CHAPTER 2

Assessment Techniques: Communication and Active Listening

LEARNING OUTCOMES

Upon completion of this chapter, the nurse will:

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:

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

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:

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:

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:

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:

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:

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:

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:

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:

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:

In telenursing, the nurse needs to be aware of:

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:

The patient will undoubtedly have questions:

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:

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