Fundementals Chapter 8 Study Guide

Chapter 08: Communication and the Nurse-Patient Relationship
Answers to Think Critically Questions
Think Critically
Look at Fig. 8.2. Identify five messages the nurse is sending through nonverbal communication.
What feedback is the patient giving to the nurse?
Answers may include the following: The nurse has a relaxed posture; the nurse maintains a
slight forward-leaning position; the nurse has a smile on her face; the nurse is using touch as a
form of communication; the nurse is in a seated position; the nurse appears unhurried; the nurse
is engaging in eye contact with the patient.
Think Critically
You are with Mrs. Ito, and the physician walks in and says, “A cardiac catheterization needs to
be done to see if the coronary arteries are blocked.” The patient has limited experience with
hospitalization and medical terminology. She shyly looks down at her hands. It is unclear if she
understands. What could you do?
You have a very important role as patient advocate to ensure patient understanding. While the
physician is present, do not interrupt; give the physician the opportunity to assess the patient’s
level of understanding (or lack thereof) and provide information. After the physician leaves the
room, ask the patient if she understands what the doctor is talking about, and follow up with a
few simple questions to try to determine her level of understanding. Without giving advice, help
the patient clarify what her questions are about the medical problem and the procedure that is
being suggested. Then, you should ask the physician to return to the room for a follow-up
discussion with the patient.
Think Critically
Observe nurses in the hospital as they communicate with patients. What types of blocks to
communication do you see occurring? Speculate as to why these nurses are blocking
communication with their patients.
Individual answers will vary but may include nonverbal behaviors (such as hurried stance, arms
folded, asking questions while performing nursing tasks) and verbal communication blocks (such
as asking closed-ended questions, changing the subject, or inattentive listening). Reasons why
nurses may block communication with or without realizing they are doing so usually revolve
around focusing on the many tasks they are required to perform within a given time frame. It is
important in nursing to be aware of the nonverbal communication that our hurried, task-
oriented demeanor can communicate to a patient. Sometimes it can help to take a moment, pause
from performing technical tasks, and simply state to the patient, “I need to check over your
equipment and make sure everything is as I expect it is, and in a moment I will be able to give
you my full attention.” Then, perhaps most importantly, do just that.
Think Critically
Why is empathy important in the nurse-patient relationship? Discuss incidents in which you (or
someone you observed) had trouble feeling empathy for a patient. What were the outcomes?
What could have been done to alter the situation?
Individual answers will vary. Suggestions on what could have been done differently will depend
on the situation encountered but should include the nurse requesting reassignment before the
situation led to distress for the patient.
Answers and Rationales for In-Text Review Questions for the NEXT GENERATION
NCLEX® Examination
1. 1; Rationale: A relaxed body position nonverbally communicates therapeutic communication

and encourages the patient to provide an honest answer. Arms folded across one’s chest (choice
2) communicates negative body language and is a barrier to communication, as is multitasking
(choices 3 and 4).
2. 4; Rationale: The nurse nodding their head in this situation nonverbally conveys that they
understood what the patient said and encourages further elaboration. It is an effective use of
silence. Choice 1 offers false reassurance; choice 2 is a communication block (changing the
subject); and choice 3 involves an assumption (fear) and possibly oversimplifies the patient’s
concerns.
3. 2; Rationale: The I in ISBAR-R stands for introduction, which involves introducing the
speaker to the listener before giving information or asking for recommendations.
4. 1, 3, 4; Rationale: The message conveyed by the nonverbal body language described in these
choices is that the patient is not able to listen or learn at this time. The nurse should reschedule
patient education for another time.
5. 2, 3, 6; Rationale: All choices are appropriate for communicating with an aphasic patient with
the exception of choice 1, which requires a verbal response; choice 4, which indicates that the
nurse is not being patient and allowing the patient to finish their own sentences; and choice 5,
which excludes the patient from the conversation and assumes that because the patient cannot
speak, the patient also cannot understand.
6. 4; Rationale: An important attitude of patient-centered care is the ability to recognize your
own attitudes about working with patients from different cultural, ethnic, and social
backgrounds. Based on the observations of staff complaining, it appears that attitudes are
interfering with patient-centered care.
7. 3; Rationale: The most important element in gaining the trust of a patient is to be reliable and
to do what you say you are going to do. Interpersonal skills, permissive attitude, and praising the
primary care provider might make the nurse liked by the patient, but trust can only be gained
through reliable behavior.
8. 4; Rationale: It is important to communicate specific expectations when delegating tasks.
You cannot assume that other personnel define nonspecific criteria (such as “keep an eye on the
patient”) in the same way that you do.
9. Your patient, a 67-year old female, just received some bad news about her medical condition
from her physician. In particular, the physician gave her some activity and travel restrictions for
the next 6 weeks. The patient stated that she wants to discuss things with you and that she has
some questions. Please evaluate each of the following nurse statements and place a check mark
in the appropriate box as to whether the response would be therapeutic, nontherapeutic, or
neutral.
Patient Statement and Therapeutic Nontherapeutic Neutral
Nurse Reply
Patient: I am so worried
about what the doctor
said to me.
Nurse: What did she X
say? Why are you
worried?
Nurse: Your doctor X
doesn’t have the best
bedside manner.
Nurse: You are X
worried?
(Nurse moves chair X
closer to patient)
Patient: the doctor said
I can’t fly to Hawaii to
see my new grandbaby.
Don’t worry, you’ll be X
able to see your
grandchild soon.
You’re concerned X
because you can’t
travel?
Nurse moves closer to X
the door and checks the
time on her watch
Grandchildren grow up X
so fast!
Rationale: the therapeutic responses above demonstrate questions designed to explore the
patient’s feelings and fears. Moving the chair closer conveys acceptance and a non-hurried
approach. The nontherapeutic responses either ask too many questions at once, give judgment,
dismissive answers, or convey that the nurse is in a hurry. The final nurse response is benign,
however could also be viewed as nontherapeutic.
Answer Guidelines for Clinical Judgment ActivitiesScenario A
You could try several things. Offer self (“I would like to sit with you for a little while”). Seek
clarification (“You say there is nothing wrong, but it does look like you have been crying”).
Reflect behavior (“You seem upset”).
Scenario B
Individual answers will vary, but communication is frequently influenced by culture and
experiences. Opportunities to learn communication techniques (such as at nursing school) can
influence one’s style. Family members may (or may not) have given positive feedback to
reinforce certain behaviors such as being polite or quiet or expressing opinions openly.
Scenario C
See Box 8.2 for guidelines to end-of-shift reports. Asking questions is a way of clarifying
information and eliciting details that may need more elaboration. The nurse who has spent the
shift with the patient is the best source of information on the changes that may have occurred in
the patient’s condition or in the treatment plan.

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Chapter 08: Communication and the Nurse-Patient Relationship

Answers to Think Critically Questions

1. 1; Rationale: A relaxed body position nonverbally communicates therapeutic communication

Answer Guidelines for Clinical Judgment ActivitiesScenario A

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