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62 Cards in this Set

  • Front
  • Back
Complex model of communication refers to:
Many messages sent never get through the receiver; some are disregarded when they do get through; some messages are out of the conscious awareness…
Complexity can be using language to impress, mystify, humiliate or indicate social position
Others will use medical jargon, technical words, in-group talk
Many messages are send but the direct message is secondary to the disguised meaning
Foundation of interviewing
Attending behavior
4 Guidelines for Attending behavior
eye contact, body language, voice qualities and voice tracking
Eye contact
its has cultural relevance; rule of thumb is its best for nurses to sustain eye-contact when the pt is speaking and less constant eye-contact when rn speaks; generally whtie clt prefers eye contact and Native/African/Asian Americans prefers less
2 Elements of body language
Kinesics: the body movement and posture
Proxemics: distance to w/c a person is comfortable; comfort zone & different for different culture
Examples of acceptable proxemics:
intimate distance =0-18in
personal distance =18-40 in
social distance = 4-12 ft
public distance = 12 ft & more
Voice quality
aka paralinguistic
refers to voice loudness, pitch, rate and fluency
its not what you say its how you say that counts
Ex: soft & gentle, rapid & high pitch
Voice quality that conveys encourage person to share thoughts and feelings
soft and gentle voice
Voice quality that is rapid and high pitch conveys:
Verbal tracking
giving cues that hear and understand what the person is saying;
giving neutral feedback like restating and summarizing; no professional opinions involve
Pacing the interview w/ the client by sticking closely w/ the clt speech content, volume& tone
4 Problematic Areas for the Nurse Interpreting specific verbal/nonverbal message of the clt
communication style
perception of touch
cultural filters
Why is communication style problematic in interpreting verbal and nonverbal messages from the client
b/c different cultures have different communication style
Ex. latin americans express alot of emotions, french and italians use a lot of facial expression and hand gestures, asian calm facad...
Why is perception of touch problematic in interpreting verbal and nonverbal messages from the client
some people view it as compassionate and caring but other might think its invasion of privacy, sexual advances, taboo
Why is cultural filters problematic in interpreting verbal and nonverbal messages from the client
its hard to listen to people without any bias; our frame of reference are influence by our bias and prejudice; we chose what we pay attention to and what we ignore; these are personal distortion in listening
How can you minimize personal distortion during a clinical interview?
being aware of cultural filters; c. acknowledge that others view the world quiet differently and understanding other people’s ways of experiencing and living in the world can go a long way toward minimizing our personal distortions in listening
Strategies to Increase cultural Awareness:
1. Workshops, training seminars that facilitate awareness of biases and prej toward others
2. Seek clarification and validate perception w/ client
3. Explore meaning of the behavior w/ the clt, being careful not to inject preconceived notions
4. Participate in culturally diverse activities and through nonprofessional contacts
5. Read hx and literature written by members of cultural group you are working w/
6. Engage in discussion of racial issues when they come up in context of your interactions w/ clt, peers and outside work setting
7. Gain appreciation in how your culture communicates and what you obs as diff in other culture
its not an absence of communication; it is a specific channel for transmitting and receiving messages
use of silence
Active listening involves
observing the clients nonverbal behaviors
listening and understanding clients verabal communication
listening and understanding the person w/in social setting of his/her life
listen for false note
provide feedback info about the client for w/c they may not be aware
Some principles in Active Listening include
the answer is always w/in the client
objective truth is never simple as it seems
everything the client hears is modified by clt's cultural filters
everything you hear is modified by your cultural filters
its ok to feel confused and uncertain
listen to yourself too
what communication technique should you use for mute and withdrawn client
making observation
what communication technique you should use if client states, What should I do to get out of here?
What communication technique should you use for client that is manic, in severe anxiety or panic level anxiety
Examining ideas, themes, experiences more fully
Tell me more about that
would you describe that more fully?
Makes available facts to the person. Allows the person to gain knowledge to make decision/conclusion
giving information
My purpose for being here is
This medication is for
Giving Advice
Pt: I don't know what to do, I can't sleep, i stay awake all night
RN: you have difficulty sleeping?
Seeking clarification
helps clarify own thoughts and maximize mutual understanding
Indicates what is real; describe the personal perceptions or fats in the situation
Presenting reality
Undermines teh client's beliefs by not reinforcing the exaggerated or false perception
voicing doubt
Seeking Consensual clarification
clarifies both the nurse and client share mutual understanding of communication. Helps the client become clearer about what he or she is thinking
puting concrete terms what the client implies, making the client communication more explicit
Verbalizing the implied
I can't talk to you anymore, its a waste of time
RN: you feel like no one understands you
verbalizing the implied
Encouraging evaluation
considering all different factors that come into play-feelings, ideas, experience
responding to the feeling being expressed not just the content
Attempting to translate into feelings/decoding
I am dead inside
RN: are you saying that you feel lifeless? Does life seem meaningless to you?
attempting to translate into feelings/decoding
Perhaps you and I can discover what produces your anxiety?
suggesting collaboration
emphasizing working with the client and NOT doing things for the client; ENC to view that change is possible
suggeting collaboration
Bringing together imporatant points in the discussion to enhance understanding. Allows opportunity to clarify communications so that nurse and client leave the interview w/ same ideas in mind
During the past hour, you and I have discussed
What could you do to let anger out harmlessly
ENC formulation of plan of action
ENC client to identify alternatives for interpersonal situations the client finds disturbing
ENC formulation of plan of action
Clarifying Techniques include:
paraphrasing, restating, reflecting, exploring
restating in different words in the same basic content of a client's message
Degree of openess sits in a continuum, what are some examples:
using open-ended question, close ended question, indirect/implied question
what type of questions would you ask a client when you dont' want to pressure them
Indirect or implied questions
Obstructive techniques to monitor and minimize
asking excessive questions, giving approval or disapproval, giving advice, and asking why questions
pschiatry's definition of mental health
changes over time and reflects social norms, society's expectation and values, professional biases, individual differences, and political climate of the time
Mental health and mental illness lies in a:
Evaluation of mental health:
identify strenghts and areas of high functioning; try to build upon these strenghts
Evaluation of mental illness
identifying weaknesses and areas of low functiong; and try to look at alternative ways to problem-solve
Important Aspects of mental health
control over behavior
appraisal of reality
effectiveness of work
healthy self-concept
satisfying relationships
effective coping strategies
Difference with DSM-IV-TR and nursing
DSM-IV-TR looks at mind and body as separate or mind-body dualism
Nurses role looks at a person as a whole delivering holistic nursing
Factors Affecting the Severity and Progress of Mental Health Illness
available support system
family influences
developmental events
culture or subcultural beliefs and values
health practices
negative influences
explanations of why certain disorders occur in some cultures but absent on others?
b/c conditions for developing mental disorders are present in that area and not on others
b/c we learn behavior through imitation
Nursing Diagnosis
make by rn that is a clinical judgement of individual, family, community response to actual or potential problem and life processes
made by psychiatrist and it is used to diagnose psychiatric disorders
Axis I
clinical disorder or other conditions that may be a focus of clinical attention
Axis II
personality disorders and mental disorders
Axis III
medical diagnosis
Axis IV
psychosocial and environmental problems
Axis V
GAF result, 1 means dysfunctinal and 100 highest functioning level