Therapeutic Communication Flashcards
Critical nursing skill used to gather data, teach and persuade, express caring and comfort
Communication
Interchange of information, ideas, or feelings between two or more people
Communication
Communication
Process:
- To influence
- To obtain information
- Includes verbal and nonverbal methods
- Includes self-talk
The Communication Process
Sender
Message
Receiver
Response
Source-encoder
Sender
A person or group who wishes to communicate a message to another
Sender
Selecting signs, symbols to transmit
Encoding
The message itself
Message
What is said or actually written
Message
The decoder
Receiver
Relating message perceived to receiver’s storehouse to sort out the meaning
Receiver
The listener
Receiver
Feedback
Response
Message that receiver returns to sender
Response
Modes of Communication
Verbal
Nonverbal
Electronic
Uses spoken or written word
Verbal Communication
Uses gestures, facial expressions, touch, and other forms
Nonverbal Communication
Makes up majority of communication
Nonverbal Communication
Technology such as e-mail
Electronic Communication
sometimes conveys meaning more effectively than words
Nonverbal Communication
Modes of Communication
Verbal communication
- Pace and intonation (rise and fall of the voice in speaking)
- Simplicity
- Clarity and brevity (being brief, concise expression)
- Timing and relevance
- Adaptability
- Credibility
- Humor
- Consider client’s perceptions
rise and fall of the voice in speaking
Intonation
being brief, concise expression)
Brevity
Modes of Communication
Nonverbal communication
- Personal appearance
- Posture and gait
- Facial expression
- Gestures
- Consider cultural differences
Modes of Communication
Electronic communication
Advantages:
- Fast, efficient
- Provides record
- Can improve communication and continuity of care
Modes of Communication
Electronic communication
Disadvantages:
- Risk to client confidentiality
- Socioeconomics
- May not enhance communication with all
- Avoid when information is urgent to client’s health, highly confidential, or potentially distressing or confusing
Factors Influencing the Communication Process
- Development
- Gender
- Values and perceptions
- Personal space
- Territoriality
- Roles and relationships
- Environment
- Congruence
- Interpersonal attitudes
- Boundaries
- Knowledge of client’s stage
- Varies across life span
Development
- Girls seek confirmation, minimize differences, and establish intimacy.
- Boys establish independence and negotiate status within group.
Gender
- Standards that influence behavior
- Personal view of an event
Values and perceptions
Personal space
- Intimate
- Personal
- Social
- Public
Intimate
touching to 1-1/2 feet
Personal
1-1/2 to 4 feet
Social
4 to 12 feet
Public
12 to 15 feet
Space, things that individual considers as belonging to self
Territoriality
Between sender and receiver
Roles and relationships
- Most effective communication in comfortable environment
- Privacy
Environment
Verbal and nonverbal aspects of message match
Congruence
- Caring and warmth
- Respect
Interpersonal attitudes
Limits crucial to nurse–client relationship
Boundaries
- Similar to baby talk
- Patronizing to older adults
Elderspeak
Therapeutic Communication Techniques
- Using silence
- Providing general leads
- Being specific and tentative
- Using open-ended questions
- Using touch
- Restating or paraphrasing
- Seeking clarification
- Perception checking or seeking consensual validation
- Offering self
- Giving information
- Acknowledging
- Clarifying time or sequence
- Presenting reality
- Focusing
- Reflecting
- Summarizing and planning
Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response
Using silence
Sitting quietly (or walking with the client) and waiting
attentively until the client is able to put thoughts and
feelings into words
Using silence
Using statements or questions that (a) encourage the
client to verbalize, (b) choose a topic of conversation,
and (c) facilitate continued verbalization
Providing general leads
“Can you tell me how it is for you?”
Providing general leads
“Perhaps you would like to talk about . . . ”
Providing general leads
“Would it help to discuss your feelings?”
Providing general leads
“Where would you like to begin?”
Providing general leads
“And then what?”
Providing general leads
Making statements that are specific rather than general
and tentative rather than absolute
Being specific and tentative
“Rate your pain on a scale of 0 to 10.” (What type of statement?)
specific statement
“Are you in pain?” (What type of statement?)
general statement
“You seem unconcerned about your diabetes.” (What type of statement?)
(entative statement)
Asking broad questions that lead or invite the client
to explore (elaborate, clarify, describe, compare, or
illustrate) thoughts or feelings
Using open-ended questions
specify only the topic to be discussed and invite answers that are longer than one or two words.
Using open-ended questions
“I’d like to hear more about that.”
Using open-ended questions
“Tell me more . . . ”
Using open-ended questions
“How have you been feeling lately?”
Using open-ended questions
“What brought you to the hospital?”
Using open-ended questions
“What is your opinion?”
Using open-ended questions
“You said you were frightened yesterday. How do you feel now?”
Using open-ended questions
Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably
among individuals, families, and cultures, the nurse
must be sensitive to the differences in attitudes and
practices of clients and self
Using touch
Putting an arm over the client’s shoulder. Placing your
hand over the client’s hand.
Using touch
Actively listening for the client’s basic message and
then repeating those thoughts or feelings in similar
words. This conveys that the nurse has listened and
understood the client’s basic message and also offers
clients a clearer idea of what they have said.
Restating or paraphrasing
Client: “I couldn’t manage to eat any dinner last night—
not even the dessert.”
Nurse: “You had difficulty eating yesterday.”
Client: “Yes, I was very upset after my family left.”
Restating or paraphrasing
A method of making the client’s broad overall meaning
of the message more understandable. It is used when
paraphrasing is difficult or when the communication is
rambling or garbled.
Seeking clarification
“I’m puzzled.”
“I’m not sure I understand that.”
Seeking clarification
Would you please say that again?”
“Would you tell me more?”
Seeking clarification
“I meant this rather than that.”
“I’m sorry that wasn’t very clear. Let me try to explain
another way.
Seeking clarification
A method similar to clarifying that verifies the meaning
of specific words rather than the overall meaning of a
message
Perception checking or seeking consensual validation
Client: “My husband never gives me any presents.”
Nurse: “You mean he has never given you a present for
your birthday or Christmas?”
Client: “Well—not never. He does get me something for
my birthday and Christmas, but he never thinks of
giving me anything at any other time.”
Perception checking or seeking consensual validation
Suggesting one’s presence, interest, or wish to understand the client without making any demands or
attaching conditions that the client must comply with to
receive the nurse’s attention
Offering self
“I’ll stay with you until your daughter arrives.”
Offering self
“We can sit here quietly for a while; we don’t need to
talk unless you would like to.”
Offering self
“I’ll help you to dress to go home, if you like.”
Offering self
Providing, in a simple and direct manner, specific factual information the client may or may not request.
When information is not known, the nurse states this
and indicates who has it or when the nurse will obtain it
Giving information
“Your surgery is scheduled for 11 a.m. tomorrow.”
Giving information
“You will feel a pulling sensation when the tube is
removed from your abdomen.”
Giving information
“I do not know the answer to that, but I will find out
from Mrs. King, the nurse in charge.”
Giving information
Giving recognition, in a nonjudgmental way, of a change
in behavior, an effort the client has made, or a contribution to a communication. May be with
or without understanding, verbal or nonverbal.
Acknowledging
“You trimmed your beard and mustache and washed
your hair.”
Acknowledging
“I notice you keep squinting your eyes. Are you having
difficulty seeing?”
“You walked twice as far today with your walker.”
Acknowledging
Helping the client clarify an event, situation, or happening in relation to time
Clarifying time or sequence
Client: “I vomited this morning.”
Nurse: “Was that after breakfast?”
Client: “I feel that I have been asleep for weeks.”
Nurse: “You had your operation Monday, and today is
Tuesday.”
Clarifying time or sequence
Helping the client to differentiate the real from the unrea
Presenting reality
“That telephone ring came from the program on
television.”
“Your magazine is here in the drawer. It has not been
stolen.”
Presenting reality
Helping the client expand on and develop a topic of
importance. It is important for the nurse to wait until
the client finishes stating the main concerns before
attempting to focus. The focus may be an idea or a
feeling; however, the nurse often emphasizes a feeling to help the client recognize an emotion disguised
behind words.
Focusing
Client: “My wife says she will look after me, but I don’t
think she can, what with the children to take care
of, and they’re always after her about something—
clothes, homework, what’s for dinner that night.”
Nurse: “Sounds like you are worried about how well she
can manage.”
Focusing
Stating the main points of a discussion to clarify the
relevant points discussed. This technique is useful at
the end of an interview or to review a health teaching
session. It often acts as an introduction to future care
planning.
Summarizing and planning
Directing ideas, feelings, questions, or content back to
clients to enable them to explore their own ideas and
feelings about a situation
Reflecting
Client: “What can I do?”
Nurse: “What do you think would be helpful?”
Client: “Do you think I should tell my husband?”
Nurse: “You seem unsure about telling your husband.”
Reflecting
“During the past half hour, we have talked about . . . ”
“Tomorrow afternoon, we may explore this further.”
Summarizing and planning
“In a few days, I’ll review what you have learned about
the actions and effects of your insulin.”
“Tomorrow, I will look at your feeling journal.”
Summarizing and planning
Barriers to Communication
Stereotyping
Agreeing and disagreeing
Being defensive
Challenging
Probing
Testing
Rejecting
Changing topics and subjects
Unwarranted reassurance
Passing judgment
Giving common advice
Offering generalized and oversimplified beliefs about
groups of people that are based on experiences too limited to be valid. These responses categorize clients and
negate their uniqueness as individuals.
Stereotyping
Similar to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that
the nurse is in a position to judge this. These responses
deter clients from thinking through their position and may
cause a client to become defensive.
Agreeing and disagreeing
Attempting to protect an individual or healthcare services
from negative comments. These responses prevent the
client from expressing true concerns. The nurse is saying,
“You have no right to complain.” Defensive responses
protect the nurse from admitting weaknesses in healthcare services, including personal weaknesses.
Being defensive
“Two-year-olds are brats.”
“Women are complainers.”
“Men don’t cry.”
“Most people don’t have any pain after this type of surgery.”
Stereotyping
Client: “I don’t think Dr. Broad is a very good doctor. He
doesn’t seem interested in his clients.”
Nurse: “Dr. Broad is head of the department of surgery
and is an excellent surgeon.”
Agreeing and disagreeing
Client: “Those night nurses must just sit around and talk
all night. They didn’t answer my light for over an hour.”
Nurse: “I’ll have you know we literally run around on
nights. You’re not the only client, you know.”
Being defensive
Giving a response that makes clients prove their statement or point of view. These responses indicate that the
nurse is failing to consider the client’s feelings, making the
client feel it is necessary to defend a position
Challenging
Client: “I felt nauseated after that red pill.”
Nurse: “Surely you don’t think I gave you the wrong pill?”
Client: “I feel as if I am dying.”
Nurse: “How can you feel that way when your pulse is 60?”
Client: “I believe my husband doesn’t love me.”
Nurse: “You can’t say that; why, he visits you every day.”
Challenging
Asking for information chiefly out of curiosity rather than
with the intent to assist the client. These responses are
considered prying and violate the client’s privacy. Asking
“why” is often probing and places the client in a defensive
position.
Probing
Client: “I was speeding along the street and didn’t see the
stop sign.”
Nurse: “Why were you speeding?”
Client: “I didn’t ask the doctor when he was here.”
Nurse: “Why didn’t you?”
Probing
Asking questions that make the client admit to something.
These responses permit the client only limited answers
and often meet the nurse’s need rather than the client’s.
Testing
“Who do you think you are?” (forces people to admit their
status is only that of client)
Testing
“Do you think I am not busy?” (forces the client to admit
that the nurse really is busy)
Testing
Refusing to discuss certain topics with the client. These
responses often make clients feel that the nurse is rejecting not only their communication but also the clients
themselves.
Rejecting
“I don’t want to discuss that. Let’s talk about . . . ”
“Let’s discuss other areas of interest to you rather than
the two problems you keep mentioning.”
Rejecting
Directing the communication into areas of self-interest
rather than considering the client’s concerns is often a
self-protective response to a topic that causes anxiety.
These responses imply that what the nurse considers
important will be discussed and that clients should not
discuss certain topics.
Changing topics and subjects
“I can’t talk now. I’m on my way for a coffee break.”
Client: “I’m separated from my wife. Do you think I should
have sexual relations with another woman?”
Nurse: “I see that you’re 36 and that you like gardening.
This sunshine is good for my roses. I have a beautiful
rose garden.”
Changing topics and subjects
Using clichés or comforting statements of advice as a
means to reassure the client. These responses block the
fears, feelings, and other thoughts of the client.
Unwarranted reassurance
“You’ll feel better soon.”
“I’m sure everything will turn out all right.”
“Don’t worry.”
Unwarranted reassurance
Giving opinions and approving or disapproving responses,
moralizing, or implying one’s own values. These
responses imply that the client must think as the nurse
thinks, fostering client dependence
Passing judgment
“That’s good (bad).”
“You shouldn’t do that.”
“That’s not good enough.”
“What you did was wrong (right).”
Passing judgment
Telling the client what to do. These responses deny the
client’s right to be an equal partner. Note that giving
expert rather than common advice is therapeutic.
Giving common advice
Client: “Should I move from my home to a nursing home?”
Nurse: “If I were you, I’d go to a nursing home, where
you’ll get your meals cooked for you.”
Giving common advice
