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Course: Fundamentals of Nursing

Topic: Effective and Therapeutic Communication

The Nurses International Community

Contact info: info@nursesinternational.org

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Define the differences between communication, effective communication, and therapeutic communication
Explain the importance of effective and therapeutic communication in professional settings
Describe effective communication techniques
Outline the technique of having clear, concise, and understandable communication techniques
List the various tactics of communicating with the different age groups, and the verbally, visually, and auditory impaired populations

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Communication

Communication is the form of exchanging and expressing information, feelings, ideas, views between person-person that can result in understanding(Cambridge Dictionary,n.d.)

Effective Communication: Is about more than just exchanging information; It’s about understanding the emotion and intentions behind the information in a clear way (Helpguide, 2020)

Therapeutic Communication: An invaluable approach to interactions with clients across multiple disciplines that focuses on client’s safety, comfort, trusts, emotional, social, physical and mental wellbeing (Sharma & Gupta, 2021)

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Importance of effective Communication

Poor communication can result in various negative outcomes, such as decreased adherence to treatment, clients dissatisfaction and inefficient use of resources ¹
Common types of professional interactions include reports to health care team members, handoff reports, and transfer reports²

Tiwary et al, 2019
Ernstmeyer & Christman, 2021

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Communication

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

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Types of Communication

Verbal communication:

An exchange of information using words understood by the receiver in a clear, concise a way that conveys professional caring and respect.
E.g. Use of medical jargon or slang interferes effective communication.

Non-Verbal Communication:

Includes body language, facial expressions, tone of voice, pace.
80% of communication is nonverbal communication.
Identifying the non verbal cues is a key to provide professional caring.
SOLER

Ernstmeyer & Christman, 2021a

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What do You Think of These Expressions?

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Styles of Communication

A passive communicator: Prioritizes others, tends to be apologetic or sound tentative when speaking and often does not speak up if they feel as if they have been wronged.

Aggressive communicators: Do not care for others feeling. Advocate for their own rights even though it might violate the rights of others.

Assertive communicators: Uses best strategies. Respect others feelings, describes the facts, positive, negative, feelings without hurting others in a direct, open and honest way.

Ernstmeyer & Christman, 2021a

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How to Communicate Assertively?

Ernstmeyer & Christman, 2021a

Instead of Saying:	Say this:
“You haven't chart the client’s intake, you are so irresponsible.”	“I understand the shift was little crazy but charting intake output chart is very essential”
“Why haven’t you positioned the client?”	“Honestly, it is so hard to start the first part of the shift with positioning, help me understand what makes it difficult for you to do”.
“You always leave the nursing station messy.” or “You never keep the desk organized”.	“Let's Keep our desk organized and clean, please share your ideas how this can be done”.

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While being aware of verbal and nonverbal messages and communicating assertively, it is also important to be aware of others’ personal space

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Important !!!!

Nurses usually communicate within the social zone to maintain professional boundaries.
However, when assessing clients and performing procedures, nurses often move into a client’s personal zone.
Therefore, nurses must be aware of clients’ feelings of psychological discomfort that can occur when invading this zone.
Additionally, cultural considerations may impact the appropriateness of personal space when providing client care.

Ernstmeyer & Christman, 2021a

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Common Barriers to Effective Communication

Jargons: Using complex language, medical terminology.
lack of attention: Busy schedule workload leads of lack of attention.
Distractions and Noises: Noise for TVs, people talking can motivate form communication.
Light: Too dark or too light can interfere communication.
Hearing or speech problems: Deafness and blindness.

Ernstmeyer & Christman, 2021a

Contact info: info@nursesinternational.org

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Common Barriers to Effective Communication

Language differences

Cultural differences

Physiological barriers

Differences in perception and views

Physical barriers for nonverbal communication

Ernstmeyer & Christman, 2021a

Contact info: info@nursesinternational.org

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Overcoming Barriers:

Jargon: Use simple plain language, avoid medical terminology, complicated language, unfamiliar words.
Lack of attention: Pause, take a deep breath, and mindfully focus on the client in front of you to give them your full attention. Clients should feel as if they are the center of your attention when you are with them, no matter how many other things you have going on.
Noise and other distractions: Create a calm, quiet environment when communicating with clients by closing doors to the hallway, reducing the volume of the TV, or moving to a quieter area, if possible.

Ernstmeyer & Christman, 2021a

Contact info: info@nursesinternational.org

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Overcoming Barriers:

Light: A room that is too dark or too light can create communication barriers. Ensure the lighting as per client’s preference.
Hearing and speech problems: Enhance the communication by the use of sign language, interpreter, tactile sign language, If your client has hearing or speech problems.
Language differences: If client speaks and understands his/her own language then a medical interpreter should be provided. If possible, provide written handouts in the client’s preferred language when possible.
Differences in cultural beliefs: Respect the culture, listen, do not judge, have intercultural awareness and use culturally appropriate body language, language.

Ernstmeyer & Christman, 2021a

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Overcoming Barriers:

Physiological barriers: Address and treat the cause of physiological barrier. eg. pain.
Physical barriers for nonverbal communication: When possible, it is best to deliver important information to others using face-to-face communication so that nonverbal communication is included with the message.
Differences in perception and viewpoints: Nurses should provide health care information in a nonjudgmental manner, even if the client’s perspectives, viewpoints, and beliefs are different from their own.

Ernstmeyer & Christman, 2021a

Contact info: info@nursesinternational.org

Physiological barriers: Address and treat the cause of physiological barrier. eg. pain. If a client is in pain, they are less likely to hear and remember what was said, so pain relief should be provided as needed before providing client education.

However, it is also important to remember that sedatives and certain types of pain medications often impair the client’s ability to receive and perceive messages so health care documents cannot be signed by a clientafter receiving these types of medications.

Physical barriers for nonverbal communication: When possible, it is best to deliver important information to others using face-to-face communication so that nonverbal communication is included with the message.

Providing information via e-mail or text is often less effective than face-to-face communication. The inability to view the nonverbal communication associated with a message such as tone of voice, facial expressions, and general body language often causes misinterpretation of the message by the receiver.

Differences in perception and viewpoints: Everyone has their own beliefs and perspectives and wants to feel “heard.” When clients feel their beliefs or perspectives are not valued, they often become disengaged from the conversation or the plan of care.

Nurses should provide health care information in a nonjudgmental manner, even if the client’s perspectives, viewpoints, and beliefs are different from their own.

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Stress Response:

Major Psychological Barrier to effective Communication

Ernstmeyer & Christman, 2021a

Stress affect the message sent by the sender or how it is received by the receiver.
Caused by common reaction to life events like: A nurse feeling stressed by workload; client feeling stressed with admission and diseases.
Symptoms of the stress response include irritability, sweaty palms, a racing heart, difficulty concentrating, and impaired sleep.

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Managing Stress response

Ernstmeyer & Christman, 2021a

Use relaxation breathing: Practice deep breathing exercise
Get enough sleep
Make healthy diet choices
Make time for exercise
Share your feelings
Use progressive relaxation

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. Strategies to manage the stress response are as follows:

Use relaxation breathing. Become aware of your breathing. Take a deep breath in your nose and blow it out through your mouth. Repeat this process at least three times in succession and then as often as needed throughout the day.
Make healthy diet choices. Avoid caffeine, nicotine, and junk food because these items can increase feelings of anxiety or being on edge.
Make time for exercise. Exercise stimulates the release of natural endorphins that reduce the body’s stress response and also helps to improve sleep.
Get enough sleep. Set aside at least 30 minutes before going to bed to wind down from the busyness of the day. Avoid using electronic devices like cell phones before bedtime because the backlight can affect sleep.
Use progressive relaxation. There are several types of relaxation techniques that focus on reducing muscle tension and using mental imagery to induce calmness. Progressive relaxation generally includes the following steps:

Start by lying down somewhere comfortable and firm, like a rug or mat on the floor. Get yourself comfortable.
Relax and try to let your mind go blank. Breathe slowly, deeply, and comfortably, while gradually and consciously relaxing all your muscles, one by one.
Work around the body one main muscle area at a time, breathing deeply, calmly, and evenly. For each muscle group, clench the muscles tightly and hold for a few seconds, and then relax them completely. Repeat the process, noticing how it feels. Do this for each of your feet, calves, thighs, buttocks, stomach, arms, hands, shoulders, and face.

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Communication with the Clients:

Ernstmeyer & Christman, 2021b

Therapeutic communication:

A type of professional communication used by nurses with clients.
Explained as “The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to client understanding and participation”.

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Example of Therapeutic communication

Starts with greeting the client, explains roles in a very good tone.
Ask client if they have any problems, identify the non verbal cues and reactions.
Put all the effort to solve the client’s problem or answer their question (if any).
Treat client with respect and present in a professional way.
Respect personal boundaries and space.
Do not judge the client, their beliefs and cultural system.
Create a space where clients feel comfortable sharing their healthcare needs with him/her.

Ernstmeyer & Christman, 2021b

Contact info: info@nursesinternational.org

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Components of Effective Communication:

(rnstmeyer & Christman, 2021b

Active listening and attending behaviour:

Refers to the listener's verbal and non verbal behaviour which shows the listener is paying attention to and is interested in the speaker's message.

The listener also actively verifies understanding with the speaker.

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Types of listening

Competitive listening Focused on sharing our own point of view instead of listening to someone else.

Passive listening Not interested in listening to the other person and we assume we understand what the person is communicating correctly without verifying.

Active listening occurs when we communicate verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker.

Ernstmeyer & Christman, 2021b

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Components of Effective Communication:

Ernstmeyer & Christman, 2021b

Touch
Therapeutic Techniques

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Components of Effective Communication:

Ernstmeyer & Christman, 2021b

Touch:

Touch is a powerful way to professionally communicate caring and empathy.
Has to be done respectfully while being aware of the client’s cultural beliefs.
Nurses commonly use professional touch when assessing, expressing concern, or comforting clients.
For example, simply holding a client’s hand during a painful procedure can be very effective in providing comfort.

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Components of Effective Communication:

Ernstmeyer & Christman, 2021b

Therapeutic Communication techniques

Active Listening: Nodding, saying “I see/what happened next/then/that is so interesting”.
Using Silence: Sometimes it better not to speak at all; it may give clients the time and space.
Accepting: Acknowledging client’s message and affirm that they’ve been heard. e.g. make eye contact and say “Yes, I understand what you are trying to say”.
Giving Broad Openings/Open-Ended Questions: E.g How are you feeling this morning?, What makes you feel so worried?

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