COMMUNICATION

DENNIS CAYABYAB PADERNILLA, RN, MN

 Communication
•Communication-the process that people
use to exchange information.
•Messages are simultaneously sent and
received on two levels: verbally through
the use of words and nonverbally by
behaviors that accompany the words
 LEVELS OF COMMUNICATION:
1. Intrapersonal Communication – occurs within an individual.

2. Interpersonal Communication – face-to-face interaction

between two people or a small group.
FACTORS THAT INFLUENCE
COMMUNICATION
• PERCEPTIONS
• VALUES
• DEVELOPMENT
• SPACE AND TERRITORIALITY
• EMOTIONS
• SOCIOCULTURAL BACKGROUND
• KNOWLEDGE
• ROLES AND RELATIONSHIPS
• ENVIRONMENTAL SETTING
•Verbal communication-consists of the words a
person uses to speak to one or more listeners.
• Words-symbols used to identify the objects and concepts being discussed.
• Content is verbal communication, the literal words that a person speaks.
• Context is the environment in which communication occurs ; can include the
time and the physical, social, emotional, and cultural environment
-includes the circumstances or parts that clarify
the meaning of the content of the message.
• Nonverbal communication- behavior that accompanies verbal
content such as body language, eye contact, facial expression, tone of
voice, speed and hesitations in speech, grunts and groans, and
distance from the listener.
• It can indicate the speaker’s thoughts, feelings, needs, and values that
the speaker acts out mostly unconsciously.
PROCESS:
• Process denotes all nonverbal messages that the speaker
uses to give meaning and context to the message.
-This component of communication requires the listener to
observe the behaviors and sounds that accent the words
and to interpret the speaker’s nonverbal behaviors to
assess whether they agree or disagree with the verbal
content.
Congruent message - when content and
process agree.
For example, a client says, “I know I haven’t been myself. I need
help.” She has a sad facial expression and a genuine and sincere
voice tone. The process validates the content as being true.
Incongruent message- when the content and
process disagree— when what the speaker says
and what he or she does do not agree
THERAPEUTIC COMMUNICATION
• Therapeutic communication is an interpersonal
interaction between the nurse and client during which
the nurse focuses on the client’s specific needs to
promote an effective exchange of information.
 Therapeutic use of self -TOOL
• With the therapeutic use of self, nurses use themselves as a therapeutic
tool to establish the therapeutic relationship with clients and to help
clients grow, change, and heal.
• The nurse uses aspects of his or her personality, experiences, values,
feelings, intelligence, needs, coping skills, and perceptions to establish
relationships with clients.
 Skilled use of therapeutic communication
techniques
• Helps the nurse understand and empathize with the client’s
experience
• Needed by all nurses to effectively apply the nursing process
and to meet standards of care for their clients.
 Therapeutic communication can help
nurses to accomplish many goals:
qEstablish a therapeutic nurse–client relationship.
qIdentify the most important client concern at that moment (the client-
centered goal).
qAssess the client’s perception of the problem as it unfolded. This
includes detailed actions (behaviors and messages) of the people
involved and the client’s thoughts and feelings about the situation,
others, and self.
qFacilitate the client’s expression of emotions.
qTeach the client and family necessary self-care skills.
qRecognize the client’s needs.
qImplement interventions designed to address the client’s needs.
qGuide the client toward identifying a plan of action to a satisfying and
socially acceptable resolution.
 To have effective therapeutic
communication, the nurse also must
consider:

•privacy and respect of boundaries

•use of touch, and
•active listening and observation.
 Privacy and Respecting Boundaries
• Privacy is desirable but not always possible in therapeutic
communication.
• The nurse needs to evaluate if interacting in the client’s room is
therapeutic.
• For example, if the client has difficulty maintaining boundaries or has
been making sexual comments, then the client’s room is not the best
setting. A more formal setting would be desirable.
 PROXEMICS:
• Proxemics- the study of distance zones between
people during communication. People feel more
comfortable with smaller distances when
communicating with someone they know rather than
with strangers.
• People from the United States, Canada, and many
Eastern European nations generally observe four
distance zones:
 4 distance zones:
• Intimate zone (0 to 18 inches between people):
• This amount of space is comfortable for parents with young children, people
who mutually desire personal contact, or people whispering.
• Invasion of this intimate zone by anyone else is threatening and produces
anxiety.
• Personal zone (18 to 36 inches):
• This distance is comfortable between family and friends who are talking.
• Social zone (4 to 12 feet):
• This distance is acceptable for communication in social, work, and business
settings.
• Public zone (12 to 25 feet):
• This is an acceptable distance between a speaker and an audience, small
groups, and other informal functions.
 Five types of TOUCH
As intimacy increases, the need for
distance decreases.
• Functional-professional touch - used in
examinations or procedures such as
when the nurse touches a client to assess
skin turgor or a masseuse performs a
massage.
• Social-polite touch - used in greeting,
such as a handshake and the “air kisses” Four types of touch. A—
some women use to greet Functional–professional
acquaintances, or when a gentle hand touch; B—Social–polite
guides someone in the correct direction. touch; C—Friendship–
warmth touch;
D—Love–intimacy touch.
 CONT.
• Friendship-warmth touch- involves a hug in greeting, an
arm thrown around the shoulder of a good friend, or the
back slapping some men use to greet friends and relatives.
• Love-intimacy touch involves tight hugs and kisses between
lovers or close relatives.
• Sexual-arousal touch is used by lovers.
 Active Listening and Observation
• To receive the sender’s simultaneous messages, the nurse must use
active listening and active observation.
• Active listening - refraining from other internal mental activities and
concentrating exclusively on what the client says.
• Active observation- watching the speaker’s nonverbal actions as he
or she communicates.
 NURSE-CLIENT RELATIONSHIP
• A dynamic interactive process between a professionally
educated person, the nurse, who helps another individual,
the client, to seek and use help.

• The relationship is productive

• Involves verbal and nonverbal communication
• An exchange of thoughts and feelings that facilitate healing
 THERAPEUTIC
COMMUNICATION
TECHNIQUES
PROBLEM SOLVING
METHOD
 PROBLEM-SOLVING METHOD
• Identify the client’s problem
• Promote discussion of desired changes.
• Identify realistic changes.
• Discuss alternative strategies for creating changes and ways to cope with aspects that
cannot be realistically changed.
• Weigh benefits and consequences of each alternative.
• Assist client to select an alternative.
• Support client’s effort to implement strategy.
• Assist the client to evaluate outcomes of the change and make modifications as
required.
 ESSENTIAL INGREDIENTS
• RAPPORT

• TRUST

• RESPECT

• GENUINENESS

• EMPATHY
PHASES OF THE NURSE-PATIENT RELATIONSHIP

• PREORIENTATION

• ORIENTATION

• WORKING

• TERMINATION
 PRE-ORIENTATION PHASE
• The only phase of the therapeutic nurse-client relationship in which the
client does not directly participate.
• During this phase, the NURSE prepares to meet the client by gathering
relevant client information and anticipating client concerns prior to the
first interaction.
• Being aware of potential client concerns before meeting with the client
is helpful; for example, the approach to a client whose baby is in ICU
would be different than with a client whose baby is healthy and
rooming in
 ORIENTATION PHASE
• Defines the purpose, roles, and rules of the process, and provides a framework for assessing client’s
needs.
• The NURSE begins to build a sense of trust by providing the client with basic information (name,
professional status and essential information about the purpose and nature of the relationship).
• Introductions are important even when the client is confused, aphasic, unresponsive, or unable to
respond.
• Nonverbal supportive communication such as a handshake, eye contact, a smile and appropriate
body language reinforce spoken words.
• A client’s dignity, autonomy and privacy are kept safe within the nurse-client relationship.
• It is important for the nurse to set the context of care by providing relevant information to the
client; for example, “Hello, my name is Jane Smith, I am your nurse for today, and I will be taking
care of you until 7:30 p.m. I will be in and out of your room frequently during the day; however, if
you need assistance and I am not here, please ring your call bell.” This information would be
presented by the LPN in a respectful manner.
WORKING PHASE
• The problem-solving phase of the relationship, paralleling the planning
and implementation phases of the nursing process.
• Within this phase, relevant treatment goals are established to guide
nursing interventions and client actions, and the conversation in the
working phase turns to active problem solving related to assessed
needs.
• Clients can more deeply disclose concerns/issues that they are having.
• Corresponding to the implementation phase of the nursing process, the
working phase focuses on self direction and self-management to
whatever extent possible in prompting the client’s health and wellbeing;
TERMINATION PHASE
• When the care provided by the NURSE is no longer required for
the context of care; for example, a client who was hospitalized
for pneumonia has recovered and no longer requires nursing
care is now discharged home.
• In this phase, the NURSE and client evaluate the client’s response
to treatment and explore the meaning of the relationship and
what goals have been achieved.
• Discussing the achievements, how the client and NURSE feel
about concluding the relationship, and plans for the future are
an important part of the termination phase.
 CONCERNS OF THE NURSE
• FEAR OF REJECTION

• FEAR OF EXPLOITING THE CLIENT

• FEAR OF HELPLESSNESS

• FEAR OF PHYSICAL AGGRESSION

• FEAR OF MENTAL ILLNESS

 CONCERNS OF THE CLIENT
• THREAT TO SELF-IMAGE
• FEELINGS OF HELPLESSNESS
• FEELINGS OF INCOMPETENCE
• FEELINGS OF INADEQUACY
• AFRAID OF BEING STIGMATIZED
• AFRAID OF CHANGE
 RELATIONSHIP ISSUES

• RESISTANCE - ANGER

• TRANSFERENCE

• COUNTERTRANSFERENCE
 TRANSFERENCE
• AN INTERPERSONAL EXPERIENCE IN WHICH
FEELINGS, ATTITUDES, AND WISHES ORIGINALLY
LINKED WITH SIGNIFICANT OTHERS IN ONE’S LIFE
ARE ATTRIBUTED TO OTHERS WHO REPRESENT
THESE PEOPLE IN THE CURRENT SITUATION.
 COUNTERTRANSFERENCE
• A CONSCIOUS OR UNCONSCIOUS RESPONSE
OCCURRING IN THE NURSE OR THERAPIST IN
RESPONSE TO THE CLIENT.
• Wishes and conflicts originating in the helper’s
own relationships with significant others are
transferred onto the client. Self-awareness is
important for recognizing countertransference
reactions.
NON-THERAPEUTIC RESPONSES
• False reassurance • Belittling feelings
• Social responding • Making stereotypical
• Moralizing comments
• Interpreting • Failing to listen
• Giving advice • Making personal
statements
• Demanding an
explanation
• Expressing approval or
disapproval
SUMMARY
• The nurse-patient relationship is a dynamic interactive process between the nurse and
the patient.
• The relationship is productive.
• It involves the use verbal and non-verbal skills of therapeutic communication by the
nurse..
END OF SLIDES