Chapter 8: Learning to

Communicate Professionally
1 NURSE-PATIENT COMMUNICATION

Focused on the patients needs and problems

Builds trusts, develops a therapeutic relationship, provides support, comfort,
growth, change, and patient education

2 CATEGORIES OF COMMUNICATION

Written reports
Telephone crisis hotlines
Email: dont send unless it is therapeutic
Must comply with HIPAA to protect health info
Speech and behavior: body language and tone must match
o Verbal and nonverbal must match
o Behaviors that show one message and verbal speech that shows
another will be confusing

2.1 DYNAMICS

OF THERAPEUTIC COMMUNICATION
Communication is influenced by:
o Individuals personal experiences, gender, culture, values, and beliefs
o Purpose of the interaction
o Physical and emotional context of the interaction

2.2 THEMES

Content themes: examines underlying messages about a patients

perceptions of self and problems
Mood themes: related to affect and feelings conveyed while discussing the
issues and concerns
o Incongruent mood theme: when the affect does not match the content
Interaction themes: examines relationships to others
Themes reflect in patients thoughts, engender feelings, and produce
behaviors

2.3 ENVIRONMENTAL CONSIDERATIONS

Privacy
Furniture
Temperature

Noise level
Boundaries
Proxemics: the way people perceive and use environmental, social, and
personal space during interactions

2.4 PHYSICAL CONSIDERATIONS

Sensory limitations (hearing loss)

Development disabilities, problems comprehending and remembering
Speech impediments
Pain interfering with ability to think clearly and concentrate

2.5 KINESIC CONSIDERATIONS

Culturally based body language

Facial expression
Eye movement
Gestures
Eye contact
Mannerisms
Might be incongruent with words

3 THERAPEUTIC COMMUNICATION
3.1 SOCIAL

Equal disclosure
Spontaneous
Meets personal needs of both
Confidentiality might or might not be observed
Listener might not be objective

3.2 THERAPEUTIC

Patient-centered and planned

Directed by professional
Meets patients needs
Guides the patient to explore personal issues and painful feelings
Listener is objective
Information may be shared with the health team

3.3 THERAPEUTIC USE

OF

Verbal and nonverbal

Silence and therapeutic
listening

SELF

Being actively alert

Using eye contact
Concentrating

Being patient
Displaying openness
Offering empathy and support
Asking question
Organizing, synthesizing, and
interpreting info

Validating and clarifying info

Responding verbally and
nonverbally
Summarizing
Giving feedback

Sensitivity: recognizing important cues and prioritizing them

Objectivity: remaining open to many aspects of the patient and their
problems
Patients must feel respected, values, and accepted
Use touch with caution; might violate personal space or be misinterpreted

3.4 TECHNIQUES

Offering self: showing interest and concern

Active listening: paying close attention to verbal and nonverbal
communication, patterns of thinking, feelings, and behavior
Silence: allowing the patient to think and say more
Questioning: using open-ended questions
Empathy: recognizing patients feelings
General leads
Restating
Verbalizing the implied
Clarification
Making observations
Presenting reality: offering a view of what is real and what isnt without
arguing
Encouraging description of perceptions
Voicing doubt

4 INTERFERENCES WITH COMMUNICATION

Nurses fears, feelings, lack of knowledge, insecurity, or ineffective responses

4.1 INEFFECTIVE RESPONSES

AND BEHAVIORS
Not fully listening; not paying attention
Looking too busy; ignoring the patient
Seeming uncomfortable with silence; fidgeting
Being opinionated; arguing with the patient
Avoiding sensitive topics; changing topics
Being superficial or using clichs
Having closed posture; avoiding eye contact
Making false promises or reassurances
Giving advice or talking too much
Laughing or smiling inappropriately
Showing disapproval or being judgmental
Minimizing problems
Being defensive; avoiding patient
Making sarcastic remarks
Lying; being insincere