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Nurse as Communicator, Quizzes of Nursing

Duke UniversityNursing

Nurse as a communicator- Communication unit 101

Typology: Quizzes

2025/2026

Available from 04/08/2026

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Nurse as Communicator
What is Communication?
-a process of:
-exchanging information between 2 or more people
-generating and transmitting meaning
-sending and receiving verbal and non-verbal messages
Why do you communicate?
-to obtain and give information
-to reach a shared understanding
How do we communicate?
-verbal
-spoken word
-written word
-non-verbal
-"body language"
-gestures, expressions, posture
-eye contact
-touch
-tone, pitch, volume of speech
-silence
-Verbal and non-feral communication occur simultaneously
-non-verbal communication
-can support or contradict verbal communication
-must be interpreted
Interpretation of message meanings are influenced by:
-past experiences
-feelings
-socio-cultural factors
-knowledge
Factors influencing effective communication
-Developmental level
-Gender: men & women communicate differently b/c of how grow up communicating and
social roles- effects interpretation; becoming less obvious now as traditional social roles blur
-Sociocultural differences: culture influences how we communicate (esp. non-verbal comm.);
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Nurse as Communicator

What is Communication?

  • a process of:
  • exchanging information between 2 or more people
  • generating and transmitting meaning
  • sending and receiving verbal and non-verbal messages Why do you communicate?
  • to obtain and give information
  • to reach a shared understanding How do we communicate?
  • verbal
  • spoken word
  • written word
  • non-verbal
  • "body language"
  • gestures, expressions, posture
  • eye contact
  • touch
  • tone, pitch, volume of speech
  • silence
  • Verbal and non-feral communication occur simultaneously
  • non-verbal communication
  • can support or contradict verbal communication
  • must be interpreted Interpretation of message meanings are influenced by:
  • past experiences
  • feelings
  • socio-cultural factors
  • knowledge Factors influencing effective communication
  • Developmental level
  • Gender: men & women communicate differently b/c of how grow up communicating and social roles- effects interpretation; becoming less obvious now as traditional social roles blur
  • Sociocultural differences: culture influences how we communicate (esp. non-verbal comm.);

language

  • Roles & responsibilities: influence knowledge and attitude (ex: profession- don't assume HCP know everything)
  • Space & territory ("personal space"): convey caring and compassion w/o encroaching on personal space; spacial comfort may be culturally defined; whose "turf" is it? (ex: hospital room vs. pt's home)
  • Physical, mental, & emotional state: physical ailments (ex: pain), emotional state (ex: depressed), and mental state (ex: thinking about something else); cognitively impaired pts may not be able to communicate
  • Values: what does the communicator value (this will be expressed) vs. what does the listener value; if something is not valued this will be expressed through communication
  • Environment: must be conducive to communication (calm, quiet, non-threatening, private, minimize distractions) Developmental Considerations
  • Infants & Toddlers: need touch; need visual & auditory stimulation; need to hold, look at, manipulate items
  • Preschoolers: communicate through play; pretend play (acting out scenarios with toys)
  • School Age: communicate through drawing, puppets
  • Adolescents: peer group important; consider parent-child relationship (want privacy from parents)
  • Adults: consider effect of sensory deficits on communication Helping Relationship
  • professional relationship that occurs between people who are providing and receiving assistance meeting human needs
  • allows for progression towards goals
  • not a social relationship
  • Nurse is helper, patient is person being helped
  • Helping relationship allows for movement towards meeting goals
  • Built on patient's needs
  • Professional relationship: sense of professionalism must be portrayed through appearance, demeanor, and behavior Rapport
  • mutual trusting relationship
  • building a rapport with the patient is essential to effective communication How to build a rapport with patient
  1. Demonstrate professionalism, confidence, and expertise to enhance trust.
  2. Have specific objectives- consider purpose of interaction- provides guidance for meaning

Listening Skills (Attentive Listening)

  • sit if possible
  • watch body language
  • eye contact (if culturally appropriate)
  • appropriate expressions, gestures
  • listen for themes
  • think before responding; do not interrupt conversation or disrupt flow of communication
  • take time to listen, do not be rushed Silence
  • wait for patient to speak or finish thought
  • invites response from patient
  • allows time to organize thoughts
  • assess non-verbal cues
  • excessive talking place focus on nurse rather than patient Touch
  • cultural considerations
  • can be conforming
  • required for many nursing interventions Humor
  • laughter reduces stress, anxiety, and frustration
  • can be detrimental if used incorrectly Interviewing Techniques: Types of Questions/ Comments
  • Open-ended question or comment: get a lot of info. from patient, patient not able to answer yes/no
  • closed question: limits patient responses (ex: yes/no); used to get specific info; can be barrier to effective communication if not used appropriately
  • Validating question: validate what the nurse thinks she heard or observed; if overused the patient may think nurse is not listening
  • Clarifying question: nurse can gain understanding of patient's comment; clarify nurse's interpretation of what was said; if overused, the pt may think the nurse is not listening
  • Reflective question: paraphrasing- repeating what pt said or describing pt's feelings; encourages pt to expand on comment; if overused the pt may think nurse is not listening
  • Sequencing question: place events in chronological order to explore cause and effect relationships
  • Directing question: direct topic of conversation to gain needed info Examples:
  • "How are you feeling today?" (Open-ended)
  • "Are you in pain?" (Closed)
  • "So, this is the worst headache you've ever had in your life?" (validating)
  • "You've been stressed..." (reflective)
  • "It sounds like you have a lot on your mind right now." (clarifying)
  • "You mentioned a fall last week- can you tell me more about that?" (directing)
  • "Did you hit your head when you fell?" (closed)
  • "And did the pain start after you hit your head?" (sequencing) Assertiveness
  • not agressive (harsh, destructive)
  • open, honest, direct communication
  • confidence, open body posture, eye contact, use of "I" statements (I feel...I think...)
  • Assertive communication includes:
  • having empathy
  • description of feelings or situation
  • clarifying expectations
  • anticipating consequences Blocks to effective communication
  • Not listening: pts will not share info w/ nurse and nurse will miss important opportunities for communication
  • Giving false reassurance: telling patient everything will be OK even when it probably will not; tells pt that nurse is not interested in their problems
  • Changing the subject: stops conversation; leads to pt frustration; ignores pt concern
  • Not seeing patient as person: patient is a person, not an object; do not refer to person by dx; nsg focuses on whole person; respectfully address pts (no "honey", "sweetie")
  • Gossip and rumor: detrimental to relationships; damage reputations
  • Aggressiveness: (among healthcare workers)- leads to poor pt outcomes b/c of poor communication b/t healthcare workers; compromises pt safety; address any aggressive behavior (bullying, criticizing, etc.)
  • Using inappropriate comments/questions:
  • Cliches- stereotyped, trite, or pat answer; offer false reassurance; may be misunderstoond ("everything will be alright", "tomorrow is another day"); generalizing- make pt feel insignificant ("men have a low pain tolerance", teenagers never follow directions")
  • Yes/no questions: stop discussion
  • Why and how questions: may be intimidating
  • Probing questions: make pts feel like they are being interrogated (given "3rd degree") and stops communication
  • Leading questions: suggests expected response- want patient to give own response
  • Giving Advice: implies that the nurse knows best; denies pt right to make own decision; and

feet to your right) or clock face cues (the telephone is at 4 o'clock)

  • when assisting with mobility allow patient to take your arm Hearing Impairment
  • face person when speaking
  • speak slowly and enunciate, keep hands and objects away from mouth, use normal tone of voice
  • if speaking through sign language interpreter, talk directly to patient, not interpreter and allow time for translation
  • gain attention of patient prior to speaking through visual or tactile cue Cognitive Impairment
  • be simple, concrete, and exact
  • may need repetition or information/questions repeated in different ways to grasp meaning
  • use pictures to help convey meaning
  • avoid open-ended questions Speech Impairment
  • Allow extra time for communication
  • Use simple questions that require short answers
  • Use communication device, pictures, have patient write
  • Repeat to ensure understanding Communication Aids
  • Call bell
  • Alarms
  • Communication boards
  • Pen and paper
  • Eye blinks, finger movements
  • Sign language
  • Flash cards
  • Language cards
  • Pictures Group Processes
  • Organizational communication
  • Communication within a group to achieve established goals
  • Group dynamics = how individual group members relate to each other while working towards group goals
  • Group members need to use personal strengths to help group accomplish goals Group Member Roles
  • task-oriented roles: focus on work to be done
  • group-building or maintenance roles: focus on well-being of people doing work
  • self-serving roles: concentrate on own need rather than need of group Effective Groups
  • balance of roles and use of personal strengths allows group to be effective Communication Nursing Diagnosis Example:
  • Impaired Verbal Communication
  • Related to:
  • Hearing loss
  • Developmental delay
  • Dementia
  • Expressive aphasia
  • Not speaking dominant language Documentation
  • communication between healthcare providers is important to ensure safe, effective patient care What is Documentation?
  • written or types legal record of all patient care and patient interactions Purposes of Documentation
  • Communication among healthcare providers- fosters continuity of care
  • Care planning- look at changes in patient's condition to plan care accordingly
  • Orders (diagnositic or therapuetic)- from MD, DO, NP, NA, etc.
  • Quality review- review quality of care provided to patients
  • Researchers can study patient records
  • Decision analysis- helps agency determine general patient needs and best ways to address these needs
  • Education- healthcare students can learn from reading patient record
  • Financial reimbursement- insurance companies may review charts to determine reimbursement
  • Legal record- may be used in court or accident/injury claims
  • Historical record- provides PMH for patient Physician Orders
  • Written Orders
  • Written by MD directly into patient chart
  • Verbal Orders
  • some patients now keep personal health records online
  • medical history
  • medications
  • test results
  • diagnostic images
  • MD notes
  • provides up-to-date, complete health information
  • improves communication with healthcare provider Nursing Documentation Includes:
  • Initial nursing assessment- comprehensive assessment of medical hx and physical assessment
  • Kardex- concise source for pt. plan of care and basic patient care info (activity level, diet, VS, meds, tests, safety concerns, diagnostic tests, etc.)
  • Nursing care plan-
  • Critical pathways- detailed, standardized plan of care for specific patient population with specific dx or procedure; includes expected outcomes and interventions with timeline
  • Progress notes- discussion of pt's progress toward expected outcomes; explanation of unusual events; any additional info beyond what is included on forms
  • Flow sheets- used to record routine nursing care (nursing assessments, VS, I&O, etc.); sometimes graphics form
  • Medication record- all meds administered to pt (including date and time, RN administering and in some cases reason and effectiveness)
  • Discharge/transfer summaries- when pt. is d/c'd or transferred- a summary of patient's condition, instructions, etc. Documentation must be:
  • complete
  • accurate
  • concise
  • relevant
  • factual
  • timely
  • sequential/chronological
  • legally prudent When documenting consider:
  • federal and state regulations
  • nursing practice standards
  • accrediting agency standards
  • agency policy

paper Documentation Guidelines

  • Write legibly in non-erasable, non-smearing black ink
  • Do not leave any blank space
  • Entries flush to the margins with a line through any empty space
  • Date and time all entries
  • Patient's name on all pages
  • All entries in chronological order
  • Do not rewrite a page of notes
  • Signature and title on all entries General Documentation Guidelines
  • Spell correctly and use correct grammar
  • Document promptly- do not wait until end of shift
  • Chart any patient non-cooperative behavior
  • Chart exact time of all critical treatments, MD contact, notices to supervisors
  • Identify late entries
  • Be as objective as possible
  • use measurements
  • if charting subjective data, use patient's exact quote
  • Do NOT mention an incident report in your notes
  • Use only hospital-approved abbreviations
  • Do not need to memorize abbreviations at this time
  • Correct errors properly
  • Chart any unusual occurrences
  • Chart any patient injuries Correcting an error when charting:
  • on paper:
  • draw a single line through the error and write "mistaken entry" with date, time, and your initials
  • on electronic medical record (EMR):
  • mark the entry "mistaken entry" acceding to EMR program Use of Abbreviations
  • Use only approved abbreviations Do NOT use "JCAHO Do Not Use" abbreviations
  • These abbreviations can lead to confusion and mis-interpretation of documentation
  • You do not need to memorize any abbreviations for this course Late Entry
  • Do not leave patient information visible on computer screen for others to see
  • Follow policy for correcting errors
  • Mark as "mistaken entry", date and electronically sign
  • If wrong chart, mark as "mistaken entry- wrong chart, date and electronically sign
  • Ensure records are backed-up
  • If any part of record is accidentally deleted, enter a progress note with an explanation, date, time, and your electronic signature, and file a report to your manager per policy
  • Do not create, change, or delete records unless you are authorized to do so
  • Do not send files over e-mail unless encrypted Report
  • Verbal or written exchange of information between individuals
  • Change-of-shift report
  • HCP report
  • Incident report
  • Report to family ISBAR Report
  • I= Identify
  • S= Situation
  • B= Background
  • A= Assessment
  • R= Recommendation Confidentiality
  • confidentiality of patient records and patient information is critical
  • all patient information is confidential Breeches of Confidentiality
  • Discussing patients in public area
  • Discussing patients with non-essential individuals
  • Leaving patient chart in public area
  • Not logging off computer terminal/ leaving patient information on computer screen ANA Code of Ethics
  • the nurse safeguards the client's right to privacy by judiciously protecting information of a confidential nature
  • use patient initials (ex. on patient board, written clinical assignments for school, etc.) AHA Patient Bill of Rights
  • the patient has the right to expect that all communications and records pertaining to his care should be treated as confidential
  • all information is shared on a need to know basis HIPAA (Health Insurance Portability and Accountability Act)
  • Federal mandate to protect patient privacy rights
  • Original passed by Congress in1996; Revised 2002
  • Ensures privacy of personal health information
  • Restriction on use and disclosure of personal health information
  • Personal health information only shared with authorized health care providers and insurers
  • Penalties for breeches of HIPAA
  • Personal health information may be verbal, written, or electronic
  • Patients indicate who they want to have access to personal health information
  • Healthcare providers, family members, etc.
  • Patients may obtain copy of health records
  • Patients must receive clear written explanations of how health information will be used or disclosed
  • Patient must sign release authorization unless for treatment, payment, or routine healthcare operations HIPAA Does allow:
  • sign-in sheet
  • calling names in waiting rooms
  • use of white boards with minimal information
  • appointment reminders on voicemail with minimal information
  • the possibility that a conversation may be overheard providing all proper precautions for privacy are taken Confidentiality Considerations for Student Nurses
  • Student nurses are responsible for confidentiality of patient information and are held to the same standards as an RN
  • Use patient initials only, NOT full name, when completing assignments for school Confidentiality and Social Media
  • Breaches of confidentiality include:
  • Discussion of confidential patient information
  • Description of patient with enough detail that patient can be identified
  • Referring to patients in a degrading way
  • Posting photos or videos of patients