Chapter 44 Therapeutic Communication Skills

Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 44

Therapeutic Communication Skills

Chapter 44

Therapeutic Communication Skills


CommunicationCommunication

• Communication

– Giving, receiving, and interpreting of information through any of the five senses by two or more interacting people

• Therapeutic communication

– An interaction that is helpful and healing for one or more of the participants


Communication and the Nursing ProcessCommunication and the Nursing Process

• Problem-solving

• The nurse needs to collect client data accurately.

• Nursing diagnosis must be clear and concise.

• Planning

• Implementation of the nursing care plan

• Ongoing evaluation of the effectiveness of nursing interventions

• Client teaching and preparation for discharge


RapportRapport

• Rapport

– Feeling of harmony

– Genuineness, caring, trust, empathy, and respect

• The nurse conveys a nonjudgmental attitude.

• Clients must experience a feeling of rapport with the nurse in order to share personal, and sometimes embarrassing, information.


Components of CommunicationComponents of Communication

• Sender: Originator or source of the idea

• Message: Idea that may be verbal or nonverbal

• Medium or channel: A means of transmitting the idea

• Receiver: The person who receives and interprets the message

• Interaction: The receiver’s response to the message


Types of CommunicationTypes of Communication

• Verbal communication

– Verbal barriers

• Responses that stop communication

• Characteristics of speech

– Volume

– Rate and rhythm

– Aphasia: Expressive aphasia, receptive aphasia

– Listening


Types of Communication (cont’d)Types of Communication (cont’d)

• Nonverbal communication (NVC)

– Proxemics and personal space

– Eye contact and facial expressions

– Body movements and posture

– Gestures and rituals, influence of culture

– Personal appearance and grooming

– Gender differences


Types of Communication (cont’d)Types of Communication (cont’d)

• Therapeutic communication

– Effective when there is congruency

– Avoid mixed message

– Haptic communication


QuestionQuestion

Is the following statement true or false?

Nonverbal communication generally conveys feelings and attitudes.


AnswerAnswer

True

Verbal communication is used to communicate information.

Nonverbal communication conveys feelings and attitudes.


Factors Influencing CommunicationFactors Influencing Communication

• Attention

• Age

• Gender


Culture and SubcultureCulture and Subculture

• Difficult client behaviors

– Sexual harassment, aggressiveness

• Social factors, religion

• History of illness

• Body image

• Physical disabilities

• The healthcare team


QuestionQuestion


Nursing care often involves the invasion of a client’s traditional personal space.


AnswerAnswer

True

Nurses are often forced to invade a client’s personal space. The nurse should alert the client before touching him or her.


Aggressive vs. Assertive BehaviorAggressive vs. Assertive Behavior

• Client may be anxious or angry, aggressive or hostile

• Nurse must remain objective and practice assertiveness.

• Characteristics: Passivity, aggressiveness, passive-aggressive

• Suggested approach

– Involve the client and family in decisions about care.

– Remain calm.

– Document having given instructions to the client, along with the client’s actions or exact words (in quotes).


Therapeutic Communication SkillsTherapeutic Communication Skills

• Interviewing

– Closed-ended or open-ended questions

• Nonverbal therapeutic techniques

– Avoid crossing the arms over the chest, pointing fingers, or holding the hands on the hips.

– Listen carefully.

• Clarification

– Necessary if not understood or if additional information is needed


Interviewing and Communication Skills (cont’d)Interviewing and Communication Skills (cont’d)

• Reflection

– The nurse may echo the client’s words or point out behavior.

• Paraphrasing

– Helps to clarify the interpretation of the message

• Summarizing

– Helps to make sure it was what the client mean.

• Using unfinished statements


QuestionQuestion


A client who insists that he does not need medication because he is not ill but has been cursed and is the victim of black magic should be diagnosed as being delusional.


AnswerAnswer

False

Many people consider folk medicine or mystical beliefs to be a normal part of life. The documentation of the actual statement by the client is appropriate and objective. This client is not “delusional.”


Communicating With Different Age LevelsCommunicating With Different Age Levels

• The young child

– Keep normal developmental stages in mind.

– Play is often the most effective means of communication.

• The older adult

– Communicate with older adults at an appropriate level.

– Be considerate of personal dignity.


Communicating With the Client Who HasSensory ProblemsCommunicating With the Client Who HasSensory Problems

• The visually impaired or hearing-impaired person

– Do not frighten the person.

– The person with a sensory impairment is normal.

– Utilize the services of a sign language interpreter.


Communicating With the Client Who HasSensory Problems (cont’d)Communicating With the Client Who HasSensory Problems (cont’d)

• The unconscious client

– Always assume the client can hear.

– Introduce self and explain procedure.

– Talk to the client but not about the client.

• The person with aphasia

– Develop a method of communication to help prevent withdrawal and social isolation.


The Client Who Is Not Able orWho Refuses to SpeakThe Client Who Is Not Able orWho Refuses to Speak

• Use “magic slate” or pencil and paper.

• Establish hand signals or eye signals.

• Most clients can hear and can often understand.

• Treat each person with respect.

• Talk to the client.

• Allow the client time to formulate words.

• Encourage the client to read.


The Client Who Speaks a Different LanguageThe Client Who Speaks a Different Language

• Provide a client’s language-to-English language dictionary.

• Make sure to schedule a qualified interpreter.

• Try to learn a few words of the client’s language.

• Ask the client to repeat back and explain what was said.

• Use translation devices.

• Try to assign staff who can speak some of the client’s language.

• Encourage family members and friends to visit.


Facilitating CommunicationFacilitating Communication

• Skillfully interview clients and listen attentively.

• Teach clients and their families.

• Document information and maintain the confidentiality of information.

• Report the condition of the client.

• Participate in conferences.

• Treat each client as a unique individual.

• Use verbal, nonverbal, haptic communication.


QuestionQuestion


If the client avoids direct eye contact, the client is probably not telling the truth or has something to hide.


AnswerAnswer

False

Hesitation before speaking or avoiding direct eye contact may be a sign of respect in your client’s culture.


End of Presentation

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Chapter 44 Therapeutic Communication Skills