Submitted by E. Shaifer RN MSNSubmitted by E. Shaifer RN MSN

COMMUNICATION & COMMUNICATION & THERAPUTIC COMMUNICATIONTHERAPUTIC COMMUNICATION

INTRODUCTIONINTRODUCTIONINTRODUCTIONINTRODUCTION

• Nurses interact with many people Nurses interact with many people dailydaily

• Success depends upon effective Success depends upon effective interpersonal skillsinterpersonal skills

““The quality of care you provide is dependant The quality of care you provide is dependant on the quality of communication that exists on the quality of communication that exists between you and your patient”between you and your patient”

OBJECTIVESOBJECTIVESOBJECTIVESOBJECTIVES

• Describe the major purpose of Describe the major purpose of communication among health communication among health practitioners practitioners

• Identify components of communicationIdentify components of communication• Describe verbal and nonverbal Describe verbal and nonverbal

behaviors that affect communicationbehaviors that affect communication• Describe the techniques which facilitiate Describe the techniques which facilitiate

communication communication • Describe techniques which block Describe techniques which block

communication communication

The Communication ProcessThe Communication ProcessThe Communication ProcessThe Communication Process

Claude Shannon & Warren Weaver Claude Shannon & Warren Weaver Communication Model (1949)Communication Model (1949)

Shannon& Weaver-Six Elements Shannon& Weaver-Six Elements Communication ProcessCommunication Process

Shannon& Weaver-Six Elements Shannon& Weaver-Six Elements Communication ProcessCommunication Process

• Encoder (sender)Encoder (sender) initiates exchange of initiates exchange of

ideas, thoughts & ideas, thoughts & feelings)feelings)

• Message (the Message (the content to transmit content to transmit to another)to another)

• Sensory Channels Sensory Channels (ways sent: visual (ways sent: visual auditory & auditory & kinesthetic-tone of kinesthetic-tone of voice, wink, hand voice, wink, hand gesturegesture

• Decoder (to whom Decoder (to whom message is aimed-message is aimed-must be able to must be able to decode)decode)

• Context-(condition Context-(condition under which under which communication occurs communication occurs i.e., therapeutic i.e., therapeutic relationshiprelationship

• Feedback (to Feedback (to determine determine effectiveness of effectiveness of communication).communication).

Communication ProcessCommunication ProcessCommunication ProcessCommunication Process

“You seem distracted

today”(Message)

sensory Auditory route

“I’m in so much pain…”

Feedback

Nurse (Encoder)

Client (Decoder)

Purpose Of CommunicationPurpose Of CommunicationPurpose Of CommunicationPurpose Of Communication

• Send/receive informationSend/receive information• Influence othersInfluence others• InterpretInterpret• RespondRespond• Interchange of InformationInterchange of Information• Role as advocate/change agentRole as advocate/change agent

KINDS OF COMMUNICATION:KINDS OF COMMUNICATION:VERBALVERBALKINDS OF COMMUNICATION:KINDS OF COMMUNICATION:VERBALVERBAL

• Language/Spoken Language/Spoken WordsWords

• Writing-transfer a Writing-transfer a thought in print thought in print form form

• Exchange of Exchange of WordsWords

• Accompanied by Accompanied by nonverbal nonverbal expressionsexpressions

KINDSKINDS OF COMMUNICATION: OF COMMUNICATION:NONVERBALNONVERBALKINDSKINDS OF COMMUNICATION: OF COMMUNICATION:NONVERBALNONVERBAL

BODY LANGUAGEBODY LANGUAGE• Personal Appearance (judged)Personal Appearance (judged)• Facial expressions (eyes, smile, Facial expressions (eyes, smile,

grimaces,frown,sadness, happiness)grimaces,frown,sadness, happiness)• Body Posture (posture and stance)Body Posture (posture and stance)• Gestures (hands talking, emotional Gestures (hands talking, emotional

coping)coping)• Personal Distance (private zone can be Personal Distance (private zone can be

cultural)cultural)• Touching (cultural, always assess Touching (cultural, always assess

first/ask permission)first/ask permission)

TYPESTYPES OF COMMUNICATON OF COMMUNICATONTYPESTYPES OF COMMUNICATON OF COMMUNICATON

• THERAPUTIC:THERAPUTIC:

~~effective, planned & consciouseffective, planned & conscious

~~goal-orientedgoal-oriented

• NON-THERAPUTIC:NON-THERAPUTIC:

~~not Therapeuticnot Therapeutic

FACTORS INFLUENCING COMMUNICATONFACTORS INFLUENCING COMMUNICATONFACTORS INFLUENCING COMMUNICATONFACTORS INFLUENCING COMMUNICATON

• Culture Culture • Perceptions and values - Perceptions and values - • Social class Social class • Relationships Relationships • Setting Setting

– Content of the message Content of the message – Toxic vs. non-toxic wordsToxic vs. non-toxic words

FACTORS INFLUENCING COMMUNICATON-2FACTORS INFLUENCING COMMUNICATON-2FACTORS INFLUENCING COMMUNICATON-2FACTORS INFLUENCING COMMUNICATON-2

• Ability of individual to send & receive Ability of individual to send & receive messages messages

• Perceptions of sender & receiver Perceptions of sender & receiver • Personal space/social distancesPersonal space/social distances• Territoriality Territoriality • Roles and Relationships Roles and Relationships • Time Environment Time Environment • Attitudes Attitudes • Emotions and Self-EsteemEmotions and Self-Esteem

WHAT IS THERAPUTIC COMMUNICATON?WHAT IS THERAPUTIC COMMUNICATON?WHAT IS THERAPUTIC COMMUNICATON?WHAT IS THERAPUTIC COMMUNICATON?

An interpersonal interaction between the An interpersonal interaction between the nurse/client in which the nurse focuses on the nurse/client in which the nurse focuses on the client’s specific needs to promote an effective client’s specific needs to promote an effective exchange of information.exchange of information.

HOW DOES IT HELP THE NURSE?HOW DOES IT HELP THE NURSE?• Identify the most important client concern at Identify the most important client concern at

that moment that moment ((client-centered goalclient-centered goal).).• To interact with client.To interact with client.• Facilitate expression of emotions (client).Facilitate expression of emotions (client).• Implement interventions designed to address Implement interventions designed to address

the client’s needs. (NCP,Process Recording)the client’s needs. (NCP,Process Recording)

THERAPUTIC COMMUNICATIONTHERAPUTIC COMMUNICATION AKAAKA :INTERPERSONAL TECHNIQUES :INTERPERSONAL TECHNIQUES

THERAPUTIC COMMUNICATIONTHERAPUTIC COMMUNICATION AKAAKA :INTERPERSONAL TECHNIQUES :INTERPERSONAL TECHNIQUES

• Offering selfOffering self

• ReflectionReflection

• Facilitative QuestionsFacilitative Questions and Statementsand Statements

• Giving RecognitionGiving Recognition

• ClarifyingClarifying

• Conveying Conveying InformationInformation

• Stating ObservationStating Observation

• SilenceSilence

• Presenting RealityPresenting Reality

• SummarizingSummarizing

**Examples to followExamples to follow

OFFERING SELFOFFERING SELFOFFERING SELFOFFERING SELF

Example:Example:

Nurse:" I'll sit with you a while”Nurse:" I'll sit with you a while”

ReflectionReflectionReflectionReflection

• PtPt: “I’m so discouraged. I thought I : “I’m so discouraged. I thought I would be home from the hospital would be home from the hospital today.” today.”

• NurseNurse: “You sound upset that : “You sound upset that you’re not going home today.”you’re not going home today.”

Facilitative Questions and Facilitative Questions and Statements (Broad Open-ended)Statements (Broad Open-ended)

Facilitative Questions and Facilitative Questions and Statements (Broad Open-ended)Statements (Broad Open-ended)

• Encourage patients to answer in their own Encourage patients to answer in their own words words

• *Broad open ended questions*Broad open ended questions “ “What brought you to the hospital?What brought you to the hospital? “ “Describe how you feel about this?Describe how you feel about this?

• Closed-ended questionsClosed-ended questions ((can become a “broken can become a “broken recordrecord”)”)

“ “how long?”how long?” “ “can you explain”can you explain” “ “are you worried about the results?”are you worried about the results?”

GIVING RECOGNITIONGIVING RECOGNITIONGIVING RECOGNITIONGIVING RECOGNITION

• Nurse: “Good Morning Mrs. S., I Nurse: “Good Morning Mrs. S., I noticed that you combed your noticed that you combed your hair.”hair.”

CLARIFYING CLARIFYING CLARIFYING CLARIFYING

• PtPt: “During certain activities, I : “During certain activities, I have the most have the most awfulawful pain in my pain in my back” back”

• NurseNurse: “Tell me what you mean by : “Tell me what you mean by awfulawful””

CONVEYING INFORMATIONCONVEYING INFORMATIONCONVEYING INFORMATIONCONVEYING INFORMATION

• PtPt: “I feel nauseous and have : “I feel nauseous and have diarrhea. Why do I feel so sick?”diarrhea. Why do I feel so sick?”

• NurseNurse: “You may be having a side : “You may be having a side effect from the lithium you are effect from the lithium you are taking. We should check your taking. We should check your level.”level.”

MAKING OBSERVATIONSMAKING OBSERVATIONSMAKING OBSERVATIONSMAKING OBSERVATIONS

• NurseNurse: “You seem upset when : “You seem upset when talking about your relationship talking about your relationship with your mother”with your mother”

• PtPt: “Yes, I’ve been estranged from : “Yes, I’ve been estranged from her since the death of my father, her since the death of my father, whom I was very close to.”whom I was very close to.”

USING SILENCEUSING SILENCEUSING SILENCEUSING SILENCE

• Usually not comforting socially Usually not comforting socially

• Conveys acceptance, support, and Conveys acceptance, support, and concern. concern.

• Allows patient to organize thoughts Allows patient to organize thoughts or reflect. or reflect.

PRESENTING REALITYPRESENTING REALITYPRESENTING REALITYPRESENTING REALITY

• PatientPatient:” I hear sirens wailing in :” I hear sirens wailing in my ears to warn me, the aliens are my ears to warn me, the aliens are coming.”coming.”

• NurseNurse:” It must be frightening for :” It must be frightening for you to hear sirens wailing, butI you to hear sirens wailing, butI don’t hear anything.”don’t hear anything.”

SUMMARIZINGSUMMARIZINGSUMMARIZINGSUMMARIZING

• PtPt: “I know drinking doesn’t really help me in : “I know drinking doesn’t really help me in the long run. And it sure doesn’t help my the long run. And it sure doesn’t help my family. My wife keeps threatening to leave. I family. My wife keeps threatening to leave. I know all this, but it’s hard to stay away from know all this, but it’s hard to stay away from the booze. Having a drink makes me feel the booze. Having a drink makes me feel relieved.” relieved.”

• NurseNurse: “During the past 30 minutes, you and I : “During the past 30 minutes, you and I have discussed some of the ways that drinking have discussed some of the ways that drinking is not very helpful to your life yet you feel is not very helpful to your life yet you feel better, less overwhelmed, after a drink…”better, less overwhelmed, after a drink…”

BARRIERS/BLOCKSBARRIERS/BLOCKS TO COMMUNICATION TO COMMUNICATION

BARRIERS/BLOCKSBARRIERS/BLOCKS TO COMMUNICATION TO COMMUNICATION

• Giving advice Giving advice (“what you should do is(“what you should do is”…)”…)• Giving false reassurance Giving false reassurance (“Everything will be (“Everything will be

alright…don’t worry, lots of people have this alright…don’t worry, lots of people have this surgery)surgery)

• Argumentative Argumentative (“Just go on and go to group. (“Just go on and go to group. Get outta my hairGet outta my hair.”).”)

• Challenging Challenging (If you’re dead, why is your heart (If you’re dead, why is your heart beating?”)beating?”)

• Disagreeing with the Patient (“You’re wrong", Disagreeing with the Patient (“You’re wrong", "that's not true”"that's not true”

• Making stereotypical comments-Making stereotypical comments- (clichés, “keep your chin up”,etc.)(clichés, “keep your chin up”,etc.)

PATIENT WITH SPECIAL NEEDSPATIENT WITH SPECIAL NEEDSPATIENT WITH SPECIAL NEEDSPATIENT WITH SPECIAL NEEDS

Hearing impaired patient Hearing impaired patient

• Check to see if the patient wears a hearing Check to see if the patient wears a hearing aidaid

• Be sure it is working Be sure it is working • Minimize background noise Minimize background noise • Always face the patient Always face the patient • Speak with a normal tone and pace Speak with a normal tone and pace • Does the patient use sign language? Does the patient use sign language? • Pay attention to non verbal communication Pay attention to non verbal communication

from you and the patient from you and the patient • Use a pen and paper if necessaryUse a pen and paper if necessary

PATIENT WITH SPECIAL NEEDS-2PATIENT WITH SPECIAL NEEDS-2PATIENT WITH SPECIAL NEEDS-2PATIENT WITH SPECIAL NEEDS-2

• Visually impaired Visually impaired • Use a normal tone and pace Use a normal tone and pace • Look at and speak to the patient Look at and speak to the patient • Tell the patient when you leave and Tell the patient when you leave and

enter the room enter the room • Orient the patient to the immediate Orient the patient to the immediate

area area • Ask for permission before touching Ask for permission before touching

the patientthe patient

PATIENT WITH SPECIAL NEEDS-3PATIENT WITH SPECIAL NEEDS-3PATIENT WITH SPECIAL NEEDS-3PATIENT WITH SPECIAL NEEDS-3

• Speech Impaired/ Aphasic Speech Impaired/ Aphasic • Assess how well the patient communicates Assess how well the patient communicates • Adapt to the patients ability for Adapt to the patients ability for

communication communication • Allow time for the patient to respond Allow time for the patient to respond • Don’t answer questions for the patient Don’t answer questions for the patient • Use closed questions when possible Use closed questions when possible • Repeat or rephrase questions when needed Repeat or rephrase questions when needed • Speak directly to the patient, not and Speak directly to the patient, not and

intermediaryintermediary

PATIENT WITH SPECIAL NEEDS-5PATIENT WITH SPECIAL NEEDS-5PATIENT WITH SPECIAL NEEDS-5PATIENT WITH SPECIAL NEEDS-5

• The emotional patient The emotional patient • Emotions are neither good or bad Emotions are neither good or bad • Actions based on emotion can be good or Actions based on emotion can be good or

bad bad • Allow the patient or family member to Allow the patient or family member to

express their emotion express their emotion • Let them know it is OK to express emotion Let them know it is OK to express emotion

a. when a person is angry a. when a person is angry

b. recognize and acknowledge that anger b. recognize and acknowledge that anger

c. bring it to their attention, give permissionc. bring it to their attention, give permission

TECHNIQUES FOR ESTABLISHINGTECHNIQUES FOR ESTABLISHING A HELPING RELATIONSHIP A HELPING RELATIONSHIP

TECHNIQUES FOR ESTABLISHINGTECHNIQUES FOR ESTABLISHING A HELPING RELATIONSHIP A HELPING RELATIONSHIP

• Helping and personalHelping and personal

• Client-focusClient-focus

• Aimed at mutual goalsAimed at mutual goals

• Develop and evolve over timeDevelop and evolve over time

• Establish trust and honestyEstablish trust and honesty

• Empathy Empathy

• Establish trust and honestyEstablish trust and honesty (“I cannot promise that I can (“I cannot promise that I can

help solve your problem, help solve your problem, but I listen and I do care.”but I listen and I do care.”

• Communication is the Communication is the meaningful interaction meaningful interaction between the two of you that between the two of you that leads to such growth.leads to such growth.

• Maintain client Maintain client confidentiality confidentiality

• Be aware of cultural Be aware of cultural differences differences

PROCESS RECORDINGPROCESS RECORDINGPROCESS RECORDINGPROCESS RECORDING

What is a Process Recording?What is a Process Recording?

A A writtenwritten account of verbal interactions with clients… account of verbal interactions with clients…recorded verbatim.recorded verbatim.

Usually verbal and non-verbal communicationUsually verbal and non-verbal communication of nurse and client.of nurse and client.

A learning tool which aids the student to developA learning tool which aids the student to develop observationobservation and and communication skills.communication skills.

Help the patient express feelings and solve a currentHelp the patient express feelings and solve a current problem.problem.

REFERENCESREFERENCESREFERENCESREFERENCES

• Harkreader,H.,Hogan.(2004Harkreader,H.,Hogan.(2004).Fundamentals of nursing: Caring).Fundamentals of nursing: Caring and clinical judgment.(2and clinical judgment.(2ndnd ed.). St. Louis, MO: Sanders. ed.). St. Louis, MO: Sanders.

• Townsend, M.(2005). Essentials of psychiatric mental healthTownsend, M.(2005). Essentials of psychiatric mental health nursing. (3nursing. (3rdrd ed.). Philadelphia, PA: F.A.Davis. ed.). Philadelphia, PA: F.A.Davis.

• Therapeutic CommunicationTherapeutic Communication.(n.d.)..(n.d.).Retrieved August 30, 2007,Retrieved August 30, 2007, from Mount Saint Mary’s College. from Mount Saint Mary’s College. http://faculty.msmc.eduhttp://faculty.msmc.edu //zychowiczychowic/therapeutic/therapeutic %20communication files/frame.htm %20communication files/frame.htm

THANK YOU!THANK YOU!THANK YOU!THANK YOU!

QUESTIONSQUESTIONS