Assessment Techniques: Communication and Active Listening


CHAPTER 2






Assessment Techniques: Communication and Active Listening


 

 





LEARNING OUTCOMES






 


Upon completion of this chapter, the nurse will:



1.  Summarize the major senses used to provide patient/client care


2.  Compare techniques used to provide traditional care with those used to provide telenursing care


3.  Analyze the importance of effective communication when providing telephonic patient/client care


4.  Examine the impact of distractions on active listening in telenursing


5.  Demonstrate approaches to overcome communication and active listening challenges when communicating with a patient/client through telenursing


SENSES USED IN PATIENT/CLIENT CARE


The major senses are vision, hearing, touch, smell, and taste. Of these, the nurse providing traditional hands-on care uses sight, hearing, touch, and smell. These senses are well developed in nurses—finely tuned by constant assessment, reassessment, and evaluation of care.


Of these senses, the predominant one is sight. Nurses:



  Observe during a general survey


  Examine the skin


  Estimate wounds


  Analyze posture and gait


  Notice improvement or changes in physical status


The next most often used is touch. Nurses use touch to:



  Assess skin turgor and condition


  Pinpoint areas of pain


  Estimate muscle tone and atrophy


  Determine degree of edema


Imagine trying to console distressed patients without being able to touch them. You might question your effectiveness if you could not hug them good-bye as they left the hospital on discharge or hold their hand during a painful bedside procedure. Supporting the patient’s psychosocial domain relies heavily on the sense of touch.


The next sense that is used extensively in patient care is hearing. Without this sense, nurses would not be able to:



  Auscultate lung and heart sounds


  Hear the anxiety in the patient’s voice


  Analyze speech patterns associated with disease processes and conditions


  Respond to audible changes in breathing patterns and respiratory rates


  Answer patient questions


The sense of smell is used by nurses, but to a lesser extent in the provision of patient care. This sense is often used to reinforce information provided through other senses and helps the nurse to:



  Detect specific odors associated with disease processes, such as ammonia in liver disease and ketones in diabetic ketoacidosis


  Discern an infection within a wound


Taste is seldom, if ever, used in nursing care.


REVIEW OF TRADITIONAL ASSESSMENT TECHNIQUES


Early in our education, nurses learn the four techniques of assessment:



  Inspection


  Palpation


  Percussion


  Auscultation


These techniques capitalize on the use of the senses. For inspection, the nurse relies on the sense of sight. Smell is used to a certain extent during inspection and provides additional clues and indicators about health status, ability to provide self-care, and ability to maintain a safe home environment. Touch is used when assessing the skin, muscle tone, and other related general body structures. Without touch, the nurse would not be able to adequately inspect.


Touch is the primary sense used in palpation. Here, the hands are placed on various body areas to identify organ structures and boundaries. Palpation is also used to validate or support data collected through inspection. Without palpation, it would be impossible to:



  Assess pulses


  Determine the presence and size of masses


  Estimate the depth of edema


  Evaluate joint function


  Discern soft tissue swelling


Although percussion uses the hands to elicit a tone from a body area, the sense of hearing is predominant when using this technique. If hearing were absent, repeatedly striking over a body part would provide no useable information for the nurse. Of the assessment techniques used by nurses, percussion is most likely the one least applied. This is because it is instructed to be used primarily when assessing the lungs. Although instructed on the value of percussion when assessing other major body organs, the average nurse usually does not rely on percussion when assessing other thoracic and abdominal structures.


The final technique, auscultation, is often augmented with a stethoscope. Nurses auscultate for:



  Heart sounds


  Lung sounds


  Bowel sounds


  Vessel integrity


The purpose in reviewing the traditional assessment techniques has not been to encourage or reinforce their use in patient/client care. Rather, it is to emphasize how important the use of the senses is when determining patient care needs and to set the stage for how these assessment techniques will need to be altered when working in telenursing.


SENSES USED IN TELENURSING


Telenursing is unique in that the traditional approaches to assessment—inspection, palpation, percussion, and auscultation—need to be altered or cannot be used. Take a few minutes now and perform this exercise:



Envision yourself sitting at home when the phone rings. The person on the line identifies herself as being with a health insurance plan or other care delivery system provider. She has your name, address, age, gender, and information about your health plan or employer. She begins talking to you and starts asking questions that expect you to divulge personal health information. Do you trust this person? How can you trust this person? Why is she talking to you? What health problem do I have that my doctor didn’t tell me about? Should I answer this person’s questions? Is this a scam or an attempt to steal my identity?


How comfortable were you when reading through that exercise? Would you talk to someone over the telephone about your health and care needs without seeing the person or understanding why the call was taking place? Would you be tempted to hang up and contact your health plan to find out what’s going on or report the call to some authority?


As you might have concluded, the sense of sight is not an integral part of telenursing. You will not be able to “see” the patient to:



  Read nonverbal communication cues


  Examine the skin


  Determine the color of skin tone


  Observe for diaphoresis


  Visually inspect the ankles for edema


  Notice nail clubbing or the presence of a barrel chest


  Identify a spinal deformity, which could negatively impact respiratory excursion or gastrointestinal functioning


  Identify basic body shape that might indicate a potential risk for the development of metabolic syndrome or type 2 diabetes mellitus


  Analyze gait and stability with walking


  Discern patterns of bruising that might indicate a specific disease process from those obtained from a fall or episode of abuse


  Estimate the ease or challenges to complete instrumental or traditional activities of daily living


  Recognize sensory deficits through the use of a hearing aid or reading glasses


As you can see, the list of areas in which the sense of sight is used when assessing can go on and on. The sense of touch, however, is also absent in telenursing. Without this sense, you will not be able to:



  Feel skin temperature


  Palpate edematous areas


  Determine the point of maximum impulse when conducting a cardiac assessment


  Estimate organ borders


  Discern fremitus


  Palpate subcutaneous emphysema


  Reach for the patient’s hand during times of stress


Before you run from the room screaming or slam the book closed, take a deep breath. Telenursing does not use rudimentary nursing assessment skills and techniques. Your skills will not be “lost” over time. You will learn new skills and techniques to replace those that rely on the primary senses of sight and touch. And you will learn to engage the patient/client to assist you during the assessment process.


FOCUS ON THE SENSE OF HEARING


In telenursing, the sense of hearing is predominant. Overall, you will be conducting patient interviews over the telephone and listening for patient responses. Of course, it is more involved than this statement, but to state the process in simple terms, in telenursing the mechanism of patient care is provided through talking and listening. Outstanding communication skills are essential.


Communication Approaches


When approaching a patient/client in a face-to-face setting, the nurse needs to keep in mind:



  Facial expressions


  Physical body language


  Tone and tempo of speech


In telenursing, the nurse needs to be aware of:



  Words/language used


  Tone and tempo of speech


Obviously, facial expressions and physical body language will not be involved in telenursing; however, keep in mind that these areas add to the quality of communication. When they are absent or not used, communication may falter or totally fail. To overcome the absence of these areas, the nurse needs to focus solely on the quality of verbal communication.


As a review, communication begins with a sender delivering a message to a receiver who, in turn, accepts the message and makes a response provided in the form of feedback. Effective communication needs a sender, a message, and a “willing” receiver. When starting out in telenursing, a willing receiver might be the most challenging part.


From the brief exercise explained earlier, how many people willingly answer the telephone and talk to someone they don’t know about personal health information? How many television commercials have been created that warn older adults about potential telephone scams? How willing would you be to spend time with someone you don’t know talking about the intimacies of your health problems and concerns?


In telenursing, the sender, or the nurse, has to be prepared to overcome these challenges. The nurse must use a tone that is pleasant and welcoming. Words must flow conversationally and not sound like someone reading a “script.” The purpose of the call must be explained immediately before the patient hangs up thinking you are a telemarketer or someone trying to scam you into providing personal information to steal your identity.


Immediately upon the call being answered, the nurse needs to:



  Ask to speak to the patient


  Validate that the person on the phone is indeed the patient


  Provide nurse’s full name


  Identify the company that the nurse is representing


  Explain the purpose of the call


The patient will undoubtedly have questions:



  How did you get my name and telephone number?


  Who are you again?


  Who are you with?


  Why are you calling me?


Yes, you did just provide all of this information when beginning the call; however, the patient was not hearing everything. Expect to repeat your opening statements over and over again. Remember, patients have no idea who you are. They will be concerned that their telephone number and personal health information is “floating” out there and will express caution and concern. You need to calm patients down and not feed into their anxieties. This means talking slowly, succinctly, and professionally. This is no time to inject humor or make light of the situation.


Answering the patient’s questions accurately and calmly is the best approach to secure his or her tentative trust at this time. Be sure to:



  Repeat your name


  State the organization you are with or representing


  Explain the purpose of your call

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Oct 5, 2017 | Posted by in NURSING | Comments Off on Assessment Techniques: Communication and Active Listening
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