READINESS FOR ENHANCED
A pattern of exchanging information and ideas with others that is suf-
ﬁcient for meeting one’s needs and life’s goals, and can be strengthened
• Expresses willingness to enhance communication ability
• Can speak or write language clearly
• Forms words, phrases, and language with articulation
• Uses and interprets nonverbal cues appropriately
• Expresses satisfaction with ability to share information and ideas
• Expresses needs in an assertive way
ASSESSMENT FOCUS (Refer to comprehensive assessment parameters.)
• Roles and relationships
• Values and beliefs
The patient will
• Maintain pulse within predetermined limit.
• Maintain blood pressure within predetermined limits.
• Have no arrhythmias.
• Exhibit skin that is warm and dry.
• Have no pedal edema.
• Maintain acceptable cardiac output.
• Verbalize understanding of reportable signs and symptoms.
• Understand diet, medication regiment, and prescribed activity level.
SUGGESTED NOC OUTCOMES
Cardiac Pump Effectiveness; Circulation Status; Tissue Perfusion:
Peripheral; Vital Signs
INTERVENTIONS AND RATIONALES
Determine: Monitor patient at least every 4 hr for irregularities in
heart rate, rhythm, dyspnea, fatigue, crackles in lungs, jugular venous
distension, or chest pain. Any or all of these may indicate impending
cardiac failure or other complications. Report changes immediately.
Perform: Provide an environment that diminishes space between the
patient and the nurse to eliminate barriers to communication such
as noise and lack of privacy.
Incorporate questions that are open-ended and start with such
words as “what,” “how,” and “could,” rather than “why.” Open-
minded, nonthreatening questioning encourages patient to discuss
issues of concern and improve communication skills.
Schedule frequent interdisciplinary treatment team meetings
regarding communication skill development with patient. Team
meetings with the patient can ensure continuity of care.
Inform: Educate patient and family members about the aging
process. Educating the patient and family will help them anticipate
processes that will naturally occur again.
Teach theory of assertive behavior and role-play assertive commu-
nication approaches. Assertive training can decrease passive or
aggressive communication patterns.
Include role-playing as a teaching strategy to model methods of
enhanced verbal and nonverbal communication skills. Role-playing in
a nonthreatening safe environment can enhance communication skills.
Attend: Encourage patient verbally and nonverbally to explore
strategies to enhance self-advocacy communication skills with health
care providers. Self-advocacy communication can guide a patient
toward autonomy, conﬁdence, and independence.
Provide support through active listening, appropriate periods of
silence, reﬂection on feelings, and paraphrasing and summarizing
comments. Active listening techniques encourage patient
participation in communication.
Provide patient with clear explanations for everything that will
happen to him. Ask for feedback to ensure that the patient under-
stands. Anxiety may impair patient’s cognitive abilities.
Manage: Identify appropriate social agencies and support groups for
the patient and provide referrals to ensure ongoing opportunities for
the patient to increase social interaction.
SUGGESTED NIC INTERVENTIONS
Active Listening; Anticipatory Guidance; Assertiveness Training;
Behavior Modiﬁcation; Social Skills; Relationship-Building Enhance-
ment; Simple Guided Imagery; Support Group
Whyte, R. E., et al. (2006, September). Nurses’ opportunistic interventions
with patients in relation to smoking. Journal of Advanced Nursing, 55(5),