Last Updated: Friday January 24, 2003


past experiences
position within sociocultural system


role as advocate, change agent

Kinds of communication

Occur concurrently BUT majority are NONVERBAL

Types of Communication

Factors influencing communication


You do not need to focus on the reading on p 321

    abbreviations - covered in sophomore year

Therapeutic Communication as a Process

5 steps:

                                Impaired Verbal Communication

Before/during Intervention

    1. Consider factors which influence effective verbal communication

    2. Use special communication aids prn

    3. Use planned therapeutic communication techniques

    4. Avoid nontherapeutic techniques

        1. Consider factors which influence effective verbal communication
                                e.g. developmental
                                personal space

Personal space

2. Use special communication aids prn

        Communication Aids

3. Use planned therapeutic communication techniques

4. Avoid nontherapeutic communication techniques


Therapeutic Communication


1. Attentive Listening

  • face the person
  • eye contact
  • open posture
  • remain relaxed
  • acknowledge
  • lean toward
  • be sensitive to use of touch

2. conveying acceptance

  • do not interrupt
  • provide verbal feedback
  • congruent verbal cues
  • do not argue

3. asking related questions

  • relevant
  • sociocultural context
  • closed questions - limited response
  • access specific information
  • open-ended questions- free response, clarify
  • explore feelings, elaborate

4. reflective questioning/paraphrasing

  • listen for the basic message
  • restate
  • encourages elaboration
  • clarifies for pt and nurse

5. Clarifying (meaning for pt and self)

  • make a guess and restate
  • confess confusion
  • verify implied
  • check accuracy of pt. perception, information
  • and nurse perception
  • clarify time, reality, sequence

6. Focusing

  • when pt vague, rambling
  • focus on one aspect

7. stating observations

  • feedback on perception, behavior
  • avoid confrontation

8. offering information

  • establishes trust
  • promotes health teaching
  • be simple, direct; avoid advising
  • State "I donít know" as needed

9. maintaining silence

  • invites a response
  • allows time to organize, process
  • requires practice and timing
  • time for assessment, observe nonverbal

10. Using assertiveness

  • speak clearly
  • learn to say no
  • constructive criticism

11. Summarizing

  • review at end
  • recall at beginning

Therapeutic = Success!

Barriers to Effective Communication

1. Giving advice

  • takes DM away from pt
  • stalls problem solving
  • present as OPTIONS

2. Offering false reassurance

  • disregards pts needs, feelings
  • discourages communication
  • genuine reassurance OK

3. Being defensive

  • protects nurses feelings, ignores pts
  • destroys trust
  • listen for basic or deeper message
  • does not imply acceptance
  • good time for paraphrasing

4. Showing approval/disapproval

  • focuses on nurses standards
  • closes communication

5. Stereotyping

  • people: inhibits true assessment
  • responses: rote, meaningless cliches
  • minimizes problem

6. Asking "why"

  • can be interpreted as accusative, hostile

7. Changing the subject inappropriately

  • focuses on nurses tasks, feelings
  • may miss important info


Evaluating communication


verbatim account of a conversation
includes verbal and nonverbal interactions
analyze in terms of:     PROCESS
Was it therapeutic? Did it flow?
Were cues missed?

What would I do diferent the next time?

Client Records

  • Purposes
    care planning
    quality review
    decision analysis
    legal documentation
    historic documentation
  • Methods of Documentation

                            critical pathway

    Guidelines for Effective Documentation


    The nurse safeguards the clientís right to privacy by judiciously protecting information of a confidential nature.


    USE PT INITIALS, not full name, on notes

    The pt has the right to expect that all communications and records pertaining to his care should be treated as confidential.



    9/7/02 7:15 PM Verbalizes sharp, throbbing pain localized along radial side, R wrist.                                        Onset 15 minutes ago. Pain increased with movement of wrist, relieved slightly with                                      elevation of hand on pillow. Radial pulses = bilaterally. R wrist circumference 1 cm larger                                    than L wrist. Dr. Kent notified at 7:10 PM. Percocet 2 tabs given for pain.---------MMcGovern RN

    Developmental Guidelines

    Infants, Toddlers

    need tactile contact
    need visual and auditory stimulation
    carry around
    things to handle, look at


    communicate thru play
    use stuffed animal, act out scene

    School age

    have child draw picture, then describe
    use puppet


    peer group important
    use group situation
    avoid parent-child interactions


    evaluate sensory deficits
    use above as appropriate

    Next: Recording Guidelines