Chapter 3 - Effective Communication

Basic Levels of Communication (4)

Intrapersonal

• “Self-talk” → communication within oneself

• Helps nurse reflect on personal values/beliefs before caring for a client

Interpersonal

• One-on-one with another person

• Used in psychosocial history-taking or when listening to client’s feelings

Small-group

• Between 2+ people in a small setting

• Used for team discussions or group therapy sessions

Public

• Speaking to a large audience

• Example: teaching high school students about suicide prevention

Verbal Communication Tips

Vocabulary

• Avoid medical jargon; limited vocabulary can hinder understanding

Denotative vs. Connotative meaning

• Words can have multiple meanings → clarify shared meaning

Clarity/Brevity

• Keep it short & simple; long/complex messages confuse clients

Timing/Relevance

• Choose the right moment → avoid when client is in pain or distracted

Pacing

• Speaking too fast → seems rushed & uncaring

• Proper pace → improves understanding

Intonation

• Tone of voice conveys feelings (acceptance, judgment, dislike, etc.)

A charge nurse is conducting a class on therapeutic communication with a group of newly licensed nurses. Which of the following aspects of communication should the nurse identify as a component of verbal communication?

a

Personal space​​​​​​​ 

b

Posture

c

Eye contact

d

Intonation

d Intonation

---

Personal space, posture, and eye contact are components of nonverbal communication.

Nonverbal Communication

Often have more impact than words

Must consider culture (impacts interpretation)

Emotions like anger, depression, anxiety may show incongruence with verbal statements → clarify client’s mood

Key Nonverbal Behaviors to Assess

Appearance

Posture

Gait

Facial expressions

Eye contact

Gestures

Sounds (e.g., sighs, groans)

Territoriality (personal boundaries)

Personal space

Silence

Nonverbal Cues

Affect (emotions):

• Frowning, grimacing, pursed lips, raised/lowered eyebrows, biting/licking lips, nose scrunching

Appearance:

• Sudden disrobing

• Clothing inappropriate for temperature

• Disheveled grooming

Autonomic response:

• Sweating, pupil dilation, facial flushing/paleness, increased respirations

Body behaviors:

• Gait, posture, hand clenching, rocking, psychomotor agitation

Eye movement:

• Suspicious squinting, minimal blinking, darting eyes

Therapeutic Communication

Purposeful communication to build helping relationships with clients, families, and care teams

• Client-centered (not social or reciprocal)

• Purposeful, planned, goal-directed

Goals

• Understand client’s thoughts, feelings, concerns, needs

• Show empathy & genuine concern for client/family issues

• Obtain information & give feedback about condition

• Promote functional behavior & better relationships

• Evaluate progress toward goals

Therapeutic Communication Components

Time

• Allow enough time to communicate

• Clients with MDD or schizophrenia may need extra time to respond

Active listening & attending behaviors

• Nonverbal interest (eye contact, posture, body language)

• Vocal quality emphasizes importance

• Verbal tracking → restate/summarize client’s words

Caring attitude → emotional connection

Honesty → open, direct, truthful

Trust → reliable without doubt

Empathy → understand client’s feelings & perspective

Nonjudgmental attitude → acceptance, encourage openness

Assessment

Assess verbal & nonverbal needs

Identify cultural factors (eye contact, personal space, touch)

Look for congruence between verbal & nonverbal messages

Consider developmental level to adapt communication

Special Considerations

• Children:

  • Use simple language

  • Be aware of nonverbal cues (kids are sensitive)

  • Enhance by being at child’s eye level

  • Include play to build trust

  • Expect concrete responses until abstract thinking develops

• Adolescents:

  • Assess how they perceive mental health diagnosis

  • Risk: refusing treatment due to desire to be “normal”

  • Check if diagnosis affects peer relationships/identity

• Older Adults:

  • May need hearing amplification

  • Minimize distractions, face client when speaking

  • Allow extra time for responses

  • If communication impaired, get input from caregivers/family

Planning

Minimize distractions & ensure privacy

Identify mutually agreed outcomes

Prioritize based on client needs

Plan enough time for interventions

Implementation

Explain purpose of notes/records upfront

Build trusting nurse–client relationship

• Reiterate privacy & confidentiality

• Explain exceptions (e.g., duty to warn)

• Diversity, equity, inclusion (DEI): respect client’s identity & differences

Provide empathetic responses using observation, hope, humor, info

Adjust environment → decrease distractions, ensure accessibility

Use bias-free language:

• Focus on relevant characteristics

• Acknowledge real differences respectfully

• Ask for preferred pronouns

• Avoid hierarchical terms like “normal”

Effective Communication Skills & Techniques

Silence → allows client time for reflection

Active listening → hearing, observing, understanding, and providing feedback

Using Questions

• Open-ended → encourages spontaneous, interactive responses

• Closed-ended → brief data collection; avoid overuse (blocks deeper communication)

• Projective → “What if…” to explore feelings/goals & problem-solving

• Presupposition → hypothetical (e.g., “If you were no longer struggling with your mental health, what would life look like?”)

Clarifying Techniques

• Restating → repeat client’s exact words

• Reflecting → direct focus back to client to examine feelings

• Paraphrasing → restate feelings/thoughts for confirmation

• Exploring → ask more about important topics

Other Therapeutic Techniques

• Offering general leads/broad openings → encourage client to decide where to start

• Showing acceptance/recognition → acknowledge interest & nonjudgmental attitude

• Focusing → help client concentrate on what’s important

• Giving information → provide needed details for decision-making

• Presenting reality → clarify what’s real vs. hallucinations/delusions

• Summarizing → highlight key points

• Offering self → willingness to spend time, showing genuine concern

• Touch → if appropriate, conveys caring & comfort

• Seating → adjust position/environment for comfort (e.g., walk with anxious client)

• Motivational interviewing → helps clients explore ambivalence & move toward behavior change

A nurse in a mental health practitioner’s office is communicating with a client. The client states, “I can’t sleep. I stay up all night.” The nurse responds, “You are having difficulty sleeping?” Which of the following therapeutic communication techniques is the nurse demonstrating?

a

Offering general leads

b

Summarizing

c

Focusing

d

Restating

d Restating

---

Offering general leads lets the nurse to take the direction of the discussion.
Focusing concentrates the attention on one single point.
Summarizing enables the nurse to bring together important points of discussion to enhance understanding.

Barriers to Effective Communication

Asking irrelevant personal questions

Offering personal opinions

Giving unsolicited advice

False reassurance (“You’ll be fine”)

Minimizing feelings (“It’s not that bad”)

Changing the topic abruptly

Asking “why” questions (can feel judgmental)

Offering value judgments (“That’s good/bad”)

Excessive questioning

Rapid questioning (overwhelms client)

Giving approval/disapproval (“I like that choice” or “I don’t agree”)

A nurse is talking with the caregiver of a child who has demonstrated recent changes in behavior and mood. When the caregiver of the child asks the nurse for reassurance about their child’s condition, which of the following responses should the nurse make?

a

“I think your child is getting better. What have you noticed?”

b

“I’m sure everything will be okay. It just takes time to heal.”

c

“I’m not sure what’s wrong. Have you asked the doctor about your concerns?”

d

“I understand you’re concerned. Let’s discuss what concerns you specifically.”

d “I understand you’re concerned. Let’s discuss what concerns you specifically.”

This therapeutic response reflects upon, and accepts, the caregivers’ feelings, and it allows them to clarify what they are feeling.

A nurse is communicating with a client who was admitted for treatment of a substance use disorder. Which of the following communication techniques should the nurse identify as a barrier to therapeutic communication?

a

Offering advice

b

Reflecting

c

Listening attentively

d

Giving information

a Offering advice

Offering advice to a client is a barrier to therapeutic communication that should be avoided. Advice tends to interfere with the client’s ability to make personal decisions and choices.

---

Giving information informs the client of needed information to assist in the treatment planning process.

Quick Memory Aids

Therapeutic Techniques: “REAL SOFT GPS”

• Restating, Exploring, Acceptance, Listening, Summarizing, Offering self, Focusing, Touch, Giving info, Presenting reality, Silence

Barriers: “VIP FAM CRAWG”

• Value judgments, Irrelevant ?, Personal opinions, False reassurance, Advice, Minimizing feelings, Changing topic, Rapid ?, Approval/Disapproval, Why questions, Giving too many questions