Transcript Client

Communication
Potter, Chapter 24
Types of Communication
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Verbal—spoken and written
 Nonverbal:
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Eye contact
Facial expression
Posture, gait
Gestures
Touch
General appearance, dress, grooming
Sounds
Voice inflection
Silence
Factors Affecting
Communication
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Developmental level
Gender
Credibility
Affect/Attitude
Emotional state
Special needs (357)
Environment
Distance
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Role
Timing
Territoriality
Culture
Knowledge level
Values
Perceptions
Expectations
Responses That Hinder
Communication
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Lack of eye contact
Hurried gestures
Closed body
language
False reassurance
Judgmental
responses
Changing subject
Negating feelings
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Giving advice
Using clichés
Closed questions
Leading questions
Stereotyping
Treating client as
object or dx
A-la-moding
The Helping Relationship
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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”
Phases on p. 347---covers entire stay
The Nursing History
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Different from medical history—more holistic
Utilizes therapeutic communication skills
Happens during orientation phase
Need organized tool developed by agency
Patients have right to refuse to answer
questions; if they agree to answer questions
they need to understand the scope of
confidentiality
Students are reluctant at first—feel like they
are prying
Therapeutic Communication
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A learned skill that
improves with practice
Planned, deliberate,
purposeful, helpful
Sometimes the only skill
a nurse can offer
Part of the therapeutic
relationship
Used with interviews
Components of Therapeutic
Communication
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Listening attentively—face client, eye contact,
open body language, no distracting
movements, nod appropriately, read verbal
and nonverbal
 Demonstrating acceptance—use person’s
name, listen without interrupting, avoid
arguing, expressing doubts, or attempting to
change client’s mind
Types of Therapeutic Interaction
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Open-ended vs. closed-ended
Non-directive comments: Oh? mm….Yes…
Reflection: ”You feel…because…”
Restating (paraphrasing): ”What I hear you
saying is….”
Clarifying—”I’m not sure I understand….”
Focusing—”Tell me more about…..”
Stating observations—”You look tired.”
Confrontation—”You say this, but……”
Summarizing
Therapeutic
Communication
Examples of Good and Bad
Techniques
Open & Closed Questions
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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
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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.”
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Summarizing
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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.”
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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.”
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Being Defensive
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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
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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’m so 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.”
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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.”
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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 your son 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!”
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Therapeutic Communication
Practice
 Change
the following to openended ?s:
 “”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.”
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Professional Communication for
Students: Clients and Families
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Always inform them you are a student
Helping and therapeutic
Don’t pretend to know things you don’t—find
out
Don’t coerce patient into cooperating
Don’t tell your problems to your patient
Don’t gossip or degrade other professionals
Avoid accepting tips, gifts, etc.
Do not give test results or a new dx
With Physicians
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Collaborative thru instructor or primary nurse
May answer questions if aware of answers
May not take orders
Follow orders
May assist with PEs, dsg changes,
procedures (don’t give meds without
instructor)
Don’t flirt!
With Nursing Staff
Introduce yourself and get report
 Collaborative
 Don’t criticize, gossip, or degrade one to
another
 Nurse may advise or assist you but may
not supervise invasive procedures or
any meds except in specialty areas
 Give report before leaving floor
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With Instructors
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Always be honest!
Don’t overstep bounds
Inform instructor if you have never done a
procedure or don’t feel comfortable
If unsure about anything, ask
No invasive procedures or meds without
instructor
Maintain respect & control—ask for privacy if
have a problem
Inform instructor of unsafe practices you
see—no matter who it is