Nursing 109

N109: Foundations in Nursing Practice Study Guide • Touch can be used to communicate understanding, caring, and reassurance. The absence of touch may indicate the opposite. Again, the astute nurse will understand cultural differences that may make touching inappropriate. Therapeutic communication is the process the nurse uses to influence the patient to produce a better outcome. Therapeutic communication can be used to obtain or provide information to the patient, caregiver, or other teammembers to develop trust and show care and concern, and to explore feelings, and ultimately reduce anxiety. Exceptional communication skills can be developed using techniques of therapeutic communication: • Focusing is the technique of steering the conversation to keep the communication focused on the topic. For the patient who is telling story after story about his children, the nurse might say, “I can tell your family is very important to you. Did your symptoms start after your last family reunion?” • Attending is the technique of actively listening to the patient. Non-verbal cues will tell the patient if the nurse is really listening or if she is preoccupied withother thoughts. Examples of this include facing the patient, adopting an open posture, leaning toward the patient, maintaining good eye contact, and appearing relaxed. • Validating is the technique of double-checking the data to ensure that it is accurate. For example, “The symptoms started two weeks ago, correct?” • Clarifying is the technique of asking the patient to repeat information when the nurse is not sure of the meaning. “Do you mean...?” • Paraphrasing is the technique of repeating the patient’s thoughts in the nurse’s own words. “Here’s what I think you are saying...” • Silence is the technique of saying nothing. This may encourage patients to expand on thoughts they are having. • Reflection is the technique of repeating all or part of a message back to the patient. This technique helps the nurse understand the message and allows the patient to hear what his message was to the nurse. Reflection can also be used to reflect a patient’s non-verbal communication. For example, “You look sad.” • Summarization is the technique of highlighting the main points the patient and nurse have discussed. Summarizing a conversation can ensure that the patient’s message has been heard and may provide an opportunity to expand on certain misunderstood messages. Communication Across the Lifespan It is critical that the nurse understand the different communication skills and styles required for different age groups. • Infants communicate through their senses and respond best to a soft, gentle tone of voice. Parents must understand the importance of touch at this stage. • Toddlers and preschoolers may take a long time to formulate and express thoughts. These age groups also have very short attention spans. Interactions should be in short bursts. For this age, a picture may be an ideal way to communicate an idea. • For school-age children, it is critical that they be included in all conversations about them. At this age, the child wants to begin to make decisions for himself but will need to be guided.

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