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Arts and Humanities
Fundamentals of Nursing Volume 1: Chapter 21: Communication and Therapeutic Relationships
Terms in this set (74)
-A dynamic, two way process of sending and receiving messages.
-Verbal and nonverbal messages.
-Helps build working relationships.
-More than the act of talking and listening.
-Used to meet physical, psychosocial, emotional and spiritual needs.
levels of communication
intrapersonal (levels of communication)
-conscious internal dialogue
-can be positive or negative
interpersonal (levels of communication)
-face-to-face conversation between two people
-used by nurses to gather information during an assessment, to teach about health issues, to explain care, and to provide comfort and support
group (levels of communication)
-interaction that occurs among several people
-small-group communication occurs when you engage of ideas with two or more individuals at the same time
-examples of small-group communication include staff meetings, committee meetings, educational groups, self-help groups, and family teaching sessions
2 components of communication
-Substance of the message
-Open to interpretation
-The active part of communication
-Involves five elements
-Message: words, gesture, letter
-Sender: initiates content delivery
-Channel: face-to-face, written, audiovisual,
-Receiver: interprets the message
content of communication
-describes the actual subject matter, words, gestures, and substance of the message
-message that everyone may hear or see
-open to communication
-the verbal and/or non-verbal information the sender communicates
-might be a conversation, a speech, a gesture, a letter, and so forth
-effective messages are complete, clear, concise, organized, timely, and expressed in a manner that the receiver can understand
-must be appropriate for the situation an for the developmental level of the person receiving the message
-begins the conversation to deliver a message (content) to another person
-sometimes called the source or the encoder, uses verbal and nonverbal methods to transmit the message
-medium used to send the message
-face-to-face communication is a commonly used channel
-nurses frequently use touch as a nonverbal way to communicate caring and concern
-written pamphlets, audiovisual aids, recordings, telephone and text messages, and the internet
-observer, listener, and interpreter of the message
-interpretation aka decoding, refers to relating the message to your past experiences to determine the sender's meaning
-uses visual, auditory, and tactile senses to decode the message
-validates that the receiver received the message and understood it as the sender intended
-feedback may be verbal, nonverbal, or both
-verifying the message avoids confusion
-involves speaking or writing words to send a message
-use of spoken and written words to send a message
-influenced by such factors as educational background, culture, language, age, and past experiences
-generally a conscious act in which the sender is able to select the most effective words to communicate a message
-when delivering a verbal message, the goal is that the receiver will understand both your words and your meaning
verbal communication is affected by:
-denotative versus connotative meaning
-pacing of conversation
-intonation: tone, pitch, cadence, volume
-clarity and brevity
-relevance of information
-credibility of the sender
-it is your responsibility to deliver messages that the client can understand; therefore, use medical terms only when you are certain the listener understands them
-when encoding a message, consider the receiver's age, knowledge, education, and any cultural differences, including primary language spoken
-encourage feedback to be sure that the receiver understood the message as you intended
denotative versus connotative meaning
denotation: the literal meaning of a word
connotation: the implied or emotional meaning of the word
pacing of the conversation
the pace and rhythm of the delivery can alter the receiver's interpretation of the message
-tone of voice: reflects the feeling behind the words
-pitch: we get a sense of a person's intonation by listening to how high or low it is
-cadence: rising and falling of the pitch
-volume: soft or loud
clarity and brevity
-using the fewest words possible
-a conversation that is clear and brief holds the interest of all parties and effectively conveys the intended messages
-the interaction must allow time for response
-rapid flow of questions or one-sided conversations inhibit interactions
relevance of information
communication is effective when both parties value the interaction and find the discussion relevant
credibility of the sender
depends on a pattern of honest and timely response to patient concerns, as well as congruence between your verbal and nonverbal communication
-humor and laughing can have a positive influence on attitude and healing
-laughter can create physiological changes that contribute to well-being and provide an emotional release in a tense situation
-the unconscious use of body language when sending a message
-Facial expression: communicates feelings behind a
-Posture and gait: clue to attitude, self-concept
-Personal appearance: clue to socioeconomic status,
-Distance: indicates extent of familiarity
-Gestures: emphasize and clarify spoken word; can
have different meanings
-Touch: can be misinterpreted
facial expression (non-verbal communication)
-communicate joy, anger, sadness, concern, or fear
-raised eyebrows, staring, squinting, or darting eyes all conveys meaning
posture and gait (non-verbal communication)
body-position, gait, and posture offer clues to a person's attitudes, emotions, physical well-being, and self-concept
personal appearance (non-verbal communication)
-clothing and personal appearance provide clues to a person's feelings, socioeconomic status, culture, and religion
-dress and accessories are powerful cultural cues
hand and body gestures emphasize and clarify the spoken word; good indicators of the feeling tone behind the conversation
-can convey affection, caring, concern and encouragement
-avoid using touch when dealing with someone who is angry or mentally disturbed because the touch may be misinterpreted (for example as a sign of aggression or sexual attraction)
-although touch can be highly effective, use it with conscious awareness of the situation, environment, culture, and receptivity of the patient
factors that affect communication in general
-life span variations
-roles and relationships
-communication is most successful in an environment that is quiet, private, free of unpleasant smells, and at a comfortable temperature
-think creatively to secure the most comfortable environment possible for communicating with patients and families
-hospital chapels, foyers, and rooms may be ideal locations for conversation
life span variations (communication)
-physical and cognitive development, language skills, level of education, and maturity influence the communication process
-modify your communication strategies to fit your client's developmental level
-gender differences in communication are important to nurses because male and female patients may communicate their needs very differently
-The gender of the nurse may affect the response to patient requests. Example: A female patient might state, "I feel so lousy today". A female nurse may interpret this as a desire to talk. In contrast, a male nurse may discuss pain control.
personal space (communication)
-people vary in the amount of physical space they are comfortable with when communicating
-the distance they maintain between one another is influenced by the relationship of the individuals, the nature of the conversation, the setting, and cultural influences
-refers to the space and things that an individual identifies as belonging to him
-may be bounded and visible to others or may be defined by the individual in a way not noticeable to others
sociocultural factors (communication)
-culture and socioeconomic status strongly influence communication
-Facial expressions, nonverbal communication, and even the selection of whom to interact with are affected. For example, in some cultures it would unacceptable for a male nurse to address and provide care to a female patient.
roles and relationships
-roles of relationships of the sender and receiver affect communication
-affect the choice of vocabulary, tone of voice, use of gestures, and distance associated with the communication
therapeutic relationships in healthcare
-Focus on improving the health of the client.
-Provide necessary information about health, treatments and care.
-Involve use of therapeutic communication.
-Strengthens therapeutic relationship.
-client-centered communication directed at achieving client goals
-used to establish the therapeutic relationship, provide and obtain healthcare information, and express interest and concern for the client and family
phases of the therapeutic relationship
1. Preinteraction: Gathering information about the client, but the nurse and client do not have direct communication.
2. Orientation: Goal is to establish rapport and trust through the use of verbal and nonverbal communication. Begins with introductions, followed by an initial exchange of information, such as the client's reason for the visit or chief concerns. Ends when the relationship has been defined.
3. Working: Nurse communicates caring, the patient expresses thoughts and feelings, mutual respect is maintained, and honest verbal ad nonverbal expression occurs. Key communication goals are to assist the client to clarify feelings and concerns.
4. Termination: Conclusion of the relationship, whether at the end of a nurse's shift or on the client's discharge from the unit, facility, or service. Reviewing and summarizing help to bring the relationship to a comfortable conclusion.
5 key characteristics of therapeutic communication
empathy (5 key characteristics of therapeutic communication)
-Desire to understand and be sensitive to the feelings, beliefs and situation of another person.
-More than sharing of information.
-Requires you to be willing to adapt your style, tone, vocabulary, and behavior to create the best approach for each client situation.
respect (5 key characteristics of therapeutic communication)
-In the therapeutic relationship, you communicated by valuing the client and being flexible to meet the client's needs.
-As a nurse, you must be willing to adjust to your client rather than expecting the client to adjust to you, the healthcare environment, or hospital routines.
genuineness (5 key characteristics of therapeutic communication)
-The ability to respond honestly.-If you are unable to answer a client's question, do not offer guesses. Be honest. Tell the client you need assistance before you can answer the question.
-Also involves willingness to self-evaluate. How well did I communicate? Did I handle that situation appropriately? How could I improve my communication?
concreteness (5 key characteristics of therapeutic communication)
In a therapeutic relationship, you must offer understandable responses to a client's questions and concerns. To do so requires you to express in concrete, specific terms what you mean.
confrontation (5 key characteristics of therapeutic communication)
-Communication is a reciprocal process.
-If your client is unable to express his thoughts clearly, you must be willing to confront her request clarification.
-You must be willing to be confronted if you are unclear.
patient factors affecting effective therapeutic communication
-Impaired cognitive skills.
language barrier (patient factors affecting effective therapeutic communication)
-Imagine how difficult it would be if you became ill while traveling in a country where you were unable to speak the language.
-Consider your client's education and literacy. You cannot assume that everyone has an extensive vocabulary, or that everyone can read and write.
impaired cognitive skills (patient factors affecting effective therapeutic communication)
-Difficulty understanding or engaging in communication may signal cognitive impairment.
-Developmental delays and pathology or injury of the central nervous system affect language and cognitive skills.
sensory-perceptual alterations (patient factors affecting effective therapeutic communication)
-Assess hearing an vision.
-Assess for aphasia (a difficulty in expressing or interpreting messages that may develop after a cerebrovascular accident [stroke] or neurological disease.
physiological barriers (patient factors affecting effective therapeutic communication)
Some conditions, such as respiratory problems, loose-fitting dentures, or cleft palate, may interfere with speaking.
What elements are involved in enhancing therapeutic communication
-Restate, clarify, and validate message.
-Interpret body language.
-Share your observations to clarify.
-Use open-ended questions.
-Summarize the conversation.
listen actively (enhancing therapeutic communication)
-An active listener gives undivided attention and allows the sender the opportunity to complete comments without interruption.
-Pay attention to verbal and non-verbal communication and look for congruence.
-If a message is unclear, seek clarification through use of probing questions or reflective comments, such as "Tell me more," or "When you say...what do you mean?"
establish trust (enhancing therapeutic communication)
-Mutual trust is an essential component not just of professional communication, but also of therapeutic communication because it facilitates disclosure and honesty.
-As you establish trust, always greet the client by name, listen actively, respond honestly to the client's concerns, and provide care competently and consistently.
be assertive (enhancing therapeutic communication)
-Be confident and comfortable and remain in charge of where the conversation is going.
-Enables you to deal directly with stressful interpersonal communication, for example, with a client who needs to make some lifestyle changes.
-Serve as a role model for the client.
-The therapeutic relationship is a safe place for clients to practice being assertive and receive feedback about their communication.
restate, clarify, and validate message (enhancing therapeutic communication)
-Restating means using your own words to summarize the message you received from the client. This demonstrates concern, active listening, and understanding of what the patient has said.
-Clarifying messages helps ensure that you have accurately interpreted the information.
-Validating means asking the client whether you are making a correct interpretation.
interpret body language (enhancing therapeutic communication)
-Note the tone of voice, rate of speech, distance, eye movement, facial expressions, and gestures.
-Look for congruence between the spoken message and the nonverbal message. If there is is inconsistency, share your observations with the patient. Share your observations by describing the patient's body language or tone of voice.
use open-ended questions (enhancing therapeutic communication)
-Obtain a clear understanding f an issue and follow your client's thoughts.
-Probing comments such as "Tell me more" encourage your client to share information.
use silence (enhancing therapeutic communication)
-Learn to be comfortable with silence.
-When you remain attentive, silence demonstrates acceptance and allows clients to compose their thoughts and provide further information.
-Especially effective if your client is emotionally upset.
summarize the conversation (enhancing therapeutic communication)
-At the end of the conversation, summarize what you have heard. For example, you might say, "Today we talked about diet, exercise, and medications for high blood pressure. Your job now is to review the handouts and start taking your medication every morning."
-Summarizing demonstrates active listening and allows the client to clarify any misunderstandings.
5 steps of assertive communication
1. Get the person's attention.
2. Express your concern.
3. State the problem.
4. Propose an action.
5. Reach a decision.
What 2 skills are essential for the delivery of high-duality safe patient care?
Effective communication and teamwork.
To avoid communication failures that can lead to unanticipated adverse events in patients, nurses must...
speak up when they have concerns and take the necessary steps to communicate assertively with the healthcare team.
Imagine a patient care scenario where something does not seem right. What steps would you take to deal with the situation?
1. Find the person who is involved in the situation and bring the issue to his attention.
2. Express your concern without emotion, accusation, or, on the other hand, without indirect or passive language.
3. State the problem clearly and succinctly. Also, propose an action that is practical and in the best interest of the patient.
4. With the collaboration of other healthcare professionals, reach a decision about how to resolve the problem.
barriers to therapeutic communication
-Keep these in mind as you start to build therapeutic relationships.
-Too many questions.
-Changing the subject too abruptly.
-Failing to listen.
-Failing to explore issue in detail.
-Expressing approval or disapproval.
-Giving false reassurance.
-Using patronizing language.
too many questions (barriers to therapeutic communication)
-Asking too many questions, especially closed questions (requiring only a yes or no answer), can make clients feel they are being interrogated.
-Excessive questioning may suggest insensitivity or lack of respect to the client's issues.
asking "Why?" (barriers to therapeutic communication)
-Directly asking for reasons suggests criticism to some people. If you ask, "Why did you stop taking your medication?" the patient may become defensive and stop talking.
-A more subtle approach is usually more comfortable for the patient. You might ask, "What concerns do you have about your medicines?" or "Tell me more about your experience with the medicines". Both of these approaches will help you gather more information about the clients concerns, without suggesting criticism.
changing the subject abruptly (barriers to therapeutic communication)
-Abruptly changing the topic of discussion makes you seem uninterested.
-This often occurs when the nurse is intent on one issue and the client is focused on another.
-In an ongoing dialogue, changing the subject can stop the flow of conversation cold.
-Both patients and nurses sometimes use this tactic to avoid discussing sensitive topics.
failing to explore issues in detail AKA failure to probe (barriers to therapeutic communication)
-Can result in incomplete assessment and affect the quality of your care.
-A thorough assessment requires you to explore issues in detail.
expressing approval or disapproval
-Although it may seem supportive, expressing approval can inhibit further sharing--it puts you in the position of being the judge of what is "right". This often prompts the patient to continue to seek approval. He thinks, "I'd bettie be careful; she may not approve of the next thing I was going to tell her. She expects me to be this way."
-Consider instead offering recommendations and allowing the patient to choose.
offering advice or an opinion (barriers to therapeutic communication)
-Avoid statements such as "If I were you..." or "You should..." These statements impose your opinion on your clients.
-In effect, your statements function as approval if they agree with the client's thoughts or disapproval if they do not.
giving false reassurance (barriers to therapeutic communication)
When clients or family members ask for information or tell you they are worried, it is easy to reassure them that everything will be okay. However, such responses are uninformed, inaccurate, and may feel dismissive -- even condescending -- to the receiver.
stereotyping (barriers to therapeutic communication)
-Racial, cultural, religious, age-related, or gender stereotypes distort assessment and prevent you from recognizing the patient's uniqueness.
-Examples of statements reflecting a stereotype include, "He's old, so he won't remember anything you tell him," and "Men are always the biggest crybabies about pain."
-Such comments may shut down communication and escalate tension.
-Avoid their use with patients and colleagues.
using patronizing language (barriers to therapeutic communication)
-Communicates superiority or disapproval.
-Statements such as, "You know better than that," are patronizing and offensive to the client.
-Condescending approaches, such as, "You should have used the call button before you got up. You're lucky you didn't hurt yourself," do not communicate respect for the client.
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