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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 Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins 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