Purposes
- Establishing a therapeutic provider-client relationship.
- Identify client’s concerns and problem.
- Assess client’s perception of the problem.
- Recognize client’s needs.
- Guide client towards a satisfying and socially acceptable solution
The Qualities of a Good Communicator
- Respect and empathy for the client.
- Good communication skills.
- Tolerance of values and beliefs different from one’s own.
- Unbiased attitudes.
- Patience.
- Awareness of gender issues
Attentive Listening
- Listening actively, using all the senses, as opposed to listening passively with just the ear
- It involves paying attention to the total message, both verbal and non verbal, and noting whether these communications are congruent.
Physical Attending
- The manner of being present to
- 5 specific ways to convey physical attending:
- Face the other person squarely
- Adopt an open posture
- Lean toward the person
- Maintain good eye contact
- Try to be relatively relaxed
Therapeutic Communication Technique
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TECHNIQUE |
DESCRIPTION |
EXAMPLES |
| Using silence | Accepting pauses or silences that may extend for several seconds or minutes without interjecting any verbal response. | Sitting quietly (or walking with the client) and waiting attentively until the client is able to put thoughts and feelings into words.
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| Providing general leads | Using statements or questions that (a) encourage the client to verbalize, (b) choose a topic of conversation, and (c) facilitate continued verbalization. | “Can you tell me how it is for you?”
“Perhaps you would like to talk about….” “Would it help to discuss your feelings?” “Where would you like to begin?” “And then what?”
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| Being specific and tentative | Making statements that are specific rather than general, and tentative rather than absolute. | “Rate your pain on a scale of 0-10”. (specific statement
“Are you in pain?” (general statement) “You seem unconcerned about your diabetes?” (tentative statement) “You don’t care about your diabetes and you will never will” (absolute statement)
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| Using open-ended question | Asking broad questions that lead or invite the client to explore (elaborate, clarify, describe, compare, or illustrate) thoughts and feelings. Open-ended question specify only the topic to be discussed and invite answers that are longer than one or two words. | “I’d like to hear more about that.”
“Tell me about….” “How have you been feeling lately?” “What brought you to the hospital?” “What is you opinion?” “You said you were frightened yesterday. How do you feel now?”
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| Using touch | Providing appropriate forms of touch to reinforce caring feelings. Because tactile contacts vary considerably among individuals, families, and cultures, the nurse must be sensitive to the differences in attitudes and practices of clients and self. | Putting an arm over the client’s shoulder. Placing your hand over the client’s hand. |
| Restating or paraphrasing | Actively listening for the client’s basic message and then repeating those thoughts and /or feelings in similar words. This conveys that the nurse has listened and understood the client’s basic message and also offers clients a clearer idea of what they have said. | Client: “I couldn’t manage to eat any dinner last night-not even the dessert.”
Nurse: “You had difficulty eating yesterday.” Client: “Yes, I was very upset after my family left.” Client: “I have trouble talking with the strangers.” Nurse:”You find it difficult talking to people you do not know?”
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| Seeking Clarification | A method of making the client’s broad overall meaning of the message more understandable. It is used when paraphrasing is difficult or when the communication is rambling or garbled. To clarify the message, the nurse can restate the basic message or confess confusion and ask client to repeat or restate the message. Nurses can also clarify their own message with statements. | “I’m puzzled.”
“I’m not sure I understand that” “Would you please say that again?” “Would you tell me more?” “I meant this rather than that.” “I’m sorry that wasn’t very clear. Let me try o explain another way.”
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| Perception checking or seeking consensual validation | A method similar to clarifying that verifies the meaning of specific words rather than the overall meaning of a message. | Client: “My husband never gives me any presents.”
Nurse:”You mean he has never given you a present for your birthday or Christmas?” Client: “Well not ever. He does get me something for my birthday and Christmas, but he never thinks of giving me anything at any other time.”
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| Offering self | Suggesting one’s presence, interest, or wish to understand the client without making any demands or attaching conditions that the client must comply with to receive the nurse’s attention. | “I’ll stay with you until your daughter arrives.”
“We can sit here quietly for awhile; we don’t need to talk unless you would like to.” “I’ll help you to dress to go home, if you like.”
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| Giving information | Providing in a simple and direct manner, specific factual information the client may or may not request. When information is not known, the nurse states this and indicates who has it or when the nurse will obtain it. | “Your surgery is schedule for 1 am tomorrow.”
“You will feel a puling sensation when the tube is removed from your abdomen.” “I do not know the answer to that, but I will find out from Mrs. King, the nurse in charge.”
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| Acknowledging | Giving recognition, in a non judgmental way, of a change in behavior, an effort the client has made, or a contribution to a communication. Acknowledgment may be with or without understanding, verbal or non verbal. | “You trimmed your beard and mustache and washed your hair.”
“I noticed you keep squinting your eyes. Are you having difficulty seeing?” “You walk twice as far today with your walker.”
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| Clarifying time or sequence | Helping the client clarify an event, situation, or happening in relationship to time. | Client:”I vomited this morning.”
Nurse:”Was that after breakfast?” Client:”I feel that I have been asleep for weeks.” Nurse:”You had your operation Monday, and today is Tuesday”.
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| Presenting reality | Helping the client to differentiate the real from the unreal. | “That telephone ring came from the program on television.”
“I see shadows from the window coverings.” “Your magazine is here in the drawer .It has not been stolen.”
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| Focusing | Helping the client expand on and develop a topic of importance. It is important for the nurse to wait until the client finishes stating the main concerns before attempting to focus. The focus may be an idea or a feeling; however, the nurse often emphasizes a feeling to help the client recognize an emotion disguised behind words. | Client:”My wife says she will look after me, but I don’t think she can, what with the children to take care of, and they’re always after her about something— clothes, homework, what’s for dinner that night.”
Nurse: “Sounds like you are worried about how well she can manage.”
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| Reflecting | Directing ideas, feelings, questions, or content back to clients to enable them to explore their own ideas and feelings about a situation. | Client: “What can I do?”
Nurse: “What do you think would be helpful?” Client: “Do you think I should tell my husband?” Nurse:”You seem unsure about telling your husband.”
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| Summarizing and planning | Stating the main points of a discussion to clarify the relevant points discussed. This technique is useful at the end on an interview or to review a health teaching session. It often acts as an introduction to future care planning | “During the past hour we have talked about…”
“Tomorrow afternoon we may explore this further.” “In a few days I’ll review what you have learned about the actions and effects of your insulin.” “Tomorrow, I will look at your feeling journal.”
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Barriers of Communication
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TECHNIQUE |
DESCRIPTION |
EXAMPLES |
| Stereotyping
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Offering generalized and oversimplified beliefs about groups of people that are based on experiences too limited to be valid. These responses categorize clients and negate their uniqueness as individuals. | “Two-year-olds are brats.”
“Women are complainers.” “Men don’t cry.” “Most people don’t have any pain after this type of surgery.”
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| Agreeing and disagreeing | Akin to judgmental responses, agreeing and disagreeing imply that the client is either right or wrong and that the nurse is in a position to judge this. These responses deter clients from thinking through their position and may cause a client to become defensive. | Client: “I don’t think Dr. Broad is a very good doctor. He doesn’t seem interested in his patients.”
Nurse: “Dr. Broad is head of the department of surgery and is an excellent surgeon.”
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| Being defensive | Attempting to protect a person or health care services from negative comments. These responses prevent the client from expressing true concerns. The nurse is saying, “You have no right to complain.” Defensive responses protect the nurse from admitting weaknesses in the health care services, including personal weaknesses. | Client: “Those night nurses must sit around and talk all night. They didn’t answer my light for over an hour.”
Nurse: “I’ll have you know we literally run around on nights. You’re not the only client you know.”
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| Challenging | Giving a response that makes clients prove their statement or point of view. These responses indicate that the nurse is failing to consider the client’s feelings, making the client feel it necessary to defend a position. | Client: “I felt nauseated after that red pill.”
Nurse: “Surely you don’t think I gave you the wrong pill?” Client: “I feel as if I am dying.” Nurse: “How can you feel that way if your pulse is 60?” Client: “I believe my husband doesn’t love me.” Nurse: “You can’t say that; why, he visits you every day.”
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| Probing | Asking for information chiefly out of curiosity rather than with the intent to assist he client. These responses are considered prying and violate the client’s privacy. Asking “why” is often probing and places the client in a defensive position. | Client: “I was speeding along the street and didn’t see the stop sign.”
Nurse: “Why were you speeding?” Client: “I didn’t ask the doctor when he was here.”
Nurse: “Why didn’t you?”
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| Testing | Asking questions that make the client admit to something .These responses permit the client only limited answers and often meet the nurse’s need rather than the client’s. | “Who do you think you are?” (forces people to admit their status is only that of client)
“Do you think I am not busy?” (forces the client to admit that the nurse is really busy)
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| Rejecting | Refusing to discuss certain topics with the client. These responses often make clients feel that the nurse is rejecting not only their communication but also the client themselves. | “I don’t want to discuss that. Let’s talk about….”
“Let’s discuss other areas of interest to you rather than the two problems you keep mentioning.” “I can’t talk now. I’m on my way for coffee break.”
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| Changing topics and subjects | Directing the communication into areas of self-interest rather than considering the client’s concerns is often a self-protective response to a topic that causes anxiety. These responses imply that what the nurse considers important will be discussed and that clients should not discuss certain topics. | Client: “I’m separated from my wife. Do you think I should have sexual relations with other woman?”
Nurse: “I see that your 36 and that you like gardening. This sunshine is good for my roses. I have a beautiful rose garden.”
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| Unwarranted reassurance | Using clichés or comforting statements of advice as a means to reassure the client. These responses block the fears, feelings, and other thoughts of the client. | “You’ll feel better soon.”
“I’m sure everything will turn out all right.” “Don’t worry.”
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| Passing judgment | Giving opinions and approving or disapproving responses, moralizing, or implying one’s own values. These responses imply that the client must think as the nurse thinks, fostering client dependence. | “That’s good (bad).”
“You shouldn’t do that.” “That’s not good enough.” “What you did was wrong (right)”.
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| Giving common advice | Telling the client what to do. These responses deny the client’s right to be an equal partner. Note that giving expert advice rather than common advice is therapeutic. | Client: “Should I move from my home to a nursing home?”
Nurse: “If I were you, I’d go o nursing home, where you’ll get your meals cooked for you.” |