Download Communication - s3.amazonaws.com

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
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)
– Proxemics and personal space
– 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
Question
Is the following statement true or false?
Nonverbal communication generally conveys feelings and
attitudes.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Verbal communication is used to communicate information.
Nonverbal communication conveys feelings and attitudes.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Factors Influencing Communication
• Attention
• 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
Question
Is the following statement true or false?
Nursing care often involves the invasion of a client’s
traditional personal space.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
True
Nurses are often forced to invade a client’s personal
space. The nurse should alert the client before touching
him or her.
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
• 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
Question
Is the following statement true or false?
A client who insists that he does not need medication
because he is not ill but has been cursed and is the victim
of black magic should be diagnosed as being delusional.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
Many people consider folk medicine or mystical beliefs to be
a normal part of life. The documentation of the actual
statement by the client is appropriate and objective. This
client is not “delusional.”
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.
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
– 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.
• 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
Question
Is the following statement true or false?
If the client avoids direct eye contact, the client is probably
not telling the truth or has something to hide.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Answer
False
Hesitation before speaking or avoiding direct eye contact
may be a sign of respect in your client’s culture.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
End of Presentation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins