Nursing Management of Clients with
Stressors that Affect Communication
NUR101 Fall 2010
Lecture #2
K. Burger MSEd, MSN, RN, CNE
Therapeutic Communication
Different from Social Communication
 Foundation of Nurse-Client Relationship
 Planned
Directed toward a goal
Client-focused
Information sharing is unequal
Nurse guides the conversation

Elements of Communication
 Source
(encoder)
 Message
 Channel- Auditory , Visual, Touch
 Receiver (decoder)
 Feedback
Nurses Role



Therapeutic
communication
Helping relationship
between nurse and
patient
Utilizes interviewing
techniques to gather
information
(assessing)
PHASES of
HELPING
RELATIONSHIP
Orientation
 Working
 Termination

Factors that Influence Communication
 Developmental
Stage
 Gender
 Sociocultural
 Role/Occupation
 Time & Setting
 Personal
Space
 Physical Ability
 Mental State
 Emotional State
Effective Communication
 Starts
with unconditional
acceptance of client and a nonjudgmental attitude
 Friendliness, openness, respect
 Empathy, trust, caring,
competence
 Purpose, privacy, confidentiality,
comfortable environment, personal
space
Verbal Communication
 Transmitting
a message using the
spoken or written word
 Nurses
speaking to patients/
nurses/doctors or writing progress
notes/ nursing care plans
Nonverbal Communication
Transmission
without using
words - gestures
 Body language
 Touch
 Eye contact
 Facial expressions
 Posture

Gait
 Physical appearance
 Dressing/grooming
 Sounds
 Silence

Techniques Facilitating
Communication
Conversational
skills-See Handout
 Tone of voice
 Knowledgeable
 Confidence
 Flexible
 Clear/Concise
 Avoid semantics

Listening skills
 Alert/relaxed
 Indicate
attentiveness
 Think before you
speak
 Listen for themes


Honesty/Authenticity
Facilitating Communication
 Silence
 Touch
 Eye
contact
 Watch your body
language
 Humor
 Assertive
 Utilize
opportunities
 Use of supportive
statements
 Displaying
empathy
Blockers to Communication
Not perceiving pt.
as a human
 Not listening
 Changing the
subject
 False reassurance
 Being judgmental

Inappropriate
comments
 Clichés
 Asking yes/no
questions
 Giving advice
 Probing questions

See Handout
Interviewing Techniques
Used by nurses to obtain information
about pt.
 Useful in the helping relationship



FIRST STEP = attentive listening!!!
ALSO NEED: privacy, comfortable environment
Open ended questions
“What brings you to the clinic today?”
Closed questions/comments – yes/no
 Validating questions/comments

“Tell me whether my understanding of what you
said is correct…..”
Interviewing Techniques






Clarifying questions/comments
Used often in therapeutic communication
Reflective (re-stating) questions/comments –
use sparingly
Paraphrasing
Also conveys attentive listening
Direct questions
Good for history taking
Sequencing – helps with determining cause
effect relationships
Re-focusing
Guides conversation back to goal
AN EXAMPLE
During your shift in the ICU you have been
assigned to care for a man injured in a
motor vehicle accident in which he has
been charged with DWI.
The driver of the other car was killed.
The patient says to you:
“I feel so terrible about what has
happened”
Clarifying
“ARE YOU FEELING BAD ABOUT HAVING
BEEN DRINKING AND DRIVING?”
“ARE YOU FEELING BAD ABOUT HAVING
KILLED SOMEONE?”
“ARE YOU FEELING TERRIBLE ABOUT YOUR
INJURIES?”
“ARE YOU FEELING TERRIBLE ABOUT THE
FACT THAT YOU ARE GOING TO BE
ARRESTED AND GO TO JAIL?”
CONVEYING EMPATHY
USING CONGRUENT NON-VERBAL
COMMUNICATION TECHNIQUES:
TOUCH
EYE CONTACT
SILENCE
ALONG WITH:
SUPPORTIVE STATEMENTS
Impaired Communication
 Hearing
impaired
 Visually impaired
 Language barriers
 Physical barriers
 Cognitively impaired
 Unconscious
SEE P&P
p.1358
Box 49-9
Communicating with
Healthcare Team Members


Exchange of patient information
between healthcare givers must be
efficient, precise, and complete.
JCAHO Goal 2 of 2007 Patient Safety
Goals:
“Implement a standardized approach to “handoff” communications, including an opportunity
to ask and respond to questions”
SBAR
S
B
A
R

Situation
Background
Assessment
Recommendation
Can be used when:
Reporting patient condition to physician
Change of shift reports
Transfer to another unit or facility
SBAR Example: A call to a physician





Dr. Jones, this is Deb McDonald RN, I am calling from ABC
Hospital about your patient Jane Smith.
Situation: Here's the situation: Mrs. Smith is having
increasing dyspnea and is complaining of chest pain.
Background: She is 2 days post-op total knee replacement.
About two hours ago she began complaining of chest pain.
Her pulse is 120, blood pressure 128/54 and she is restless
and short of breath.
Assessment: My assessment of the situation is that she
may be having a cardiac event or a pulmonary embolism.
Recommendation: I recommend that you see her
immediately and that we start her on 02 stat.
Using SBAR for
Change of Shift Report