COMMUNICATION

Communication
 the exchange of thoughts, feelings, and
other information
 Components of
Communication
 Sender

 Message
 Channel (visual, auditory,
kinesthetic)
 Receiver
 Feedback (Specific, Given
in a timely manner, Clear,
Direct and honest)
Modes of Communication

Verbal

Nonverbal
Modes of Communication

Verbal

Nonverbal
 Types of Personal Space
Type Description
Intimate distance • Reserved for people who
(0 to 18 inches feel close
around the • Vision is affected in that
person’s body) it is restricted to one
portion of the other’s
body; may be distorted
• Tone of voice may seem
louder
• Body smells are noticeable
• Increased sensation of
body heat
Personal distance • Usually maintained with
(zone extends 1.5 friends
to 4 feet around • Vision is clear since more
the person’s body) of the other person is
visible
• Tone of voice is moderate
• Sensations of body smells
and heat are lessened
Social or public • Generally used when
distance conducting impersonal
(zone extends from business
4 feet and beyond; • Communication is more
social: 4-12 feet formal and less intense
public: 12-15 • Sensory involvement is
feet) less intense
• Increased eye contact
Nursing Implications
• Nurses often must intrude on
this space to provide care
• Explain intention to client
• Respect client’s space as
much as possible
• This space may be used for
comforting and protecting
• Therapeutic examples:
— Rocking a toddler
— Administering a massage
— Checking vital signs
• Better able to read nonverbal
communication at this
distance
• Therapeutic examples:
— Conversation between
client and nurse usually
occurs in this zone
— One-to-one teaching
— Counseling
• Therapeutic examples:
— Making rounds
— Leading a group
— Teaching a class
 Therapeutic
COMMUNICATION
 Therapeutic
Communication
 using communication for the purpose of
creating a beneficial outcome for the
client
 purposeful, in that it is directed toward
a specific outcome

 the hallmark of the nurse-

client relationship
Therapeutic Communication
TECHNIQUES OF THERAPEUTIC COMMUNICATION

Technique Description Example

Techniques that allow the client to set the pace
Offering Nurse is available, physically and “I’ll sit with you
self emotionally awhile.”
Indicates nurse’s willingness/intent “Go on.”
to help “Uh-huh.”
Nurse’s presence is reassuring; may Head nodding
prompt client to continue
Indicates nurse’s attention and
interest
Broad Encourages client to choose topic “What do you want to
openings for discussion talk about?”
Demonstrates respect for client’s “Can you tell me more
thoughts about that?”
Emphasizes importance of client’s “How have things been
needs going?”

Silence Gives client time to reflect Sit quietly and observe

Encourages client to express self client’s behavior
Indicates interest in what client Use appropriate eye
has to say contact
Increases nurse’s understanding of Employ attending
client’s message behaviors
Helps to structure and pace the Control own discomfort
interaction during quiet periods
Conveys respect and acceptance or conversation lulls
Therapeutic Communication
TECHNIQUES OF THERAPEUTIC COMMUNICATION
Technique Description
Techniques that encourage spontaneity
Using Unfinished sentences that
Open-ended prompt client to continue
questions Questions that cannot be
answered with a one-word
answer
Allows client to decide what
content is relevant
Reflecting Focuses on content of
client’s message and
feelings
Repeating client’s last
words in order to prompt
further expression
Communicates nurse’s
interest
Lets client know the nurse
is actively listening
Restating Repeating or paraphrasing
client’s main idea
Indicates nurse is listening
to client
Encourages further dialogue
Gives client an opportunity
to explain or elaborate
Example
“Tell me about your pain?” instead
of “Are you in pain?”
“Tell me about your family” rather
than “How many children do you
have?”
Client: “Do you think I should
tell the doctor I stopped taking
my medication?”
Nurse: “What do you think about
that?”
Client: “I probably should. But
the medicine makes me
so tearful and agitated.”
Nurse: “You sound a bit agitated
now.”
Client: “I told the doctor that I
had problems with this medicine,
but he just didn’t listen to me!”
Nurse: “Sounds like you’re pretty
angry at him.”
Client: “I don’t sleep well
anymore.”
Nurse: “You’re having problems
sleeping ?”
Therapeutic Communication
TECHNIQUES OF THERAPEUTIC COMMUNICATION

Technique Description Example

Techniques that focus on the client by responding to verbal, paraverbal, and
nonverbal cues

Exploring Attempts to develop in “Tell me more about how you feel

more detail a specific when you do not take your
area of concern to medication.”
client “Could you tell me about one of
Identifies patterns or those times when you felt so
themes upset?”

Acknowledging Nurse points out observed “I notice that you became

cues to client embarrassed when . . .”
“I see that you have some pictures
of the new baby.”

Focusing Questions or statements “You mentioned that you are having

that help client develop a problem with . . .”
or expand an idea Directs “You say you feel nauseous a lot.”
conversation toward key
topics

Directing Comments that elicit Client: “They told me I needed to

specific information from see a specialist.”
the client Nurse: “What made them say that to
Is used to collect you?” or
assessment data, not to “When were you told this?” or
satisfy nurse’s curiosity “Where were you when they told
you?” or
“How do you feel about seeing
another doctor?”
Therapeutic Communication
TECHNIQUES OF THERAPEUTIC COMMUNICATION
Technique Description Example
Techniques that encourage expression of feelings
Verbalizing An attempt to detect the Client: “How much is this x-ray going to
true meaning of the cost?”
implied verbal messages Nurse: “You’re worried about your
medical bills?”

Making Nurse calls attention to “You seem sad today.”

observations behavior indicative of “You’re limping as if your leg hurts.”
feelings

Clarifying Makes the meaning of Client: “Whenever I talk to my doctor, I

client’s message clear feel upset.”
Prevents nurse from Nurse: “Tell me what you mean by upset.”
making assumptions Client: “They said I could be discharged
about client’s message tomorrow.”
Nurse: “Who told you this?”

Techniques that encourage the client to make some changes

Perception Nurse’s verbal response Client: “I am so angry at her” (stated
checking to incongruence between while smiling).
client’s words and Nurse: “You say you’re angry, yet you’re
actions smiling.”
Encourages client to
recognize potential
areas for change

Limit setting Stating expectations for Nurse: “It seems that you are feeling
appropriate behavior unsure of how to behave right now.”
Establishing behavioral Client: “What do you mean?”
parameters Nurse: “Well, you’re asking me a lot of
personal questions. How can I help you
tell me more clearly what brought you
here to the clinic?”
Therapeutic Communication
COMMUNICATING WITH VULNERABLE POPULATIONS
Clients who are Determine if the client reads lips. If so, face the client
hearing impaired and reduce background noise to a minimum.
If client is using a hearing aid, check to see that it is in
working order.
Always face the client.
Speak at a normal pace in a normal tone of voice.
Focus on nonverbal cues from the client.
Use gestures and facial expressions to reinforce verbal
messages.
Provide pen and paper to facilitate communication if client
is literate.
Clients who are When speaking to visually impaired clients, always face them
visually impaired as if they were sighted.
Follow the cues of the clients in order to allow as much
independence as possible.
Look directly at the client.
Speak in a normal tone of voice; it is demeaning to yell.
Ask for permission before touching the client.
Orient the client to the immediate environment.
Clients who are Assess the client’s usual method of communication; adapt the
aphasic interaction to accommodate the client’s abilities.
Use a written interview format, letter boards, or yes/no
cards.
Allow additional time for client’s responses.
Do not answer for the client.
Use closed (one-word response) questions when possible.
Repeat or rephrase the comment if client does not understand.
Speak directly to the client, not to the intermediary.
To reinforce verbal messages, use facial expressions,
gestures, and voice tone.
Therapeutic Communication
COMMUNICATING WITH VULNERABLE POPULATIONS
Unconscious Assume the client can hear.
clients Talk to the client in a normal tone of voice.
Engage in normal conversational topics as with any
client.
Speak to the client before touching.
Use touch to communicate a sense of presence.
Decrease environmental stimuli (especially auditory).
Confused Maintain appropriate eye contact.
clients Keep background noises to a minimum.
Use simple, concrete words and sentences.
Use pictures and symbols.
Use closed rather than open-ended questions.
Give the client time to respond.
Angry Use caution when communicating with a client who has a
clients history of violent behavior or poor impulse control.
Do not turn your back on the client. Arrange the
setting so that the client is not between you and the
door to the room.
Focus on the client’s body language.
Be alert for physical indicators of impending
aggression: narrowed eyes, clenched jaw, clenched
fist, or a loud tone of voice.
Model the expected behavior by lowering your tone of
voice.
Stay within the client’s line of vision.
Do not use touch.
 Documenting
and Reporting
 Documentation
 serves as a permanent record
of client information and care
 purposes:
- communication
- legal documentation
- research
- education
 Reporting
 oral, written, or computer-based
communication intended to convey
information to others
 takes place when two or more
people share information
about the client, either face to
face or by telephone
Documentation Systems
 Source-Oriented Record
- traditional client record
- narrative charting
 Problem-Oriented Medical
Record (POMR)
- database
- problem list
- plan of care
- progress notes (SOAP, SOAPIE,
SOAPIER,APIE)
 Computer Record