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Chapter 44
Therapeutic
Communication Skills
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication
• *Communication
– Giving, receiving, and interpreting of information
through any of the five senses by two or more
interacting people
• *Therapeutic communication
– An interaction that is helpful and healing for one or
more of the participants
• Encourage them to express their thoughts
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communication and the Nursing Process
• Problem-solving
• The nurse needs to collect client data accurately.
• Nursing diagnosis must be clear and concise.
• Planning
• Implementation of the nursing care plan
• Ongoing evaluation of the effectiveness of nursing
interventions
• Client teaching and preparation for discharge
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
*Rapport
• Rapport
– Feeling of harmony
– Genuineness, caring, trust, empathy, and respect
• The nurse conveys a nonjudgmental attitude.
• Clients must experience a feeling of rapport with the
nurse in order to share personal, and sometimes
embarrassing, information.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Components of Communication
• Sender: Originator or source of the idea
• Message: Idea that may be verbal or nonverbal
• Medium or channel: A means of transmitting the idea
• Receiver: The person who receives and interprets the
message
• Interaction: The receiver’s response to the message
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication
• Verbal communication
– Verbal barriers
• Responses that stop communication
• Characteristics of speech
– Volume
– Rate and rhythm
– Aphasia: Expressive aphasia, receptive aphasia
– Listening
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication (cont’d)
• Nonverbal communication (NVC)
– Sharing information without using words or language,
expresses emotions and attitudes as well as enhancing
what is being expressed verbally*
– *Proxemics and personal space
• Social 4-12 feet, demonstrations, group interactions,
parties
– Eye contact and facial expressions
– Body movements and posture
– Gestures and rituals, influence of culture
– Personal appearance and grooming
– Gender differences
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Types of Communication (cont’d)
• Therapeutic communication
– Effective when there is congruency
– Avoid mixed message
– Haptic communication
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Factors Influencing Communication
• Attention
– What the client is saying
• Age
• Gender
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Culture and Subculture
• Difficult client behaviors
– Sexual harassment, aggressiveness
• Social factors, religion
• History of illness
• Body image
• Physical disabilities
• The healthcare team
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Aggressive vs. Assertive Behavior
• Client may be anxious or angry, aggressive or hostile
• Nurse must remain objective and practice assertiveness.
• Characteristics: Passivity, aggressiveness, passiveaggressive
• Suggested approach
– Involve the client and family in decisions about care.
– Remain calm.
– Document having given instructions to the client,
along with the client’s actions or exact words (in
quotes).
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication Skills
• *Silence gives the nurse and the client an opportunity to
collect their thoughts and to prepare to continue the
conversation, many clients will respond verbally to silence
• Interviewing
– Closed-ended or open-ended questions*
• Nonverbal therapeutic techniques
– Avoid crossing the arms over the chest, pointing fingers,
or holding the hands on the hips.
– Listen carefully.
• *Clarification
– Necessary if not understood or if additional information is
needed
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interviewing and Communication Skills
(cont’d)
• *Reflection
– The nurse may echo the client’s words or point out
behavior.
• Paraphrasing
– Helps to clarify the interpretation of the message
• Summarizing
– Helps to make sure it was what the client mean.
• Using unfinished statements
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communicating With Different Age Levels
• *The young child
– Keep normal developmental stages in mind.
– Play is often the most effective means of
communication.
• *The older adult
– Communicate with older adults at an appropriate
level.
– Be considerate of personal dignity.
– Help client resolve feelings and speak up
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communicating With the Client Who Has
Sensory Problems
• The visually impaired or hearing-impaired person
– Do not frighten the person.
– The person with a sensory impairment is normal.
– Utilize the services of a sign language interpreter.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Communicating With the Client Who Has
Sensory Problems (cont’d)
• *The unconscious client
– Always assume the client can hear.
– Introduce self and explain procedure.
– Talk to the client but not about the client.
• **The person with aphasia
– Aphasia is the inability to communicate verbally or
who cannot communicate via writing or by sign
language or who cannot comprehend what is being
said
– Develop a method of communication to help prevent
withdrawal and social isolation.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Client Who Is Not Able or
Who Refuses to Speak
• Use “magic slate” or pencil and paper.
• Establish hand signals or eye signals.
• Most clients can hear and can often understand.
• Treat each person with respect.
• Talk to the client.
• Allow the client time to formulate words.
• Encourage the client to read.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Client Who Speaks a Different
Language
• Provide a client’s language-to-English language
dictionary.
• Make sure to schedule a qualified interpreter.
– Interpretors must be facility approved before
becoming involved in client care*
• Try to learn a few words of the client’s language.
• Ask the client to repeat back and explain what was said.
• Use translation devices.
• Try to assign staff who can speak some of the client’s
language.
• Encourage family members and friends to visit.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Facilitating Communication
• Skillfully interview clients and listen attentively.
• Teach clients and their families.
• Document information and maintain the confidentiality of
information.
• Report the condition of the client.
• Participate in conferences.
• Treat each client as a unique individual.
• Use verbal, nonverbal, haptic communication.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins