Professional Documents
Culture Documents
convey, and share information about” (Webster’s New Collegiate Dictionary, 1974, p.
emotions, opinions, or information by speech, writing, or signs. Nurses can use this
support, and acquire essential information necessary for survival, growth, and an overall
facilitate therapeutic interactions, assess client need, and implement interventions that
with primary caregivers are the origin of trust, security and safety, and lifelong
2003).
Research findings indicate that effective communication between the nurse and
physician enhances problem solving and decision making and improves treatment
outcomes (Boyle & Kochinda, 2004; Schmidt & Svarstad, 2002). In contrast, negative or
poor communication between the nurse and physician has a deleterious impact on staff
morale, staff and client satisfaction, treatment outcomes, and quality of care (Larson,
thoughts, feeling, and other information. It is the interchange of information between two
or more people; in other words the exchange of ideas or thoughts. It is where thoughts
are conveyed to others not only by spoken or written words but also by gestures or body
actions. It can be transmission of feelings or a more personal and social interaction
individual affects another. The two main purpose of communication are to influence
involving the sending and the receiving of a message. The sender a person or groups
who wish to convey a message to another can be considered the source-encoder. This
term suggest that the person or group sending a message must have an idea or reason
communicating (source) and must put the idea or feeling into a form that can be
transmit the message such as which language and words to use how to arrange the
words to use how to arrange the words and what tone of voice and gestures to use. The
said or written the body language that accompanies the words and how the message is
transmitted. The medium used to convey the message is the channel and it can target
any of the receiver’s senses. It is important for them to be appropriate for the message
and it should help make the intent of the message clearer. The receivers the third
component of the communication process is the listener who must listen observe and
attend. This person is the decoder who must perceive what the intended (interpretation).
Perception uses all of the senses receive verbal and nonverbal messages. The fourth
component of the communication process the response is the message that the
receiver returns to the sender is also called feedback. Feedback can be either verbal or
non verbal or both. Nonverbal examples are a nod of the head or a yawn. Either way
which is largely conscious because people choose the words they use. The words used
education. As a result countless possibilities exist for the way ideas are exchange. An
feelings can be conveyed when people talk. When choosing words to say or write,
body language. It includes gestures body movements use of touch and physical
about what a person is felling than what is actually said because nonverbal behavior is
through their senses. Teach parents about the importance of touch. They respond best
to high-pitched soft or gentle tone of voice and eye contact .While in toddlers and
preschoolers; allow time for them to complete verbalizing their thoughts without
interruption. Provide them a simple response to question because they have short
attention spans. For them, drawing a picture can provide another way for the child
communicates. In school-age children talking to them at his or her eye level is important
to increase their self- esteem. Include the children in the conservation when
communicating with the parents. For adolescent, it is important to take time to build
rapport, use active listening skills and project nonjudgmental attitude and non reactive
There are several factors which influences the communication process; the
psychosocial and intellectual development moves through the stages across the life
span. Knowledge of a client’s development stage will allow the nurse to modify the
message accordingly. The use of dolls and games with simple language may help
abstract thinking skill a more detailed explanation can be given where as a well
information provided. Older clients are apt to have a wider range of experiences with the
health care system which may influence their response and understanding. With aging
also come changes in vision and hearing acuity that can affect nurse-client interactions.
The roles and the relationship between sender and receiver affect
communication process. Roles such as nursing student and instructor client and
physician or parent and child affect the content and responses in the communication
process. Choice of words sentence structure and tone of voice vary considerably from
the role to the role in addition the specific relationship between the communicators is
significant. The nurse who meets with a client for the first time communicates differently
from the nurse, who has previously developed a relationship with that client,
Temperature extremes excessive noise and a poorly ventilated environment can all
interfere with communication Also lack of privacy may interfere with a clients
communication about matter that clients considers private. Environmental distraction
constructive relationship between the nurse and the client. Unlike the social relationship
where there may not be a specific purpose of direction the therapeutic helping
relationship is client and goal directed. Nurses needed to respond not only the content
of client’s verbal message but also the felling expressed. It is important to understand
how the clients view the situation and feels about it before responding.
There is a helping relationship between the nurse and the client. Nurse client
facilitating process that strives to achieve two basic goals (Egan 1998). It may be a way
which helps client manage their problems more effectively and develop unused or
underused opportunities more fully. And also, it helps client become better at helping
phases, each characterized by identifiable tasks and skills. The relationship must
progress through the stages in succession because each builds on the one before.
most situations, the nurse has information about the client before the first face-to-face
meeting. Planning for the initial visit may generate some anxious and feeling specific
because it sets the tone for the rest of the relationship. During this initial encounter, the
client and the nurse closely observe each other and form judgments about the others’
behavior. The tree stages of this introductory phase are opening the relationship,
clarifying the problem, and structuring and formulating the contact. Other important
tasks of the introductory phase include getting to know each other and developing a
degree of trust.
During the working phase of a helping relationship, the nurse and the client begin
to each other as unique individuals. They begin to appreciate this uniqueness and care
about each other. Caring is sharing deep and genuine concern about the welfare of
another person. Once caring develops the potential for empathy increases.
The working phase has two major stages: exploring and understanding thought
and feelings, and facilitating and talking action. The nurse helps the client to explore
thought, feelings, and actions and helps the client plan a program of action to meet
reestablished goals. In exploring and understanding thoughts and feelings, the nurse
confrontation for this phase of the helping relationship. During the first stage of the
working phase, the intensity of interaction increases, and feelings such as anger,
filled with ambivalence. However, if the previous phases have evolved effectively, the
client generally has a positive outlook and feels able to handle problems independently.
On the other hand, because caring attitudes have developed, it is natural to expect
some feeling loss, and each person needs to develop a way of saying good-bye.
Therapeutic communication refers to a healing or curative dialogue between
people. This is particularly significant to the nurse because it is the basis of therapeutic
facilitates problem solving, change, learning, and growth. The nurse-client relationship
reciprocal process enables the nurse to effect adaptive changes in the client.
(Travelbee, 1971)
harmony or accord between people. This initial alliance is vital to the formation of trust.
As the therapeutic relationship evolves, so does the client’s willingness to trust and
People are social beings. Emotional ties foster a sense of identity, comfort,
security, and support. From birth to death, relationships with others are central to human
existence.
neurobiological and psychosocial factors into the communication process enhances the
nurse-client relationship.
into gurgles and variations in sounds and sucking rates that convey different
needs.
2. The second stage involves cry vocalizations and variations in sounds and
pitches.
3. The third stage consists of babbling, which varies with culture and is influenced
4. The evolution of “true speech” begins in the fourth stage, which ends the first
applying Piaget’s theory, nurses can interpret a child’s behaviors (both verbal and
motor gestures between the infant and the primary caregivers (Condon &
understand the meaning of the message. The message is processed and decoded and
understood by the recipient, or decoder. In essence, people must convey clear
The value of communication lies in the ability to use various symbols or ideas to
communication.
yet not enough attention in nursing is focused on this area in communication training
programs (Krujiver, Kerkstra, Franke, Bensing, & Van de Wiel, 2000). The old adage,
society.
meaning of feelings.
influenced by various factors that direct the communication process, these includes
attitude, trust, empathy, language, culture, perception and observation, self-concept and
The nurse’s interest, acceptance, and attitude toward the client play major roles
relationship. Clients need to feel valued and respected. The nurse conveys trust and
is more likely to be cooperative and participate in treatment when the nurse uses calm,
concerned approach.
The concerned and caring nurse generates trust. The client feels confident and
review of the literature reveals a lack of clarity and consensus on what exactly is meant
by “empathy” (Reynolds, Scott, & Austin, 2000), yet it is always viewed as a critical
This powerful communication tool conveys “I am with you and I have a sense of
what you are experiencing,” without totally losing one’s identity. More specifically
though, empathy involves the sensitivity to current feelings and the ability to
Verbal cues consist of using words to communicate ideas, thoughts, and feelings.
Language is a complex phenomenon and the tool we use to communicate with each
and validate perceptions of the world and ourselves by sharing feelings and thoughts.
not be possible to know all cultural nuances, being attentive to understanding various
influences may facilitate the delivery and quality of health care. Communication is
difficult at best, but when the sender and receiver are from different cultures, the
Perception is the way events are interpreted through sensory stimulation. Past
and present experiences and innate traits that validate or correct the receiver’s
feelings respond to thoughts. In the following example, the nurse’s perception interferes
Self-concept refers to one’s beliefs and feelings about self. It serves as a frame
of reference for life experiences and perceptions of the world. It evolves over time and
arises from interactions with others. Self-concept plays a major role in adaptation and
Client interactions normally produce anxiety in both the client and the nurse.
psychologically and biologically. Response to anxiety varies among people and can be
both motivating and distressful. Lower levels of anxiety increase alertness and enhance
experiences, nurses need to take steps to help clients handle anxiety. Reducing anxiety
He believed that human beings are constantly changing positions and that social
interactions are affected by space. He defined space or zone norms from a Western
public speaker). It is important for the nurse to respect comfort zones and be aware of
A question often posed by students and nurses is, “What are therapeutic
communicate effectively is an art that uses basic listening and communication skills.
The nurse can use this collaborative interaction to assess the client’s needs, formulate
needed by the nurse to bear in mind, favorable reception of another person by implying
a client has the right to exist, to live and to have somebody to care about. Second is
interest, nurses communicate when they are genuinely curious and express a desire to
know another person. Interest is conveyed by asking about those aspects of a client’s
life that others often reject. Another is show consideration for another by communicating
their willingness to work with the client and accept the client’s ideas, feelings, and rights.
This is all conveyed with respect. Next is honesty, nurses must show consistency, open
and frank. Nurses do not take refuge behind a professional mask but instead
communicate with the client as an authentic person. Nurses must be honest and
nondefensive about their thoughts and feelings that they discover through self-
being specific, to the point and clear when they communicate with the client should be
practiced. Client’s who speak in vague, general, unfocused ways are helped to be more
specific and focused. And the sixth is assistance, nurses assist clients by committing
time and energy to therapeutic relationships. They convey that they are present and
available and have tangible aid to offer that will help the client to choose and develop
permission by conveying the massage that it is acceptable to try new ways of behaving.
Often client’s are afraid to choose freely and autonomously. They are bound by
misconceived archaic rules and magical thinking and need to be given permission and
encouragement to see and to things in new ways. Lastly the principle of protection,
nurses protect clients by ensuring client’s safety, and assumes responsibility of working
with the client to anticipate trouble spots with new behavior and develop effective ways
good therapeutic communication. The nurse offers solutions and advices the client
about what course of action to take. This approach denies the client’s ability to formulate
solutions to problems and assume responsibility for direction of his/her life. Second is
giving assurance, nurses offer information to the client that it is not based on fact and
truth and differs from conveying information or giving realistic feedbacks. Reassurance
denies the client’s right to the feelings being experienced and closes off communication
about them. Next is changing the subject. The nurse diverts the focus of the interaction
at crucial times to something less threatening. Changing the subject usually occurs
when the nurse is unwilling or unable to lessen the painful feelings being expressed by
the client. Also being judgmental is a barrier to good therapeutic communication. The
nurse respond to the client with value-laden judgments that come form the nurses value
system. The fifth barrier is giving directions. The nurse approaches the client with
specific directions to be followed and frequently lectures the client about advisability of
following this course of action. Sixth is excessive questioning, on the part of the nurse it
controls the nature of range of the client’s responses. The nurse can be perceived by
the clients as an interrogator who is demanding information with out respect for the
client’s ability or readiness to respond. Another one is using emotionally charged words.
The nurse uses emotionally charged words with the client who cannot tolerate or accept
such feelings. The client may withdraw physically and emotionally. Next is challenging,
nurse sometimes feels that if the client is challenged to prove unrealistic ideas or
perception, the client will realize that there is no proof to support such ideas and will be
Offering trite expressions and meaningless clithes as responses diminishes the value of
the nurse-client interaction. The tenth barrier is self focusing behavior. It is characterized
feelings, or actions. And lastly is double-bind message. The nurse delivers two
conflicting messages, one verbal, the other is nonverbal. The nonverbal message
Distance: 12 to 25 feet. It is important for the nurse to respect comfort zone and be
communicate effectively is an art that uses basic listening and communication skills.
The nurse can use this collaborative interaction to assess the client’s needs, formulate
techniques include:
Active listening is the basis of all nurse client interactions. Listening is more than
hearing. It is a dynamic and active process that requires enormous concentration and
energy. It literally means using all the senses to assess verbal and non-verbal message.
Active Listening conveys concern and respect for the client. It fosters a trusting
relationship that encourages the client to express feelings and share thought. “Knowing
the patient” and encouraging her to “tell their story” (Chamber Evans , Stelling &
identifying barriers to active listening. The art of active listening requires perseverance
and patience.
Questioning is a valuable tool that nurse use to encourage the expression and
feelings and self-disclosure and to gain insight into the meaning of present stressors.
The basis of the client response depends on her level of trust and security or in the
comfort with questions. Nurse can put their clients at ease by introducing themselves
and calling them by name, making eye contact and shaking hands at the same time
helps nurses connect with clients both verbally and nonverbally. This establishes a safe
environment that promotes trust, care, and empathy. The nurse can use questioning as
interaction between people. The likelihood of confusion exists in all human interactions.
involves listening to the client basic message and repeating themusing similar words.
This technique focuses on the content of the message. It affords the nurse with a
Touching is the key to survival, particularly during infancy, because it conveys trust,
Therapeutic touch enables the client to experience trust, reassurance, and acceptance.
practice and skill to master. Silence can be use to help clients explore the meaning of
Physiologically, it stimulates the circulatory and respiratory system, relaxes the muscle
and increase the productions of endorphins. Humor helps client express their feeling,
thereby reducing anxiety and tension or stress (King, Novic, & Citrebaum, 1983,
communication. This technique is useful when clients are vague and need assistance
with goal directed communication. Focusing is useful when clients don not express their
feelings clearly, when they ramble, or when they discussed several issue at one time.
associate this term with conflict or angry discussion between opposing bodies. In reality,
is and art that involves pointing out contradictions or incongruities between feelings,
from the nurse and client. Major points are reviewed and used to generate future client
outcomes.