Which of the following statements are reflective of barriers to communication? Select all that apply
a. "I see you had a heart attack. Why are you still smoking?"
b. "I know you are having pain in your knee. I will check your vital signs before getting your pain medications."
c. "The nursing assistant told me you are having back pain. I'll get your pain medication now."
d. "Tell me a little more about the chest pain you were having at home."
e. "Let's talk about all the possible causes and treatments for chest pain."
A, B, C, E
Barriers to effective communication include asking too many questions, asking "why" questions, changing the subject inappropriately, failing to probe, offering advice, "fire-hosing," and many others. In this item, it is inappropriate for the nurse to ask the patient why he hasn't stopped smoking. This may make the patient feel the nurse does not approve of him or he may become defensive and stop talking. In the response in which the nurse asks to obtain vital sign measurements and then provide pain medication, she is changing the subject. If the patient is in pain, he may not be receptive to having his vital signs measured and recorded. This can also make a patient feel that the nurse's tasks are more important than are the patient's needs. Failing to probe can result in inaccurate assessment, leading to inaccurate care. The nurse must further assess the patient's pain before administering pain medications. She cannot rely solely on a statement by the certified nursing assistant (CNA). Talking about all the possible causes of chest pain is an example of "fire-hosing" information, which is delivering an overwhelming amount of information all at once. This barrier to communication can lead the patient or family to feel stunned, confused, intimidated, and helpless. The only appropriate statement in this item is to request and further investigate the chest pain the patient was experiencing at home. This is an open-ended question and will lead to more dialogue between the patient and nurse.
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