evaluate the effectiveness of clinical judgment Signup and view all the answers

Which of the following is an attitude of critical thinking?

Responsibility and accountability Signup and view all the answers

What is the primary goal of critical thinking in the clinical judgment model?

To develop competence Signup and view all the answers

What is the distinction between basic and complex critical thinking?

Level of complexity Signup and view all the answers

Which of the following is a component of critical thinking in the clinical judgment model?

Competence Signup and view all the answers

What is the purpose of critical thinking synthesis in the evaluation of clinical judgments?

To integrate critical thinking with clinical judgment Signup and view all the answers

Which of the following is an example of a critical thinking competency?

Diagnostic reasoning Signup and view all the answers

What is the primary focus of commitment in the levels of critical thinking?

Long-term commitment to critical thinking Signup and view all the answers

Which of the following is an example of a critical thinking attitude?

Risk taking Signup and view all the answers

Which ethical approach prioritizes the greatest good for the greatest number?

Utilitarianism Signup and view all the answers

What is the primary role of an ethics committee in nursing?

To provide a forum for discussing ethical dilemmas Signup and view all the answers

What is the primary focus of values clarification in ethical discourse?

To distinguish among value, fact, and opinion Signup and view all the answers

What is the primary goal of Step 3 in processing an ethical problem?

To examine personal values and principles Signup and view all the answers

Which ethical principle prioritizes doing no harm?

Nonmaleficence Signup and view all the answers

What is the primary distinction between moral distress and ethical dilemma?

Moral distress is a emotional response, while ethical dilemmas are cognitive Signup and view all the answers

What is the primary focus of the Code of Ethics for Nursing?

Nurse accountability and responsibility Signup and view all the answers

What is the primary focus of feminist ethics in healthcare?

Fostering empathy and care in healthcare relationships Signup and view all the answers

What is the primary goal of bioethics in healthcare?

To examine the ethical implications of healthcare decisions Signup and view all the answers

What is the primary role of a nurse in resolving ethical conflicts?

To clarify values and principles with patients and colleagues Signup and view all the answers

What is the primary purpose of a patient's health care record?

To provide a legal record of care Signup and view all the answers

What is the primary difference between an Electronic Health Record (EHR) and an Electronic Medical Record (EMR)?

An EHR is an individual's lifetime record, while an EMR is a record for a single healthcare visit Signup and view all the answers

What is the primary purpose of maintaining privacy, confidentiality, and security of healthcare records?

To protect sensitive patient information Signup and view all the answers

What is the basis for determining a patient's acuity level?

The type and number of medical interventions required by that patient over a 24-hour period Signup and view all the answers

What is the primary purpose of acuity rating systems in healthcare?

To determine hours of care and staff required for a group of patients Signup and view all the answers

Which organization has specific guidelines to establish eligibility for home care reimbursement?

Medicare Signup and view all the answers

What is the primary focus of standards and guidelines for quality nursing documentation?

Promoting complete and accurate documentation Signup and view all the answers

What is the primary purpose of documenting communication with providers and unique events?

To ensure continuity of care Signup and view all the answers

What is the purpose of documentation in the home care setting?

To justify reimbursement from Medicare, Medicaid, or private insurance companies Signup and view all the answers

What is a critical pathway?

An interprofessional care plan that identifies patient problems, key interventions, and expected outcomes within an established time frame Signup and view all the answers

What is the primary purpose of the American Recovery and Reinvestment Act (ARRA)?

To support the adoption of electronic health records Signup and view all the answers

What is a variance in the context of a critical pathway?

An unexpected outcome, unmet goal, or interventions not specified within a critical pathway Signup and view all the answers

What is the primary focus of the Health Information Technology for Economic and Clinical Health (HITECH) Act?

Promoting the adoption of electronic health records Signup and view all the answers

What is the primary purpose of flow sheets and progress notes in documentation?

To document patient assessment data Signup and view all the answers

What is the primary goal of health care information technology (HIT)?

To enhance quality and efficiency of care Signup and view all the answers

What is a clinical information system (CIS)?

An example of a computerized provider order entry (CPOE) system Signup and view all the answers

What is the primary purpose of charting by exception in documentation?

To document only abnormal or significant findings Signup and view all the answers

What is the primary focus of nursing informatics?

To integrate nursing science, computer science, and information science Signup and view all the answers

What is the primary goal of clinical decision support systems (CDSS)?

To aid and support clinical decision making Signup and view all the answers

What is the primary benefit of nursing clinical information systems (NCIS)?

Better information access, better documentation quality, reduced errors of omission, reduced hospital costs, and increased nurse job satisfaction Signup and view all the answers

What is the primary goal of patient education?

To help individuals, families, or communities achieve optimal levels of health Signup and view all the answers

What is the nurse's role in teaching and learning?

Nurses are legally responsible for providing education to all patients Signup and view all the answers

What is the process of understanding and applying newly acquired concepts?

Learning Signup and view all the answers

What is effective communication in teaching?

Effective communication involves feedback from the sender and receiver Signup and view all the answers

What is the purpose of patient education in health promotion?

To maintain and promote health and illness prevention Signup and view all the answers

What is the role of the nurse in patient education?

To help individuals, families, or communities achieve optimal levels of health Signup and view all the answers

What is teaching in patient education?

Imparting knowledge through a series of directed activities Signup and view all the answers

What is the primary focus of patient education?

Maintenance and promotion of health and illness prevention Signup and view all the answers

What is learning in patient education?

Process of understanding and applying newly acquired concepts Signup and view all the answers

What are the three main domains of learning?

Cognitive, Affective, and Psychomotor Signup and view all the answers

What is a key factor in motivation to learn?

All of the above Signup and view all the answers

In which setting do nurses have more time to identify patients' learning needs and provide comprehensive ongoing education?

Clinic, home care, and rehabilitation settings Signup and view all the answers

What is a key factor in readiness to learn?

Developmental capability Signup and view all the answers

What is essential for nurses to predict the topic and level of instruction required in patient education?

Knowledge of a patient's health condition and patient information gained from assessment Signup and view all the answers

What is a key consideration for nurses in an acute care setting?

Learning the resources a patient has as early as possible Signup and view all the answers

What is a key aspect of clinical judgment in patient education?

Predicting the topic and level of instruction required Signup and view all the answers

What is a key factor in the learning environment?

Physical capability Signup and view all the answers

What is essential for nurses to identify in an acute care setting?

Patients' learning needs Signup and view all the answers

What is the primary focus of the assessment phase in the nursing process?

Understanding the patient's learning needs and abilities Signup and view all the answers

Which of the following is a key aspect of building on existing knowledge and ability during implementation?

Reinforcing previously learned material Signup and view all the answers

Which of the following is an important consideration in instructional methods during implementation?

Considering the patient's literacy level and disability Signup and view all the answers

What is the primary focus of teamwork and collaboration in planning and outcomes identification?

Collaborating with the patient and healthcare team to establish outcomes Signup and view all the answers

Which of the following is a key aspect of cultural diversity in implementation?

Considering the patient's cultural background and values Signup and view all the answers

What is the primary purpose of using teaching tools during implementation?

To supplement verbal instruction with visual aids Signup and view all the answers

Which of the following is an important consideration in health literacy during assessment?

Considering the patient's ability to understand and apply health information Signup and view all the answers

What is the primary focus of incorporating teaching with nursing care during implementation?

Integrating patient education into nursing care activities Signup and view all the answers

Which of the following is a key aspect of maintaining learning attention and participation during implementation?

Building on existing knowledge and ability Signup and view all the answers

What is the main purpose of the teach-back method in evaluation?

To assess the patient's understanding of new information Signup and view all the answers

Study Notes

Communication and Nursing Practice

Communication is a lifelong learning process.
Competent communication maintains effective relationships within the entire sphere of professional practice and meets legal, ethical, and clinical standards of care.

Importance of Interpersonal Relationships

Caring relationships are at the core of nursing.
Being able to relate to others is important for interpersonal communication.
Therapeutic communication occurs within a healing relationship between a nurse and patient.

Developing Communication Skills

Nurses who develop critical thinking skills and clinical judgment make the best communicators.
Critical thinking applied during any patient interaction helps to overcome perceptual biases or stereotypes that interfere with accurately perceiving and interpreting messages from others.

Levels of Communication

Intrapersonal communication
Interpersonal communication
Small-group communication
Public communication
Electronic communication

Elements of the Communication Process

Circular transactional model
Referent
Sender and receiver
Message
Channels
Feedback
Interpersonal values
Environment

Forms of Communication

Verbal Communication

Vocabulary
Denotative and connotative meaning
Pacing
Intonation
Clarity and brevity
Timing and relevance

Nonverbal Communication

Personal appearance
Posture and gait
Facial expression
Eye contact
Gestures
Sounds
Territoriality and personal space
Metacommunication

Professional Nursing Relationships

Nurse-patient caring relationships
Motivational interviewing
Nurse-family relationships
Nurse-health care team relationships
Lateral violence
Nurse-community relationships

Elements of Professional Communication

Courtesy
Use of names
Trustworthiness
Autonomy and responsibility
Assertiveness

Nursing Process

Assessment

Through the patient’s eyes
Environmental factors
Physical and emotional factors
Gender
Developmental factors

Analysis and Nursing Diagnosis

Planning and outcomes identification
Outcomes
Setting priorities
Teamwork and collaboration

Therapeutic Communication Techniques

Active listening
Clarifying
Sharing observations
Focusing
Sharing empathy
Sharing hope
Sharing humor
Sharing feelings
Using touch
Using silence
Providing information
Paraphrasing
Validation
Asking relevant questions
Summarizing
Self-disclosure
Confrontation

Nontherapeutic Communication Techniques

Asking personal questions
Giving personal opinions
Changing the subject
Automatic responses
Defensive responses
False reassurance
Sympathy
Arguing
Asking for explanations
Approval or disapproval
Passive or aggressive responses

Building a Nursing Team

A strong nursing team works together to achieve the best outcomes for patients, requiring team building and training, trust, communication, and a collaborative workplace.

Empowered Teams

Empowered teams begin with the nurse executive, who demonstrates transformational leadership and servant leadership.

Magnet Recognition Program Standards

The Magnet Recognition Program standards for building a nursing team include:
- Shared decision making
- Leadership
- Safety
- Quality
- Well-being
- Professional development

Nursing Care Delivery Models

Nursing care delivery models include:
- Patient- and family-centered care
- Case management

Decision Making

Decision making in a nursing team involves:
- Shared governance
- Responsibility
- Autonomy
- Authority
- Accountability
- Staff involvement

Nursing Manager's Role

The nursing manager supports staff involvement through:
- Establishing nursing practice through problem-solving committees or professional shared governance councils
- Interprofessional collaboration among nurses and healthcare providers
- Interprofessional rounding
- Staff communication
- Staff education

Clinical Judgment in Nursing Practice

Nurses must make accurate and appropriate clinical decisions or judgments.
Clinical judgment is the observed outcome of critical thinking and decision making.
Clinical decision making separates professional nurses from technicians or other assistive personnel.

Models for Clinical Judgment

A model helps to explain the many variables involved in making decisions and clinical judgments about patients.
Critical thinking in nursing is complex and a model explains the variables.

Critical Thinking

Critical thinking is the ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process.
The aim of critical thinking is to focus on important issues in any clinical situation and make decisions that produce desired patient outcomes.

Critical Thinking Competencies

General critical thinking competencies include scientific method, problem solving, and decision making.
Specific critical thinking competencies include diagnostic reasoning and clinical decision making.

Levels of Critical Thinking

There are three levels of critical thinking: basic, complex, and commitment.

Components of Critical Thinking in the Clinical Judgment Model

The components of critical thinking in the clinical judgment model include competence, knowledge base, experience, and environment.

Critical Thinking Attitudes

Critical thinking attitudes include confidence, perseverance, thinking independently, fairness, responsibility and accountability, risk taking, discipline, and humility and self-awareness.

Evaluation of Clinical Judgments

Evaluation of clinical judgments involves reflection, meeting with colleagues, concept mapping, and critical thinking synthesis.

Ethics and Values in Nursing

Morals: Fundamentally held principles that guide behavior and decision-making
Value: Deeply held belief about the worth of an idea, attitude, custom, or object that affects choices and behaviors
Bioethics: Ethics related to healthcare and biological sciences
Autonomy: Respect for an individual's right to make decisions about their own life
Beneficence: Doing good and promoting the well-being of others
Nonmaleficence: Avoiding harm or injury to others
Justice: Fairness and equal distribution of benefits and risks
Fidelity: Loyalty and faithfulness to others

Professional Nursing Code of Ethics

Code of ethics: Set of guiding principles that all members of a profession accept
Code of Ethics for Nursing: Key principles include:
- Advocacy
- Responsibility
- Accountability
- Confidentiality

Values Clarification

Values clarification: Distinguishing among value, fact, and opinion to resolve ethical conflicts
Importance of values clarification: Understanding one's own, patients', and coworkers' values to facilitate ethical discourse

Approaches to Ethics

Deontology: Focus on duties, obligations, and rules
Utilitarianism: Focus on maximizing overall happiness and well-being
Casuistry: Focus on case-by-case analysis
Feminist ethics: Focus on gender and power dynamics
Ethics of care: Focus on empathy, compassion, and relationships

Nursing Point of View

Types of ethical problems:
- Ethical dilemma
- Moral distress
Ethics committees: Organized groups that provide guidance and support for ethical decision-making
Processing an ethical problem:
- Step 1: Ask if it's an ethical problem
- Step 2: Gather relevant information
- Step 3: Identify ethical elements and examine values
- Step 4: Name the problem
- Step 5: Identify possible courses of action
- Step 6: ... ( incomplete information)

Documentation

Documentation is a key communication strategy in healthcare that produces a written account of patient data, clinical interventions, and patient responses.
It is available to all members of the healthcare team and allows others to track a patient's clinical course.

Purposes of the Health Care Record

Facilitates interprofessional communication among healthcare providers.
Provides a legal record of care.
Provides justification for financial billing and reimbursement of care.
Supports quality and performance improvement.
Serves as a resource for education and research.

Interprofessional Communication within the Medical Record

Legal documentation.
Reimbursement, including diagnosis-related groups.
Auditing and monitoring.
Education.
Research.
Shift to electronic documentation using Electronic Health Record Systems (EHRS) and Health Information Technology for Economic and Clinical Health Act (HITECH).
Electronic Health Record (EHR) is an individual's lifetime computerized record.
Electronic Medical Record (EMR) is the record for an individual health care visit.

Maintaining Privacy, Confidentiality, and Security

Protected Health Information (PHI) must be maintained with privacy, confidentiality, and security mechanisms.
Firewall and password protection are examples of security measures.
Handling and disposing of information must follow procedures, including policies for the use of fax machines.

Standards and Guidelines for Quality Nursing Documentation

Guidelines for quality documentation include being factual, accurate, appropriate use of abbreviations, current, organized, and complete.
Standards for quality documentation must be followed.

Methods of Documentation

Documentation methods include flow sheets, progress notes, and charting by exception.
Patient assessment data must be documented accurately.

Common Record-Keeping Forms within the Electronic Health Record

Admission nursing history form.
Patient care summary.
Care plans.
Discharge summary forms.

Documenting Communication with Providers and Unique Events

Telephone calls and verbal orders must be documented.
Incidence or occurrence reports must be documented.

Acuity Rating Systems

Acuity rating systems are used to determine hours of care and number of staff required for a group of patients.
Patient's acuity level is based on the type and number of nursing interventions required over a 24-hour period.

Documentation in Long-Term Health Care Settings

Governed by individual state regulations, The Joint Commission (TJC), and Centers for Medicare and Medicaid Services (CMS).

Documentation in Home Health Care Settings

Medicare has specific guidelines for establishing eligibility for home care reimbursement.
Documentation is quality control and justification for reimbursement from Medicare, Medicaid, or private insurance companies.
Nurses use OASIS and Omaha system data sets to document clinical assessments and care provided in home care settings.

Case Management and Use of Critical Pathways

Case management model incorporates an interprofessional approach to delivery and documentation of patient care.
Critical pathways are interprofessional care plans that identify patient problems, key interventions, and expected outcomes within an established time frame.
Variances are unexpected outcomes, unmet goals, and interventions not specified within a critical pathway.

Informatics and Information Management in Health Care

Health care information technology (HIT) enhances quality and efficiency of care.
Health care information system (HIS) includes clinical information systems and administrative information systems.
Clinical information system (CIS) is an example, including computerized provider order entry (CPOE).
Nursing clinical information systems (NCIS) have two designs: nursing model and critical pathway, with advantages including better information access, better documentation quality, and reduced errors of omission.
Clinical decision support systems (CDSS) aid and support clinical decision making.

Patient Education

The primary goal of patient education is to help individuals, families, or communities achieve optimal levels of health through maintenance and promotion of health and illness prevention, restoration of health, and coping with impaired functions.

Teaching and Learning

Teaching involves imparting knowledge through a series of directed activities.
Learning is the process of understanding and applying newly acquired concepts.
Nurses are legally responsible for providing education to all patients.

Domains of Learning

There are three domains of learning: cognitive, affective, and psychomotor.

Basic Learning Principles

Motivation to learn is a key factor, and nurses can use theories to enhance motivation and learning.
Cultural factors, active participation, and readiness to learn are also essential.
Ability to learn depends on developmental capability, physical capability, and learning environment.

Clinical Judgment in Patient Education

Nurses should use their knowledge of a patient's health condition to predict the topic and level of instruction required.
In clinical settings, nurses have more time to identify patients' learning needs and provide comprehensive ongoing education.

Nursing Process

Assessment

Assessment involves identifying learning needs, motivation to learn, readiness and ability to learn, environmental factors, resources for learning, and health literacy.

Analysis and Planning

Analysis involves identifying nursing diagnoses, and planning involves setting outcomes, priorities, and organizing teaching material through teamwork and collaboration.

Implementation

Implementation involves maintaining learning attention and participation, building on existing knowledge and ability, and using various teaching approaches such as telling, participating, entrusting, and reinforcing.
Nurses can use instructional methods like verbal one-on-one discussion, group instruction, preparatory instruction, demonstrations, analogies, and simulation.
Other considerations include cultural diversity, using teaching tools, and special needs of children and older adults.

Evaluation

Evaluation involves assessing patient outcomes, using teach-back methods, and identifying areas for improvement.

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Description

This quiz covers the fundamentals of communication in nursing practice, including effective relationships and legal, ethical, and clinical considerations.