Therapeutic Communication Skills Chapter 44 By Debi Campbell, RN, MSN And Kelli Olson, RN, BSN

Learning Objectives Define communicationDefine communication List the five component of effective process.List the five component of effective process. Discuss the three parts of the communication process.Discuss the three parts of the communication process. Explain rapport and its importance in nursingExplain rapport and its importance in nursing Differentiate between verbal and nonverbal communication.Differentiate between verbal and nonverbal communication. List at least five nonverbal cues, and discuss each oneList at least five nonverbal cues, and discuss each one Discuss factors that influence the effectiveness of communication.Discuss factors that influence the effectiveness of communication. Demonstrate a teaching session for the following: young children, older adults, visually impaired persons, hearing- impaired persons, unconscious clients, and aphasic individuals.Demonstrate a teaching session for the following: young children, older adults, visually impaired persons, hearing- impaired persons, unconscious clients, and aphasic individuals. Demonstrate means of communicating with a client who does not speak your language.Demonstrate means of communicating with a client who does not speak your language. Demonstrate effective telephone communication skills.Demonstrate effective telephone communication skills.

Define these terms Alias (544) Alias (544) Aphasic (535) Aphasic (535) Assertiveness (538) Assertiveness (538) Body language (535) Body language (535) Close ended questions (539) Close ended questions (539) Communication (534) Communication (534) Eye contactn(536) Eye contactn(536) Interview (539) Interview (539) Non-verbal communication (535) Open-ended questions (539) Personal space (536) Rapport (534) Therapeutic communication (534) Verbal communication (534)

Acronyms: –AKA (544) –ROI (543) –TO (543) –VO (543)

Define communication (534) What is communication? What is communication? It is the giving, receiving and interpreting of information through any of the five senses by two or more interacting people (that includes the unconscious). It is the giving, receiving and interpreting of information through any of the five senses by two or more interacting people (that includes the unconscious). It is the foundation on which interpersonal relationships are built It is the foundation on which interpersonal relationships are built Therapeutic Communication Therapeutic Communication Is healing and helpful Is healing and helpful Benefits from knowing someone cares and understands Benefits from knowing someone cares and understands Nurse has satisfaction from knowing she/he has been helpful to someone Nurse has satisfaction from knowing she/he has been helpful to someone Goal is to help clients communicate and resolve feelings and problems about their health, treatment (including medications), and nursing care Goal is to help clients communicate and resolve feelings and problems about their health, treatment (including medications), and nursing care If successful the client will move towards self-care. If successful the client will move towards self-care.

List the five component of effective process. Sender – the source of informationSender – the source of information Message – the informationMessage – the information Medium or channel – how it is transmitted (verbal, writing, eye contact, body language, tone, volume, etc)Medium or channel – how it is transmitted (verbal, writing, eye contact, body language, tone, volume, etc) Receiver – the person who receives and interprets the informationReceiver – the person who receives and interprets the information Interaction – the response of the receiver to the informationInteraction – the response of the receiver to the information

Discuss parts of the communication process. The interview Use of silence Use of silence Clarification Clarification Reflection Reflection Summarizing Summarizing Using unfinished sentences Using unfinished sentences Different age levels Different age levels The young child The older adult Special situations Special situations Visually impaired Hearing impaired Unconscious client Aphasic person Different languages Specific behaviors

Explain rapport and its importance in nursing Characteristics of communication or rapport are genuineness, caring, trust, empathy and respect.Characteristics of communication or rapport are genuineness, caring, trust, empathy and respect. Conveying these attitudes created a harmony called rapport.Conveying these attitudes created a harmony called rapport. Maintain nonjudgmental attitude, respect each person’s rights to his/her own beliefs.Maintain nonjudgmental attitude, respect each person’s rights to his/her own beliefs. Clients must have or develop this rapport with you in order for them to feel safe in disclosing information which is often personal and sometimes embarrassing to them.Clients must have or develop this rapport with you in order for them to feel safe in disclosing information which is often personal and sometimes embarrassing to them.

Differentiate between verbal and nonverbal communication. Verbal is sharing by written or spoken Verbal is sharing by written or spoken Nurses use this by speaking, writing care plan, document information, assessments, charting and giving report. Nurses use this by speaking, writing care plan, document information, assessments, charting and giving report. Education level is often shared by vocabulary, how they utilize sentence structure and pronunciation (keep in mind the cultural and geographical location differences) Education level is often shared by vocabulary, how they utilize sentence structure and pronunciation (keep in mind the cultural and geographical location differences) Voice inflection, tone, volume and censorship may indicate messages in themselves. Voice inflection, tone, volume and censorship may indicate messages in themselves. Nonverbal is saying without word or language, often called body language. Nonverbal is saying without word or language, often called body language. Gritting teeth and other facial expressions, clenching fists, and avoiding eye contact are forms Gritting teeth and other facial expressions, clenching fists, and avoiding eye contact are forms Be sure you clarify before assuming what their body language means. Be sure you clarify before assuming what their body language means.

Verbal Barriers Barrier Offering empty reassurancesOffering empty reassurances Changing the subjectChanging the subject Using trite clichés such as “the doctor knows best”Using trite clichés such as “the doctor knows best” Imposing your ideas or values on the client and giving advice according to your valuesImposing your ideas or values on the client and giving advice according to your values Disapproving of or judging the clientDisapproving of or judging the client Voicing personal experiences, especially those that are health- relatedVoicing personal experiences, especially those that are health- related More Effective Response Reassuring the client with factual response Helping the client express feelings by staying on track Involving the client in decision- making Helping the client explore his or her own values when a decision or choice must be made Accepting each client as unique; considering ethic and cultural practices in understanding values and behaviors Allowing the person to discuss his or her own concern; answering questions factually; offering client-oriented reference material.

List at least five nonverbal cues, and discuss each one Personal space Personal space Eye contact Eye contact Facial expressions Facial expressions Body movement and posture Body movement and posture Personal appearance and grooming Personal appearance and grooming Therapeutic use of touch Therapeutic use of touch

Discuss factors that influence the effectiveness of communication. AttentionAttention AgeAge Culture and subcultureCulture and subculture The aggressive clientThe aggressive client Social factorsSocial factors ReligionReligion History of illnessHistory of illness Body imageBody image Physical disabilitiesPhysical disabilities Health care teamHealth care team

Time to brainstorm scenario 1 In groups demonstrate a teaching session for the following as assigned: In groups demonstrate a teaching session for the following as assigned: young children young children older adults older adults visually impaired persons visually impaired persons hearing-impaired persons hearing-impaired persons unconscious clients unconscious clients aphasic individuals. aphasic individuals.

Time to brainstorm scenario 2 Demonstrate means of communicating with a client who does not speak your language.Demonstrate means of communicating with a client who does not speak your language.

Time to brainstorm scenario 3 Demonstrate effective telephone communication skills. Demonstrate effective telephone communication skills.

References Rosdahl, C. B., (2003). Textbook of basic nursing, 8 th edition. Lippincott, Williams, & Wilkins.Rosdahl, C. B., (2003). Textbook of basic nursing, 8 th edition. Lippincott, Williams, & Wilkins. Butler, R. N., (2003). Learning to speak Alzheimer’s: A groundbreaking approach for everyone dealing with the disease. First Mariner Books 2004.Butler, R. N., (2003). Learning to speak Alzheimer’s: A groundbreaking approach for everyone dealing with the disease. First Mariner Books 2004.