MH 2

Definition
- Purposeful, goal-directed interaction between nurse and client.
Involves:
- Verbal communication
- Nonverbal communication
Goal:
- Promote growth, coping, and improved functioning.

When the nurse:
  - Shows empathy.
  - Uses effective communication skills.
  - Focuses on client needs, thoughts, feelings.
  - Builds trust and rapport.
Outcome: Encourages expression and healing.

Cultural & Social Factors
   - Cultural differences in:
     - Emotional expression
     - Eye contact
   - Language barriers
   - Social class differences in slang.
Nurse Factors
   - Attitude: Accepting vs judgmental.
   - Past experiences.
   - Knowledge level:
     - Too little → confusion.
     - Too much → overwhelming patient.
Personal Communication Style
- Outgoing vs shy.
- Ability to relate to others.
Interpersonal Perception
- Misinterpretation risk: “What you heard is not what I said.”
Environment
   - Privacy (VERY IMPORTANT).
   - Noise level.
   - Presence of others.
   - Time constraints.

Example:
- ❌ Hallway discussions about personal issues.
- ✅ Private, quiet setting.

Verbal Communication
   - Spoken or written words.
   - Includes:
     - Language.
     - Word choice.
     - Tone.
   - Nurse must understand client’s meaning of words.
Nonverbal Communication
- (VERY IMPORTANT FOR NCLEX)
- 💡 Key Point: More accurate than verbal (harder to control).

Types of Nonverbal Communication:
  - Vocal Cues:
    - Tone (flat, shaky, loud, soft).
    - Pauses/hesitation.
  - Gestures:
    - Finger tapping → anxiety/anger.
    - Palm rubbing → nervousness.
    - Hand wringing → helplessness.
  - Appearance:
    - Poor hygiene → depression/confusion.
    - Bright clothing/excess makeup → possible mania.
  - Personal Space:
    - Therapeutic distance:
      - 1.5 – 4 feet.
  - Posture & Body Language:
    - Arms crossed → defensive.
    - Slumped posture → low self-esteem.
  - Touch:
    - Use cautiously.
    - Always:
      - Ask permission first.
  - Facial Expressions:
    - Eye contact = engagement.
    - Lack of eye contact:
      - Shyness.
      - Low self-esteem.
      - Cultural differences.

Clarification
- Ensures understanding.
- Example: “Can you explain what you mean?”
Reflection
- Restates feelings.
- Example: “You sound worried about your daughter.”
Restating
- Repeats main idea.
- Encourages elaboration.
Focusing
- Directs conversation.
- Example: “Let’s go back to what you said about your son.”
Giving Information
- Educates patient.
- Promotes involvement.
Silence
- Allows thinking time.
- Shows presence.
Broad Openings
- Lets client lead.
- Example: “What would you like to talk about?”
Sharing Perceptions
- Clarifies inconsistencies.
- Example: “You say you’re fine, but you look anxious.”
Suggesting
- Offers options (NOT advice).
General Leads
   - Encouragement:
     - “Go on…”
     - “I see…”
Questioning
   - Closed-ended:
     - Yes/no → specific info.
   - Open-ended:
     - Encourages discussion.
     - BEST TYPE.
   - Avoid “WHY” questions (defensive).
Offering Self
- Shows presence:
- “I’ll stay with you.”
Reality Orientation
- Corrects hallucinations/delusions.
- Example: “I don’t hear the voices, but I understand you do.”
Exploring
- Encourages deeper discussion.

✅ Assertiveness:
  - Respectful expression.
  - Uses “I” statements.
    - Example: “I’m concerned about your health.”
❌ Aggression:
- Blaming, threatening, coercive.

Used when behavior is inappropriate.
Done in a caring, nonjudgmental way.
3-Step Process:
  1. Describe behavior.
  2. Offer interpretations.
  3. Ask for explanation.

Sharing personal experience.
Used to:
- Help client open up.
RULES:
  - Keep brief.
  - Do NOT overuse.
  - Only share resolved experiences.
  - Never shift focus away from client.

Social Communication:
  - Small talk.
  - Casual.
  - Two-way.
Therapeutic Communication:
  - Focus = client.
  - Goal: Explore feelings, fears, concerns.
  - Requires: Skill, practice, knowledge of human behavior.