1. Chapter 44 Therapeutic Communication Skills

2. 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

3. 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

4. *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.

5. 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

6. Types of Communication
Verbal communication
Verbal barriers
Responses that stop communication
Characteristics of speech
Volume
Rate and rhythm
Aphasia: Expressive aphasia, receptive aphasia
Listening

7. 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

8. Types of Communication (cont’d)
Therapeutic communication
Effective when there is congruency
Avoid mixed message
Haptic communication

9. Factors Influencing Communication
Attention
What the client is saying
Age
Gender

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

11. 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).

12. 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

13. 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

14. 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

15. 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.

16. 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.

17. 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.

18. 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.

19. 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.