JUDITH M. WILKINSON LESLIE S. TREAS KAREN BARNETT MABLE H. SMITH FUNDAMENTALS OF NURSING Copyright © 2016 F.A. Davis Company Chapter 21: Communication & Therapeutic Relationships

Copyright © 2016 F.A. Davis Company What is Communication? HF Pg 459 Basic human function Sending messages back and forth between two or more people Consists of verbal and nonverbal messages Helps build working relationships Helps meet physical, psychosocial, emotional, and spiritual needs

Copyright © 2016 F.A. Davis Company Levels of Communication Intrapersonal: self-talk; can be positive or negative Interpersonal: between two or more people Group: with many people at the same time

Copyright © 2016 F.A. Davis Company Components of Communication: Content HF Pg 460 Subject matter Words Gestures Substance of the message Open to interpretation

Copyright © 2016 F.A. Davis Company Components of Communication: Process The active part of communication Involves five elements –Message: words, gesture, letter –Sender: initiates content delivery –Channel: face-to-face, written, audiovisual, telephone, –Receiver: interprets the message –Feedback

Copyright © 2016 F.A. Davis Company Communication Components HF Pg. 460

Copyright © 2016 F.A. Davis Company Verbal Communication Involves speaking or writing words to send a message

Copyright © 2016 F.A. Davis Company Factors Affecting Verbal Communication Vocabulary Denotative versus connotative meaning Pacing of conversation Intonation: tone, pitch, cadence, volume Clarity and brevity Timing Relevance of information Credibility of the sender Humor

Copyright © 2016 F.A. Davis Company Nonverbal Communication The unconscious use of body language when sending a message

Copyright © 2016 F.A. Davis Company Factors Affecting Nonverbal Communication Facial expression: communicates feelings behind a message Posture and gait: clue to attitude, self-concept Personal appearance: clue to socioeconomic status, culture, feelings Distance: indicates extent of familiarity Gestures: emphasize and clarify spoken word; can have different meanings Touch: can be misinterpreted

Copyright © 2016 F.A. Davis Company Factors That Affect Communication in General HF Pg 465 Environment Life span variations Gender Personal space Territoriality Sociocultural factors Roles and relationships

Copyright © 2016 F.A. Davis Company Therapeutic Relationships in Healthcare Focus on improving the health of the client Provide necessary information about health, treatments, and care Involve use of therapeutic communication

Copyright © 2016 F.A. Davis Company Therapeutic Communication Client centered Goal directed Strengthens therapeutic relationship

Copyright © 2016 F.A. Davis Company Phases of the Therapeutic Relationship HF Pg 469 Stage 1: Preinteraction phase Gathering information prior to meeting client

Copyright © 2016 F.A. Davis Company Phases of the Therapeutic Relationship (cont’d) Stage 2: Orientation phase Meeting the client; introductions; establishing rapport and trust

Copyright © 2016 F.A. Davis Company Phases of the Therapeutic Relationship (cont’d) Stage 3: Working phase Use of techniques germane to therapeutic communication Active part of the relationship Client clarifies feelings and concerns through verbal and nonverbal communication

Copyright © 2016 F.A. Davis Company Phases of the Therapeutic Relationship (cont’d) Stage 4: Termination phase Conclusion of the relationship

Copyright © 2016 F.A. Davis Company Key Characteristics of Therapeutic Communication HF Pg. 470 Empathy Respect Genuineness Concreteness Confrontation

Copyright © 2016 F.A. Davis Company Client Factors Affecting Effective Therapeutic Communication Language barrier Impaired cognitive skills Sensory-perceptual alterations Physiological barriers

Copyright © 2016 F.A. Davis Company Enhancing Therapeutic Communication Listen actively. Establish trust. Be assertive. Restate, clarify, and validate message.

Copyright © 2016 F.A. Davis Company Enhancing Therapeutic Communication (cont’d) Interpret body language. Share your observations to clarify. Use open-ended questions. Use silence. Summarize the conversation.

Copyright © 2016 F.A. Davis Company Five Steps of Assertive Communication 1.Get the person’s attention. 2.Express your concern. 3.State the problem. 4.Propose an action. 5.Reach a decision. Source: Leonard, M., Graham, S., and Bonacum, D. (2004). The human factor: The critical importance of effective teamwork and communication in providing safe care. Quality and Safety in Health Care, 13(Supplement), 85–90.

Copyright © 2016 F.A. Davis Company Barriers to Therapeutic Communication HF Pg 475 Too many questions Closed-ended questions Asking “Why?” Changing the subject abruptly Failing to listen

Copyright © 2016 F.A. Davis Company Barriers to Therapeutic Communication (cont’d) Failing to explore issues in detail Expressing approval or disapproval Offering advice Giving false reassurance Stereotyping Using patronizing language

Copyright © 2016 F.A. Davis Company Think Like a Nurse Think of an example of communication in which the connotative meaning may be different from the denotative meaning of what is said.