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

2. 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.

3. 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.

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

5. 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.

6. 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.

7. 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.

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

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

10. 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.

11. 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.

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

13. 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.

14. 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.

15. 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.

16. 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.

17. 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.