NRS 205 - Communication Notes

Therapeutic Communication

  • What is it? An interpersonal interaction between the nurse and client in which the nurse focuses on the client’s specific needs.
  • Quote: "Real listening is a willingness to let the other person change you." — Alan Alda
  • What are the benefits?
    • Effectively apply the nursing process
    • Meet the standard of care the clients expect

Setting Boundaries

  • Privacy
  • Proxemics and Zones:
    • Intimate Zone
    • Personal Zone
    • Social Zone
    • Public Zone
  • Question in transcript: Which zone is most effective in the nurse/client relationship?
  • Note: Consider various cultures when determining appropriate zone and boundaries.

Touch

  • Touch can be comforting and supportive when welcomed/permitted.
  • Touch can be threatening and an invasion of space.
  • Nurse should evaluate touch based on patient preference and history.

Active Listening

  • Active Listening Definition: Concentrating on what the client says.
  • Observation: Watching the speaker’s nonverbal actions during communication.
  • Goals:
    • Recognize the most important issue
    • Guide further questioning
    • Understand the client’s entire perception of the issue
    • Respond objectively

Nonverbal Behaviors that affect communication

  • Physical appearance
  • Facial expressions
  • Attitude and Demeanor
  • Posture
  • Distraction and distance
  • Gestures
  • Eye contact
  • Use of touch
  • Active listening
  • Silence
  • Body language helps provide cues that may be correlated with truer feelings.
  • Recognize importance of unconscious messages.

Conversation Skills

  • Tone of voice
  • Knowledge and accuracy about topic
  • Be flexible
  • Be clear, concise; use simple statements
  • Avoid words with multiple interpretations
  • Be truthful
  • Have an open mind

Verbal communication techniques

  • Open-ended questions
  • Closed-ended questions
  • Laundry list
  • Rephrasing (Clarifying)
  • Well-placed phrases (Facilitation)
  • Inferring
  • Exploring
  • Providing information
  • Empathy

Diminishing Techniques / Communication to Avoid

  • Nonverbal: Excessive or insufficient eye contact; Distraction and distance; Standing
  • Verbal: Rushing through the interview; Interrupting the client; Reading the questions; Using Medical Jargon; Using authority; Using “why” questions; Providing false assurance; Comments that give advice; Biased or Leading Questions

Communication: Clients with Special Needs

  • Visually Impaired
  • Hearing Impaired
  • Cognitively Impaired
  • Unconscious
  • Limited English Skills
  • Physical Barrier

Communicating with Different Ages

  • Infants (Birth to 1212 months): Gentle handling with quiet, calm voice; Give one direction at a time and provide simple explanations; Short directions with concrete explanation; Ask questions to gather data and be nonjudgmental; Respectful, honest attitude with focus on the individual; Stages of Cognitive Development
  • Toddlers ( 1212 to 3636 months): [Transcript indicates age range; describe developmentally appropriate approach]
  • Preschoolers ( 33 to 66 years old): [Transcript indicates age range; describe developmentally appropriate approach]
  • School-Age ( 77 to 1212 years old): [Transcript indicates age range; describe developmentally appropriate approach]
  • Adolescents (Starts with puberty): [Transcript indicates age range; describe developmentally appropriate approach]

Disruptive Interpersonal Behavior and Communication

Managing Awkward Moments

  • Answering personal questions:
    • Provide a brief direct answer.
    • Share experiences that support the patient.
    • This can enhance relationship and increase credibility.
  • Displays of emotion:
    • Crying is natural and should be expected.
    • May need to postpone further questioning until the patient is ready.
    • A compassionate response enhances the relationship.

Clients with Various Emotional Needs

  • Depressed client:
    • Express interest in and understand; respond in a neutral manner.
    • Ask if there is anything you can do, instead of asking what’s wrong.
  • Anger:
    • Approach the client in a calm, reassuring, in-control manner.
    • Allow the client to ventilate feelings; do not argue with or touch the client.
    • Acknowledge feelings.
    • Facilitate personal space so the client doesn’t feel threatened or cornered.
    • Never allow the client to position themselves between you and the door.
  • Anxiety:
    • Appear unhurried and take the time to listen to all of the client’s concerns; this can help diffuse anxiety.
    • Use therapeutic communication to help diffuse anxiety.

Manipulative, Seductive, and Sensitive Issues

  • Manipulative client:
    • Provide structure and set limits.
    • Differentiate between manipulation and a reasonable request.
  • Seductive client:
    • Personal questions may extend to flirtatious compliments, seductive innuendo, or sexual advances.
    • Your response must make it clear that you are a health professional who can best care for the person by maintaining a professional relationship.
    • Set appropriate verbal boundaries: say, “I am uncomfortable when you talk to me that way; please don’t. If behavior continues, report to your supervisor.”
  • Sensitive issues:
    • Be aware of your own thoughts and feelings.
    • If you aren’t comfortable discussing personal, sensitive topics, a referral can be made to a pastoral counselor or other specialists as needed.
    • Ask simple questions in a nonjudgmental manner.
    • Allow clients to vent and/or express their feelings as needed.

Clients with Various Emotional Needs con’t

What is assertive communication?

  • Expressing positive and negative ideas and feelings in an open, honest, and direct way.
  • Aggressive communication:
    • Negativity that violates the rights of others; incivility; disruptive or intimidating behavior; bullying
  • Incivility and Bullying

Considerations

  • Others in the room:
    • Do not assume relationships; clarify.
    • Parent or guardian may answer for a child.
    • Interview adolescents directly.
    • For adults unable to answer, guardian or caregiver may assist.
  • Cultural variations and language barriers:
    • Interpreter
    • Takes more time to obtain data
    • Assistance of communication with pictures