1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 44 Therapeutic Communication Skills

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Communication (cont’d) Therapeutic communication –Effective when there is congruency –Avoid mixed message –Haptic communication

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Nonverbal communication generally conveys feelings and attitudes.

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Verbal communication is used to communicate information. Nonverbal communication conveys feelings and attitudes.

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Factors Influencing Communication Attention Age Gender

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Culture and Subculture Difficult client behaviors –Sexual harassment, aggressiveness Social factors, religion History of illness Body image Physical disabilities The healthcare team

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? Nursing care often involves the invasion of a client’s traditional personal space.

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Nurses are often forced to invade a client’s personal space. The nurse should alert the client before touching him or her.

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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).

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic 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

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? 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.

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 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.”

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 –Develop a method of communication to help prevent withdrawal and social isolation.

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

24. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The 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.

25. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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.

26. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? If the client avoids direct eye contact, the client is probably not telling the truth or has something to hide.

27. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Hesitation before speaking or avoiding direct eye contact may be a sign of respect in your client’s culture.

28. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation