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WESTMINSTER COLLEGE SCHOOL OF NURSING NURSING 315 THERAPEUTIC COMMUNICATION CHAPTER 5 & 6 CLASS NOTES Developing Therapeutic Communication Skills Communication Skills (Five communication skills to use with your patients-Heather Schroeder, RN, Green Bay Healthcare) 1. Acknowledgment : Very first impression, builds trust and confidence. 2. Introduction of you : Who you are and what your role is, and anyone present with you. 3. Duration with client : Estimating how much time you will spend with the person. 4. Explanation of what you will do and length of time: Everyone needs to know what you are doing with time, and how much time. What someone needs to know and what it is that is going to be done. Repeating back what you’ve described to see if they understand. 5. Thank you and “Is there anything else I can do for you before I leave?” Never leave before asking “if there is anything I can do for you?” Letting the patient know that we have time! Definition of Therapeutic Communication: “…a dynamic interactive process entered into by health care providers with their patients… for the purpose of achieving identified health-related goals” (Ruesch, 1961). WORDS MATTER!!! Verbal expressions should be _Clear_______, _Complete_______, ___Concrete_____ and easily __Understandable____________.

Four Categories of non-verbal communication: (__50___% of communication) 1.

Kinesics: Movement and body positioning, and tension when we are communicating 2. Proxemics: Space between people. ½ - 4 feet. 3. Paralanguage : Vocal tone, rate rhythm and volume. 4. Autonomic physical responses: Sweating, blushing, blochy skin. The word “communication” derives from the Latin word “to share” 1. Nurses strive toward client-centered communication which goes beyond patient problems

2. The nurse and the client work together for mutually determined health interventions 3. With person-centered care there are better outcomes 4. The nurse needs to consider the client’s worldviews, values and preferences in interactions 5. Both the nurse and client are responsible for the effectiveness of communication 6. Client-centered communication helps the nurse understand the client

Barriers to Communication (for patients) 1. 2. 3. 4. 5. 6. 7.

Pain, stress, fear and worry Lack of understanding of what is being said (terminology, language) When the topic is emotionally charged When the client feels judged or defensive When the topic is too complex When there is a lack of privacy When there are cognitive or educational deficits

Lack of understanding can contribute to poor compliance!

Barriers to Communication (for nurses) 1. 2. 3. 4. 5. 6. 7. 8.

Thinking about personal issues Being in a hurry Making assumptions about the client Cultural biases Feeling insecure Focusing on what we will say next Emotional reactions to client’s behaviors (dress, hair, personal appearances) Environmental noise (cell phones, TV, music, bad smells)

We need to be aware of our own responses and remain nonjudgmental, kind and patient with others!

Therapeutic communication involves ACTIVE MINDFUL listening! 1. Limit self-disclosure 2. Avoid giving advice 3. Ensure patient privacy (HIPAA) Building Rapport

1. Show interest and BE interested in patient 2. Have a desire to know the person and learn about them 3. Value and respect others

Building Rapport Exercise

History Taking is important for the nurse. Five strategies to maximize history taking (Fairhurst): 1. 2. 3. 4. 5.

Ask open-ended questions Listen and be mindful of nonverbal behaviors (active listening) Communicate empathy Address the client’s concerns Strive for agreement with the plan of care

Three categories of Questions: 1. Open-ended questions 2. Focused questions 3. Closed-ended questions Open-ended Questions: 1. 2. 3. 4. 5. 6.

Helps to gather information Allows the client to tell their story Cannot be answered “yes” or “no” Encourages reflection Helps the client connect pieces Moves from simple questions to more complex questions EXAMPLE: Can you please tell me what brought you here today?

Focused Questions: 1. Requires a specific short response EXAMPLE: Can you please tell me about the pain in your back?

Closed-ended Questions: 1. Requires a “yes” or “no” response 2. Allows the nurse to quickly gather information EXAMPLE: Did you eat today? Does your foot hurt?

Patient History Exercise

The nurse listens for: 1. 2. 3. 4. 5. 6. 7.

Content themes Communication patterns Discrepancies in content, body language and verbalizations Client’s feelings (expressed in body language or facial expressions) What is said and what isn’t said The nurse’s inner response or reaction The effects the client’s communication has on others

EXERCISE: Listening for Themes

1. 2. 3. 4. 5. 6. 7.

Minimal cues and leads: communicate interest Clarification: ask for more information Restatement: Repeat the client’s words Paraphrasing: checks to see if nurse heard accurately Reflection: gives permission to have feelings Summarization: helps pull information together Silence: intentional pauses

Negative Listening Responses 1. 2. 3. 4. 5. 6. 7.

False reassurance Giving advice False inferences Over generalizing Moralizing Giving value judgments Social responses

Nonverbal Communication Nonverbal cues help us to interpret the meaning 1. Tone of voice

2. Facial expression 3. Gestures or movement For Effective Communication: 1. Allow silence 2. Nonverbal behaviors should be congruent with the message 3. Use open body language (lean forward, face client, have eye contact & use gestures)

“Wit” videoclip 1. Discuss the communication techniques used by nurse and patient Facilitation: Allowing the client to gather her thoughts and emotions at the time. Silent attentiveness was performed by the nurse to give the client time to vent and express her feelings while the nurse observed her body language. And refletion, the nurse kept repeating what the patient was saying and validating her information. 2. State if therapeutic or not therapeutic and why Therapeutic communication was performed very well. The nurse did not give the client any false reassurance but rather validating what the client kept saying. She was listening to the client. 3. What did the nurse do well? The nurse stayed and talked to the client after she pressed the call button. The patient was able to talk to her and the nurse kept validating her. The patient felt like she had built that trust with the patient and the patient felt like she could talk to the nurse. The nurse was finding ways to comfort the patient. 4. What should she have done differently? Storming into the patient room so quickly and abruptly probably set the patient off when she pressed her call light. And also— I don’t think it was 100% right for her to sit there and eat the popsicle with the patient. Do not take food, gifts, or any other things from patients....