Communication: All Rights Reserved Volume Two, Second Edition

Communication
Nursing: A Concept-Based Approach to Learning Copyright © 2015, 2011 by Pearson Education, Inc.
Volume Two, Second Edition All Rights Reserved
Overview
• Interactive process between nurse, client

• Integral part of therapeutic relationship
• Helps client
 Overcome temporary stress
 Get along with other people
 Adjust to the unalterable
 Overcome psychological blocks
• Nurse responds to content, feelings,
nonverbal cues
Therapeutic Communication
Techniques
• Embrace techniques
• Adapt to each situation to improve
communication with clients
• Use a holistic approach to communicating
Empathizing
• Empathy is a process.
 People feel with one another
 Embrace attitude of person who is speaking
 Grasp idea that what client has to say
important
• NOT synonymous with sympathy
• Interprets clients feelings without inserting
own
Attentive Listening
• Mindful listening
• Active process
• Paying attention to verbal, nonverbal
messages
• Listening for key themes
• Being aware of own biases
• Highly developed skill, can be learned with
practice
Clarifying
• Attempt to understand client's statement

• Ask client to give an example
Paraphrasing
• Nurse restates in own words

• Nurse can test own understanding
• Reflective in nature
Questioning
• Very direct way of speaking with clients

• Open-ended questions elicit more
information
• Closed question limits choice of responses
• Careful not to ask questions that steer
answer
Structuring
• Attempt to create order, establish

guidelines
• Define parameters of nurse–client
relationship
Pinpointing
• Calls attention to inconsistencies

• Points out differences between actions,
words
Linking
• Nurse responds to client

 Ties together events, experiences, feelings
 Connects past experiences with current
behaviors
Giving Feedback
• Nurse shares reaction to client

statements, behaviors
• Immediate, honest, supportive
• Give in a way that does not threaten client
• Risk of client feeling rejected
• Nurses should be open, receptive to client
cues
Confronting
• Deliberate invitation to examine some

aspect of personal behavior: discrepancy
between actions and words
• Informational confrontation
 Describes visible behavior
• Interpretive confrontation
 Draws inferences about the meaning of
behavior
Summarizing
• Highlighting the main ideas expressed

• Conveys understanding
• Reviews main themes of conversation
• Use at different times during interaction
• Don't rush to summarize
Barriers to Communication
• Failure to listen
• Improperly decoding intended message
• Placing the nurse's needs above client's
The Therapeutic Relationship
• Growth-facilitating process
 Help client manage problems in living
• More effectively
• Develop unused, underused opportunities
fully
 Help client become better at helping self
• May develop over weeks or within minutes
• Influenced by nurse and client
 Personal and professional characteristics
Characteristics of a Therapeutic
Relationship
• Intellectual and emotional bond
 Focused on client
• Respects client as individual
• Respects client confidentiality
• Focuses on client's well-being
• Based on mutual trust, respect,
acceptance
Therapeutic Relationship Phases
• Preinteraction phase
• Introductory phase
 Orientation, pretherapeutic phase
 Nurse and client observe each other
 Client may display resistive behaviors
• Nurse can overcome with caring, interest,
competence
Therapeutic Relationship Phases,
continued
 By end of this phase, client begins to:
• Develop trust in nurse; view as competent
• View nurse as honest, open, concerned
• Believe nurse will try to understand, respect
client values
• Believe nurse will respect client
confidentiality
continued
 By end of this phase, client begins to:
• Feel comfortable talking about feelings
• Understand purpose of relationship, roles
• Feel an active participant in plan of care
continued
• Working phase
 First stage: exploring and understanding
thoughts and feelings
 Second stage: facilitating and taking action
 Skills need for working phase
• Empathetic listening and responding
• Respect, genuineness
• Concreteness
• Reflecting, paraphrasing, clarifying,
confronting
continued
• Working phase
 In first stage
• Intensity of interaction increases
 In second stage
• Client must make decisions and take action
• Responsibility belongs to client
• Nurse collaborates, provides support
• Nurse may offer options or information
continued
• Termination phase
 Difficult, ambivalent
 Summarizing process
 Termination discussions
 Allow time for client adjustment to
independence
Developing Therapeutic
Relationships
• Set mutual goals with client
• Many ways of helping do not require
training
 Listen actively
 Help identify the client's feelings
 Be empathetic, honest, genuine, and
credible
Communicating with Children and
Families
• Accepting
• Broad openings
• Clarifying
• Focusing
• Observation
• Reflection
• Summarizing
Establishing Trust
• Follow through with promises

• Respect confidentiality
• Be truthful, even if it isn't what they want
to hear

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Communication

• Interactive process between nurse, client

• Attempt to understand client's statement

• Nurse restates in own words

• Very direct way of speaking with clients

• Attempt to create order, establish

• Calls attention to inconsistencies

• Nurse responds to client

• Nurse shares reaction to client

• Deliberate invitation to examine some

• Highlighting the main ideas expressed

• Follow through with promises

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