COMMUNICATION

 Is a Latin word “communicare” meaning to make common, share or impart.

 The reciprocal exchange of information, ideas, feeling and attitude from one entity to
another.

ELEMENTS OF COMMUNICATION

1. Sender – the encoder of the person who initiates the transmission.

2. Receiver – the decoder or the person who receives the message
3. Message – the unit of information received. They are made up of many variables such
as:

a. Communication Skill – includes ability of the sender and the receiver to observe,
listen, clarify, validate and evaluate the meaning of the message.
b. Verbal & Non-verbal Stimuli – gives shape, direction and focus to the message
c. Setting – refers to the place or location where communication takes place. ( well
ventilated, peaceful, clean environment, free from disgusting smell)
d. Noise – interference within the communication system that may hinder the
accuracy of the message.

4. Feedback – the return response. It involves the continuous interpretation of the

responses of the sender and the receiver.

TYPES OF COMMUNICATION

1. Verbal Communication – use of spoken or written words.

2. Non- verbal Communication – exchange of information without the use of words. It
is considered the accurate expression of feelings.

a. Kinesis – includes body languages, movements, gesture, eye contact and facial
expressions.

Body Language, Movements, Postures

- Designates authority, cowardice, boredom, indifference, etc.
Gestures
- Pointing finger, tapping, winking of an eye, eyebrow raising
Facial Expressions
- Convey anger, joy, suspicion, sadness, fear, doubt, contempt,
annoyance, etc.

b. Paralanguage – includes voice qualities or change in tone of voice.

Ex. Pausing or hesitating while conversing, talking in tense
 c. Proxemics – is the study of distances zones between people during
communication.

 Intimate – 0 – 18 inches ( ex. Transferring the patient, taking v/s )

 Personal – 18 – 36 inches ( 4 feet ) this is ideal space for NPR for
protection to observe the patient non-verbally.
 Social – 4 to 12 feet, this is space for formal business and social
activities and gatherings.
 Public – 12 feet and above, this is a space where there is no
physical contact and little eye contact. People who maintain
this zone of communication remain stranger.

CRITRERIA OF SUCCESSFUL COMMUNICATION

1. Feedback – there should be an accurate return response, relevant.

2. Appropriateness – they reply should be fitting and relevant to the communication
received.
3. Efficiency – the language must be easy and simple to understand, clear, concise
information.
4. Flexibility – absence of overcontrol and undercontrol.

Overcontrol – when there is checking or counterchecking of

communication exchanged and deliberate prescribing of response

Undercontrol – when the participants do and say as they wish to the

extent of disregarding the influential affects of feedback, appropriateness
and effiency.

THERAPEUTIC COMMUNICATION

 An interpersonal interaction between the nurse and the client during which the nurse
focuses in the clients specific needs to promote an effective exchange of information.

Therapeutic communication can help nurses to accomplish many goals

1. Establish a therapeutic nurse-patient relationship
2. Foundation for building trust
3. Provide support and comfort
4. Encourage growth and change
5. Identifies clients concerns ( client-centered goal )
6. Assessing client’s perception of the problem
7. Facilitate the client’s expression of emotions
8. Recognize the client’s needs
9. Implement interventions designed to address the client’s needs
THERAPEUTIC COMMUNICATION

1. Silence – absence of verbal communication which provides time to the client

to put thoughts or feelings into words, regain composure or continue talking.

Ex. Sitting quietly (or walking with the client) and waiting
attentively until the client is able to put thoughts and feelings into
words. Nurse says nothing, continue to maintain eye contact and
convey interest.

2. Offering Self – making self available and showing interest and concern

Ex. “I stay with you until your daughter arrives”

“We don’t need to talk unless you would like to”

3. Acceptance – indicating reception

Ex. “yes”
“I follow what you said”

4. Giving Recognition – acknowledging, indicating awareness

Ex. “Good morning Ms. S”

5. Making Observation – verbalizing what the nurse perceive

Ex. “I notice you are biting tour lip”

6. Encouraging Description of Perception – asking the client to verbalize what

he or she perceives.

Ex. “Tell me when you feel anxious”

7. Using Broad Opening – allowing the client to take the initiative in

introducing the topic.

Ex. “What do you want to talk about today?”

8. Offering General Leads – giving encouragement to continue using neutral

expression to encourage patients to continue talking.

Ex. “go on”

THERAPEUTIC RELATIONSHIPS

 Series of interaction between the nurse and the client in which the nurse assists the client
meet his/her needs and attain positive behavioral change. It is goal directed, focused on
the needs of the patient, planned, time limited and professional.

ELEMENTS OF NURSE-PATIENT RELATIONSHIPS

1. Self-awareness – is the process of developing an understanding of one’s own values,

beliefs, thoughts, feelings, attitudes, motivations, strengths and limitations and how
these qualities affect others. Self- awareness allows the nurse to observe, pay
attention to and understand the subtle responses and reactions of the clients when
interacting with them.
2. Trust – Trust is built in the nurse-patient relationship when the nurse exhibits the
following behaviors; friendliness, caring, interest, understanding, consistency,
congruent, keeping promises, honest and truthful.
3. Positive Regard – when the nurse appreciates the client as a unique, worthwhile
human being, and respects the client of his behavior, background, lifestyle, etc.
4. Acceptance – the nurse conveys acceptance when she does not become upset and
respond negatively to a client’s outburst, avoids judgment no matter what the
behavior.
5. Genuine Interest – when the nurse is comfortable by herself/himself, aware of his
or her strengths and limitations and clearly focused, the client will perceive a
genuine person.
6. Empathy – the ability of the nurse to perceive the meanings and feelings of the
client and to communicate that understanding to the client.

THERAPEUTIC USE OF SELF

 Means developing self-awareness and beginning to understand his attitudes, the nurse
can begin to use aspects of his personality, experiences, values, feelings, intelligence,
needs, coping skills and perceptions to establish relations with the clients.

TYPES OF RELATIONSHIPS

1. Social Relationships – is primarily initiated for the purpose of friendship,

socialization, companionship or accomplishment of tasks.
2. Intimate Relationship – involves two people who are emotionally committed to
each other. Both parties are concerned about having their individual needs met as
well as sharing their mutual goals.
3. Therapeutic Relationship –patient centers, goal oriented and structures.
PHASES OF NURSE-PATIENT RELATIONSHIP

1. Pre- Orientation
a. Read background materials available.
b. Become familiar with any medications the client is taking.
2. Orientation Phase
a. Begins when the nurse and the patient interacts for the first time.
b. Provide a therapeutic environment
c. Establish rapport and gain the patient’s trust
d. Identify the patient’s problem
e. Gather pertinent data about the patient
f. Determine why the patient sought help
g. Develop a mutually acceptable contact which includes the parameter of the
subsequent meeting
h. Clarifies expectation
3. Working Phase
a. Maintaining the relationship
b. Gathering more data
c. Exploring perception of reality
d. Developing positive coping mechanisms
e. Promoting positive self-concept
f. Facilitating behavioral changes
g. Evaluating progress and redeeming goals as appropriate
h. Promoting independence
i. Preparing for the termination
- Gradually increase interaction time
- Encourage expression of feelings
4. Termination Phase
a. Begins when the problem of the patient resolved.
- When the patient is emotionally stable
- When the patient exhibits independence
- When the patient able to cope with anxiety separation, fear and
loss
b. Assess the patient’s acceptance of terminating the relationship
c. Assess patient’s feelings of the termination

BLOCKS TO THERAPEUTIC RELATIONSHIPS

1. Transference – the development of an emotional attitude of the patient either positive

or negative towards the nurse.
2. Countertransference – the development of an emotional attitude of the nurse
towards the patient.
3. Resistance – development of ambivalent feelings towards self-exploration
4. Inappropriate boundaries
5. Feelings of sympathy
6. Encouraging client dependency

GUIDELINES THAT HELP PROMOTE EFFECTIVE COMMUNICATION

1. Verbal Skills Effectively

a. Be knowledgeable about the topic of conversation
b. Be flexible
c. Be clear and concise
d. Avoid words that are interpreted differently
e. Be truthful
f. Keep an open mind
2. Focusing on the Patient and his Needs During Communication
3. Demonstrating Interest and Concern While Communicating
4. Listening to What is Being said During Communication
5. Posing Questions and Comments that Promote Communication
a. Use open-ended questions
b. Reflective questions or comments
c. Clarifying
d. Offering general leads
e. Placing events in time of sequence
6. Observing While Communicating
7. Using Silence Appropriately During Communication
8. Using Touch to Communicate
9. Providing an Environment Conducive to Communication
10. Assuring the Confidentiality of Communication
11. Avoiding Comments and Questions that Impede Communication
a. Using false reassurances, clichés and pat responses
b. Using questions requiring only “yes” or “no” responses
c. Using why questions
d. Using questions that probe for information
e. Using comments that give advice
f. Using judgmental comments
g. Changing the subject
h. Avoid verbalizing value judgment, giving personal opinion or moralizing.