Chapter 44 Therapeutic Communication Skills

Communication *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 Encourage them to express their thoughts

Communication 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

*Rapport 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 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 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) Nonverbal communication (NVC) Sharing information without using words or language, expresses emotions and attitudes as well as enhancing what is being expressed verbally* *Proxemics and personal space Social 4-12 feet, demonstrations, group interactions, parties 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) Therapeutic communication Effective when there is congruency Avoid mixed message Haptic communication

Factors Influencing Communication Attention What the client is saying Age Gender

Culture and Subculture Difficult client behaviors Sexual harassment, aggressiveness Social factors, religion History of illness Body image Physical disabilities The healthcare team

Aggressive 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 Skills *Silence gives the nurse and the client an opportunity to collect their thoughts and to prepare to continue the conversation, many clients will respond verbally to silence 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) *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

Communicating 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. Help client resolve feelings and speak up

Communicating With the Client Who Has Sensory 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 Has Sensory 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 Aphasia is the inability to communicate verbally or who cannot communicate via writing or by sign language or who cannot comprehend what is being said Develop a method of communication to help prevent withdrawal and social isolation.

The Client Who Is Not Able or Who 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 Language Provide a client’s language-to-English language dictionary. Make sure to schedule a qualified interpreter. Interpretors must be facility approved before becoming involved in client care* 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 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.