Rita Carey, MSN, RN

Therapeutic Communication

Communication Process

 One-way communication  Sender controls the message  No opportunity for feedback  Two-way communication  Each person contributes equally  Involves feedback or discussion Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Factors that Affect Communication

 Personal characteristics of sender and receiver  Age, gender, income, marital status, attitude, etc.

 Cultural characteristics  Space, language, touch, manners, gestures, etc.

 Situational influences  Physical and emotional state, background noise, interruptions, etc.

 Context  Appropriateness/inappropriateness of the message Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Types of Communication

 Verbal  Nonverbal  Affective Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Types of Communication

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Verbal communication: spoken messages

  Speak clearly Speak professionally  Speak only about what you know   No slang No medical jargon  Colloquial expressions may be appropriate Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Types of Communication



Nonverbal communication: body language

 Expressions, posture, movements, gestures, physical appearance  Clues to the truth of the spoken message  Indicators of patient discomfort  Physical appearance is a part of nonverbal communication Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Types of Communication

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Affective communication: feeling tone

 Tone of communication  Emission of energy Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Communication Strategies

Active Listening

 Most important part of any therapeutic communication  Key factors include purpose, disciplined attention, and focus  A common mistake is to listen to the words, but not really hear the words Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Communication Strategies

Types of Questions

 Open-ended questions   Permit variety of responses Often begin with what, where, when, how, or why 

“What happened to your leg?”

 Closed-ended questions  Require a specific answer 

“When did you first notice the pain?”

 Focused questions  Provide more definitive information 

“On a scale of 1 to 10, with 10 as the worst possible pain, how would you rate your pain right now?”

Communication Strategies

Active Listening Behaviors

 Restating  Clarification  Reflection  Paraphrasing  Minimal encouraging  Silence  Summarizing  Validation Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Patient: My knee hurts even while I’m sitting in my chair.

Nurse: So you are telling me you have pain in your left knee even at rest?

 Restating

Nurse: “I am not sure I follow that.” 

Clarification

Nurse: “In this hour you and I discussed….” 

Summarizing

Patient: “It’s a waste of time to talk to anyone.” Nurse: “You don’t think anyone understands?” 

Paraphrasing

Nurse: “Tell me whether my understanding is the same as yours.” 

Validation

Nurse: “Go on…I see.” 

Minimal encouraging

Patient: “Should I have the surgery?” Nurse: “Do you think you should?” 

Reflection

Communication Strategies

Nurse/Patient Communication Evaluation

 Communication is far more complex than just talking  Evaluate the characteristics that are working for you and those you need to work on Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Blocks to Communication

 False reassurance guarantees positive outcome  Probing pushes for information beyond medical necessity  Chiding or scolding for behavior such as smoking  Belittling, mimicking, or making fun of the patient, downplaying symptoms  Giving advice  Providing pat answers negates individuality of the situation Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Male/Female Differences

 Most males and females follow certain patterns with regard to:  Conversation   Head movements Smiling  Posture  Differences in patient communication have important nursing implications Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Cultural Differences

 Understanding cultural differences will help nurses respond respectfully and therapeutically  Differences apply generally to groups as a whole  Individual patient differences should still be identified Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Role Changes for the Patient

 Dependent position  Set tone by providing respect and information; do not use first name unless specifically requested by patient  Avoid medical jargon  Ask if patient has questions  Be sensitive to personal or environmental factors that may cause anxiety Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Communication Characteristics

Important in All Communications    Respect Trust Honesty        Empathy Sensitivity Humor Knowledge Patience Commitment Self-esteem Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Communication Characteristics

 Self-esteem  Earned, not learned  Gives you permission to recognize that you have something very special to offer in nursing communication  Thoughts  Random thoughts usually pass through, unless you pick a thought and change it into an active thought  Straightforward communication  Be direct in your conversation, remembering that language is never innocent Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Life Span Communication

Each age group has different communication needs

  Infants    Cries have different meanings Influenced by the sound of the voice Respond to calm, low tones Preschool    Cannot verbally express frustration, leading to tantrums Communicate by pointing Can help if coached Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Life Span Communication

 School-age   Can be part of many discussions Can use drawings or pictures to explain an illness  Teenage   Extend same courtesy as to adults Encourage expression of feelings Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Life Span Communication

 Adult   Collect data at all three communication levels Limit questions to medical areas  Elderly   Check which side is best for hearing Read directions aloud Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Conflict Resolution

         Accept conflict as a natural part of life Shift your own attitude and behavior Take time to think critically before reacting Treat conflict as an opportunity to voice your own opinion and listen to the other side of the story Choose your approach Listen and learn Discover what is important Respect each other Find common ground, generally the patient’s highest good Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Electronic Communication

   Fax machines Computer patient charting E-mail  Keep sentences and paragraphs short; check spelling, punctuation       Skip a line to separate topics Send message to the right person Write “subject” line carefully Be specific Be cautious with humor Avoid all CAPS Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Electronic Communication

Cell Phones and Text Messaging

 Shut off cell and text messaging phones during class and clinical  Avoid behaving in ways disruptive to the instructor and other students Elsevier items and derived items © 2009, 2005 by Saunders, an imprint of Elsevier, Inc. All Rights Reserved.

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Assertiveness: Expected in Nursing

 Helps nurse advocate for the patient  Promotes honest, open communication and behavior  Considers others’ feelings and needs  Benefits nurse, patient, and staff Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Communication Styles

 Translate into behavior patterns  Nonassertive (passive)  Aggressive  Assertive Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Nonassertive (Passive) Behavior

 Automatic response not based on choice  Emotional response based on fear  Dishonest, self-defeating  Overall message: “I do not count. You count.”  Consequence: nurse unable to recognize and meet patient needs Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Aggressive Behavior

 Automatic response not based on choice  Emotional behavior based in anger  Violates the rights of others  Attacks person instead of behavior  Overall message: “You do not count. I count.”  Consequence: distances aggressor from staff and patients Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Assertive Behavior

 Assertiveness: current name for honesty  Pro-active, not emotional response  Positive, confident, open stand  Overall message: “I count. You count.”  Consequence: Nurse feels in control of emotions and responses, and can be more effective patient advocate.

Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Assertive Behavior

 Nonassertive (passive) and aggressive behaviors are based on emotional hooks.  These styles are ultimately damaging to all parties.  Be alert to unresolved feelings that can lead to a cycle of: worry > fear > anger > rage Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Assertive Behavior

 Own your own feelings.

 Don’t blame others.

 Be direct.

 Use “I” statements to make your feelings known.

 Make sure verbal and non-verbal messages are consistent.

Elsevier items and derived items © 2009, 2005 Saunders, an imprint of Elsevier, Inc. All rights reserved.

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Work-Related Aggressiveness

   Workplace assaults take place more often against health care workers, especially nurses, than people in any other occupation.

Contributing factors    Personal Factors Workplace Practices Environmental Factors  Risk Diagnosis Nurses can and should   protect themselves.

advocate for a safer workplace.

Sexual Harassment

 Unwanted Sexual Advances  Verbal or Physical Conduct of a Sexual Nature   A condition of employment or advancement A hostile environment, where the advances intimidate, offend, or interfere with the nurses’ ability to do their work  Not about sex or passion; about abuse of power

Sexual Harassment: What the Nurse Can Do

 Respond assertively.

 Make sure verbal, nonverbal, and affective messages are consistent.

 Document what happened.

 Report to management.

 Consider counseling.

 Consider seeking legal redress.