Communication & Therapeutic Relationships

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Communication

Basic human function

The way we can get information and show patients that we care

Sending messages back and forth between two or more people

Consists of verbal and nonverbal messages

You are the first person patients usually see and everyone is looking at you - make an approachable prescence

Helps build working relationships

Helps make patients feel comfortable

Helps meet physical, psychosocial, emotional and spiritual needs

Levels of Communication

Intrapersonal

Conscious internal dialogue = Self-talk

Can be positive or negative

Always try to be positive, be confident in your abilities and learn

Interpersonal

Between two or more people

Face to face convo

Helps gather information, teach about health issues, explain care and provide comfort

Group

With many people at the same time exchanging ideas

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Components of Communication: Content

Subject matter

What we're talking about

Words

Positive and about other people

Gestures

Can be positive or negative

Substance of the message

What is the energy that the sender is giving to the receiver

Open to interpretation

Depends on the population you are coming from

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Components of Communication: Process

The active part of communication

Involves 5 elements:

Message = words, gesture, letter

Nurses = caring messages + non-judgemental

Clear, concise, organized, timely and expressed in a way they can understand + appropriate

Sender = initiates content delivery

Source/ encoder = uses verbal and nonverbal methods to transmit the message

Patient education

Channel = medium that sends the message

Face-to-face, written, audiovisual, telephone, and e-mail

Receiver = interprets the message

Observer, lister and interpreter

Uses sense to decode

Feedback = both sender and receiver have a mutual understanding (return demonstration)

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Communication Components

Shows inter and intrapersonal communication

Have to decode the message and see what they mean

Environment influences communication

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Verbal Communication

Involves speaking or writing words to send a message

Factors Affecting Verbal Communication

Vocabulary - be basic/ the simpler the better

Denotative vs. Connotative - the way you send the message

Pacing of Conversation - be much slower than talking

Intonation - tone, pitch, cadence, volume should be appropriate

Clarity and brevity - make sure you have enough time to talk to your patient

Relevance of information

Credibility of sender - trustworthy and professional (always uphold this status)

Humor - do not take everything seriously

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Nonverbal Communication

The unconscious use of body language when sounding a message

Factors Affecting Nonverbal Communication

Facial Expression = communicates feelings behind a message

Refrain from expressing feelings

Posture and gait

Clue to attitude, self-concept

Personal Appearance

Clue to socioeconomic status, culture, feelings

Uphold our professional appearance

Have to be non-judgemental when providing treatment

Distance

Indicates extent of familiarity = give enough personal space but not too far away

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 - multiple ages

Gender - different gender identities (be open minded)

Personal space

Territoriality - how close you can get to a person

Sociocultural factors - cultural competency

Roles and relationships

Therapeutic Relationships in Healthcare

Focus on improving the health of the client

Deals with presence and patient education

Provide necessary information about health, treatments and care

Need to explain exactly about what is going on during tests and examinations

Involve use of therapeutic communication

Therepautic Communication

Client centered = Main Goal (do they understand and are they comfortable)

Goal directed = What you want the patient to achieve and make sure they follow through

Strengthens therapeutic relationships = we serve as the patient's advocate and find out what they need

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Phases of the Therapeutic Relationship

Stage 1: Pre-interaction Phase

Gathering information prior to meeting the client

The nurse and the client do not have direct communication

Find out language, medical history, educational level, vitals, age, access to care, and support system

Age can make it harder to make some changes in patient education

Stage 2: Orientation Phase

Meeting the client; introductions; establishing rapport and trust

Make small talk and learn more about the patient

Stage 3: Working Phase

Active part of the relationship

Use therapeutic communication

Clarifies feelings and concerns with verbal and nonverbal communication

Spotlight is on the patient and how we're going to help this patient

Stage 4: Termination Phase

Conclusion of the relationship

See what the patient understands

You are not disappearing - can always offer assistance

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Key Characteristics of Therapeutic Communication

Empathy - viewing yourself in another person's place and seeing how they can help the problem

Sympathetic - feel bad for the person and only try to relate to the problem

Respect - for patient and yourself

Genuineness - open heart and open mind

Concreteness - educate and follow orders

Confrontation - don't want to lie to the patients and question doctors

Client Factors Affecting Effective Therapeutic Communication

Language barrier

Impaired cognitive skills

Sensory-perceptual alterations

assessing hearing and vision

be mindful of alterations

Physiological barriers

Enhancing Therapeutic Communication

Listen actively

Establish trust

Be assertive

Restate, clarify, and validate message

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 Communication

Get the person's attention - Hook

Express your concern - About the situation

State the problem

Propose an action

Reach a decision - See if they are compliant

Barriers to Therapeutic Communication

Too many questions

Close-ended questions

Asking "Why?" - Patients become intimidated

Changing the subject abruptly

Failing to listen

Failure to explore issues in detail

Expressing approval or disapproval

Offering advice

Giving false reassurance

Stereotyping

Using patronizing language