Chapter 06: Communicating with Older Adults

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. When caring for an ill adult client, the nurse is particularly concerned that the client communicates well since: a. assessment, planning of care, and even the therapeutic relationship is based on effective communication. b. it is the social connection that all individuals base interpersonal relationships upon. c. how well an individual communicates is a reflection on both his or her physical and emotional well-being. d. the need to communicate is a basic need of all individuals.

ANS: A

Good communication skills are the basis for accurate assessment, care planning, and the development of therapeutic relationships between the nurse and the older person. While the other options are true they do not directly address the concerns of an ailing client.

DIF: Cognitive Level: Understanding REF: p. 65

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance a. “It takes a special nurse to provide good care to the older population of clients.” b. “It’s difficult for a nurse to develop an effective relationship with an older client because of the barriers their age creates.” c. “It is so difficult to find nurses who are truly effective geriatric nurses.” d. “With the older population increasing so dramatically in numbers, nursing will have a difficult time meeting their needs.”

2. Which statement by the nurse is the strongest example of ageism by professional nurses?

ANS: C

Ageism affects health professionals as well as the general public and this attitude is reflected in the lack of nurses who choose to work in the field of geriatrics. The characteristics of a “good geriatric nurse” are no different than those of any effective nurse. Assuming that age produces barriers to an effective nurse-client relationship is an example of ageism. The growing number of older adults is not an example of ageism.

DIF: Cognitive Level: Understanding REF: p. 66

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

3. When conducting an admissions interview with an older client, the nurse observes that the client pauses for a period of time before responding to the questions. The nurse responds to this client based on the assumption that the client is: a. exhibiting signs of mild cognitive impairment. b. nervous and having difficulty concentrating on the questions. c. reluctant to share information with someone with whom he or she has no relationship. d. sorting through his or her vast life experiences in order to answer appropriately.

ANS: D

Basically, elders may need more time to give information or answer questions simply because they have a larger life experience to draw from. Sorting through thoughts requires intervals of silence, and therefore listening carefully without rushing the elder is very important. It is an unfounded assumption to assume that the client’s response is due to senility based exclusively on his or her age. The remaining options would not be unique to an older client but might be experienced at any age.

DIF: Cognitive Level: Applying REF: p. 67

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance a. Sitting in a chair at the foot of the bed b. Standing near the client’s head on his or her dominant side c. Sitting in a chair at the bedside facing the client d. Standing at the foot of the bed

4. Which technique is most effective when communicating with a client who is positioned in bed?

ANS: C

When communicating with individuals in a bed or wheelchair, position yourself at their level and directly face them rather than talking over a side rail or standing above them.

DIF: Cognitive Level: Applying REF: p. 67

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance a. “It’s so nice to see them excited and engaged as they tell the stories.” b. “It helps their memory so much to retell their stories.” c. “I learn so much about clients when they share their life story with me.” d. “They are so proud of the things they have accomplished in their life.”

5. Which nursing statement shows a true appreciation for an older client’s willingness to tell his personal stories about “the war”?

ANS: C

A memory is an incredible gift given to the nurse, a sharing of a part of oneself when one may have little else to give, and it provides insight into who the person really is telling the story.

DIF: Cognitive Level: Applying REF: p. 67

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance

Multiple Response

1. A nurse manager is providing a novice geriatric nurse with guidelines when encouraging an older client to reminisce about his or her life and past experiences. Which suggestions will be included? (Select all that apply.)

a. Don’t correct the client even when you suspect the memory is incorrect b. When the focus remains on sad topics, assess the client for possible depression c. Refrain from interjecting personal stories into the reminiscing process d. Expect and respect a degree of repetition e. Use close-ended questions to help focus the reminiscing

ANS: A, B, D

Suggestions for encouraging reminiscing include listening without correction or criticism, remembering that it is the client’s recollections that are important; being patient with repetition since sometimes people need to tell the same story often to come to terms with the experience, especially if it was very meaningful to them; being attuned to signs of depression in conversation (dwelling on sad topics) or changes in physical status or behavior, and providing appropriate assessment and intervention; and keeping the conversation focused on the person reminiscing, but not hesitating to share some of your own memories that relate to the situation being discussed. Use open-ended questions to encourage reminiscing since they encourage free thought.

DIF: Cognitive Level: Applying REF: p. 68, Box 6-3

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Health Promotion and Maintenance a. Explain a task using simple, concise phrasing and one step at a time b. Give instructions to a group whenever possible to provide peer support c. Allow for additional time for the client to respond to questions or directions d. Use nonverbal as well as verbal cues to help get your message across to the client e. Speak loudly to gain and retain the client’s attention

2. Which intervention is therapeutic when facilitating communication with a cognitively impaired older client? (Select all that apply.)

ANS: A, C, D

Useful strategies for communicating with individuals experiencing cognitive impairment include giving one-step directions, allowing time for the expected response, and giving clues and cues as to what you want the person to do. It is also helpful to interact with one person at a time and to speak slowly rather than loudly.

DIF: Cognitive Level: Applying REF: p. 69

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance a. A nursing assistant refers to one of her patients as “grandma” b. A nurse attempts to medicate a patient and states, “Now come on and be a good girl” c. A nurse explains a procedure to a patient using simple nonmedical terms d. A nurse makes sure that she is directly facing a patient who has hearing loss when she is speaking e. A nursing assistant tells a patient, “It is time for our bath now”

3. Which of the following are examples of elderspeak? (Select all that apply.)

ANS: A, B, E

Elderspeak is a form of patronizing speech. Examples include using diminutives or pet names, speaking very slowly, and speaking to older adults as if they were children, or using collective pronouns. Option C is not an example of elderspeak; it is appropriate to explain a procedure using nonmedical terminology. Option D is the correct manner in which to address an individual with hearing loss; facing the patient allows the patient to read lips.

DIF: Cognitive Level: Applying REF: p. 66

TOP: Integrated Process: Communication and Documentation

MSC: Client Needs: Health Promotion and Maintenance