NRS 311 Chapter Notes - Chapter 7: Pain, Constipation, Analgesic
27 May 2018
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Communications Notes – Chapter 7 + Chapter 14
Nonverbal Communication: Cues and Body Language
• Patients might adapt certain postures that indicate vulnerability or openness to
conversation
• There is significant cultural variation in facial expressions, especially eye contact.
• nonverbal cues from facial expressions serve to reinforce the spoken words
• Folded arms and closed hands or laced fingers might indicate a reticence to talk or to
divulge personal information.
• Body posture may indicate how receptive one person feels toward another.
• Rigid posture, in contrast, might convey a reluctance to engage in meaningful
conversation.
• Crossed legs could be interpreted as self-protection, or they could be a position of
comfort if all other nonverbal and verbal communication indicates openness.
• Tapping feet might indicate nervousness or impatience and could be an indicator
of blocked communication
• Social distance is usually considered to be approximately 3 to 4 feet between
people
• Uses of Touch
o Refocuses patients who are rambling or self absorbed
o Reduce anxiety in stressful situations
o Convey interest in patient’s experience
o Create human connections
o Express caring
o Provide physical care
Helping Patients with Pain
• OLDCART
o O: Onset of the Pain
o L: Location(s)
o D: Duration – how long the patient has been experiencing the pain
o C: Characteristics – pain intensity, pain with movement, words used to describe
pain
o A: Aggravating factors – what makes the pain worse
o R: Relieving factors – what makes the pain better
o T: Treatment – Which treatments have been tried and which ones work
• Older Adults
o Try to obtain a self-report, even in patients with dementia
o Speak clearly and loud enough to be heard
o Patients may prefer a vertical thermometer to rate pain over a horizontal one
• Nonverbal adults – use 5 step approach
o Try to obtain a self-report of pain
o Look for indicators that pain is likely to be present
o Use a nonverbal behavioral scale to assess the pain
o Obtain a surrogate report, as a loved one who knows the patient may inform the
assessment about the possible presence of the pain
o Try an analgesic trail to see if pain behaviors subside
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