1 of 42

Course: Fundamentals of Nursing

Topic: Effective and Therapeutic Communication

The Nurses International Community

Contact info: info@nursesinternational.org

2 of 42

COPYRIGHT

NI Privacy Policy and Terms of Use.

Contact info: info@nursesinternational.org

3 of 42

Student Learning Outcomes

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

Contact info: info@nursesinternational.org

4 of 42

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)

Contact info: info@nursesinternational.org

5 of 42

Communication

Ernstmeyer & Christman, 2021

Contact info: info@nursesinternational.org

6 of 42

Types of Communication

Adapted from Bowen, Draper & Moore, 2024

Communication Type	Example
Verbal	Spoken word
Nonverbal	Hand gestures, tone
Written	Handwritten letter
Visual	Infographic
Electronic	Electronic health record

Contact info: info@nursesinternational.org

7 of 42

Non-Verbal Communication

Contact info: info@nursesinternational.org

8 of 42

What do You Think of These Expressions?

Contact info: info@nursesinternational.org

9 of 42

Respecting Personal Boundaries in Communication

Contact info: info@nursesinternational.org

10 of 42

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

Contact info: info@nursesinternational.org

11 of 42

Why is Effective Communication Important?

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

Contact info: info@nursesinternational.org

12 of 42

Components of Effective Communication:

Bowen, Draper & Moore, 2024

Factual: Nursing communication should be accurate and evidence-based.�
Practical: Communication should give realistic, achievable guidance.�
Clear and Concise: Messages should be simple and easy to understand.�
Persuasive: Nurses encourage healthy behaviours through effective communication

Contact info: info@nursesinternational.org

13 of 42

Overcoming Barriers:

Ernstmeyer & Christman, 2021a

Communication Barrier	Solution Examples
Medical Jargon	Use plain, simple language and avoid unnecessary medical terminology
Environment	Communicate in a calm, quiet environment. Ensure adequate lighting.
Lack of Attention	Communicate mindfully, and give listener full attention.
Language Barrier	Utilise language translator.
Visual & Hearing differences	Ensure client is wearing glasses and hearing aid if appropriate. Utilise sign language such as ASL or Makaton.

Contact info: info@nursesinternational.org

14 of 42

Overcoming Barriers:

Ernstmeyer & Christman, 2021a

Communication Barrier	Solution Examples
Physical barrier	Use face-to-face communication when available. If communicating via phone, ask questions to clarify understanding.
Physiological barrier	Address the physiological barrier e.g treat pain with analgesia. Aim to revisit communication when pain resolved.
Cultural differences	Develop cultural competency. If possible, ask someone who has greater understanding of client culture to explain and communicate.
Psychological barrier	Aim to create a trusting environment. Practise active listening. Address anxieties or stressors.

Contact info: info@nursesinternational.org

15 of 42

Stress Response:

Major Psychological Barrier to Effective Communication

Ernstmeyer & Christman, 2021a

Stress affects how the sender communicates and how the message is received.

Caused by common reaction to life events, for example: a nurse feeling stressed by workload; client feeling stressed with admission and diseases.

Signs of Stress Response: irritability, sweaty palms, a racing heart, difficulty concentrating, and impaired sleep.

Contact info: info@nursesinternational.org

16 of 42

Managing the Stress Response

Ernstmeyer & Christman, 2021a

Utilise relaxation techniques, such as breathing exercises or progressive relaxation

Get enough sleep

Make healthy diet choices

Make time for exercise

Share your feelings & practice reflection

Contact info: info@nursesinternational.org

. 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.

17 of 42

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”.

Contact info: info@nursesinternational.org

18 of 42

Components of Therapeutic 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?

Contact info: info@nursesinternational.org

19 of 42

Example of Therapeutic communication

Ernstmeyer & Christman, 2021b

Greet the client, introduce self and role.

Ask client how they would like to be addressed.

Ask client if they have any concerns or queries: Look out for non-verbal cues and reactions.

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.

Contact info: info@nursesinternational.org

20 of 42

Therapeutic Communication Techniques

Ernstmeyer & Christman, 2021b

Giving Recognition: Giving praise and encouragement.

Seeking Clarification: Clarify confusion or ambiguity. E.g. You mentioned…… can you explain that to me?

Validation: Acknowledge client’s thoughts, feelings and emotions.

Contact info: info@nursesinternational.org

21 of 42

Therapeutic Communication Techniques

Ernstmeyer & Christman, 2021b

Placing the Event in Time or Sequence: Asking questions about when certain events occurred in relation to other events can help clients (and nurses)

Making Observations: Careful observation of their comforts, discomforts, worries and fears.

Encouraging Descriptions of Perception : Encourage them to verbalize their perception: E.g for auditory or visual hallucination, ask “what do you hear? what does it look like?”

Contact info: info@nursesinternational.org

22 of 42

Therapeutic Communication Techniques

Ernstmeyer & Christman, 2021b

Encouraging Comparisons: Drawing upon previous experiences to deal with current problems. Encourage them to make comparisons to situations they have coped with before.

Offering Hope and Humor: Sharing hope that they can persevere through their current situation and lightening the mood with humor can help nurses establish rapport quickly.

Contact info: info@nursesinternational.org

23 of 42

Therapeutic Communication Techniques

Ernstmeyer & Christman, 2021b

Summarizing: Summarize what clients have said this demonstrates active listening. Summarize what client told and say “Did I hear you right?”
Reflecting: Ask client what they think they should should do about the problem, it encourages them to be accountable for their own action.
Focusing: Sometimes during a conversation, clients mention something particularly important nurses can more easily pick out the topics on which to focus.

Contact info: info@nursesinternational.org

24 of 42

Therapeutic Communication Techniques

Ernstmeyer & Christman, 2021b

Confronting: In some situations, it is important to disagree with the client and present them with reality, or challenge their assumptions. It can help clients break destructive routines or understand the state of their current situation.
Voicing Doubt: Voicing doubt can be a gentler way to call attention to incorrect or delusional ideas and perceptions of clients. By expressing doubt, nurses can force clients to examine their assumption.

Contact info: info@nursesinternational.org

25 of 42

What to Avoid? Non-therapeutic responses

Ernstmeyer & Christman, 2021b

Asking Personal Questions
Giving Personal Opinions
Changing the Subject
Stating Generalizations and Stereotypes
Providing False Reassurances
Pity
Asking “Why” Questions
Approving or Disapproving
Giving Defensive Responses
Providing Passive or Aggressive Responses
Arguing

Contact info: info@nursesinternational.org

26 of 42

Nursing Specific Strategies

Ernstmeyer & Christman, 2021b

In addition to all the above techniques, ask the following specific questions:

What concerns do you have about your plan of care?
What questions do you have about your medications?
Did I answer your question(s) clearly or is there additional information you would like?

Contact info: info@nursesinternational.org

27 of 42

What would the nurse do?

A teenager diagnosed with schizophrenia says “ I have a connection with my great grandfather, he talks to me most of the time and right now he has assigned me some task, therefore I demand discharge”.

What is the best initial response by the nurse?

Contact info: info@nursesinternational.org

The client has auditory hallucination/delusion. Therefore, the nurse should first assess the client’s risk for harm, especially because the client follows the order of his great grandfather. Other than that a nurse has to find out what kind of task he is intending to do. It is equally important to show kindness, compassion and patience and to later explain the hallucinations are not real.

Example:

Encourage client to take a minute to sit in a calm, quiet environment
Nurse can say “I understand you would like to be discharged. You said that your great granfasther has asked you to complete a task? Where is your great grandfather? What tasl has he assigned?”
Ensure Nurse is calm, and displaying positive body language. Avoid asking multiple questions at one time (client may feel suspicious), encourage to open up slowly over time.
Give reassurance “I am sorry you are feeling distressed at the moment, I can see it is a difficult time for you”

28 of 42

Modifying Communication to the Audience

Ernstmeyer & Christman, 2021b

Age, cognition, communication differences, educational and social class may require different communication styles.

For example:

Children: Speak calmly and gently, offer dolls, drawings, play to build trust.

Adolescents: Set boundaries, give freedom to make choices .

Older adults: Be aware of potential vision and hearing impairments and act accordingly, help with the visual or hearing aids.

Language differences: Arrange trained medical interpreters when important information is communicated.

Contact info: info@nursesinternational.org

29 of 42

Communicating with Impaired Hearing:

Ernstmeyer & Christman, 2021b

Gain the client’s attention before speaking (e.g., through touch)

Minimize background noise.

Position yourself 2-3 feet away from the client.

Ensure enough lightning to facilitate lip-reading.

Use gestures, when necessary.

Allowing the client adequate time to process communication and respond.

Contact info: info@nursesinternational.org

30 of 42

Communicating with Impaired Hearing:

Ernstmeyer & Christman, 2021b

Do not shout at the client, use simple language.
Ask the client about the mode of communication e.g., speaking toward better ear, assist with hearing aids or other assistive devices.
Face the client directly, establish eye contact, and avoid turning away.
Note and document the client’s preferred method of communication e.g., verbal, written, lip-reading

Contact info: info@nursesinternational.org

31 of 42

What would the nurse do?

Nurse Anna is supervising a Student Nurse who is caring for an older adult who has dementia and wears a hearing aid. Nurse Anna observes Student Nurse asking the client to brush his teeth. Which of the following actions of the Student Nurse indicates she needs further learning about communicating with hearing-impaired clients?

Student nurse is handing over a printed written timechart of ALDS to the client.
The student nurse stands near to the client and instructs in a loud voice so that he can hear the instructions.
Student Nurse stands in a way so that the client can see her face, and uses hand gestures.

Contact info: info@nursesinternational.org

32 of 42

Communicating with Impaired Vision:

Ernstmeyer & Christman, 2021b

Identify yourself when entering the client’s space.

Provide adequate room lighting.

Minimize glare (i.e., offer sunglasses or draw window covering)

Provide educational materials in large print.

Contact info: info@nursesinternational.org

33 of 42

Communicating with Impaired Vision:

Ernstmeyer & Christman, 2021b

Apply labels to frequently used items (i.e., mark medication bottles using high-contrasting colors).
Read pertinent information to the client.
Provide magnifying devices.
Provide referral for supportive services (e.g., social, occupational, and psychological).

Contact info: info@nursesinternational.org

34 of 42

Communicating with Impaired Speech

Ernstmeyer & Christman, 2021b

Modify the environment to minimize excess noise and decrease emotional distress.
Phrase questions that can be answered with “yes” or “No”.
Monitor the client for frustration, anger, depression, or other responses to impaired speech.

Contact info: info@nursesinternational.org

35 of 42

Communicating with Impaired Speech

Ernstmeyer & Christman, 2021b

Provide alternative methods of communication e.g., writing tablet, flash cards, eye blinking, communication board, pictures and letters, hand signals or gestures, and tablets.
Adjust your communication style; speak slow, listen, avoid shouting, or solicit family’s assistance in understanding the client’s speech.

Contact info: info@nursesinternational.org

36 of 42

Communicating with Impaired Speech

Ernstmeyer & Christman, 2021b

Ensure the call light is within reach.
Repeat what the client said to ensure accuracy.
Instruct the client to speak slowly.
Collaborate with the family and a speech therapist to develop a plan for effective communication.

Contact info: info@nursesinternational.org

37 of 42

Communication within Healthcare Team Members

Ernstmeyer & Christman, 2021b

Professional communication is an important component of every nurse’s job.
Nurse should communicate and report with other health care team everyday.
It has been estimated that 27% of medical malpractice is the result of the communication failures.
To know more about the techniques of effective communication within healthcare members please click here.

Contact info: info@nursesinternational.org

38 of 42

What would the nurse do?

A client who has had a craniotomy tells the nurse, “ I am scared of my own face, I do not want to live with this deformity” Which of the following responses by the nurse would be MOST appropriate?

“Everything is going to be fine. Doctors will take very good care of you”

“I know what you mean. One of my relative also had craniotomy and he hated it.”

“I’ll call your doctor so you can discuss it with him.”

“It’s normal to feel that way. Let's discuss future options which may help”

Contact info: info@nursesinternational.org

39 of 42

Cultural Considerations

Cultural considerations may impact the appropriateness of personal space when providing client care.
In Chinese culture, it is considered impolite to talk disagree or say No and they may not talk openly about their problems as they assume their problem can be easily understood by the health professionals.
In Philippines, doctors and nurses are generally highly respected for their knowledge, education and expertise and few Filipinos will question them.
Indian clients may say yes in order to please the health professional, even if they do not understand the concept of treatment. They often expect that a physician will only gather a complete history and perform a thorough examination.

Queensland Health, n.d

Contact info: info@nursesinternational.org

40 of 42

References:

Bower, C., Draper, L., and Moore, H. (2024) OpenStax: Fundamentals of Nursing. Houston, Texas. https://openstax.org/books/fundamentals-nursing/pages/1-introduction

Cambridge Dictionary. (n.d). English: Communication definition. Retrieved on August 19, 2021 from https://dictionary.cambridge.org/dictionary/english/communication

Ernstmeyer, K., & Christman, E. (Eds.). (2021a,b). Open RN: Fundamentals of Nursing. By Wisconsin Technical College System licensed under CC BY 4.0. https://wtcs.pressbooks.pub/nursingfundamentals/chapter/2-3-communicating-with-clients/

Contact info: info@nursesinternational.org

41 of 42

References:

Queensland Health (n.d). Multicultural Clinical Support Resource: Cultural Dimension of Pregnancy, Birth and postnatal care. Retrived on 23rd of August 2021 from https://www.health.qld.gov.au/__data/assets/pdf_file/0035/158669/14mcsr-pregnancy.pdf

Sharma N, Gupta V. Therapeutic Communication. [Updated 2021 May 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567775/

Tiwary, A., Rimal, A., Paudyal, B., Sigdel, K. R., & Basnyat, B. (2019). Poor communication by health care professionals may lead to life-threatening complications: examples from two case reports. Wellcome open research, 4, 7. https://doi.org/10.12688/wellcomeopenres.15042.1

Contact info: info@nursesinternational.org

42 of 42

Please go to

My Learning Experience

to provide feedback on your experience.

Thank you, and come back soon!

Contact info: info@nursesinternational.org