Communication
 complex process
 combination of verbal and nonverbal behaviors used in various
ways to share information.
Factors that Influence Communication
 Environment
 Relationship between two people
 Context or content of the message
 Attitude
 Knowledge differences
 Perception
Modes of Communication
 Written Communication
 Verbal Communication
 Nonverbal Communication
 More revealing and truthful than verbal communication.
Therapeutic Communication
 an interpersonal interaction between the nurse and the client
during which the nurse focuses on the client’s specific needs
to promote an effective exchange of information.
 Client Centered (client emotion, experience etc.)
Purposes of Therapeutic Communication
1.Establish a therapeutic nurse client relationship.
2. Identify the most important client concern at that moment
(the client centered goal).
3. Assess the client’s perception of the problem as it unfolds.
4. Facilitate the client’s expression of emotions.
5. Teach the client and family the necessary self-care skills.
6. Recognize the client’s needs.
7. Implement interventions designed to address the client’s
needs.
8. Guide the client toward identifying a plan of action to a
satisfying and socially acceptable resolution.
Active Listening and Observation
 Active listening means refraining from other internal mental
activities and concentrating exclusively on what the client
says.
 Active observation means watching the speaker’s nonverbal
actions as he or she communicates.
 Empathy the ability to place oneself into the experience of
another for a moment in time.
 is understanding others' feelings.
 Sympathy is feeling for them.
Active Listening and Observation
Help the nurse:
• Recognize the issue that is most important to the client
currently
• Know what further questions to ask the client
• Use additional therapeutic communication
techniques to guide the client to describe his or her perceptions
fully.
• Understand the client’s perceptions of the issue instead of
jumping to conclusions
• Interpret and respond to the message objectively
Verbal Communication Skills
 Using Concrete Messages
 the words are explicit and need no interpretation; the speaker
uses nouns instead of pronouns.
 Concrete Questions
 Clear, direct, and easy to understand.
 Elicit more accurate response.
 Abstract messages
 Unclear patterns of words that often contain figures of speech
that are difficult to interpret.
 require the listener to interpret what the speaker is asking.
Using Therapeutic Communication Techniques
 Accepting
 Does not indicate agreement rather indication the nurse has
heard and followed the thought of patient.
 Facial Expression, tone of voice and so forth also convey
acceptance.
 E.g. “Yes”, Nodding, “I follow what you said.”
 Broad Openings
 General “Opening” that make it explicit that the client has the
lead in interaction.
 “Is there something you’d like to talk about.”
 Consensual Validation
 Clarifying the information.
 Agree upon both parties.
 “Are you using this word to convey that…?”
 Encouraging
 Recalling from experience
 “was it something like…?”, “Have you had similar
experiences?”)
 Encouraging description of perception
 Asking client to verbalize perception (audio, see) to
understand client emotion or action.
 “What does the voice seem to be saying?”, “What is
happening.”
 Encouraging expression
 Asking client to express their emotions.
 “What are your feelings in regards to…”
 Exploring
 You ask questions to understand or know more about your
client.
 Helpful if client only give vague explanation.
 “Tell me more about that.”
 Focusing
 Concentrating on a single point.
 Helpful when client has a lot of topic at once.
 “Of all the concerns you’ve mentioned, which is most
troublesome?”
 Formulating a plan of action
 Planning ahead for the future similar situations
 “What could you do to let your anger out harmlessly”
 General Leads
 Encouraging client to continue to talk.
 “Go on.” “and then”, “Tell me about it”
 Giving Information
 Give facts that the client needs.
 Only give needed information.
 Giving recognition
 Acknowledging, indicating awareness of change or noting
efforts the client is doing
 Just state the fact don’t praise.
 “you’ve finished your list of things to do.”
 Making Observation  Belittling feelings expressed.
 Nurse verbalizes what she is perceives.  Ignoring the client feeling or emotion
 “are you uncomfortable when…”. I notice your biting your  “I’ve felt that way myself and it will be find”
lips”  Challenging
 Offering Self  Demanding proof from client
 Nurse offers herself to client what ever the setting or the  Never ever challenge the client, he might really do it and it
emotion of the client. might be dangerous for him or for others too.
 Placing event in time or sequence  Defending
 Clarifying the sequence of events to understand the client.  Attempting to protect someone or something from verbal
 “Was this before or after…?” attack.
 Presenting Reality  Don’t defend the doctor, facility or something. You just need
 When it’s obvious that the client is misinterpreting reality or to listen to client.
his hallucinating.  Disapproving
 Don’t disagree with the client just state the fact.  Implies that the nurse has the right to pass judgement on the
 “ your mother is not here; I am a nurse” client’s thoughts or actions. It further implies that the client is
 Reflecting expected to please the nurse.
 Directing client actions, thoughts and emotion back to the  “That’s bad” “ I’d rather you wouldn’t…”
client so that he can reflect form it.  Giving Approval
 E.g. “ mam mahadlok ko sa akong mama kay nahagbung ko sa  Saying what the client thinks or feels is “good” implies that
mga major subjects dli ko ganahan mo sulti niya. Unsa man the opposite is “bad”.
angay nako buhaton?”” nya tan.aw nimo dapat pa ba nimo  Approval then to limit the client’s freedom to think, speak, or
sulti.an imong mama? act in a certain way.
 Restating  This lead to client’s acting in a particular way just to please
 Repeating the main idea to validate if what we heard was the nurse.
correct.  Giving Literal Response
 Seeking Information  Responding to figurative comment as though it were a
 Clarifying to client to make clear that which is meaningful or statement of fact.
vague so that nurse will avoid making assumptions.  Indicating the Existence of an external Source
 “have I heard you correctly”  This means believing that something outside of yourself, like
 Silence other people or outside forces, is responsible for your
 Absence of verbal communication which provide time for thoughts, feelings, and actions.
client to put thoughts or feelings in words.  “Who told you that you were a prophet?”
 To regain composure or to continue talking.  Interpreting
 Suggesting Collaboration  The client thoughts and feelings are his or her own, not to be
 Offering to share, to strive and to work together with the client interpreted by the nurse for hidden meaning
not us doing the work.  Only the client can identify or confirm the presence of feeling.
 Don’t let you client manipulate you in any way.  Introducing an unrelated topic
 Summarizing  Changing the topic just because you are uncomfortable.
 To be use in the last part of the interaction.  Making Stereotyped Comments
 Organizing and summing up the conversation.  Social conversations contains many cliché’s and much
 “you’ve said that…” meaningless chit-chat.
 Verbalizing the implied  Such comments are of no value in the nurse-client
 Voicing out what the client has hinted at or suggested. relationship.
 “I can’t talk to you or anyone. It’s a waste of time.” “do you  Any automatic responses lack the nurse’s consideration or
feel that no one understands” thoughtfulness.
 Voicing doubt  Probing
 Expressing uncertainty about the reality of the client’s  Persistent questioning of the client
perception.  Over asking questions
 “isn’t that unsual”  Reassuring
 Comforting client, indicating there is no reason for anxiety or
Avoid Nontherapeutic Communication other feelings of discomfort.
 “Everything will be alright.”
 Advising  Rejecting
 Teeling client what to do.  Refusing to consider or showing contempt for the client’s idea
 “I think you should…” or behavior.
 Agreeing  Let’s not discuss that”
 Approval indicates the client is “right” rather than ”wrong”.  Requesting an explanation
 “That’s right”, I agree.”  Usually, a “Why” question is intimidating.
 Disagreeing  In addition, the client is unlikely to know “why” and may
 Disagreeing implies the client is “wrong” Consequently, the become defensive trying to explain him or herself.
client feels defensive about his or her point of view.  Testing
 “I don’t believe that”  Asking questions to test the client knowledge.
 “do you still have the idea that…”
 Using Denial
 Refusing to admit that a problem exists
 Nurse denies the client’s feelings or the seriousness of the
situation by dismissing his or her comments without
attempting to discover the feelings or meaning behind them.
Interpreting Signals or Cues
people whispering. Invasion of this intimate zone by anyone
else is threatening and produces anxiety.
 Personal zone (18-36 in)
 This distance is comfortable between family and friends who
are talking.
 Social zone (4-12 ft)
 This distance is acceptable for communication in social, work,
and business settings.
 Public zone (12-25 ft)
 This is an acceptable distance between a speaker and an
audience, small groups, and other informal functions
 Touch
 Functional professional
 professional touch is used in examinations or procedures such
as when the nurse touches a client to assess skin turgor or a
massage therapist performs a massage
 Social polite touch
 polite touch is used in greeting, such as a handshake and the
“air kisses” some people use to greet acquaintances, or when a
gentle hand guides someone in the correct direction.
 Friendship warmth touch
 warmth touch involves a hug in greeting, an arm thrown
around the shoulder of a good friend, or the backslapping
some people use to greet friends and relatives.
 Love intimacy touch
 intimacy touch involves tight hugs and kisses between lovers
or close relatives.
 Sexual arousal touch
 arousal touch is used by lovers.
 Appearance

Special communication Techniques

Considerations:

 Touch will only communicate warmth if the nurse is

comfortable with it
 Touch carries a different meaning for each person
 Severable variables influencing the intended message of the
touch
 Abused client may pull away and feel frightened
 For the paranoid confrontation

Nonverbal Communication Skills

 Facial expressions (expressive, impassive, or confusing
 Body postures
 Hand gestures
 Vocal cues
 Eye contact
 Silence

Nonverbal Communication
 Proxemics*
 Intimate zone (0-18 in between people)
 This amount of space is comfortable for parents with young
children, people who mutually desire personal contact, or