Communication and the Clinical Interview Chapter 9 Communication and the Clinical Interview Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

The Communication Process Stimulus for information, comfort, or advice Sender – Initiates contact Message – Sent or expressed Variety of media – Hearing, visual, touch, smell Feedback received Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Case Study A new nurse on a psychiatric unit wants to effectively communicate in a therapeutic relationship with a patient. What are some things that will help this communication? The nurse should know what they are trying to convey (the purpose of the message), (2) communicate what is really meant to the patient, and (3) comprehend the meaning of what the patient is intentionally or unintentionally conveying. Communication should include clarity, which ensures that the meaning of the message is accurately understood by both parties "as the result of joint and sustained effort of all parties concerned," and (2) continuity, which promotes connections among ideas "and the feelings, events, or themes conveyed in those ideas.” Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Factors That Affect Communication Personal factors Environmental factors Relationship factors Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Verbal Communication All words a person speaks Communicates Can convey Beliefs and values Perceptions and meaning Can convey Interest and understanding Insult and judgment Clear or conflicting messages Honest or distorted feelings Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nonverbal Communication Tone of voice Emphasis on certain words Physical appearance Facial expressions Body posture Amount of eye contact Hand gestures Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Therapeutic Communication Techniques Tools for enhancing communication Using silence Active listening Listening with empathy Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clarifying Techniques Paraphrasing Restating Reflecting Exploring Projective questions Presumption questions Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Asking Questions and Eliciting Patient Responses Open-ended questions Closed-ended questions Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Nontherapeutic Communication Techniques Excessive questioning Giving approval or disapproval Giving advice Asking “why” questions Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Cultural Considerations Communication style Eye contact Touch Cultural filters – Form of bias or prejudice Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Preparing for the Interview Pace Setting Seating Introductions Initiating the interview Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Attending Behaviors Foundation of the interview Eye contact Body language Vocal quality Verbal tracking Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Clinical Supervision Communication and interviewing are acquired skills Fosters professional growth and helps minimize the development of nontherapeutic nurse-patient relationships. Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Process Recording Written record of a segment of the nurse-patient session that reflects as closely as possible the verbal and nonverbal behaviors of both patient and nurse Useful tool for identifying communication patterns Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions As a nurse assesses a new client, the nurse makes sure the door remains open. Which type of communication factor is this action? Environmental Relationship Personal ANS: A   Environmental factors that may affect communication include physical factors (e.g., background noise, lack of privacy, uncomfortable accommodations) and societal determinants (e.g., sociopolitical, historical, and economic factors, the presence of others, expectations of others). REF: 148 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

Audience Response Questions A nurse assesses a newly hospitalized client. Which communication technique will the nurse use most? Rapid, high-pitch voice tone Closed-ended questions Direct eye contact Frequent touch ANS: B   Closed-ended questions are most useful in an initial assessment or to ascertain specific information. REF: 153 Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.