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Communication & Therapeutic Relationships

Terms in this set (68)

Elements of professional communication
7& spoken words
38% voice, tone
55% body language
Intrapersonal
conscious internal dialog (self-talk); can be positive or negative (e.g., I can do this! or I know I am not smart enough)
Interpersonal
between two or more people, face to face, also include emails, texting, etc.
Group
with many people at the same time
Public speaking
a form of group communication
What is the purpose of professional nursing communication?
- Help build working relationships
- Help meet physical, psychosocial, emotional, and spiritual needs of the client
What does the content describe?
- Subject matter
- Words and gestures
- Substance of the message

It's the message that others see and hear and is open to interpretation - subjective
Active listening
SOLER
S - Sitting squarely facing the client
O - Open posture when interacting with a client
L - Leaning forward toward the client
E - Establishing eye contact
R - Relaxing
Five elements of communication
- Sender
- Message
- Channel
- Receiver
- Feedback
Sender
initiates the conversation to deliver a message (or content) can involve verbal and nonverbal messaging; also known as the encoder; encoding involves selecting words, choosing gestures, tone of voice, signs and symbols to deliver the message
Message
the verbal or nonverbal information the sender communicates; may include letter, speech, or gestures
Channel
medium used to send the message; for example, face-to-face; written; audiovisual; telephone; e-mail
Receiver
is the observer, the listener that interprets the message (known as decoding or interpretation of the message)
Feedback
once the receiver has interpreted or decoded the message, he may wish to respond back (verbal, nonverbal, or both); validates that the receiver received the message and understood
Communication process
a sender encodes and transmits a message to a receiver, who decodes it and transmits feedback
Communication
the process of sending messages back and forth between two or more people
Verbal messages
- Denotative the dictionary meaning, it is literal (e.g., I'm dying from cancer)

- Connotative means implied or emotional meaning
(e.g., I'm dying from the heat).
Nonverbal messages
gestures, facial expressions, posture, gait, touch
Factors that influence effective verbal communication
- Intonation
- Clarity and Brevity
- Timing and Relevance
- Credibility of the sender
- Humor
- Vocabulary
- Pacing of conversation
Intonation
tone, pitch, cadence, volume
Clarity and Brevity
conciseness of expression in speech, shortness in duration
Timing and Relevance
important for everything with regards to the patient; use good judgment
Credibility of the sender
- Believability
- Stick to facts
- Acknowledge your discomfort
- Be open and honest
Humor
you need to be careful when using humor, can be misinterpreted, what you think is funny may not be funny to another
Vocabulary
healthcare workers use technical terms and jargon; consider the client or family members age, knowledge-level, educational level, is English their primary language? What are the cultural influences?
Pacing of conversation
keep conversation at a steady, comfortable pace, pause and confirm understanding
Factors that effect nonverbal communication
- Facial expression
- Posture and galt
- Personal appearance
- Distance
- Gestures
- Touch
Facial expression
especially the eyes communicate feelings behind a message
Posture and galt
clue to attitude, self-concept
Personal appearance
clue to socioeconomic status, culture, feelings
Distance
indicates extent of familiarity
Gestures
emphasize and clarify spoken word; can have different meanings
Touch
can convey affection, caring, concern, and encouragement, it can also be misinterpreted
6 factors that effect communication
- Environment
- Gender
- Life Span Considerations
- Personal space
- Territorial
- Sociocultural factors
Environment
communication is most successful in a quiet, private environment free of smells and has a comfortable temperature
Gender
males and females communication patterns are different, the purpose of speech and communication are also different
Life Span Considerations
communicating with small children is very different than communicating with adults, developmental needs are different across the lifespan
Personal Space
understanding cultural norms for appropriate distances and space needed when communicating
Territorial
indicates what items around an individual is interpreted as his own; for example, in some cultures it would be unacceptable for a male nurse to approach and speak directly to the wife of a client
Sociocultural Factors
cultural social and economic factors impact how a nurse will approach and communicate with clients
Assertiveness
- Question care decisions openly and honestly
- Use I statements
- Focus on the issue not the participants
- Use effective non verbal language
- Avoid negative talk
- Strive for a workable compromise
- Say " I need clarity"
- Use CUS acronym:
Concerned - "I am concerned"
Uncomfortable - "I am uncomfortable"
Safety - "This is unsafe" or "I am scared"
Therapeutic Communication
Client-centered - not focused on the nurse.
Encourages the client to talk about and work through problems, say to the client " tell me more."
It is not appropriate to ask a client why? "Why did you ...." "Why didn't you...." can be viewed as highly judgmental. Seek to understand, not judge.
Focuses on:
Providing necessary information about health, treatments, and care.
Goal-directed - improve the health and well-being of the client.
Focuses on communicating in a way that strengthens the therapeutic relationship - so you are building a relationship.
Four phases of a therapeutic relationship
- Pre-interaction phase
- Orientation phase
- Working phase
- Termination phase
Phase 1: Pre-interaction
occurs before you meet the client: reading the client's chart, receiving report
Phase 2: Orientation
meeting the client; introductions; establishing rapport and trust, may be very brief in an emergency situation; ends when relationship has been defined (who you are and your role in their care)
Phase 3: Working
active part of the relationship and were the bulk of interaction takes place; the goals are to have the nurse exhibit care, the client is provided an opportunity to relay his/her thoughts and feelings, mutual respect is maintained and honest open communication occurs through the nurses use of therapeutic communication techniques (e.g., active listening, clarifying, etc.)
Phase 4: Termination
occurs at the end of the relationship (can be end of shift or at discharge or following discharge); when the interaction ends, the therapeutic relationship is terminated
5 Key Characteristics of Therapeutic Communication
Therapeutic use of self - requires the nurse to recognize the boundaries of a therapeutic relationship and to keep the focus on the client rather than your feelings and experiences
- Empathy
- Respect
- Genuineness
- Concreteness and confrontation
Empathy
involves looking outside of yourself and putting yourself in the clients place. The desire to understand and be sensitive to the feelings, beliefs, and situation of another person. Demonstrate being non-judgmental, willing to change your approach based on the needs of the client
Respect
valuing the client and being flexible to meet the client's needs. You adjust to the client. Address them properly, careful select your words and tone
Genuineness
the ability to respond honestly, don't guess at answers you are unsure of - be honest - "let me find out for you." Ability to self-evaluate the communication
Concreteness and Confrontation
offering understandable responses to questions and concerns. Using concrete, specific terms you must be willing to confront the client if their communication is unclear and allow yourself to be confronted
Listen actively
face client, make good eye contact, indicate you are interested in what they have to say, nod your head
Establishing trust
greet client by last name, listen actively, show your interest
Being assertive
be confident and in charge of the conversation, have a presences
Restate, clarify, and validate message
"so let me tell you what I have heard", " I hear you say...", "Do I understand you to say...."
Interpret body language
"you look like you are in pain"
Exploring issues
"And then what did you do .....", "Tell me more..."
Use silence
minutes at a time, to allow for reflection and thought
Summarize the conversation
"We have discussed your feelings about being a newly diagnosed with diabetes. You are concerned about "the cost of medications and your ability to learn and follow a diabetic meal plan."
Make and share your observations to clarify
"I notice you are grimacing when you move in bed."
Use open-ended questions
"How do you feel about that?"
Nursing barriers to communication
- Asking too many questions
- Using closed-ended questions - yes or no
- Asking "Why?"
- Changing the subject inappropriately
- Failing to probe - get more information
- Failing to explore issues in detail - as many details as you deem necessary
- Expressing approval or disapproval - nodding or shaking your head
- Offering advice, "If I was in your situation, I would ......"
- Providing false reassurance "you are going to be ok", "everything will be fine"
- Stereotyping - generalizing
- Using patronizing language - such as sweetie or assuming that a client is younger than you and use their first name. Always ask first what they would like to be called!
Client barriers to communication
- Language barrier
- Impaired cognitive skills
- Sensory-perceptual altercations
- Physiological barriers
Language barrier
use a picture board, ask for relative to be present to interpret - not first option and not with admission questions or medical procedures, nothing private - use a hospital interpreter; family can assist only general conversational questions
Impaired cognitive skills
make every attempt, give client time to absorb, don't rush them, use short sentences with few words
Sensory-perceptual altercations
make sure hearing aids are in, and glasses are on
Physiological barriers
client may have tubes in mouth or throat, use a pen/pencil to allow them to write and respond to questions; easy yes - no questions, maybe even write out yes/no on the tablet and allow them to point; repeating/confirming their answer as you progress
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