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Communication in Nursing Part 1: Therapeutic Communication Notes

Overview

  • This course splits communication into two parts: Part 1 focuses on talking to patients using therapeutic communication and distinguishing therapeutic versus nontherapeutic communication, as well as how to use verbal and nonverbal communication and pick up on patient cues. Part 2 will cover how to talk to the health care team, the health care provider, and documentation.
  • The slide shows the Part 1 objectives and what will be covered in this section.

Objectives

  • Define the concept of communication and identify its attributes
  • Differentiate between therapeutic and nontherapeutic communication
  • Recognize the patient’s verbal and nonverbal communication cues
  • Apply effective communication in nursing practice
  • Apply the concept of communication across the lifespan from newborn to older adult and note how communication varies with age

Definition of communication

  • Based on a curriculum reference from Giddings: a process of interaction between people in which symbols are used to create, exchange, and interpret messages about ideas, emotions, and mind states
  • In nursing and health care, communication prevents miscommunication and ensures information is transferred between a sender and a receiver
  • Modes include spoken verbal, written, electronic documentation, and nonverbal cues such as body language and emotions
  • The sender conveys to the receiver; ensure the recipient is the intended person; protect patient privacy under HIPAA and speak about patients only in private settings and with those who need to know

Types of communication and relationships

  • Communication can be one way or two way; one person can dominate a conversation in one way communication
  • For a trusting nurse patient relationship, two way communication is essential so the patient can provide input and the nurse can build trust

Communication styles

  • Aggressive: interrupting, controlling the conversation, blaming others, not listening; often perceived as abusive; uses you statements; not acceptable with patients
  • Passive: avoids conflict; does not express own feelings or opinions; common in new graduate nurses; lacks confidence
  • Passive aggressive: contains resentment, sarcasm; appears powerless while being covertly hostile
  • Assertive: open, direct, and honest; demonstrates confidence; best style for nursing; supports patient advocacy

Verbal communication

  • Verbal communication includes spoken or written words; misinterpretation can occur due to vocabulary and connotations
  • Use plain language; avoid excessive medical terms when speaking to patients with limited medical knowledge
  • Keep messages short and simple
  • Timing and pacing matter; avoid rushing; ensure the patient has time to listen and learn
  • Tone matters; adjust tone to the context of the situation

Nonverbal communication

  • Nonverbal communication is what you are saying without words; includes appearance, posture, facial expressions, and emotion
  • Nonverbal cues can be misinterpreted if they do not align with verbal messages; watch for mismatches
  • Posture: open vs closed; leaning forward indicates listening; standing over the patient can convey control or talking down
  • Eye contact: signals interest but excessive eye contact can be uncomfortable; cultural variation exists
  • Personal space: respect the patient’s personal space; enter and exit appropriately
  • Gestures: can emphasize points; may be cultural or offensive in some contexts; use appropriately
  • Sounds: crying, sobbing, moaning can signal pain or discomfort

Therapeutic relationship and effectiveness

  • Effective communication builds a therapeutic relationship based on trust and empathy
  • Nontherapeutic interactions include rushing, detachment, insincerity; they undermine trust
  • The patient should be the focus in every interaction; address the patient first and then tasks and equipment
  • Follow through on commitments to build trust and ensure patient comfort and safety

Nonverbal techniques for building a therapeutic relationship

  • Listening: remain quiet while the patient speaks and attend to verbal and nonverbal cues
  • Active listening: fully interpret the message and provide feedback to show understanding
  • Passive listening: nodding and minimal acknowledgment; shows interest but does not confirm understanding
  • Silence: use silence to allow time for response; can be comforting in distress or grief situations
  • Touch: can convey warmth and support when appropriate; be mindful of gender, culture, and norms; maintain professional boundaries

Verbal techniques for therapeutic communication

  • Encouragement: prompt the patient to speak more and elaborate
  • Questioning: use closed or open questions
    • Closed questions yield yes or no answers and limited information
    • Open questions invite elaboration and detail
  • Restating: repeat the main point to show you heard
  • Paraphrasing: restate in your own words to confirm understanding
  • Clarifying: ensure understanding by asking for clarification
  • Focusing: steer the conversation to specific details when needed
  • Reflection: help the patient reflect on their feelings and support independent decision making
  • Stating observations: share observable cues when verbal and nonverbal cues do not align
  • Offering information: tailor education to the patient’s level and confirm understanding
  • Summarizing: review the main ideas and agreements from the discussion

Nontherapeutic communication techniques

  • False reassurance: statements like everything will be okay; may be comforting but can be misleading or unrealistic
  • Giving advice or personal opinions: can undermine patient autonomy
  • Being defensive or negative; dismissive
  • Automatic or stereotyped responses that are not personalized
  • Minimizing the patient’s feelings; failing to acknowledge concerns

Factors that affect communication

  • Environment: ensure privacy; reduce noise; create a calming setting; use curtains for shared rooms
  • Language: use certified interpreters; avoid relying on family members for translation; document the use of interpreters
  • Culture: be aware of cultural differences in touch, eye contact, and expressions; consider willingness to receive care from a provider of the opposite gender
  • Vision: assess and accommodate vision loss; confirm use of glasses or other aids; use visual cues and ensure visibility
  • Hearing: ensure hearing aids are in place; speak clearly and face the patient; consider sign language interpreters when needed
  • Speech impairment: be patient; ask one question at a time; give ample time to respond; use visual cues
  • Developmental or cognitive impairment: use short direct sentences; limit distractions; use visuals and simple questions
  • Special communication supports: interpreters for sign language or other assistive technology as needed

Communicating with special populations and impairments

  • Sign language interpretation via certified interpreters or remote video interpreters
  • Use visual aids, demonstrations, and written instructions for cognitive impairments
  • Be patient and allow extra time for responses, especially for stroke or Parkinson disease patients; avoid rushing

Lifespan communication differences

  • Infants: main mode is nonverbal cues (crying, facial expressions, body movements); respond with a soothing tone and approach; cry signals needs such as hunger or diaper change
  • Toddlers and preschoolers: use simple one step directions at first; you can progress to multi step directions after age four; pictures and play are helpful; allow child to participate in conversation; sit at eye level
  • School aged children: engage the child in the conversation; use age appropriate language; involve child in health discussions
  • Adolescents: prioritize active listening and a nonjudgmental attitude; build trust because adolescents are sensitive to judgment
  • Older adults: assess assistive devices (glasses, hearing aids); consider cognitive or neurological impairments; minimize distractions; provide alternative communication methods such as writing or devices; avoid elder speak and terms of endearment; use respectful language and tone; be mindful of patient preferences and cultural considerations
  • Always tailor communication to individual patient needs and preferences across the lifespan