Nursing Communication Essentials

• Mrs. Hood recommended reviewing ATI activities for the exam.

Communication

• Communication: A process where messages are sent and received using words, sounds, expressions, body movements, and behaviors.
• Communication is a basic element of human relationships and occurs at different levels.
• Intrapersonal: self-talk.
• Interpersonal: involves two or more people.
• Group: communication within a group.
• Public speaking: addressing a larger audience.

Communication Process

• Sender: the individual or group conveying a message, decides how to relay the message through encoding, including words, tones, and gestures.
• Message: Information communicated by the sender.
• Receiver: the listener, responsible for interpreting the message through decoding.
• Feedback: response from the receiver to the sender, validating that the message was received.

Modes of Communication

• Verbal communication involves both the pace/rhythm and intonation/feeling of the message.
• Vocabulary should use medical terminology.
• Clarity means saying exactly what is meant.
• Brevity means using as few words as possible.
• Time and relevance should be considered.
• Adaptability is required to alter responses based on client cues.
• Credibility is being truthful, trustworthy, and reliable while ensuring body language aligns with words to avoid false reassurance.
• Humor can be positive but use it with care.
• Electronic communication via social networking means do not share patient information, maintain nurse-patient boundaries, no pictures/videos, avoid disparaging remarks, and promptly report confidentiality or privacy breaches.
• Non-verbal communication includes personal appearance, posture and gait, facial expression (surprise, fear, anger, disgust, happiness, sadness), gestures (helpful or harmful), and touch.

Factors Influencing Communication

• Developmental variations and gender affect the communication process.
• Males are purpose-driven, goal-oriented, focus on task information and independence, seeking a higher rank hierarchy.
• Females aim to form a connection/relationship while conveying messages.
• Sociocultural factors mean take cultures, values, and perceptions of relevance into account.
• Personal space and territoriality should be respected in patient rooms.
• Roles and relationships, as well as the environment, are factors too.

Therapeutic Relationship

• Pre-interaction Phase: happens before meeting the client where a review of available data (diagnosis, history, shift report) takes place, colleagues are consulted, and concerns are anticipated.
• Introductory Phase: Involves introducing oneself, setting a positive and empathetic tone, assessing health status, prioritizing problems and goals, clarifying roles, and informing the patient when to expect the relationship to end.
• Working Phase: involves empathetic listening and responding, respect, genuineness, concreteness, and techniques like reflecting, paraphrasing, clarifying, and confronting.
• Termination Phase: Involves reminding the patient that termination is near, evaluating goal achievement, and separating from the patient by relinquishing responsibility for care while ensuring smooth transitions to other caregivers.

Developing Therapeutic Relationships

• Empathy: Understanding the patient’s feelings by relating to their experiences.
• Respect: Valuing the client as an individual.
• Genuineness: Being authentic and sincere.
• Concreteness: Being specific and clear in communication.
• Confrontation: Addressing discrepancies in the patient’s behavior or statements.
• Sympathy: Feeling sorry for the patient but not relating to their experience

Therapeutic Communication Techniques

• Involve addressing the patient, active listening, establishing trust, assertiveness, restating/clarifying/validating, interpreting body language, exploring issues, silence, and summarizing conversations.
• Barriers to communication involve asking too many/ closed-ended questions, "fire-hosing" information, asking "why," changing the subject, failing to probe, expressing approval/disapproval, offering advice, false reassurance, stereotyping, and using patronizing language ("elderspeak").
• When enhancing communication with patients, use in-house translator for different cultures, non-verbal communication for impaired speech, short sentences and patience for impaired cognition, and nonverbal cues for hearing impairments.
• Remaining calm/gentle, using a quiet/friendly tone, simple language, honesty while preparing children for the expected can help communicate with children and adolescents along with speaking at the child's eye level.
• Maintaining a quiet environment, being attentive, avoiding subject shifts, skipping elderspeak, allowing plenty of response time and reminiscence helps in communicating with older adults.
• The nurse-client relationship is built through the nurse's use of scientific knowledge, understanding of human behavior, and commitment to caring, and doesn't just happen automatically as it takes work through care, scale, and therapeutic communication.
• The goal is to help clients manage their problems, empowering them to help themselves.
• Defined as making an entry on a client record, is also called recording or charting.
• A client's record/chart is confidential, permanent, and a legal document, and documentation must be done because "not charted? Not done!" which provides evidence of care, reflects patient status and incident reports should not be charted in the record. When documenting:
• Do not erase, use correction fluid, or scratch out entries.
• Avoid critical remarks about patients or healthcare professionals.
• Write a "late entry" if you forget to chart something.
• Leave no blank spaces in nursing notes, record legibly with black ink.
• Note when clarification was sought for orders, chart only for yourself.
• Skip generalities (“status unchanged", or "had a good day").
• Open each entry with date/time, sign with title, and secure charting passwords.

Confidentiality

• Confidentiality is a Legal/ ethical obligation and requires keeping patient information private with HIPAA; protected patient privacy for health information, written material in student clinical practice should not have patient identifiers, access to electronic medical records is traced through login information, and record information of other patients.
• Recording guidelines:
• Date/Time: Use military time for clarity.
• Timing: Record ASAP while following agency frequency policies.
• Legibility: Write clearly.
• Accepted: Use approved abbreviations/symbols.
• Spelling: check "look alike, sound alike" medications.
• Signature: Include credentials.
• Accuracy: chart facts, not interpretations.
• Sequence: Document events in order.
• Appropriateness: Record relevant client health problems.
• Completeness: Utilize the nursing process.
• Conciseness: Be brief.
• The Joint Commission enforces a "Do Not Use" list.
• Communication considerations: Hand-off communication when patients transfer, and communicate verbally/written encompasses nursing care, promoting continuity of care.
• Change of shift report should be oral, written, or audiotaped reporting, background info, health problems, significant data (no gossip), STAT/PRN meds, and changes in medications, treatments, procedures, or discharge plans and the SBAR tool involves Situation, Background, Assessment, and Recommendation.
• Telephone communication needs data preparation, SBAR format, documenting caller/receiver, documenting the message, reading back information/orders and telephone orders should be written and read back, as well as labeled (TO or VO).

Oxygenation

• The right lung has three lobes, while the left has two.
• Terms to know:
• Ventilation: Air moving in and out of the lungs.
• Respiration: Exchange of oxygen and carbon dioxide, with involvement of the alveolar capillary/capillary cell membrane.
• Oxygenation: Oxygen entering the bloodstream.
• Perfusion: Oxygen reaching the tissues.
• Breathing control:
• Involuntary but can be voluntarily overridden by the motor cortex for activities like talking.
• Chemoreceptors detect pH, O2, and CO2 changes; Lung receptors are sensitive to breathing patterns, and CO2 levels.
• Factors affecting ventilation:
  • Rate - Tachypnea: >20 breaths/min; Bradypnea: <12 breaths/min
  • Depth, Lung Compliance, and Airway Resistance.
• Affecting ventilation and lung function:
  • Stages of development, air quality, stress, allergic reactions, chronic conditions (COPD), pregnancy, smoking, and medications.
  • Respiratory Infections: Viral or bacterial (upper like colds/influenza and lower infections )
• Respiratory Infections cause sputum increase that needs treatment: deep breathing, coughing, hydration, and suctioning.
• Lifespan/developmental considerations: Prematurity (inadequate surfactant) and Infants (small chest, rapid rate, risk of infection) and Young children(risk for obstruction) and Older Adults (diseases, trouble coughing, declining immunity).
• Assessing oxygen status:
• Physical examination is a respiratory effort and pulse which is 95-100%.
• Use inspection, palpation, percussion, and auscultation with breathing patterns: eupnea, tachypnea, bradypnea, apnea, stridor, Kussmal's, Biot's, and Cheyne-Stokes.
• Hypoxemia signs: Tachypnea, tachycardia, restlessness, pale skin, elevated BP and late signs are stupor, cyanosis, bradypnea, bradycardia, hypotension.

Assessing Oxygenation

• Diagnostic Testing: include sputum/TB testing and pulse oximetry, capnography.
• Incentive Spirometry: exercises lungs, especially post-op.
• Arterial Blood Gases (ABGs): measures O2/CO2 levels via arterial draw.
• Peak flow monitoring: Measures exhaled air force used to manage asthma.
• Promoting Respiratory Function: with turning, coughing, and deep breathing, frequent position changes to prevent pooling and preventing aspiration in at-risk patients.

Health Promotion

• Patient Education: focuses on smoking cessation, managing stress/anxiety, and dietary changes.
• Modification to environments, like avoiding secondhand smoke/perfumes.
• Yearly flu vaccine for adults/children over six months, especially recommended for at-risk groups.
• Pneumococcal vaccine: over 65, chronic diseases, and pregnant women with healthcare consultation prior.
• Incentive Spirometry for exercises lung for bedbound or post-op patients every 1-2 hours involving secured the mouth around mouthpiece for deep breaths through mouth.
• Altered Airway Clearance
• Impaired Gas Exchange
• Impaired Spontaneous Ventilation
• Dysfunctional Ventilatory Weaning Response
• Risk for Aspiration.

Interventions for Optimal O2

• Involve administering medications, using ventilators, chest tubes, and promoting respiratory function which prevents pneumonia with immunizations and smoking cessation.
• Positioning, incentive spirometry, precautions, and mobilizing secretions through coughing/hydration/chest physiotherapy; supplementing with oxygen therapy if oxygen falls below 95% should be done via delivery devices.
• FiO2 refers to the fraction of inspired oxygen. Its normally at room air, or supplemented.
• Room Air FiO2: 21%
• 1L/min=24%
• 2L/min=28%
• 3L/min=32%
• 4L/min=36%
• 5L/min=40%
• 6L/min=44%
• Low Flow Oxygen Delivery: e.g., nasal cannula (easy to eat/talk), simple face mask (not easy to eat), and non-rebreather (does not rebreath CO2).
• High Flow Oxygen Delivery: e.g., Venturi mask and trach collar.
• Oxygen delivery systems deliver varying levels of oxygen.
• Low flow systems: Nasal cannula, simple face masks, and rebreather masks.
• High flow systems: Venturi masks, aerosol face masks, and face tents with up to 100% FiO2.
• Oxygen Delivery Tips:
• DO NOT allow smoking or open flames.
• Humidified air can reduce nosebleeds when using a nasal cannula.
• Oxygen Toxicity results from high concentrations of oxygen, long durations of oxygen therapy, and lung disease which the least amount of oxygen needed to maintain SpO2. Decrease FiO2 as SpO2 improves using weaning.

Artificial Airways

• Oropharyngeal: used in unconscious patients.
• Nasopharyngeal: used in semiconscious patients.
• Endotracheal/ Tracheostomy Tubes.
• Artificial Airway Patency: through Suctioning.
• Suctioning removes secretions.
• Pt needs Suctioning if there is gurgling sounds, restlessness, labored breathing, decreased saturation, increased heart/respiratory rates, and breath sounds.
• Medications affect the respiratory system, lowering respiratory rate (call if RR < 12) with medications like opioids, and pain medications.
• Use other medications (bronchodilators, anti-inflammatory agents, suppressants, decongestants, and antihistamines) to improve respiratory function.

Key Respiratory Points

• Maintaining an open airway should be high priority!
• Use appropriate oxygen interventions.
• Recognize signs of poor oxygenation (hypoxia)
• What gas provides the drive to breathe?
• Follow airway, breathing, circulation (ABCs)

Psychosocial Wellbeing: Culture, Spirituality, Grief, Loss, Death and Dying

• Culture means understanding the group and acting with values, thoughts, and actions.
• Beliefs include customs, traditions and religions, but does not include race or ethnicity and geographical roots.
• Ethnocentrism: Thinking that one's culture is superior.
• Biases/Prejudice: having negative associations with different people.
• Remember to:
• Avoid stereotypes, advocate for your patient, respect cultural background/practices, and plan/provide safe, effective, and culturally sensitive care. Show awareness to:
• Cultural values, patient requests, dietary needs, avoid judging, and watch body language.

Assessing Cultures 4 C's

• What do you CALL the issue?
• How do you COPE?
• What are your CONCERNS?
• What CAUSED it?
• Include OLDCARTS and ask about fears and religious practices.

Special Considerations

• Life events may hold significant value, such as end-of-life, prayer, surgery, and end of life procedures.

Communication

• Be aware of non-verbal cues, the time/place, belief practices and grieve the loss.
• Acknowledge death rituals and allow them to grieve.
• Clear communication & teach back tools are essential during patient teaching.
• Use hospital translators where needed

Spirituality

• Unique, a state of being with belief in God by thinking of:
• Meaning of purpose
• Values: beliefs and standards
• Transcendence: beyond oneself
• Connecting: relating to others
• Spiritual health and wellbeing is feeling alive and fulfilled, as wellness as the lifestyle.
• Assess spirituality by asking questions such as:
• "Are there religious practices important to you?"
• "Has being sick interfered with your religious practices?",
• "How is your faith helpful to you?",
• "Would you like a visit?",
• "What comforts you during hard times?”
• Ask open-ended questions.
• Spiritual distress: impaired ability and integrates meaning while illness involves may view it as punishment.
• Knowledge involves patients' faith, culture, your own beliefs, and values will aid care.

Stage and Development

• Identity v. Role Confusion:
• Reflects on inconsistencies in stories
• Begins to question spiritual practices
• Forms own opinions
• Discards parents’ beliefs
• Abstract reasoning leads to exploration of moral issues
• Intimacy v. Isolation:
• Establishes self-identity and world view
• Forms independent beliefs, attitudes, and lifestyles
• Uses principles to solve problems when individual’s and society’s rules conflict
• Generativity v. Stagnation:
• Develops appreciation of past spiritual experiences
• Embraces people from different faiths/religions
• Reviews value system during crisis
• Values others
• Ego integrity v. Despair:
• Values love and interactions with others
• Focuses on overcoming oppression/violence
• Beliefs vary based on: gender, past experiences, religion, economic status, ethnic backgrounds
• Trust v. Mistrust:
• Spiritual well-being provided by parents:
• Trust provides basis for: hope
• Love
• Affection
• Security
• Autonomy v. Shame & Doubt:
• Fascination with magic and mystery
• Believes illness from bad behavior
• Learns difference btw right and wrong
• Imitates parents’ spiritual/religious actions
• Recites prayers but does not understand,
• Interprets meanings literally
• Initiative v. Guilt:
• Feels guilty when not acting responsibly
• Influenced by spiritual/religious stories/examples
• Models moral behaviors of parents
• Begins to about God or supreme beings
• Industry v. Inferiority:
• Wants to learn about spirituality
• Has a clear picture of God, morality, and difference between right and wrong
• Sorts fantasy from fact

Spiritual Beliefs and Healthcare

• Beliefs include Complementary and alternative medicine, blood products, rituals, traditions and values.
• In Judaism: no organ transplants accepted but kosher diet (no pork, some seafood), and fasting is followed.
• Christianity has many denominations, no specific diet, but fasting and prayer is okay, organ donations are accepted.
• Catholics participate in Anointing/Confession, communion and priest visits should there be sickness .
• Christian Science believes illness is faulty and avoids tobacco/alcohol which consent to treat kids and may refuse adult treatments.
• If refusing, get ETHICS consulted if lifesaving to the child.
• Jehovah's Witness refuses blood products or blood transfusions and organ transplants containing blood, as well as meat (raw or red) and tobacco.
• Mormons have sacred garments worn at all times which must avoid tea, coffee, alcohol and tobacco.
• Seventh Day Adventists have Saturday sabbath, refuse euthanasia and recommend vegetarian diets.
• Islam: They usually refuse organ transplants, do not eat pork( halal meat) and fast, wash hands before and women prefer female caregivers as well women may wear a locket to protect which avoid birth control.
• Hindus: There may be no meat and fasting as well accept contraception, and blood transfusions.
• It is important to know that women prefer care and jewelry is religious.
• Buddism: It is vegetarian with exceptions to contraception and organs for transplants as active euthanasia is avoided.
• Native American Religions: In value the silence and note taking and the treatment/women and medicine healthcare. rastafarianism: Can't be clothing refues gown, no sea food and blood tranfusuons, they all have reasurrance
• Atheism have values with focus on humanism.

Grief and Loss

• Loss occurs when values are rendered inaccessibly with family or dependce.
• Actual Loss is loss of touch,near and identified by
• Loss of experience, Perceived by a individual and cant be verifiied has diagnosis and hypersension by others
• Grief is varied and natural, its important: Commonly emotions and behaviours with sorrows sadness and lonlieness.
• Complicated about 6 month after becoming debilitating
• Anticipatory, Experience before something happens ex grie ing with fam
• Disenframched: Experiences a loss with acknowledgement.
• Kubler-Ross involved denial of losing, anger, bargaining time, depression and future plans.
• Spiritual Beliefs: is life after death.

Factors if Death and Dying

• Include Spiritual Beliefs, comfort Measures, Dying(pallative or END of life)
• Physiologial symptoms with Irregularbreathing mucus, Hypotension, NAUSE, Altered
• As Nurse help and focus trwating support, provide comfortable family and treat syptos; let dyingeat provide comfort for family and make sure to donate to other patients.
• Make sure pt wishes are granted
• Requests are private
• Autopsy: can can by homnacide with to remain and finish documentation
• Pallative care: is end of life when other medicine doesnt work.
• Comfort and emphaizes family patient _Nurisng is death anxiety,spiritual and less effective.

Aging

• They are alert, and perceptive in what they do like eating and drinking. _cognitive_Dementias for those.
• Pylmomary and gaster
• They need to go slow.
• Be there for time being with.
• Keep them from being distracted, and ask if they are cold.
• Let there be light, and assist with every

Key Points

• Respect their choices because their body, and the right to refuse but make sure they are well advised on what can happen.
• Make sure that what they choose comes with safe and compassion.
• We have to be culturally competitive for family and friend as holistics in volueme on table
• Volume in table with davos.

Health

• Has everything together as physical and social
• Emotional: is understanding those emotions with help as they use to manage.
• Intelltectual: is good communication skills.
• Spitiual:
• Occpataitla: Enjoy and give to good.
• Social: Perform well,skills.
• Physical: Prevent illness and eat well.
• Be safe so have safety.

Maslow's Need and Hiearchy

• Safety if physical and PhyscoLogical.
• love with family.
• SE; Self-esteem with competence recognition.
• Sa; MAxium Potencial for some peopple.

Primary

• Illiness prventioj. Secondry: is early.
• Tertary : is a decline support

Lifestyle

• Be smart and scree n often
• 3-5 up to 40
• Anual After 40.
• dental are montly.
• Exam - is 2 with fam and without.
• Testicular- is 15, and routine check up at 20.
• Breast and anuy at 20

##Lung Assesment

• Less than 90 is ensympa
• C7 is where lungs start
• Refernce the 4.
• Lung- is Exhale if to depend
• Apex is 3-w on vclav
• Has two.

Assess,s,

• Has the ph 7.
• Has.pule ox.

Terms

• Dysnpe
• Rjthpe a
• Apen
• To take to much fluide out.
• Has to do this.
• Has tb sking.
• Has . _bronsh- pt us asleep.
• Ex.
• They can b.

They

• Have asthma
• Have congestio _vesci-.