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Communicating with clients who have special needs:Clients who cannot speak clearly-listen attentively, be patient, do not interrupt-ask simple questions-allow time for understanding and response-use visual cues-do not shout or speak too loudly-Use communication aid12. Clients who are cognitively impairedReduce environmental distractionsGet clients attention prior to speakingUse simple sentencesBe an attentive listener23. Client who are unresponsive-call client by name during interactions-communicate both verbally and by touchProvide orientation to person, place, and time

34. Communicating with hearing impaired client-establish a method of communication -pay attention to clients non-verbal cues-always face client when speaking

45. Client who do not speak englishSpeak in normal tone of voiceProvide interpreterDevelop communication board, pictures, or cards-have dictionary available.5Levels of communication:Small group communicationPublic communicationIntrapersonal Interpersonaltranspersonal6Therapeutic relationshipHelping relationship between the nurse and a client focusing on meeting the needs of the clientPatient centeredProfessional relationshipStructuredGoal directedTime bound7Phases of therapeutic relationship:Pre-orientationSelf awarenessData gathering82. Orientation Establish boundaries and acceptanceEstablish trustEstablish contract

93. WorkingProblem identificationExploitation 104. Termination-begins when the client problem is resolved11Therapeutic technique12Offering self-making self available and showing interest and concern13Active listening-paying close attention to what patient is saying by observing both verbal and non-verbal cues14Exploring-delivering further into a subject or idea15Giving broad openings-allowing client to take initiative in introducing a topic16Silence -planned absence of verbal marks to allow patient and nurse to think over what is being discussed and to say more17Giving observations-verbalizing what is observed in the patient, for validation and to encourage discussion18Summarizing-reviewing the main points of discussions and making appropriate conclusions19Presenting reality or confronting- Stating what is real and what is not without arguing with the patient20Seeking clarification- Asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear21Verbalizing the implied-rephrasing the patients words to highlight an underlying message to clarify statements22Reflecting-throwing back the patients statement in a form of question helps the patient identify feelings23Restating-repeating the exact words of patients to remind them of what they said and to let them know they are heard24General leads- Using neutral expressions to encourage patients to continue talking25Asking open-ended question-achieve relevance and depth in discussion26Focusing-pursuing a topic until its meaning or importanceis clear

27Suggesting collaboration-offering to help patients solve problems28Non-therapeutic Communication techniques29-agreeing/ disagreeing-approving/ disapproving-advising-probing-challenging-changing topic-false reassurance-30313233