may be experiencing anxiety over the alteration
in his/her physical appearance.
d.Posture: A patient stands erect with good body
alignment. The patient may be experiencing
good health.
e.Gait: A patient walks slightly bent over. The
patient may be accommodating an illness.
f. Gestures: A patient gives you a thumbs-up sign
after receiving test results. The patient is most
likely happy with the results.
g.General physical appearance: A patient is sweat-
ing and having difficulty breathing. The patient
may be experiencing a life-threatening
condition.
h.Mode of dress and grooming: A patient who has
been bedridden for a week asks to take a shower
and get dressed. The patient is probably feeling
better.
i. Sounds: A patient sighs whenever you mention
her significant other. The patient may be expe-
riencing difficulty with this relationship.
j. Silence: A patient who has undergone a mastec-
tomy remains silent when asked how she is
feeling. The patient may be overwhelmed with
emotion and unable to express her feelings.
2.Sample answers:
a.An 8-year-old boy: An 8-year-old has limited
understanding of surgical procedures.
Therefore, the nurse must explain the
procedure in simple terms so that the child will
cooperate without being frightened.
b.A 16-year-old girl: Adolescents are developing
their ability to think abstractly and can under-
stand fairly detailed descriptions of clinical
procedures.
c. A 65-year-old man with a hearing impairment:
The nurse should talk directly to the patient
while facing him. When necessary, nonverbal
communication should be used (e.g., sign lan-
guage or finger spelling, or by writing any ideas
that cannot be conveyed in another manner).
3.Occupation may reveal a person’s abilities, talents,
interests, and economic status.- a.Assessing: Verbal and nonverbal communication
are essential nursing tools because the major
focus of patient assessment is information gath-
ering. Written words, patient records, spoken
words, and observational skills are employed.
b.Diagnosing: Once a nurse formulates a diagno-
sis, it must be communicated through the spo-
ken and written word to other nurses as well as
to the patient.
c. Planning: The patient, nurse, and other health-
care team members must communicate with
each other as patient goals and outcomes are
developed and interventions selected.
d.Implementing: Verbal and nonverbal commu-
nication allows nurses to enhance basic caregiv-
ing measures and to teach, counsel, and
support patients and their families.
e.Evaluating: Nurses often rely on the verbal and
nonverbal clues they receive from their patients
to determine whether patient objectives or
goals have been achieved.
f. Documenting: The documentation of data pro-
motes the continuity of care given by nurses
and other healthcare providers.- a.Having specific objectives: Having a purpose
for an interaction guides the nurse toward
achieving a meaningful encounter with the
patient.
b.Providing a comfortable environment: A com-
fortable environment in which the patient and
nurse are at ease helps to promote meaningful
interactions. Relationships are enhanced when
the atmosphere is relaxed and unhurried.
c. Providing privacy: Every effort should be made
to provide privacy during nurse–patient conver-
sations.
d.Maintaining confidentiality: The patient should
know his/her right to specify who may have
access to clinical or personal information.
e.Maintaining patient focus: Communication in
the nurse–patient relationship should focus on
the patient and the patient’s needs, not on the
nurse or an activity in which the nurse is
engaged.
f. Using nursing observations: Observation is
especially valuable in validating information
and helping the nurse become aware of the
patient’s nonverbal communication. It also
demonstrates the nurse’s caring and interest in
the patient.
g.Using optimal pacing: The nurse must consider
the pace of any conversation or encounter with
a patient and let the patient set the pace.
h.Providing personal space: Nurses must try to
determine each patient’s perception of personal
space; invasion of this zone can evoke uncom-
fortable feelings.
i. Developing therapeutic communication skills:
Nurses must train and practice using therapeutic
skills by controlling the tone of their voices,
being knowledgeable about the topic, being
flexible, being clear and concise, avoiding words
that may be interpreted differently, being truth-
ful and open minded, and taking advantage of
opportunities for communicating.
j. Developing listening skills: Nurses should sit
when communicating with a patient, be alert
and relaxed, keep the conversation natural,
maintain eye contact if culturally correct, indi-
cate they are paying attention, think before
respondingto the patient, and listen for themes
in the patient’s comments.
k.Using silence as a tool: The nurse can use
silence appropriately by taking the time to wait
for the patient to initiate or continue speaking.
Nurses should be aware of the different possible
meanings of silence (the patient is comfortable
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