ch21 communication

JUDITH M. WILKINSON LESLIE S. TREASKAREN BARNETT MABLE H. SMITH

FUNDAMENTALS OFFUNDAMENTALS OFNURSINGNURSING

Copyright © 2016 F.A. Davis Company

Chapter 21: Chapter 21: Communication & Therapeutic Communication & Therapeutic

RelationshipsRelationships


What is Communication?

• Basic human function• Sending messages back and forth between

two or more people• Consists of verbal and nonverbal messages• Helps build working relationships• Helps meet physical, psychosocial,

emotional, and spiritual needs


Levels of Communication

• Intrapersonal: self-talk; can be positive or negative

• Interpersonal: between two or more people

• Group: with many people at the same time


Components of Communication: Content • Subject matter• Words• Gestures• Substance of the message • Open to interpretation


Components of Communication: Process• The active part of communication • Involves five elements

– Message: words, gesture, letter– Sender: initiates content delivery– Channel: face-to-face, written, audiovisual,

telephone, e-mail– Receiver: interprets the message– Feedback


Communication Components


ClickerCheck

During the communication process, “decoding” is

a.The selection of words by the senderb.The interpretation of the message by the receiverc.The method by which the message is givend.The way in which feedback is interpreted


ClickerCheck (cont’d)

Correct answer: C


Verbal Communication

Involves speaking or writing words to send a message


Factors Affecting Verbal Communication• Vocabulary• Denotative versus

connotative meaning• Pacing of

conversation• Intonation: tone,

pitch, cadence, volume

• Clarity and brevity• Timing• Relevance of

information• Credibility of the

sender• Humor


ClickerCheck

The nurse is teaching the client about his upcoming procedure, and the client is very stressed. It would be most important for the nurse to

a.Use humor first to decrease the client’s stress level.b.Determine if the teaching should take place at a different time.c.Introduce himself as the RN to give credibility to his message.d.Speak to the client when family members are there so they can teach the client.



Correct answer: B

Clients who are stressed may be unable to listen fully and will not receive/understand the intended message.


Nonverbal Communication

The unconscious use of body language when sending a message


Factors Affecting Nonverbal Communication• Facial expression: communicates feelings behind

a message• Posture and gait: clue to attitude, self-concept• Personal appearance: clue to socioeconomic

status, culture, feelings• Distance: indicates extent of familiarity • Gestures: emphasize and clarify spoken word; can

have different meanings • Touch: can be misinterpreted


Factors That Affect Communication in General• Environment• Life span variations• Gender• Personal space

• Territoriality• Sociocultural

factors• Roles and

relationships


Therapeutic Relationships in Healthcare• Focus on improving the health of the client

• Provide necessary information about health, treatments, and care

• Involve use of therapeutic communication


Therapeutic Communication

• Client centered• Goal directed• Strengthens therapeutic relationship


Phases of the Therapeutic RelationshipStage 1: Preinteraction phase• Gathering information prior to meeting client


Phases of the Therapeutic Relationship (cont’d)

Stage 2: Orientation phase• Meeting the client; introductions; establishing

rapport and trust



Stage 3: Working phase• Use of techniques germane to therapeutic

communication• Active part of the relationship• Client clarifies feelings and concerns through

verbal and nonverbal communication



Stage 4: Termination phase• Conclusion of the relationship


ClickerCheck

Use of the statements “Tell me more about…” or “I see” encourage clients to continue talking and expressing themselves. This is called:

a.Summarizingb.Open-ended questionsc.Focusingd.Encouraging elaboration



Correct answer: D


Key Characteristics of Therapeutic Communication• Empathy• Respect• Genuineness• Concreteness• Confrontation


Client Factors Affecting Effective Therapeutic Communication• Language barrier• Impaired cognitive skills• Sensory-perceptual alterations • Physiological barriers


Enhancing Therapeutic Communication• Listen actively.• Establish trust.• Be assertive.• Restate, clarify, and validate message.


Enhancing Therapeutic Communication (cont’d)

• Interpret body language.• Share your observations to clarify.• Use open-ended questions.• Use silence.• Summarize the conversation.


Five Steps of Assertive Communication1. Get the person’s attention.2. Express your concern.3. State the problem.4. Propose an action.5. Reach a decision.

Source: Leonard, M., Graham, S., and Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Supplement), 85–90.


Barriers to Therapeutic Communication• Too many questions• Closed-ended questions• Asking “Why?”• Changing the subject abruptly• Failing to listen


Barriers to Therapeutic Communication (cont’d)

• Failing to explore issues in detail• Expressing approval or disapproval• Offering advice• Giving false reassurance• Stereotyping• Using patronizing language


Think Like a Nurse

Think of an example of communication in which the connotative meaning may be different from the denotative meaning of what is said.

ch21 communication

Health & Medicine