I.

Components of verbal communication pace and intonation simplicity clarity and brevity timing and relevance adaptability credibility humor

2. Nonverbal Communication: body language. includes gestures, body movements, use of touch , and physical appearance, including adornment. Components Personal appearance Posture and gait Facial expressions Gestures

How can one improve? Relax Use facial, hand, and body gestures judiciously Get feedback on nonverbal communication Practice

3. Factors that affect the communication process age/development gender culture/education/economic level values and perceptions personal space aka proxemics (intimate distance, personal distance, social distance, public distance) territoriality roles and relationships

environment congruence interpersonal attitudes elderspeak group speak

4. Communicating at the appropriate developmental level Infants communicate nonverbally, often in response to body feelings rather than in a conscious effort to be expressive perceptions related to sensory stimuli, gently voice is soothing

Toddlers and preschoolers need time to complete verbalizing their thoughts without interruption adults should provide simple responses, and give simple one-step directions because toddlers have short attention span drawing pictures is another way to communicate

School-age children adults to talk to a child at his or her eye level to help decrease intimidation when communicating with a child's parents about a child's health status, the nurse should include the child in conversation

Adolescents it takes time to build rapport with adolescents adults should use active listening skills use nonjudgmental attitude

5. Appropriate personal space = 1.5-4 ft 6. Elderspeak: speech style similar to babytalk, which gives the message of dependence and incompetence to older adults. 7. Barriers to communication stereotyping agreeing/disagreeing being defensive

challenging probing testing rejecting changing topics and subjects unwarranted reassurance passing judgment giving common advice

8. Facilitating communication with older adults use communication aids keep environmental distractions to a minimum speak in short, simple sentences, one subject at a time repeat when necessary always face the person include family and friends in conversation use reminiscing believe the nonverbal over verbal when there is an incongruence find out what has been important and has meaning to the person and try to maintain these things as much as possible. simple things such as bedtime rituals become more important, especially in a hospital or extended care setting

9. Nursing process in communication p. 2158-2163

Assessment the clients communication, the nurse determines communication impairments or barriers and communication style (language deficits, sensory deficits, cognitive impairments, structural deficits, and paralysis) Diagnosis ex: anxiety r/t impaired verbal communication, powerlessness r/t impaired verbal communication, situational low self-esteem r/t impaired verbal communication, social isolation r/t impaired verbal communication, impaired social interaction r/t impaired verbal communication Plan establish an effective means for the client to communicate, maximize the client's ability to perceive messages accurately, obtain resources as needed to optimize the client's ability to communicate

Implementation nursing interventions to facilitate communication with clients who have problems with speech or language include manipulating the environment, providing support, employing measures to enhance communication, and educating the client and support person Evaluation establish whether client outcomes have been met in relation to communication, the nurse must listen actively and observe nonverbal cues.

10. Therapeutic communication- an interactive process between nurse and client that helps the client overcome temporary stress, to get along with other people, to adjust to the unalterable, and to overcome psychological blocks which stand in the way of self-realization. 11. Therapeutic communication techniques

Empathizing-feeling with one another. embracing attitude of the person speaking. Attentive listening-mindful listening. listening actively. conveys attitude of caring & interest. focus on clients needs. ex: nodding head, repeating words the client says, or saying "I see what you mean" BLOCKS: rehearsing, being concerned with oneself, assuming, judging, identifying, getting off track, filtering

Physical attending-being present to another or being with another. ex: facing the other person squarely, adopt an open posture, lean toward the person, maintain good eye contact, try to be relatively relaxed Using silence-encourages client to communicate, allows client time to collect thoughts Reflecting (content and feelings)-repeating the client's verbal or nonverbal message for the client's benefit. ex: "sounds like you are really angry at your brother" "you're feeling anxious about being discharged from the hospital" Imparting information-helping the client by supplying additional data. goal is to provide effective education that empowers clients & their families. client is more likely to achieve positive mental health outcomes and less likely to need admission or readmission to an acute care facility. Avoiding self-disclosure-use honesty, benign curiosity, refocusing, interpretation, seek clarification, respond with feedback & limit setting Clarifying-attempt to understand the basic nature of a client's statement ex: "I'm confused about exactly what is upsetting to you. Could you go over that again, please?" Paraphrasing-the nurse assimilates or restates in his or her own words what the client has said. ex: "In other words, you're fed up with being treated like a child." Checking perceptions-sharing how one person perceives and hears another ex: "Let me know if this is how you see it too", "I want to understand.." Questioning-very direct way of speaking with clients. open ended questions elicit more information; focuses on topic but allow freedom of response ex: "what" "when" "how" "how were you feeling when your mother said that to you?"

Structuring-an attempt to create order or establish guidelines. it helps the client become aware of problems and the order in which the client might deal with them. ex: "No, I won't be giving you advice, but we can discuss some possible solutions together." used when a client introduces a number of concerns Pinpointing-calls attention to certain kinds of statements and relationships. "You say you're sad, but you're smiling" Linking-the nurse responds to the client in a way that ties together two events, experiences feelings, or people. ex: "So, the arguments didn't really begin until after you got your promotion." Giving feedback-occurs when the nurse shares his or her reaction to what the client has said. effective communication should be immediate, honest, supportive ex: "sometimes when you turn your head away from me, i think you're angry." Confronting-a deliberate invitation to examine some aspect of personal behavior that indicates a discrepancy between what the person says and what the person does. Summarizing-highlighting of the main ideas expressed in an interaction ex: "you had three main concerns today" Processing-processing is most useful when therapeutic intimacy has been achieved. process comments direct attention to the interpersonal dynamic of the nurse-client experience-in the content, feelings, and behavior being expressed ex: "It seems that important things that need to be taken care of come up in the last 5 minutes we have together"

12. Blocks to attentive listening rehearsing being concerned with oneself assuming judging identifying getting off track filtering

13. Physical Attending being present to another or being with another face the other person squarely adopt an open posture lean toward the person maintain good eye contact try to be relatively relaxed

14. Constructively confront deliberate invitation to examine some aspect of personal behavior that indicates a discrepancy between what the person says and what the person does. constructive confrontation often lead to productive change. use of personal statements with the words I, me, and me use of relationship statements expressing what you thing or feel about the client in the here and now use of behavior descriptions (statements describing the visible behavior of the client

15. Characteristics of therapeutic relationship p. 2173 A therapeutic relationship: is an intellectual and emotional bond between the nurse and the client and is focused on the client Respects the client as an individual, including the following: a. Maximizing the clients abilities to participate in decision making and treatments b. Considering the clients ethnic background and cultural practices c. Considering family relationships and values Respects client confidentiality Focuses on the clients well-being Is based on mutual trust, respect, and acceptance

16. Phases of therapeutic relationship p.2173

1. Preinteraction phase: planning phase in which the nurse may have acquired information on
the client before the first face-to-face meeting such as name, address, age, medical history and/or social history. If the nurse recognized feelings and identifies specific information to be discussed, positive outcomes can evolve.

2. Introductory phase: (orientation phase or pretherapeutic phase) Important because it sets

the tone for the rest of the relationship. The client and nurse closely observe each other and form judgements about the others behavior. There are 3 stages here: Opening the relationship Clarifying the problem Structuring and formulating the contract Client may exhibit resistive behaviors (inhibit involvement, cooperation, or change) that may arise from the clients difficulty in acknowledging the need for help, fear of exposing and facing feelings, anxiety about the discomfort involved in changing problem-causing behavior patterns, and fear/anxiety of the nurses approach, which may be inappropriate in the clients opinion. Overcome the clients resistive behaviors by: conveying a caring attitude, genuine interest in the client, and competence. This forms trust and trust enables the client to express thoughts and feelings openly. By the end of the introductory phase, clients should begin to: Develop trust in the nurse

View the nurse as competent and capable of helping View the nurse as honest, open, and concerned about their welfare Believe the nurse will try to understand and respect their cultural values and beliefs Believe the nurse will respect client confidentiality Feel comfortable talking with the nurse about feelings and other sensitive issues Understand the purpose of the relationship and the roles Feel that they are active participants in developing a mutually agreeable plan of care 3. Working phase: 2 major phases exploring and understanding thoughts and feelings, and facilitating and taking action gain insight into personal behaviors and plan programs with clients capabilities while considering short- and long-term goals. Reinforce successes and help client recognize failures realistically The nurse requires the following skills for this phase of the therapeutic relationship: Empathetic listening and responding Respect Genuineness Concreteness Reflecting, paraphrasing, clarifying, and confronting

4. Termination phase: Nurse and client accept feelings of loss. The client accepts the end of the relationship without feelings of anxiety or dependence

17. How can the nurse better create a therapeutic environment in each phase of the therapeutic relationship? p. 2174 Preinteraction phase: Gather data, recognize limitations, seek assistance as required Introductory phase: Opening the relationship: Have a relaxed and attending attitude Clarifying the problem: Attentive listening, paraphrasing, clarifying, and other effective communication techniques. Do not ask too many question but rather focus on priorities Structuring and formulating the contract: Same communiation skills as above; overcome resistive behaviors if they occur. Working phase: Use listening and attending skills, empathy, respect, reflecting, clarifying, paraphrasing, and confrontation. Employ decision-making and goal-setting skills; reinforcement for the client; risk taking Termination phase: Use summarizing skills

18. What is genuineness and what are components? p. 2175 Genuineness is exuding a genuine care for the client by maintaining professional behaviors that promote the therapeutic helping relationship. The components of genuineness: The genuine The genuine The genuine The genuine say another helper does not take refuge in or overemphasize the role of counselor person is spontaneous person is nondefensive person displays few discrepancies is consistent: does not think/feel one way but

The genuine person is capable of deep self-disclosure when appropriate

19. What are some things that YOU need to do to improve your communication? p. 2175 Focus on above traits and techniques 20. How does one develop therapeutic relationship with families? p. 2176 Same as above; with nurse-child-family relationship trust plays a critical role: follow through with promises, respect confidentiality, and be truthful with the child and family even if the truth is not what they want to hear 21. How can the nurse establish rapport with a child? p. 2176 Make efforts to help the child feel like they are important in the interaction: Sit at childs level Note what the child is playing with or reading Agree with the child when appropriate and share your feelings Compliment a physical feature or activity performed by the child Use a calm tone of voice with developmentally appropriate language

Pace the discussion or procedure in a nonhurried manor Preschoolers have a limited concept of time; explain concepts in terms they understand (your mom will be back after lunch) Include the adolescent in discussion about his/her care Listen more than you talk, and avoid distractions Be truthful with the child

22. How does the concept of therapeutic communication relate to the concept of client advocate? Advocacy protects and defends the client from harm; represents the clients needs and wishes therapeutic communication helps develop the trusting relationship required to define a clients needs and wishes and plan/set goals to meet them