ch21 communication
TRANSCRIPT
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JUDITH M. WILKINSON LESLIE S. TREASKAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OFFUNDAMENTALS OFNURSINGNURSING
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Chapter 21: Chapter 21: Communication & Therapeutic Communication & Therapeutic
RelationshipsRelationships
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What is Communication?
• 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
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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
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Components of Communication: Content • Subject matter• Words• Gestures• Substance of the message • Open to interpretation
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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, e-mail– Receiver: interprets the message– Feedback
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Communication Components
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ClickerCheck
During the communication process, “decoding” is
a.The selection of words by the senderb.The interpretation of the message by the receiverc.The method by which the message is givend.The way in which feedback is interpreted
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ClickerCheck (cont’d)
Correct answer: C
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Verbal Communication
Involves speaking or writing words to send a message
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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
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ClickerCheck
The nurse is teaching the client about his upcoming procedure, and the client is very stressed. It would be most important for the nurse to
a.Use humor first to decrease the client’s stress level.b.Determine if the teaching should take place at a different time.c.Introduce himself as the RN to give credibility to his message.d.Speak to the client when family members are there so they can teach the client.
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ClickerCheck (cont’d)
Correct answer: B
Clients who are stressed may be unable to listen fully and will not receive/understand the intended message.
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Nonverbal Communication
The unconscious use of body language when sending a message
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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
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Factors That Affect Communication in General• Environment• Life span variations• Gender• Personal space
• Territoriality• Sociocultural
factors• Roles and
relationships
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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
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Therapeutic Communication
• Client centered• Goal directed• Strengthens therapeutic relationship
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Phases of the Therapeutic RelationshipStage 1: Preinteraction phase• Gathering information prior to meeting client
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Phases of the Therapeutic Relationship (cont’d)
Stage 2: Orientation phase• Meeting the client; introductions; establishing
rapport and trust
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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
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Phases of the Therapeutic Relationship (cont’d)
Stage 4: Termination phase• Conclusion of the relationship
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ClickerCheck
Use of the statements “Tell me more about…” or “I see” encourage clients to continue talking and expressing themselves. This is called:
a.Summarizingb.Open-ended questionsc.Focusingd.Encouraging elaboration
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ClickerCheck (cont’d)
Correct answer: D
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Key Characteristics of Therapeutic Communication• Empathy• Respect• Genuineness• Concreteness• Confrontation
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Client Factors Affecting Effective Therapeutic Communication• Language barrier• Impaired cognitive skills• Sensory-perceptual alterations • Physiological barriers
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Enhancing Therapeutic Communication• Listen actively.• Establish trust.• Be assertive.• Restate, clarify, and validate message.
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Enhancing Therapeutic Communication (cont’d)
• Interpret body language.• Share your observations to clarify.• Use open-ended questions.• Use silence.• Summarize the conversation.
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Five Steps of Assertive Communication1. 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.
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Barriers to Therapeutic Communication• Too many questions• Closed-ended questions• Asking “Why?”• Changing the subject abruptly• Failing to listen
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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
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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.