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1 page double spacedDISCUSSION BOARD ASSIGNMENT:Discuss
why “use of technologies to assist in effective communication in a
variety of healthcare settings” is listed as an expected nurse
competency by QSEN and other nursing organizations.Refer to three points “Electronic Records” discussed in the textbook which is “Interoperability, portability, and ease of use.”
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Interpersonal Relationships
Professional Communication Skills
for Nurses
SEVENTH EDITION
Elizabeth C. Arnold, PhD, RN,
PMHCNS-BC
Associate Professor, Retired, University of Maryland School of Nursing,
Baltimore, Maryland
Family Nurse Psychotherapist, Montgomery Village, Maryland
Kathleen Underman Boggs, PhD, FNPCS
Family Nurse Practitioner, Associate Professor Emeritus, College of Health and
Human Services, University of North Carolina Charlotte, Charlotte, North
Carolina
2
Table of Contents
Cover image
Title page
Copyright
Dedication
Reviewers and contributor
Acknowledgments
Preface
Part I. Conceptual Foundations of Interpersonal
Relationships and Professional Communication
Skills
Chapter 1. Theory Based Perspectives and Contemporary Dynamics
Basic Concepts
The Discipline of Nursing
The Science of Nursing
Communication Theory
Applications
The Future of Nursing
Summary
Discussion Questions
Chapter 2. Professional Guides for Nursing Communication
Basic Concepts
Organizations or Agencies Issuing Health Care Communication Guidelines
Professional Nursing Organizations Issuing Health Care Communication Guidelines
Other Professional Organizations and Accrediting Agencies Issuing Communication Guidelines
Affecting Nursing
Ethical standards and Issues
Legal Standards
Applications
Evidence-Based Practice
Standards
Using the Nursing Process in Nurse-Client Relationships
Application of Ethical and Legal Guidelines
Summary
3
Discussion Questions
Chapter 3. Clinical Judgment and Ethical Decision Making
Basic Concepts
Ethical Reasoning
Critical Thinking
Applications
Participation in clinical Research
Solving Ethical Dilemmas in Nursing
Professional Values Acquisition
Applying Critical Thinking to the Clinical Decision-Making Process
Summary
Discussion Questions
Chapter 4. Clarity and Safety in Communication
Basic Concepts
General Safety Communication Guidelines for Organizations
Barriers to Safe, Effective Communication in the Health Care System
Innovations that Foster Safety
Applications
Tools for Safer Care
Team Training Models
Client Safety Outcomes of Team Training Programs
Other Specific Nursing Efforts
Summary
Discussion Questions
Part II. Essential Communication Skills
Chapter 5. Developing Therapeutic Communication Skills
Basic Concepts
Verbal Communication
Nonverbal (Behavioral) Communication
Purpose of Client-Centered Communication
Theoretical Perspectives
Applications
Building Rapport
Asking Questions
Empathetic Listening for Understanding
Themes
Observing Nonverbal Behaviors
Observing Communication Patterns
Using Active Listening Responses
Verbal Responses
4
Other Forms of Communication
Using Technology in Communication
Summary
Reflective Discussion Questions
Chapter 6. Variation in Communication Styles
Basic Concepts
Verbal Communication
Verbal Style Factors that Influence Nurse-to-Client Professional Communication
Nonverbal Communication
Communication Accommodation Theory
Effects of Sociocultural Factors on Communication
Applications
Interpersonal Competence
Style Factors that Influence Relationships
Advocate for Continuity of Care
Summary
Discussion Questions
Chapter 7. Intercultural Communication
Basic Concepts
Applications
Cultural Competence
Care of the Culturally Diverse Client
Theoretical Frameworks
Cultural Implications in Client-Centered Decision Making
Working with Language Barriers
Communication Principles
Key Cultural Groups
Poverty
Summary
Discussion Questions
Chapter 8. Therapeutic Communication in Groups
Basic Concepts
Characteristics of Small Group Communication
Applications to Health-Related Groups
Group Leadership
Applications
Applications in Therapeutic Groups
Types of Therapeutic Groups
Group Principles Applied to Professional Work Groups
Summary
Discussion Questions
5
Part III. Therapeutic Interpersonal Relationship
Skills
Chapter 9. Self Concept in Professional Interpersonal Relationships
Basic Concepts
Theoretical Frameworks
Applications
Patterns and Nursing Diagnosis Related to Self-Concepts
Personal Identity
Self-Esteem
Self-Efficacy
Summary
Discussion Questions
Chapter 10. Developing Therapeutic Relationships
Basic Concepts
Definitions
Level of Involvement
Therapeutic Use of Self
Applications
Adaptation for Short-Term Relationships
Summary
Discussion Questions
Chapter 11. Bridges and Barriers in Therapeutic Relationships
Basic Concepts
Respect
Caring
Empowerment
Trust
Empathy
Mutuality
Veracity
Other Barriers to the Relationship
Applications
Steps in the Caring Process
Strategies for Empowerment
Application of Empathy to Levels of Nursing Actions
Reduction of Barriers in Nurse-Client Relationships
Veracity and Trust
Respect for Personal Space
Violation of Confidentiality
Avoiding Cross-Cultural Dissonance
6
Summary
Discussion Questions
Chapter 12. Communicating with Families
Basic Concepts
Family Composition
Theoretical Frameworks
Applications
Assessment
Applying the Nursing Process
Summary
Discussion Questions
Chapter 13. Resolving Conflicts between Nurse and Client
Basic Concepts
Nature of Conflict
Causes of Conflict
Risk for Violence: Incidence Statistics
Stage of Anger
Conflict Outcomes: Why Work for Conflict Resolution?
Understand Own Personal Responses to Conflict
Outcome: Positive Growth
Outcome: Dysfunction, Such as Unresolved Conflict
Nature of Assertive Behavior
Safety
Applications
Preventing Conflict
Assessing the Presence of Conflict in the Nurse-Client Relationship
Techniques for Conflict Resolution
Nursing Communication Interventions: Following the C.A.R.E. Steps
The Anger Management Process: Nursing Behaviors to Avoid Violent Client Behavior
Conflict Communication Skills
Clinical Encounters with Angry Clients
Strategies Useful During Clinical Encounters with Violent Clients
Defusing Potential Conflicts when Providing Home Health Care
Summary
Discussion Questions
Part IV. Communicating to Foster Health Literacy,
Health Promotion and Prevention of Disease
among Diverse Populations
Chapter 14. Communicating to Encourage Health Literacy, Health
7
Promotion, and Prevention of Disease
Basic Concepts
Definitions
Global and National Health Promotion Agendas
Theory-Based Frameworks
Applications
Health Education for Health Promotion
Community Voices in Health Promotion Activities
Summary
Discussion Questions
Chapter 15. Health Teaching and Coaching
Basic Concepts
Theoretical Frameworks
Domains of Learning
Core Dimensions of Client Education
Applications
Summary
Discussion Questions
Chapter 16. Empowerment Oriented Communication Strategies to Reduce
Stress
Basic Concepts
Stress Frameworks
Coping
Applications
Summary
Discussion Questions
Part V. Accommodating Clients with Special
Communication Needs
Chapter 17. Communicating with Clients Experiencing Communication
Deficits
Basic Concepts
Legal Mandates
Home-Based Health Care
Types of Deficits
Applications
Early Recognition of Communication Deficits
Assessment of Current Communication Abilities
Communication Strategies
Client Advocacy
8
Summary
Discussion questions
Chapter 18. Communicating with Children
Basic Concepts
Attitude
Cognition
Interpersonal
Applications
Assessment
Communicating with Children with Psychological Behavioral Problems
Communicating with Physically Ill Children in the Hospital and Ambulatory Clinic
Communication with Infants from Birth to 12 Months
Communication with Children 1 to 3 Years of Age (Toddlers)
Communication with Children 3 to 5 Years (Preschoolers)
Communication with Children 6 to 11 Years (School Age)
Communication with Children Older than 11 Years of Age (Adolescents)
Forming Health Care Partnerships with Parents
Summary
Discussion Questions
Chapter 19. Communicating with Older Adults
Basic Concepts
Concepts of Aging
Theoretical Frameworks
Applications
Assessment Strategies with Older Adult Clients
Empowerment: Building on Client Strengths
Relationships with Cognitively Impaired Older Adults
Summary
Discussion Questions
Chapter 20. Communicating with Clients in Crisis
Basic Concepts
Theoretical Frameworks
Applications
Structuring Crisis Intervention Strategies
Mental Health Emergencies
Disaster Management
Helping Children Cope With Trauma
Helping Older Adults Cope With Trauma
Summary
Discussion Questions
Chapter 21. Communicating with Clients and Families at End of Life
9
Basic Concepts
Theoretical Frameworks
The Nature of Grief and Grieving
Patterns of Grieving
Applications
Pain Management
Communication in End-of-Life Care
Addressing Cultural and Spiritual Needs
Palliative Care for Children
Helping Clients Achieve a Good Death
Caring of the Client After Death
Stress Issues for Nurses in Palliative Care Settings
Summary
Discussion Questions
Part VI. Collaborative and Professional
Communication
Chapter 22. Role Relationships and Interprofessional Communication
Basic Concepts
Nursing Education and Professional Role Development
Applications
Creating Supportive Work Environments
Developing Leadership Skill Sets
Client Advocacy Roles
Summary
Discussion Questions
Chapter 23. Communicating with Other Health Professionals
Basic Concepts
Standards for a Healthy Work Environment
Creating A Collaborative Culture of Regard to Eliminate Disruptive Behavior
Applications
Conflict Resolution
Conflict Resolution
Delegation or Supervision of Unlicensed Personnel
Strategies A Nurse Can Use to Communicate and Help Create a Better Work Environment
Advocacy
Strategies to Remove Barriers to Communication with Other Professionals
Develop A Support System
Organizational Strategies for Conflict Prevention and Resolution: Work Toward an Organizational
Climate of Mutual Respect
Summary
10
Discussion Questions
Chapter 24. Communicating for Continuity of Care
Basic Concepts
Continuity of Care Concepts
Applications
Relational Continuity
Essential Elements of Relational Continuity
Informational Continuity
Transition and Discharge Planning in Continuity of Care
Management Continuity
Summary
Discussion Questions
Chapter 25. Documentation in an Electronic Era
Basic Concepts
Documenting Client Information
Plan of Care
Standards: Ethical, Regulatory, and Professional
Applications
Communicating Medical Orders
Workload and Work-Arounds
Documenting on A Client’s Health Record
Confidentiality
Coding
Classification of Care: Use of Standardized Terminologies and Taxonomies
Reference Terminology Systems that Exchange Data Between Classification Systems
Summary
Discussion Questions
Chapter 26. Communication at the Point of Care: Application of e-Health
Technologies
Basic Concepts
Decentralized Access: Technology for Communicating at the Point of Care
Enhanced Work Flow: Remote Site Monitoring, Diagnosis, Treatment, and Communication
Computerized Clinical Decision Support Systems
Client Engagement
Technology for Client Health Self-Management
Outcomes of Technology Use
Applications
Clinical Decision Support Systems
Application of Clinical Guidelines to Practice
mHealth: Technology for Client Engagement
Issues
11
Professional Online Nursing Education
Summary
Discussion Questions
Glossary
Photograph Credits
Index
12
Copyright
3251 Riverport Lane St. Louis, Missouri 63043
INTERPERSONAL RELATIONSHIPS: PROFESSIONAL
COMMUNICATION SKILLS FOR NURSES, SEVENTH EDITION ISBN:
978-0-32324281-3
Copyright © 2016 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form
or by any means, electronic or mechanical, including photocopying,
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and our arrangements with organizations such as the Copyright Clearance
Center and the Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected
under copyright by the Publisher (other than as may be noted herein).
Notices Knowledge and best practice in this field are constantly
changing. As new research and experience broaden our understanding,
changes in research methods, professional practices, or medical treatment
may become necessary.
Practitioners and researchers must always rely on their own experience
and knowledge in evaluating and using any information, methods,
compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of
others, including parties for whom they have a professional
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With respect to any drug or pharmaceutical products identified, readers
are advised to check the most current information provided (i) on
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and duration of administration, and contraindications. It is the
responsibility of practitioners, relying on their own experience and
knowledge of their patients, to make diagnoses, to determine dosages
and the best treatment for each individual patient, and to take all
13
appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors,
contributors, or editors, assume any liability for any injury and/or
damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods,
products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2011, 2007, 2003, 1999, 1995, and 1989.
International Standard Book Number: 978-0-32324281-3
Herdman, T.H. (Ed.) Nursing Diagnoses-Definitions and Classification
2015-2017. Copyright © 2014, 1994-2014 NANDA International. Used by
arrangement with John Wiley & Sons Limited.
Content Strategist: Jamie Randall Content Development Manager: Jean
Fornango Associate Content Development Specialist: Melissa Rawe Publishing
Services Manager: Julie Eddy Senior Project Manager: Marquita Parker
Designer: Julia Dummitt Printed in the United States of America Last digit
is the print number: 9 8 7 6 5 4 3 2 1
14
Dedication
To the memory of my husband George Arnold who believed in me
and supported me unconditionally, and to all the students I have
had the privilege of teaching.
Elizabeth C. Arnold
To Sydney Lavarnway, may you find strong mentors.
Kathleen Underman Boggs
15
Reviewers and contributor
Reviewers
Amy Ellsworth, AND
Nursing Instructor
Kirkwood Community College Cedar Rapids, Iowa
Cindy Carter, MSN, RN, IBCLC, RLC, ICCE
Nursing Instructor
Colorado Christian University Indiana Wesleyan University Texas Health
Resources
Nocona, Texas
Kim Clevenger, EdD, MSN, RN, BC
Baccalaureate & RN-BSN Program Coordinator Associate Professor of
Nursing Morehead State University Morehead, Kentucky
Dr. Bonnie DeSimone, EdD, RN, BC
Professor of Nursing
Coordinator of the ABSN Weekday Division of Nursing
Dominican College of Blauvelt Orangeburg, New York
Linda Finch, PhD, ANP-BC
Associate Professor/Associate Dean-Retired Loewenberg School of Nursing
University of MemphisMemphis, Tennessee
Shari Kist, PhD, RN, CNE
Assistant Professor
Goldfarb School of Nursing at Barnes-Jewish College St. Louis, Missouri
Robyn C. Leo, MS, RN
16
Associate Professor Nursing Worcester State University Putnam,
Connecticut
Scott A. Davis
Police Officer
Crisis Intervention Team (CIT) Coordinator Montgomery County Police
Department,Gaithersburg, Maryland
Danette Yolanda Wall, DNP, MSN, MBA, ACRN,
RN, CPHQ, LNC
Chief Operating Officer
Odot, LLC
Clinical Advisor Quality Improvement Humana CarePlus, Inc.
Tampa, Florida
Brian Zager, MA
PhD Candidate
Department of Speech Communication Southern Illinois
UniversityCarbondale, Illinois
Contributor
Shari Kist, PhD, RN, CNE
Assistant Professor
Goldfarb School of Nursing Barnes-Jewish CollegeSt. Louis, Missouri
17
Acknowledgments
Elizabeth C. Arnold
Kathleen Underman Boggs
The seventh edition of Interpersonal Relationships: Professional Communication
Skills for Nurses continues to reflect the ideas and commitment of our
students, valued colleagues, clients, and the editorial staff at Elsevier. The
first edition, aligned with an interpersonal relationship communication
seminar developed at the University of Maryland School of Nursing, was
published 25 years ago. Developing effective communication was
important then and it remains central to effective clinical practice in
contemporary health care. The text was originally designed by faculty to
facilitate nursing students’ understanding of therapeutic communication in
clinical settings, using case examples and experiential simulations. At this
point in time, professional nursing role relationships and the use of
relational communication in health care is more complex and multilayered.
The scope of content in the seventh edition reflects a markedly different
contemporary health care landscape, one which is open-ended, clientactivated and interdisciplinary in function and skill development. The
vitality of its contents reflects the commitment of faculty and students from
many nursing programs and the clinical nurses who have deepened the
understanding of the materials presented in this text through their positive
support, ideas, and constructive feedback. In particular, the voices of the
following faculty and professional nurses have contributed directly and
indirectly to the development of this text: Verna Carson, PhD, RN, PCNS;
Judith W. Ryan, PhD, RN, CRNP; Michelle Michael, PhD, APRN, PNP;
Barbara Harrison, RN, PMH-NP; Ann O’Mara, PhD, RN, AOCN, FAAN;
Barbara Dobish, MS, RN; Anne Marie Spellbring, PhD, RN, FAAN; Kristin
Bussell, MS, RN, CS-P; Patricia Harris, MS, APRN, NP; and Jacqueline
Conrad, BS, RN, from the University of Maryland; Ann Mabe Newman,
DSN, RN, CS and David R. Langford, RN, DSNc, from the University of
North Carolina Charlotte, and Dr. Bonnie DeSimone from Dominican
College of Blauvelt. Nurses in the community: Luwana Cameron, RN;
Nancy Pashby, RN; Mary Jane Joseph, RN; and Dr. Stephanie Wright
provided valuable input related to their clinical expertise. We are indebted
18
to Dr. Shari Kist of the Goldfarb School of Nursing at the Barnes-Jewish
College for her thoughtful revision of Chapter 12.
We acknowledge with deep gratitude the unique Elsevier team efforts of
Melissa Rawe, Associate Content Development Specialist, Jamie Randall,
Content Strategist, and Marquita Parker, Senior Project Manager-book
production. Their dedicated commitment to the completion of this text and
expertise were notable in making the revision process for this seventh
edition a seamless and timely developmental experience.
Finally, we acknowledge the loving support of our families and Michael
J. Boggs for their unflagging support and encouragement.
19
Preface
Elizabeth C. Arnold
Kathleen Underman Boggs
Recognition of the importance of therapeutic communication and
professional relationships with clients and families as a primary means of
achieving treatment goals in health care continues to be the underlying
theme in Interpersonal Relationships: Professional Communication Skills for
Nurses. This seventh edition has been thoroughly revised, rewritten, and
updated to meet the challenge of serving as a primary communication
resource for nursing students and professional nurses.
While maintaining the integrity of previous text versions, the seventh
edition introduces a broadened interprofessional perspective on
communication, occasioned by historical transformational changes
currently occurring in contemporary health care delivery. Expanded
content is competency based and draws from many different sources: Joint
Commission Standards, the Institute of Medicine (IOM) reports, QSEN,
communication theory, Essentials of Baccalaureate Education, systems
thinking and interprofessional team-based communication, as advocated
by AHRQ’s TeamSTEPPS program. The content, exercises, and case
examples are intentionally integrated to support …
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