NR473 Communication Facilitators & Blockers PDF

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FACILITATORS OF COMMUNICATION 1. Listening-eye contact, body posture, gestures and facial expressions that shows the client the nurse is active in receiving information. 2. Broad openings-Encouraging clients to select the topic for discussion. “What are you thinking about? What would you like to talk about today?” 3. Restating-Repeating the main thought expressed by the client. Purpose: To make sure the nurse accurately hears the client. “You said your father left you when you were 16.” “What I hear you saying is you’re angry your family hasn’t visited today?” 4. Clarification-asking for more information to make the client’s message clear. “I’m not sure I am following you. Tell me about your last hospitalization again. You said your father left when you were a teenager. I’m unclear about what happened before he left.” 5. Reflection-Directing back to the client, expressed ideas feelings, questions or content, usually using the client’s own words. “You’re feeling tense and anxious and it is related to a conversation you had last night with your spouse.” 6. Humor-Discharging energy through comic enjoyment of the imperfect. “That gives a whole new meaning to the word “nervous..” 7. Informing-skillfully giving information or teaching. “I think you need more information on your medication’s side effects. The side effect written here is lethargy. It means to move slowly.” 8. Focusing-Questions or statements that help clients expand on a topic of importance. “I Wonder if we should spend some time talking about your feelings about your father.” 9. Sharing perceptions-Asking the client verify the nurse’s perception/understanding of that he/she is thinking and/ or feeling. “You seem sad all of a sudden.” “While you are looking at me, I sense your mind is someplace else.” 10. Theme identification-Underlying issues or problems experienced by the client that emerge repeatedly during the course of the nurse/client relationship. “I’ve noticed that in all of your serious relationships with men/women, something has happened and you get angry and leave the relationship impulsively. I wonder if you fear closeness?” 11. Silence-Lack of verbal communication for a therapeutic reason. Ex: Sitting silently with a client communicating interest and involvement. 12. Suggesting-Presenting alternatives for clients to consider. “Have you considered approaching your son in a different way? For example, you’re assuming he is angry with you. Perhaps you could ask him if he is angry with you or with something else.”

COMMUNICATION BLOCKS 1. Failure to listen. Checking emails, texts, your watch, eyes wandering 2. The nurse dominating the interaction on a topic selected by the nurse. 3. Being judgmental. “And you’ll keep getting sick as long as you don’t take your meds like you are supposed to.” More appropriate: It looks like this is your third acute admission this year; let’s talk about why you keep getting sick. 4. Falsely reassuring. “Of course you’re going to get better. You don’t need to worry.” 5. Defending. “You couldn’t be in a better hospital, or have better doctors and nurses.” More appropriate: Tell me about your concerns. 6. Failure to probe. Pt: “I’m afraid I won’t make it through surgery.” Nurse-“You’ll be fine, don’t worry.” More appropriate response: You are concerned you won’t make it through surgery? 7. Assumed understanding. “I’m dreading my family visiting me today. It’s the first time they have seen me since I got sick.” Nurse: “You’re going to do just fine. You look great.” Nurse assumes he/she knows what the pt’s concern is. More appropriate: Talk to me about that. 8. Making stereotyped comments. “Different stroke for different folks. Get a life. Whatever.” 9. Inappropriate timing. Sharing information or observations before the client is ready to hear it. 10. Belittling the client. “You shouldn’t feel that way.” More appropriate: Tell me more about how you feel. 11. Avoiding therapeutic intimacy. After the nurse has a therapeutic alliance with a pt. taking hypertension medication, the pt. says, “I’m not having as much desire for sex as I did.” Nurse-“You need to talk to the doctor about that.” More appropriate: It sounds like you’re concerned about your lessened desire for sex. 12. Giving advice. “You should have the surgery.” More appropriate: Tell me about your concerns regarding surgery. 13. Making generalizations. Pt-“I’m going home today nurse.” Nurse-“That’s good!” More appropriate response: How do you feel about going home? 14. Changing the subject. Pt: “I’m concerned about my husband’s lack of attention to me when I come home from work.” Nurse -“What’s your husband like?” More appropriate: Tell me about that. Or You’re telling me your husband isn’t paying attention to you when you come home from work? 15. Interrupting.

16. Challenging the client. “Tell me how you know the doctor is lying to you.” More appropriate-“What leads you to think the doctor isn.t telling you the truth?” 17. Disapproving of the client. “I thought you could handle that better.” More appropriate: I’m concerned with the way you handled the situation. 18. Asking “Why” questions. Clients can describe circumstances and the situation and often cannot tell you why. Often elicits a defensive response. 19. Failure to break a non-therapeutic silence. Pt. is using a resistant silence and nurse allows it. More appropriate: It seems you are not ready to talk right now. I can sit here with you for a few minutes if you would like.

TYPES of QUESTONS Open-ended question-A question that requires the client to answer with more than one word and with an explanation. “What would you like to talk about today?” Closed-ended question-A question that is usually answered with one or two words. “How many children do you have?” Direct question-A question the client feels compelled to answer. “What happened the last time you were admitted to the hospital?” Indirect question-A question for which the client decides whether to answer. “I wonder if there is a relationship between not taking your medications and how often you end up in the emergency room.”...