Show
Why you should read this article:
Nurses are often faced with situations in their practice where they have to break bad news to patients and their families. Such conversations are complex and can be challenging for all parties. It is essential that nurses are equipped with the skills required to manage such situations effectively to ensure optimal outcomes and quality of care for patients and their families. This article discusses some of the barriers to breaking bad news effectively to patients and the communication skills required to engage in challenging conversations. It also describes two mnemonic protocols that can be used by nurses to structure challenging conversations with patients face to face and over the phone. Nursing Standard. doi: 10.7748/ns.2022.e11898 Peer review This article has been subject to external double-blind peer review and checked for plagiarism using automated software @AbyAbymitchell Correspondence
Conflict of interest None declared Mitchell A (2022) Breaking bad news. Nursing Standard. doi: 10.7748/ns.2022.e11898 Published online: 22 August 2022 Want to read more?Already subscribed? Log inORUnlock full access to RCNi Plus todaySave over 50% on your first 3 monthsYour subscription package includes:
Subscribe RCN student member? Try Nursing Standard StudentAlternatively, you can purchase access to this article for the next seven days. Buy now Or which context factor influencing communication is a problem resolution to be categorized as Situational - situational context involves the reason for communication, which in this case is problem resolution Which communication technique is the nurse using when stating “I see you haven’t eaten anything” while taking a patient’s hx Sharing observations - involves nurse making observations on how the other person looks/sounds/acts Situational context factors (these are the reason for communication) Which zone of personal space would the nurse be using when holding an inconsolable infant Which communication strategy would the nurse use when caring for a pt who is unresponsive Call pt by name during interactions; provide orientation to person, place, time; articulate to the pt as though the pt can hear Which communication technique is the nurse exhibiting when stating “I’m so very sorry about your condition; you must be devastated after your surgery” Showing sympathy - non therapeutic technique showing concern, sorrow, or pity for another person Which pt would benefit from the use of a picture that mimics the desired action Which skill would facilitate attentive listening while interacting with the pt? Sit at an angle facing the pt; maintain intermittent eye contact; be relaxed & comfortable Which type of communication pattern would be exhibited when the nurse observes and acknowledges a pts verbal and nonverbal indications of stress and prompts the pt to elaborate on these feelings Meta communication - broad term that refers to all factors that influence communication; involves being aware of influencing factors and helping people better understand what is communicated Which communication skill would the nurse use during the assessment phase of the nursing process? Verbally interview and ask for a hx; visually observe for nonverbal behavior; gather data during a physical examination Involves recognizing patient’s opinions when they conflict with the nurse’s opinions, reviewing positions, and finally determining how to communicate to reach mutually beneficial decisions Which strategy would be contraindicated while communicating with a patient who has cognitive impairment Offer detailed explanations while asking questions - nurse should use simple sentences and avoid long explanations Which statement by the nurse represents “background” when using SBAR (situation-background-assessment-recommendation) ”the patient has a history of CHF” - background refers to pt background such as past pertinent hx Which approach is likely to be effective when communicating with a Spanish-speaking patient who has a hand fracture Assessing pts level of fluency in English; incorporate pts communication methods; provide written info in both English & their primary language Which factor influences the relational context of communication Balance of power & control; shared history of participants Which element of the communication process is the pt displaying when frequently nodding & saying “i see” as the nurse explains steps of a process Feedback - verbal and nonverbal messages the receiver sends Which type of communication technique is represented when the nurse asks cancer survivors to share their stories on how they went through treatment and how their family members supported them Narrative interaction - sharing personal stories What activity does the nurse carry out while maintaining a zone of personal distance Teaching or educating a patient (personal zone is 18-40 inches) Which term describes the use of the word basketball in a conversation about a basketball game in which both the nurse and pt are referring to the sport Denotative - a word that has the same meaning for all people who speak the same language Influenced by thoughts, feelings, or ideas of individuals and means different things to different people Which technique would the nurse use to develop trust Treat pt with respect; answer pt honestly; display consistent behavior with them Helps nurses deal with criticism and manipulation by others, and learn to say no, set limits, and resist intentionally imposed guilt. Assertive messages contain “I,” not “you” Which situation is typical regarding lateral violence Colleagues using badmouthing, nasty remarks, or nonverbal expressions of disapproval Which action would the nurse perform for easy communication with a pt who has aphasia Ask mainly questions that require simple responses like yes/no Which communication strategy would the nurse use when caring for an older pt who is visually impaired speaking in a normal tone of voice; check for use of glasses/corrective lenses; use at least 14-point typed font What message would the horse who is keeping arms and legs uncrossed during conversation portray to the pt Nurse is open to what the patient says Which action performed by the nurse indicates the working phase of the helping relationship Encouraging and helping the pt set goals; take actions to help them meet these goals; help pt express feelings Assessing health status of the patient and making inferences about the pt messages and behaviors Nurse anticipates health concerns or issues during this phase - prior to actually meeting but after reading chart Which statement by the nurse illustrates the technique of sharing hope “You are a fighter and I believe you can find a way to face this” Which nursing action is involved in the termination phase of the nurse-patient relationship for a pt with diabetes Evaluate whether the pt has achieved the goal of maintaining normal sugar levels - evaluate goal achievement Which question would be most relevant when nurse is seeking more specific info about an area Open-ended & focused questions…example “how has pain affected your life at home” Which strategy would the nurse use to communicate with patients who are cognitively impaired Ask one question at a time; use simple sentences and avoid long explanations; use pictures or gestures that mimic the action desired Arrange steps in sequence of phases, first to last, that characterize nurse patient relationship, for a pt who is obese 1) review pt for family hx of obesity Which technique would the nurse use to address lateral violence Directly ask for the abuse to stop Acknowledge, Introduce, Duration, Explain, Thank You Which communication technique would the nurse use when communicating with a hearing impaired patient Reduce environmental noise; face pt with mouth visible; check pt for hearing aids Which statement by the nurse indicates a correct understanding of personal zones of space and touch I should be in personal zone while counseling a patient (18-40 inches); speaking at a community forum involves the public zone (12+ feet); ask for permission when assessing any body part (consent zone/intimate zone 0-18 inches) Initial step the nurse should take if lateral violence occurs in the workplace Start by informing manager to obtain support Aspects of verbal communication which improve effectiveness Pacing of speech, intonation, vocabulary Which message does the nurse convey to a pt when sitting at an angle facing the patient Nurse is interested in what pt is saying Which pt could be most challenging to communicate with Someone who states loss of interest in things they care about & communicates feelings of emptiness - may create challenges in decision making Which nursing intervention is appropriate for communicating with a visually impaired patient Use reading material with at least 14 font Which communication technique is the nurse using when they comments on positive aspects of a patients behavior and response Which distance of personal space is involved when giving a verbal report to a group of nurses 9 feet (social distance 4-12 feet) Which zone of personal space is involved when the nurse is instructing visitors in the hallways to be quiet Nurse needs permission to touch pts mouth, wrist, and feet 5 phases of nursing process Assessment, diagnosis, planning, implementation, evaluation Nurse compares actual and expected outcomes and identifies any factors affecting outcomes Interventions to be performed when speaking to pt with varying degrees of hearing loss Speak slowly & clearly; check for hearing aids; make pt aware while talking Message the receiver returns that indicates understanding Speaking to patients through interpreters Very important to look at and speak directly to patient Where is the most therapeutic place for the nurse to sit when taking pts health hx 18 inches-4 feet away (personal zone) How should nurse respond when pt suddenly becomes quiet after discussing heavy information Allow the pt to break the silence because they initiated it When asking about something such as abdominal pain, the nurse should use which method of effective communication Appropriate intonation; properly paced statements; clear and concise phrasing; open ended questions for description from pt Regarding professional approach in communication, the way one responds to a question or situation indicates state of mind. Some supporting examples are Passive responses serve to avoid conflict and sidestep issues; aggressive responses provoke confrontation; assertive responses are a more professional approach Which measures would the nurse adopt to ensure effector communication when caring for a non English speaking pt Understand cultural and language differences; avoid interpreting based on personal cultural beliefs; provide written info in pts primary language; speak directly to pt even when using interpreter Elements of nonverbal communication to consider when establishing a nurse-patient helping relationship Posture shows confidence, positive attitude, and sense of well being; eye contact shows respect and willingness to listen The nurse asks another how to collect a specimen; they respond with “why don’t you figure it out.” How should the nurse respond to this lateral violence “When you brush me off like that, it takes me even longer to do my job” - use assertive communication Which therapeutic communication technique would the nurse apply in attending to an agitated pt Listen actively; share empathy; ask relevant questions. These techniques encourage pt to express ideas and feeling openly Which strategy would the nurse use when communicating with a patient who has difficulty speaking because of injuries from facial trauma Communicate directly to the patient - helps nurse assess pts ability to interact and respond; review medical records to assess level of sensory loss; listen patiently while the patient speaks - makes them more comfortable with difficult communication Active listening includes Establishing eye contact; sit facing the patient; lean toward the patient; be relaxed while communicating Method of confrontation as therapeutic means Should be done gently & only after establishing trust; improves pt self awareness; helps pt become aware of inconsistent feelings…by confronting pt in therapeutic way, nurse helps the pt become more aware of inconsistencies in their feelings, believes etc Pt diagnosed with terminal cancer has come to see nurse with her daughter and husband to talk about diagnosis. Which action would the nurse take? Inform the patient about palliative care. Family being present with her is fine Which nursing interventions help to establish a therapeutic relationship while working with a patient to solve problems and accomplish goals Encouraging and helping pt set goals; taking action to meet those goals set with patient; providing info needed to understand and change behavior A patient states she gets anxious when she thinks about giving herself insulin. Which approach to intrapersonal communication would help Coach the pt to give herself positive messages about ability to do this (key word is intrapersonal) What are some non therapeutic techniques which should be avoided when talking with patients Giving false reassurance; responding aggressively; asking for explanation (can be perceived as hostile or judgemental) Which strategy maintains good interpersonal communication Being authentic; take initiative in communicating; respond appropriately to others Sitting with arms and/or legs crossed indicates When a patient may not seem to understand verbal instructions, what should be done Restate/rephrase the sentence the patient didn’t understand; don’t repeat it exactly Restating another’s message briefly using one’s own words. Take care not to distort or change the meaning of their message When giving report to charge nurse, nurse refers to pt as “room 31.” What is inappropriate about this Referring to pts by name is important; it is inappropriate to refer to them by room number or diagnosis Exploring pt feelings about issues occurs during ___ phase Socializing is used during the ___ phase to get acquainted and establish trust pt reports cough for 3 days that’s getting worse. the nurse says “tell me about your cough.” Pt says he “wishes I could. You tel me what’s wrong!” Which response would enhance communication Response should validate pts info, relay empathy, and seek further knowledge. Example could be “after 3 days, your cough has gotten worse. Have you also had a fever?” Indirect communication which has a strict healing effect on pts; examples include use of music to instill joy or peace Observable examples of speech and behavior which might lead the nurse to conclude pt has difficulty communicating Inappropriate verbalization; inability to articulate words; difficulty comprehending Which phase of helping relationship involves activities such as reviewing available medical & nursing history of a patient A patient has been told she has cancer and is crying. Which actions facilitate therapeutic communication Creating environment of privacy; sitting quietly and holding her hand (presence & touch convey caring and compassion); offering to discuss relevant info can help tell people what they want or need to know. “Why are you crying” or similar why questions may seem intrusive and block communication Which level of communication is exhibited by the nurse performing a mental rehearsal on how do you deal effectively in difficult situations with increased confidence?Intrapersonal communication involves developing self-awareness and self-esteem that enhances appropriate self-expression. This level of communication is also called self-talk and may involve a mental rehearsal to deal effectively with difficult tasks or situations with increased confidence.
What are the four types of communication in nursing?This includes using verbal and nonverbal communication skills, along with active listening and patient teach-back techniques.. Verbal Communication. ... . Nonverbal Communication. ... . Active Listening. ... . Written Communication. ... . Presentation Skills.. Which communication technique is the nurse exhibiting?Nurses use intrapersonal communication to develop self-awareness and a positive self-esteem that enhances appropriate self-expression. Nontherapeutic communication involves asking personal questions or giving personal opinions, which discourages further expression of patient's feelings and ideas.
What are the five levels of communication in nursing?Levels of Communication. Intra-personal communication.. Inter-personal communication.. Public communication.. Mass communication.. Small Group communication.. |
Which level of communication is exhibited by the nurse performing a mental rehearsal?
zusammenhängende Posts
Urheberrechte © © 2024 nguoilontuoi Inc.
