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Communication. Potter, ch. 24 Varcarolis, ch. 10. Developmental level Gender Credibility Affect/Attitude Emotional state Special needs Environment Distance. Role/Relationships Timing Territoriality Culture Knowledge level Values Perceptions Expectations.
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Communication Potter, ch. 24 Varcarolis, ch. 10
Developmental level Gender Credibility Affect/Attitude Emotional state Special needs Environment Distance Role/Relationships Timing Territoriality Culture Knowledge level Values Perceptions Expectations Factors Affecting Communication
Lack of eye contact Hurried gestures Closed body language False reassurance Judgmental responses Changing subject Negating feelings Giving advice Using clichés Closed questions Leading questions Stereotyping Treating client as object or dx A-la-moding Responses That Hinder Communication
The Therapeutic Relationship • Focuses on client needs and helps client identify problems • Promotes client growth and self-care • Conveys kindness, concern, warmth, genuineness, acceptance • Is empathetic—seeing situation from client’s point of view—being receptive without losing objectivity—able to communicate to client that he is understood • Is confidential without being a “sick contract”
Therapeutic Communication • Essential component of the therapeutic relationship. • Utilizes open-ended and non-threatening techniques • Primarily used during interviews, but also at any appropriate time. • Sometimes the only skill a nurse can offer.
Social vs. Therapeutic Communication • Social communication includes sharing information, feelings, and ideas without the active intention of helping another person. • Therapeutic is planned, deliberate, purposeful, helpful, patient-centered, goal-directed. A learned skill that improves with practice.
Components of Therapeutic Communication • Listening attentively (active listening)—face client, eye contact, open body language, no distracting movements, nod appropriately, read verbal and nonverbal • Demonstrating acceptance (conveying empathy)—use person’s name, listen without interrupting, avoid arguing, expressing doubts, or attempting to change client’s mind
Therapeutic Communication Techniques • Examples of good and bad techniques are given in Varcarolis pp. 181-185, Tables 10-2 and 10-3 • More examples follow in the next several slides with a few practice sessions at the end.
Open & Closed Questions • Closed: “Are you happy about this?” • Open: “How does this make you feel?” • Closed: “Do you get along with your husband?” • Open: “How is your relationship with your husband?” • Closed: “Does this make you sick to your stomach?” • Open: “Describe the feeling you are having.”
Reflective Statements • Client: “Sometimes I’m happy about having a new baby, but I don’t know if I can handle it at home.” • Nurse: “You sound anxious about caring for your baby after you leave here.” • Client: “I wish I was dead.” • Nurse: “You sound depressed.” • Client: “I wish I could be somewhere else.” • Nurse: “Somewhere else?”
Paraphrasing • Client: “I’ve had it! My doctor won’t tell me what’s going on. He doesn’t seem to care what I think!” • Nurse: “You’re frustrated because you and your doctor haven’t talked about your diagnosis.”
Summarizing • Mr. Jones enters the client’s room and says, “Good morning, Mrs. Raymond. I’ve come to talk with you more about your diabetes. If you recall, yesterday we discussed the purpose of insulin, it’s side effects, and how to give an injection.”
Avoid Using Clichés • Client: “I slept poorly last night. My incision seemed to be pulling.” • Nurse: “You can’t win them all. At least the incision is healing well.” • Client: “I am so sad about losing my baby.” • Nurse: “It was God’s will.”
Avoid Changing the Subject • Nurse: “Good morning, Mr. Smith. How are you feeling?” • Client: (Facial expression shows discomfort.) “Oh, not so good. My incision is rather sore.” • Nurse: “Well, let’s get you up in the chair. We need to discuss your exercises.”
Being Defensive • Client: “I hope I don’t have to see Dr. Warren today.” • Nurse: “I don’t understand. Is something wrong? Dr. Warren has been your doctor for some time.” • Client: “I don’t care. She was the one who put me in this hospital, and that was a waste of time” • Nurse: “That’s silly. Dr. Warren is an excellent doctor.” • Client: “You think so, huh? He hasn’t put you in the hospital for no reason!” • Nurse: “You were very ill, Mr. Locke. I know Dr. Warren made the right decision.”
Better • Client: “I hope I don’t have to see Dr. Warren today.” • Nurse: “You seem upset. Would you like to talk about it?” • Client: “I just don’t think she should’ve put me in the hospital.” • Nurse: “You believe hospitalization was unnecessary?” • Client: “Yes, they really didn’t do much of anything. They took a few tests and did some x-rays.” • Nurse: Mr. Locke, did Dr. Warren tell you what the tests showed?” • Client: “No, not really. That’s why I’mso angry.”
Giving Advice • Nurse: “Mr. Jones, you really look like you’re in deep thought.” • Client: “Oh no, not really. I was just thinking about whether my daughter was coming to see me.” • Nurse: “Well, if you ask me, she should’ve been here before now. It would mean so much to you.”
False Reassurance • Client: “I’m so afraid of becoming dependent on my wife. I feel like I’m never going to get any better.” • Nurse: “There’s no reason to be afraid. Everything is going to turn out fine.”
Showing Approval/Disapproval • Client: “I’ve decided that when I leave the hospital I’ll stay with my son. He doesn’t want me to be alone.” • Nurse: “Oh, I’m glad to hear that. I think you definitely made the right decision. It’s best for you to be with him so he can look after you.” • Client: “Oh, I feel good. I was able to get up in the chair once today.” • Nurse: “Only once? You going to have to do better than that!”
Therapeutic Communication Practice: Change to Open-Ended • “Are you feeling better?” • “How are you feeling?” • “Are you having pain?” • “Tell me about the pain you are having.”
Practice cont’d • Client: “I’ve had this funny feeling for a week.” • Nurse: “Funny feeling?” • Client: “Nothing ever goes right for me.” • Nurse: “You sound depressed.” • Client: “I’ve had enough of your questions.” • Nurse: “You seem upset.”
Cultural Considerations • It is the nurse’s responsibility to understand the patient, not vice-versa. • Healthy People 2010 addresses cultural barriers to communication when it says, “eliminate disparities in access to quality health care.” One disparity is the communication barrier. • Hospitals recognize this need and are directed by Joint Commission assist individuals with limited English-speaking ability.
Problem Areas • Communication style • Use of eye contact • Perception of touch • Cultural filters
Communication Style • Degree of emotion when communicating • Hispanic, French, Italians, African-Americans more emotional • Asian, German, British more reserved
Eye Contact • Should not be used to assess attentiveness, truthfulness • Most Americans consider lack of eye contact as sign of disinterest, lying, or evasion • Certain Native Americans, Asians, Middle Eastern may consider it disrespectful
Touch • Generally considered a gesture of warmth and empathy • How and when and even whether to touch is culturally driven • Could be perceived as intrusive, aggressive or sexually suggestive • Not encouraged among professionals due to sexual harassment laws.
Cultural Filters • A form of bias or prejudice • Have been learned over time as we grow • Important to understand why we have the biases we do and not to let them interfere with professional, helpful interactions
Interviewing Points • Make sure seating and distance is appropriate • Start with introduction, purpose and open ended statement • Engage in attending behaviors: appropriate eye contact, body language, even, low tonal voice quality with appropriate inflection, and verbal tracking (following what client says by giving verbal feedback to show you are listening)
Using Process Recordings (191) • Reviewing your own clinical interactions as they occur. • Records both verbal and nonverbal interactions • Helps you identify good and bad techniques from both parties • Better to evaluate immediately after interaction, not during. • Use Facilitative Skills Checklist on p. 188 for ongoing self-evaluation of interactions.
