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Chapter 4
Therapeutic Communication Skills
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Importance of Communication
• Foundation for all patient care
• Therapeutic communication skills create
feelings of comfort for patients
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The Communication Cycle
• Involves two or more individuals
exchanging information
• Involves sending and receiving messages
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The Communication Cycle
^^ The communication cycle and channels of communication.
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Four Elements of
the Communication Cycle
• The sender begins cycle by encoding
message
• The message delivered via a channel or
mode of communication
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Speaking
Listening
Gestures or body language
Writing
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Four Elements of
the Communication Cycle
• The receiver must decode the meaning of
the message
• Feedback takes place after receiver has
decoded message sent by sender
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The Communication Cycle
• Listening skills
– Active listening involves verifying message from
sender
– Received message is sent back to sender worded
slightly differently
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Verbal Communication
• Takes place when message is spoken
• Sender and receiver must apply same
meaning to spoken words
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Verbal Communication
• The Five C’s of Communication:
– Complete
– Clear
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Eye contact enhances clarity
Articulate and enunciate
Time to process message
Message must be heard
– Concise
– Cohesive
– Courteous
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Verbal Communication
• Good communication skills help establish
rapport with patients
– Call patients by full name
– Encourage patients to verbalize feelings
– Give technical information to patients clearly
• Allow patients to make practical application
to their health needs
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
• Body language
– Unconscious body
movements, gestures, and
facial expressions
Body language can
communicate more than
spoken words >>
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
• Body Language
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Expressions that accompany speech
Kinesics is study of body language
Body language learned first
Body language influenced by primary caregivers and
culture
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
• Feelings and emotions are communicated
through nonverbal means
– 70% of language is nonverbal
– Tone of voice communicates 23% of message
– Spoken word communicates 7% of message
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
• Facial expression
– Eyes reflect feelings
– Staring is invasion of privacy
– Cultural influences affect facial expressions
• Personal space
– Comfortable personal space
– Handled differently by various cultures
– Explain procedures that will be invasive
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
• Posture
– Relates to position of body or parts of body
– Involves at least half the body
• Position
– Face-to-face communication
– Should enable observation of verbal and nonverbal cues
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
Positive posture and position
encourage therapeutic
communication >>
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Nonverbal Communication
• Gestures and mannerisms
– “Talk” with hands
– Enhances spoken word
• Touch
– Appropriate touch is therapeutic
– Not all patients are comfortable with touch
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Congruency in Communication
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Congruency in Communication
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Verbal and nonverbal messages must agree
The meaning of mixed messages
Clustering groups of nonverbal messages
Masking conceals true feeling or message
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Congruency in Communication
• Perception
– Conscious awareness of one’s own feelings and the
feelings of others
– Sense another’s attitudes, moods, and feelings
– Follow perceived assessments with verbal validation
– Easily misinterpreted
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Barriers to Therapeutic
Communication
• Age and gender barriers
• Economic barriers
• Education and life experience barriers
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Barriers to Therapeutic
Communication
• Bias and prejudice barriers
• Verbal roadblocks to therapeutic
communication
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Defense Mechanisms as Barriers
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Regression
Denial
Repression
Projection
Sublimation
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Displacement
Compensation
Rationalization
Undoing
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Barriers to Therapeutic
Communication
• Barriers caused by cultural and religious
diversity
– Caregiving expectations
– Time focus
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Barriers to Therapeutic
Communication
• Human needs as
barriers to
communication
Maslow’s hierarchy of needs
>>
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Establishing Multicultural
Communication
• The patient must trust the professional
• Steps to building trust include:
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Risk/trust
Conveying empathy
Showing respect
Being genuine
Active listening
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Working with Multicultural and
Diverse Patient Populations
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Cultural Brokering
• Cultural broker serves as a go-between
• One who advocates on behalf of another
individual or group within the health care
community
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Cultural Brokering
• Goal of cultural brokering
– Increase the capacity of health care and mental health
programs to design, implement, and evaluate culturally
and linguistically competent service delivery systems
• Cultural brokers may assume the role of
medical interpreter
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Working with Interpreters
• Interpreters do not provide word-for-word
equivalence, rather focus on the accurate
expression of equivalent meaning
• Remember to speak directly to the patient,
not to the interpreter
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Working with Interpreters
• A family member may serve as the
interpreter
• Disadvantage of a family member serving
as interpreter
– They may not understand medical terminology
– It would be very difficult for a family member to share
a poor prognosis or a life-threatening diagnosis
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Interview Techniques
• Closed questions
– “Are you taking your medications?”
• Open-ended questions
– “How are you coming along with your diet?”
• Indirect statements
– “Tell me what you’ve been doing since your
retirement.”
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Point of Care Techniques
• Location where the patient and provider or
patient and office personnel physically
interact
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Community Resources
• Need to refer patient to a community
resource
• Developing a community resource
document
Copyright © 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.