Remember that nonverbal communication is just as important as the words you speak. Be mindful of your facial expression, body posture, and other nonverbal aspects of communication as you work with clients.
Ask colleagues for feedback about your communication style. Ask them how they communicate with clients in difficult or uncomfortable situations.
Examine your communication by asking questions such as “How do I relate to men? To women? To authority figures? To elderly persons? To people from cultures different from my own?” or “What types of clients or situations make me uncomfortable? Sad? Angry? Frustrated?” Use these self-assessment data to improve your communication skills.
Identify a situation in which you felt frustrated with another person, or angry about something that occurred, but you kept silent about your feelings. What led to your silence? What assertive communication
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statements could help you express your feelings and thoughts?
The nurse is working with a client whose culture includes honoring one’s parents and being obedient, keeping “private” matters within the family only, and not talking with strangers about family matters.
Given this client’s belief system, how will the nurse use therapeutic communication effectively?
Communication is the process people use to exchange information through verbal and nonverbal messages. It is composed of both the literal words or content and all the nonverbal messages (process), including body language, eye contact, facial expression, tone of voice, rate of speech, context, and hesitations that accompany the words. To communicate effectively, the nurse must be skilled in the analysis of both content and process.
Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the needs of the client to promote an effective exchange of information between the nurse and the client.
Goals of therapeutic communication include establishing rapport, actively listening, gaining the client’s perspective, exploring the client’s thoughts and feelings, and guiding the client in problem solving.
The crucial components of therapeutic communication are confidentiality, privacy, respect for boundaries, self-disclosure, use of touch, and active listening and observation skills.
Proxemics is concerned with the distance zones between people when they communicate: intimate, personal, social, and public.
Active listening involves refraining from other internal mental activities and concentrating exclusively on what the client is saying.
Verbal messages need to be clear and concrete rather than vague and abstract. Abstract messages requiring the client to make assumptions can be misleading and confusing. The nurse needs to clarify any areas of confusion so that he or she does not make assumptions based on his or her own experiences.
Nonverbal communication includes facial expressions, body language, eye contact, proxemics (environmental distance), touch, and vocal cues. All are important in understanding the speaker’s message.
Understanding the context is important to the accuracy of the message. Assessment of context focuses on the who, what, when, how, and why of an event.
Spirituality and religion can greatly affect a client’s health and health care. These beliefs vary widely and are highly subjective. The nurse must be careful not to impose his or her beliefs on the client or to allow differences to erode trust.
Cultural differences can greatly affect the therapeutic communication process.
When guiding a client in the problem-solving process, it is important that the client (not the nurse) chooses and implements solutions.
Therapeutic communication techniques and skills are essential to successful management of clients in the community.
Assertive communication is the ability to express one’s self in an open, direct way. These skills are useful in resolving conflicts, solving problems, and expressing thoughts and feelings safely.
The greater the nurse’s understanding of his or her own feelings and responses, the better the nurse can communicate and understand others.
REFERENCES
Andrews, M., & Boyle, J. (2011). Transcultural concepts in nursing care (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.
DeVito, J. A. (2013). The interpersonal communication handbook (13th ed.). Boston, MA: Pearson Education.
Hall, E. (1963). Proxemics: The study of man’s spatial relationships. In J. Gladstone (Ed.), Man’s image in medicine and anthropology (pp. 109–
120). Philadelphia, PA: Mosby.
Knapp, M. L. (1980). Essentials of nonverbal communication. New York, NY: Holt, Rinehart & Winston.
Knapp, M. L., & Hall, J. A. (2013). Nonverbal behavior in human interaction (8th ed.). New York, NY: Wadsworth.
Peplau, H. (1952). Interpersonal relations in nursing. New York, NY: G. P. Putnam.
Satir, V. (1967). Conjoint family therapy: A guide to theory and technique (Rev. ed.). Palo Alto, CA: Science and Behavior Books.
Sheldon, L. K., & Foust, J. B. (2014). Communication for nurses: Talking with patients (3rd ed.). Boston, MA: Jones & Bartlett.
ADDITIONAL READINGS
Cleary, M., Hunt, G. E., Horsfall, J., et al. (2012). Nurse-patient interaction in acute inpatient mental health units: A review and synthesis of qualitative studies. Issues in Mental Health Nursing, 33(2), 66–79.
Farley-Toombs, C. (2012). The stigma of a psychiatric diagnosis: Prevalence, implications, and nursing interventions in clinical care settings.
Critical Care Nursing Clinics of North America, 24(1), 149–156.
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MULTIPLE-CHOICE QUESTIONS
Select the best answer for each of the following questions.
Client: “I had an accident.”
Nurse: “Tell me about your accident.”
This is an example of which therapeutic communication technique?
Making observations Offering self General lead Reflection
“Earlier today you said you were concerned that your son was still upset with you. When I stopped by your room about an hour ago, you and your son seemed relaxed and smiling as you spoke to each other. How did things go between the two of you?”
This is an example of which therapeutic communication technique?
Consensual validation Encouraging comparison Accepting
General lead
“Why do you always complain about the night nurse? She is a nice woman and a fine nurse and has five kids to support. You’re wrong when you say she is noisy and uncaring.”
This example reflects which nontherapeutic technique?
Requesting an explanation Defending
Disagreeing Advising
“How does Jerry make you upset?” is a nontherapeutic communication technique because it gives a literal response.
indicates an external source of the emotion.
interprets what the client is saying.
is just another stereotyped comment.
Client: “I was so upset about my sister ignoring my pain when I broke my leg.”
Nurse: “When are you going to your next diabetes education program?”
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This is a nontherapeutic response because the nurse has used testing to evaluate the client’s insight.
changed the topic.
exhibited an egocentric focus.
advised the client what to do.
When the client says, “I met Joe at the dance last week,” what is the best way for the nurse to ask the client to describe her relationship with Joe?
“Joe who?”
“Tell me about Joe.”
“Tell me about you and Joe.”
“Joe, you mean that blond guy with the dark blue eyes?”
Which of the following is a concrete message?
“Help me put this pile of books on Marsha’s desk.”
“Get this out of here.”
“When is she coming home?”
“They said it is too early to get in.”
MULTIPLE-RESPONSE QUESTIONS
Select all that apply.
The advantages of assertive communication are:
All persons’ rights are respected.
It gains approval from others.
It protects the speaker from being exploited.
The speaker can say “no” to another person’s request.
The speaker can safely express thoughts and feelings.
The speaker will get his or her needs met.
Which of the following are examples of a therapeutic communication response?
“Don’t worry—everybody has a bad day occasionally.”
“I don’t think your mother will appreciate that behavior.”
“Let’s talk about something else.”
“Tell me more about your discharge plans.”
“That sounds like a great idea.”
“What might you do the next time you’re feeling angry?”
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Key Terms culturally competent culture
environmental control ethnicity
hardiness race resilience resourcefulness self-efficacy sense of belonging social networks social organization social support socioeconomic status spirituality
time orientation
Learning Objectives
After reading this chapter, you should be able to:
Discuss the influences of age, growth, and development on a client’s response to illness.
Identify the roles that physical health and biologic makeup play in a client’s emotional responses.
Explain the importance of personal characteristics, such as self-efficacy, hardiness, resilience, resourcefulness, and spirituality, in a client’s response to stressors.
Explain the influence of interpersonal factors, such as sense of belonging, social networks, and family support, on the client’s response to illness.
Describe various cultural beliefs and practices that can affect mental health or illness.