Guidelines/Healthcare Team

• Nonverbal communication


  Communication without words, including appearance, demeanor, facial expressions, attitude, silence, and listening
• Appearance


  • Wear comfortable, neat clothes and a laboratory coat or uniform, have a clearly visible name tag, have neat and short fingernails, wear minimal jewelry, and have neat and not extreme hairstyle
• Demeanor


  • Display poise, focus on the client and the upcoming interview and assessment, do not enter the room unprofessionally, greet the client calmly by name, maintain a professional distance and avoid being overwhelmingly friendly or "touchy"
• Facial expressions


  • Monitor them closely, keep a neutral and friendly expression regardless of personal thoughts or emotions, and explain if unable to hide emotions
• Attitude


  • Maintain a nonjudgmental attitude, accept clients regardless of beliefs, ethnicity, lifestyle, and healthcare practices, avoid lecturing or projecting an attitude of disgust, and focus on how to help the client achieve the highest possible level of health
• Silence


  • Allow time for reflection and organizing thoughts, facilitating more accurate reporting and data collection
• Listening


  • Maintain good eye contact, smile or display an open facial expression, maintain an open body position, avoid preconceived ideas or biases, and keep an open mind
• Verbal communication


  Communication using words, including open-ended questions, closed-ended questions, laundry lists, rephrasing, well-placed phrases, inferring, and providing information
• Open-ended questions


  • Elicit the client's feelings and perceptions, typically begin with "how" or "what", and require more than a one-word response
• Closed-ended questions


  • Obtain facts and focus on specific information, the client can respond with one or two words, and typically begin with "when" or "did"
• Laundry list


  Providing the client with a list of words to choose from in describing symptoms, conditions, or feelings
• Rephrasing


  Restating information the client has provided to clarify and enable reflection on what was said
• Well-placed phrases


  Phrases used to encourage client verbalization, such as "um-hum," "yes," or "I agree"
• Inferring


  Drawing conclusions from what the client tells you and what you observe in their behavior, to elicit more data or verify existing data
• Providing information


  Answering the client's questions thoroughly, and explaining if you don't know the answer
• Gerontologic variations in communication

  • Assess hearing acuity, speak slowly, face the client, use straightforward language, avoid medical jargon and modern slang, show respect, and have a significant other present if the client is mentally confused or forgetful
• Cultural variations in communication


  • Be aware of possible variations in communication and self-disclosure styles, including reluctance to reveal personal information to strangers, indirect communication, and different attitudes towards time
• Communicating with older adult client

  • Speak on the side of the client that has the ear with better acuity
  • Do not yell at the client
  • Speak clearly and use straightforward language
  • Ask questions in simple terms
  • Avoid medical jargon and modern slang
  • Do not talk down to the client
  • Showing respect is very important
• Communicating with mentally confused or forgetful older client


  • Have a significant other (e.g., spouse, child, close friend) present during the interview to provide or clarify the data
• Cultural variations in communication and self-disclosure styles

  • Reluctance to reveal personal information to strangers for various culturally based reasons
  • Variation in willingness to openly express emotional distress or pain
  • Variation in ability to receive information (listen)
  • Variation in meaning conveyed by language
  • Variation in use and meaning of nonverbal communication: eye contact, stance, gestures, demeanor
  • Variation in disease/illness perception: culture-specific syndromes or disorders are accepted by some groups
  • Variation in past, present, or future time orientation
  • Variation in the family's role in the decision-making process: A person other than the client or the client's parent may be the major decision maker regarding appointments, treatments, or follow-up care for the client
• Emotional variations in communication

  • Scared or anxious about their health or about disclosing personal information
  • Angry that they are sick or about having to have an examination
  • Depressed about their health or other life events
  • Have an ulterior motive for having an assessment performed
  • Grappling with sensitive issues
• Interacting with an anxious client

  1. Provide the client with simple, organized information in a structured format

  2. Explain who you are, along with your role and purpose

  3. Ask simple, concise questions

  4. Avoid becoming anxious like the client

  5. Do not hurry, and decrease any external stimuli
• Interacting with an angry client

  1. Approach this client in a calm, reassuring, in-control manner

  2. Allow him to ventilate feelings

  3. Obtain help from other health care professionals as needed

  4. Avoid arguing and facilitate personal space so that the client does not feel threatened or cornered
• Interacting with a depressed client

  1. Express interest in and understanding of the client and respond in a neutral manner

  2. Do not try to communicate in an upbeat, encouraging manner
• Interacting with a manipulative client

  1. Provide structure and set limits

  2. Differentiate between manipulation and a reasonable request

  3. Obtain an objective opinion from other nursing colleagues if unsure
• Interacting with a seductive client

  1. Set firm limits on overt sexual client behavior and avoid responding to subtle seductive behaviors

  2. Encourage client to use more appropriate methods of coping in relating to others
• Discussing sensitive issues (e.g., sexuality, dying, spirituality)

  1. Be aware of your own thoughts and feelings regarding dying, spirituality, and sexuality

  2. Ask simple questions in a nonjudgmental manner

  3. Allow time for ventilation of client's feelings as needed

  4. Make referrals as appropriate, for example, to a pastoral counselor for spiritual concerns or other specialists as needed
• Team-based approach in health assessment

  • Each staff member works fully within the realm of his or her educational and clinical expertise and job description
  • Each staff member is accountable for client care and outcomes of care delivered in accordance with the licensing and practice scope as determined by hospital policy and the government
  • Characterized by a high degree of respect for and maturity of team members and a high degree of communication and collaboration between members
• Roles of the health care team members

  • Nurse: Promote health and disease prevention, Provide comfort and care to clients, Make decisions, Act as a client advocate, Lead and manage the nursing team, Serve as a case manager, Function as a rehabilitator, Be a communicator, Educate clients and health team members, Act as a resource person, Allocate resources in a cost-effective manner
  • Primary Health Care Provider: Diagnose and treat disease
  • Physician's assistant: Acts to a limited extent in the role of the physician during the physician's absence, Conducts physical examinations, Performs diagnostic procedures, Assists in the operating room and emergency department, Performs treatments
  • Nurse practitioner: Diagnose and treat acute illness and chronic conditions, Focus on health promotion and maintenance
  • Physical therapist: Assists in examining, testing, and treating clients recuperating from injuries, illness, or surgery and physically disabled clients
  • Occupational therapist: Develops adaptive devices that help chronically ill clients or clients with a disability perform activities of daily living
  • Respiratory therapist: Delivers treatments designed to improve the client's ventilation and oxygenation status
  • Speech therapist: Evaluates a client's ability to swallow safely and evaluates speech and communication ability, Develops a plan to treat communication and swallowing disorders
  • Nutritionist/Dietitian: Assists in planning dietary measures to improve or maintain a client's nutritional status
  • Continuing care nurse: Coordinates discharge plans for the client
  • Assistive personnel: Help the registered nurse with specified tasks and functions
  • Pharmacist: Formulates and dispenses medications
  • Social worker: Counsels clients and families about home care services and assists the continuing care nurse with planning and facilitating discharge
  • Chaplain: Offers spiritual support and guidance to clients and families
  • Administrative staff: Organize and schedule diagnostic tests and procedures and arrange for services needed by the client and family