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Chapter 4
Therapeutic Communication Skills
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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
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
Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Verbal Communication
The Five Cs of Communication:
Complete
Clear
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
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

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Nonverbal Communication
Positive posture and position
encourage therapeutic
communication >>
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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
Click Here to play the video
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Congruency in Communication
Verbal and nonverbal messages must agree
The meaning of mixed messages
Clustering groups of nonverbal messages
Masking conceals true feeling or message
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Congruency in Communication
Perception
Conscious awareness of ones own feelings and the
feelings of others
Sense anothers 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
Regression
Denial
Repression
Projection
Sublimation
Displacement
Compensation
Rationalization
Undoing

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Barriers to Therapeutic
Communication
Barriers caused by cultural and religious
diversity
Caregiving expectations
Time focus
Copyright 2010 Delmar, Cengage Learning. ALL RIGHTS RESERVED.
Barriers to Therapeutic
Communication
Human needs as
barriers to
communication





Maslows hierarchy of needs
>>
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Establishing Multicultural
Communication
The patient must trust the professional
Steps to building trust include:
Risk/trust
Conveying empathy
Showing respect
Being genuine
Active listening
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Working with Multicultural and
Diverse Patient Populations
Click Here to play the video
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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 youve 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