Rashida Manzoor, DCN, Timergara

Rashida Manzoor, DCN, Timergara
COMMUNICATION
RASHIDA MANZOOR
MSN, P.h.D
PRINCIPAL
DCN, TIMERGARA LOWER DIR
Objectives of the session
Define communication
Explain the process of communication
Enlist communication channels
Discuss Communication model
Define therapeutic communication
Explain techniques of TC
Introduction
• Communication is the process of conveying information through a complex
variety of verbal and nonverbal behavior and consists of various components
like the sender, message to be send, receiver and feedback.
• The therapeutic interaction between the nurse and the patient helps to develop
mutual growth of two individuals and the world of each is enlarged and enriched
by the other.
• The general goal of nurse-patient interaction is to help the patient to grow

Types of communication
• Verbal communication-
• consists of the words a person uses to speak to one or more listeners.
• Words-symbols used to identify the objects and concepts being discussed.
Content
• is verbal communication, the literal words that a person speaks.
Context
• Is the environment in which communication occurs ;can include the time and the
physical, social, emotional, and cultural environment-includes the circumstances or
parts that clarify the meaning of the content of the message.

Types of communication
• Nonverbal communication-
• behavior that accompanies verbal content such as body language, eye
contact, facial expression, tone of voice, speed and hesitations in speech,
and distance from the listener.
• It can indicate the speaker’s thoughts,
• feelings, needs, and values that the speaker acts out mostly unconsciously.

Communication process
• Process denotes all nonverbal messages that the speaker uses to give
meaning and context to the message.
-This component of communication requires the listener to observe the

behaviors and sounds that accent the words and to interpret the speaker’s
nonverbal behaviors to assess whether they agree or disagree with the verbal
content.

Congruent and incongruent communication
• Congruent message - when content and process agree.

• For example, a client says, “I know I haven’t been myself. I need help.” She
has a sad facial expression and a genuine and sincere voice tone. The
process validates the content as being true.
• Incongruent message- when the content and process disagree—
when what the speaker says and what he or she does do not agree

Model of communication
The sender-message-channel-receiver (SMCR) model of communication,
sometimes called the Berlo model, is the most basic form of communication
developed by David Berlo, 1960 in Michigan State University
• The SMCR model relies on four key elements:
1.Sender - This is the person who originates the message
2.Message - The content that is being communicated
3.Channel - The medium being used to transmit the message
4.Receiver - The person who the message is directed toward

Two actions needed in this model
• Encoding: happens on the sender's end, involving the way in which
the message is transmitted; and
• Decoding: The receiver must decode the message through the

channel that was used
• Noticeably absent in the SMCR model is any feedback loop (feedback
from the recipient back to the sender).

communication channels
• There are number of different types of communication channels exist as
listed below:
• Face-to-face conversations
• Videoconferencing
• Audio conferencing
• Emails
• Written letters and memos
• Chats and messaging
• Blogs
• Formal written documents
• Spreadsheets etc.
What is THERAPEUTIC
COMMUNICATION ?
Therapeutic communication is an
interpersonal interaction between the
nurse and client during which the
nurse focuses on the client’s specific
needs to promote an effective
exchange of information.
Therapeutic use of self -TOOL
 With the therapeutic use of self, nurses use

themselves as a therapeutic tool to establish
the therapeutic relationship with clients and
to help clients grow, change, and heal.
 The nurse uses aspects of his or her
personality, experiences, values, feelings,
intelligence, needs, coping skills, and
perceptions to establish relationships with
clients.
Skilled use of therapeutic
communication techniques
 Helps the nurse understand and empathize

with the client’s experience
 Needed by all nurses to effectively apply the
nursing process and to meet standards of
care for their clients.

Therapeutic communication can help
nurses to accomplish many goals:
Establish a therapeutic nurse–client relationship.
Identify the most important client concern at that moment
(the client-centered goal).
Assess the client’s perception of the problem as it
unfolded. This includes detailed actions (behaviors and
messages) of the people involved and the client’s thoughts
and feelings about the situation, others, and self.
Facilitate the client’s expression of emotions.
Teach the client and family necessary self-care skills.
Recognize the client’s needs.
Implement interventions designed to address the client’s
needs.
Guide the client toward identifying a plan of action to a
satisfying and socially acceptable resolution.
 To have effective therapeutic
communication, the nurse also must
consider:
 privacy and respect of boundaries
 use of touch, and
 active listening and observation.

Privacy and Respecting Boundaries
 Privacy is desirable but not always possible in therapeutic
communication.
 The nurse needs to evaluate if interacting in the client’s
room is therapeutic.
 For example, if the client has difficulty maintaining boundaries or
has been making sexual comments, then the client’s room is not
the best setting. A more formal setting would be desirable.

PROXEMICS
 Proxemics- the study of distance zones between people
during communication. People feel more comfortable with
smaller distances when communicating with someone they
know rather than with strangers.
 People from the United States, Canada, and many Eastern
European nations generally observe four distance zones:

4 distance zones
 Intimate zone (0 to 18 inches between people):
 This amount of space is comfortable for parents with young
children, people who mutually desire personal contact, or
people whispering.
 Invasion of this intimate zone by anyone else is threatening
and produces anxiety.
 Personal zone (18 to 36 inches):
 This distance is comfortable between family and friends who
are talking.
 Social zone (4 to 12 feet):
 This distance is acceptable for communication in social,
work, and business settings.
 Public zone (12 to 25 feet):
 This is an acceptable distance between a speaker and an
audience, small groups, and other informal functions.
Five types of TOUCH
As intimacy increases, the need
for distance decreases.
• Functional-professional touch -
used in examinations or
procedures such as when the
nurse touches a client to
assess skin turgor or a
masseuse performs a
massage.
• Social-polite touch - used in
greeting, such as a handshake
and the “air kisses” some
women use to greet
acquaintances, or when a
gentle hand guides someone in Four types of touch. A—Functional–
professional touch; B—Social–polite
the correct direction. Rashida Manzoor, DCN, Timergaratouch; C—Friendship–warmth touch;
D—Love–intimacy touch.
• Friendship-warmth touch- involves a hug in greeting, an arm
thrown around the shoulder of a good friend, or the back
slapping some men use to greet friends and relatives.
• Love-intimacy touch involves tight hugs and kisses between
lovers or close relatives.
• Sexual-arousal touch is used by lovers.

Active Listening and Observation
 To receive the sender’s simultaneous messages, the nurse must
use active listening and active observation.
 Active listening - refraining from other internal mental
activities and concentrating exclusively on what the client says.
 Active observation- watching the speaker’s nonverbal actions
as he or she communicates.

THERAPEUTIC COMMUNICATION
TECHNIQUES

1. Accepting—  An accepting response
indicates the nurse
 Accepting- indicating reception has heard and
 “Yes.” followed the train of
 “I follow what you said.” thought.
 Nodding  Not the same as
agreeing!
 It does not indicate
agreement but is
nonjudgmental.
 Facial expression,
tone of voice, and so
forth also must convey
acceptance or the
words will lose their
meaning.
A nurse notes that an assigned client is lying tense
in bed staring at the cardiac monitor. The client
states, “There sure are a lot of wires around there. I
sure hope we don’t get hit by lightning.”
A. “Would you like a mild sedative to help you relax?”

B. “Oh, don’t worry, the weather is supposed to be sunny and
clear today.”
C. “Yes, all those wires must be a little scary. Did someone
explain what the cardiac monitor was for?”
D. “Your family can stay tonight if they wish.”

2. Broad openings—
 Broad
 Broad openings make explicit
openings— that the the
allowing clientclient
has thetolead in the
take the
interaction.
initiative For the client who isthe
in introducing hesitant
topicabout talking, broad openings
may stimulate him or her to take the initiative.
 “Is there something you’d like to talk about?”
 “Where would you like to begin?”

THERAPEUTIC COMMUNICATION TECHNIQUES cont….
Using silence: allows client to take control of the discussion, if he or she

so desires
hanges.
Accepting :-conveys positive regard
Giving recognition: -acknowledging, indicating awareness
listically be changed and
Offering self : making oneself available
ways
ly. Using comparisons
Encourage expression
r creating changes
Giving broad openings theto select
: allows client clientthe topic

Cont …
Reflecting : directs questions or feelings back to client so that they may be recognized
and accepted
Focusing : taking notice of a single idea or even a single word
Exploring : delving further into a subject, idea, experience, or relationship
Seeking clarification and validation: striving to explain what is vague and searching for
mutual understanding
Presenting reality : clarifying misconceptions that client may be expressing

9. General leads—
 General leads indicate
 General leads—that the nurse is listening and following what
the client is saying without taking away the initiative for the interaction.

giving
They also encourage the client to continue if he or she is hesitant or
encouragement
uncomfortable to
about the topic.
continue
 “Go on.”
 “And then?”
 “Tell me about it.”

A female victim of a sexual assault is being seen in the crisis center
for a third visit. She states that although the rape occurred nearly 2
months ago, she still feels “as though the rape just happened
yesterday.” the nurse would respond by stating:
A. “What can you do to alleviate some of your fears about being assaulted
again?”
B. “Tell me more about those aspects of the rape that cause you to feel like the
rape just occurred.”
C. “In time, our goal will be to help you move on from these strong feelings
about your rape.”
D. “In reality, the rape did not just occur. It has been over two months now.”

10. Giving information—

 Giving
Informing theinformation
client of facts increases his or her knowledge about a
topic or lets the client know what to expect.

— making available
The nurse is functioning as a resource person
 theinformation
Giving facts thatalsothebuilds trust with the client.
client needs
 “My name is . . .”
 “Visiting hours are . .
.”
 “My purpose in
being here is . . .”
• ANS: B “Tell me more about those aspects of the rape that cause you
to feel like the rape just occurred.”

A 4-year-old child who was recently hospitalized is brought to
the clinic by his mother for a follow-up visit. The mother tells
the nurse that the child has begun to wet the bed ever since
the child was brought home from the hospital. The mother is
concerned and asks the nurse what to do. The appropriate
nursing response wuld be:
A. “You need to discipline the child.”

B. “This is a normal occurrence following
hospitalization.”
C. “We need to discuss this behavior with the
physician.”
D. “The child probably has developed a
urinary tract infection.”
 Ans: B“This is a normal occurrence following
hospitalization.”

15. Presenting reality—
 When it is obvious that the
 Presenting client is misinterpreting reality,
the nurse can indicate what is
reality— real.
offering for  The nurse does this by calmly
consideration and quietly expressing the
that which is nurse’s perceptions or the facts
real not by way of arguing with the
 “I see no one client or belittling his or her
else in the experience.
 The intent is to indicate an
room.”
alternative line of thought for
 “That sound the client to consider, not to
was a car “convince” the client that he or
backfiring.” Rashida Manzoor, DCN, Timergara
she is wrong.

16. Reflecting—
 Reflection encourages the client to recognize and accept his or her
 Reflecting—directing
own client
feelings.
actions, thoughts, and
 feelings
The nurse back to client
indicates that the client’s point of view has value, and that
the client

has “Do
Client: theyou
right
think to Ihave
shouldopinions, make decisions, and think
tell the doctor . . . ?”
independently.
Nurse: “Do you think you
should?”
Client: “My brother spends all
my money and then has nerve
to ask for more.”
Nurse: “This causes you to
feel angry?”

A client says to the nurse, “I’m going to die and I wish my family would stop hoping
for a cure! I get so angry when they carry on like this! After all, I’m the one who’s
dying.” the nurse makes which therapeutic response to the client?
A. You’re feeling angry that your family continues to hope for you to be
cured?”
B. “I think we should talk more about your anger at your family.”
C. “Well, it sounds like you’re being pretty pessimistic. After all, years
ago, people died of pneumonia.”
D. “Have you shared your feelings with your family?

 Ans: A You’re feeling angry that your family continues
to hope for you to be cured?”


17. Restating—
 The nurse repeats what
 Restating— the client has said in
approximately or nearly
repeating the the same words the client
has used.
main idea  This restatement lets the
expressed client know that he or she
 Client: “I can’t communicated the idea
effectively.
sleep. I stay awake  This encourages the client
all night.” to continue. Or if the client
 Nurse: “You have has been misunderstood,
he or she can clarify his or
difficulty her thoughts.
sleeping.”
19. Silence—
 Silence often encourages
 Silence— the client to verbalize,
absence of verbal provided that it is
interested and expectant.
communication,  Silence gives the client
which provides time to organize thoughts,
time for the client direct the topic of
to put thoughts interaction, or focus on
issues that are most
or feelings into important.
words, regain  Much nonverbal behavior
composure, or takes place during

silence, and the nurse
continue talking needs to be aware of the
 Nurse says client and his or her own
nothing but nonverbal behavior.
continues to
21. Summarizing—
 Summarization seeks to
 Summarizing— bring out the important
organizing and points of the discussion and
to increase the awareness
summing up that and understanding of both
which has gone participants.
before  It omits the irrelevant and
 “Have I got this organizes the pertinent

aspects of the interaction.
straight?”  It allows both client and
 “You’ve said nurse to depart with the
that . . .” same ideas and provides a
 “During the past sense of closure at the
completion of each
hour, you and I Rashida Manzoor,discussion.
DCN, Timergara
have
24. Voicing doubt—
 Another means of responding to
distortions of reality is to express
 Voicing doubt doubt.
 Such expression permits the
— expressing client to become aware that
uncertainty others do not necessarily perceive
about the events in the same way or draw
the same conclusions. This does
reality of the not mean the client will alter his or
client’s her point of view, but at least the
nurse will encourage the client to
perceptions reconsider or reevaluate what has
 “Isn’t that happened.
 The nurse neither agreed nor
unusual?” disagreed; however, he or she
 “Really?” has not let the misperceptions
and distortions pass without
 “That’s hard to comment.
believe.”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES

2. Agreeing—
 Approval indicates the client
 Agreeing— is “right” rather than “wrong.”
indicating accord  This gives the client the
impression that he or she is
with the client “right” because of agreement
 “That’s right.” with the nurse.
 “I agree.”  Opinions and conclusions
should be exclusively the
client’s. When the nurse
agrees with the client, there
is no opportunity for the client
to change his or her mind
without being “wrong.”
3. Belittling feelings expressed—
 Belittling feelings  When the nurse tries to

equate the intense and
expressed— overwhelming feelings
Misjudging the the client has expressed
degree of the to “everybody” or to the
nurse’s own feelings, the
client’s discomfort nurse implies that the
 Client: “I have discomfort is temporary,
nothing to live for . . mild, self-limiting, or not
. I wish I was dead.” very important.
 The client is focused on
Nurse: “Everybody
gets down in the dumps.” his or her own worries
OR and feelings; hearing the
problems or feelings of
 “I’ve felt that way
others
Rashida Manzoor, DCN, Timergara is not helpful.
myself.”
4. Challenging—
 Challenging—  Often the nurse believes
that if he or she can
demanding proof challenge the client to
from the client prove unrealistic ideas,
 “But how can you the client will realize there
is no “proof” and then will
be recognize reality.
 President of the  Actually challenging
United States?” causes the client to
 “If you’re dead, defend the delusions or
why is your heart misperceptions more
strongly
beating?”  than before.
5. Defending—
 Defending—  Defending what the
client has criticized
attempting to implies that he or she
protect someone has no right to express
or something impressions, opinions,
or feelings.
from verbal  Telling the client that
attack his or her criticism is
 “This hospital unjust or unfounded
has a fine does not change the
reputation.” client’s feelings but
only serves to block
 “I’m sure your further communication.
doctor has your
best interests in
mind.”
Arguing with the patient about routine activities in
the hospital
 Arguing with the patient about routine activities in the

hospital will only increase agitation.

6. Disagreeing—

 Disagreeing implies the client is the
Disagreeing—opposing “wrong.”
client’s ideas
 Consequently the client feels defensive about his or her point of view
 “That’s wrong.”
or ideas.
 “I definitely disagree with . . .”

Rashida Manzoor, DCN, Timergara

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Rashida Manzoor, DCN, Timergara

Explain the process of communication

Enlist communication channels

Discuss Communication model

Define therapeutic communication

• The general goal of nurse-patient interaction is to help the patient to grow