Communication Skills for Nursing
How to make best use
of YOU!
Objectives
Discuss therapeutic nursing communication techniques
Identify therapeutic and non-therapeutic responses.
Discuss basics of good communication.
Discuss responsibility of the LVN in communicating with
patients, instructors, staff members and physicians.
Identify barriers to effective communications
Discuss emotional needs of patients
Describe two types of communication.
Differentiate between sympathy and empathy.
Discuss the use of verbal and non-verbal communication.
What is Nursing?
Caring for individuals
– Understanding
– Action
– Concern
Knowledge
Skill
Relationships
Social
Business
Therapeutic
The Therapeutic Relationship
Goal oriented
Focused on the patient
Time limited
Characteristics of the Therapeutic
Relationship
Unconditional acceptance
Empathy
Attending and listening
Open ended questioning
Silence
Concreteness
Professionalism
Warmth and genuiness
Shared agreement on goals
Integrate humor as appropriate and helpful
Phases of the Therapeutic Relationship
Orientation
Working
Termination
Establishing a Therapeutic
Relationship
Tips for Building Rapport with Your Patient
– Become visible.
– Anticipate needs.
– Be reliable.
– Listen.
– Stay in control.
– Use self-disclosure.
– Treat each patient as an individual.
– Use humor when appropriate.
– Educate.
– Give the patient some control.
– Show support with small gestures.
Holistic Nursing
View people as whole individuals
The patient is NOT a disease process
All aspects of the individual must be taken
into consideration
All needs addressed
Florence Nightingale, who believed in care that focused on unity,
wellness, and the interrelationship of human beings and their
environment, is considered to be one of the first holistic nurses.
What is communication?
From the Latin communicare, meaning to
share, to impart, to partake,
to make things common, communion,
community
Communication Techniques
Therapeutic
– An exchange of information that facilitates the
formation of a positive nurse-patient relationship
and actively involves the patient in all areas of the
nursing process
Nontherapeutic
– Prevents the patient from becoming a mutual
partner in the relationship and may place the
patient in a passive role
Overview
Requirements for Communication
– Sender
– Receiver
– One-way communication: highly structured with the
sender in control and expecting and getting very little
response
– Two-way communication: requires that both the
sender and the receiver participate equally
Fact or Fiction?
1. Listening is a passive activity.
2. The audience does not play a role in communication.
3. People who speak the same language do not have problems
with communication.
4. Speaking directly is universally acceptable.
5. The more words used in communicating, the better.
6. It’s the speaker’s job to make me understand.
7. Communication is an inborn talent. Either you have it or you
don’t.
8. Nonverbal signals are universally understood.
9. Silence is not feedback.
10. Communication means giving information.
Communication 1A
“The message is received according to the
mode of the receiver.”
St. Thomas Aquinas
Communication in Nursing
To establish nurse-patient relationship
To be effective in expressing
interest/concern for patient/family
To provide health care information
Challenges to Communication
Anxiety
Anger
Culture
Essential skills
Personal insight
Sensitivity
Knowledge of communication strategies
Levels of communication
Social: safe
Structured: interviewing, teaching
Therapeutic: patient focused, purposeful, time limited
Nurse comes to know the patient as a unique individual.
Patient comes to trust nurse
Context set for nurse to provide care and to help patient
identify, resolve, or adapt to health problems
Types of Communication
Verbal: conscious use of spoken or written
word
Choice of words can reflect age, education,
developmental level, culture
Feelings can be expressed through tone,
pace, etc.
Types of Communication
Verbal communication: spoken messages
– Speak clearly
– Speak professionally
– Speak only about what you know
– No slang
– No medical jargon
– Colloquial expressions may be appropriate
20
Types of Communication
Non-verbal: use of gestures, expressions, behaviors
(body language)
85% of communication
Less conscious than verbal
Requires systematic observation and valid
interpretation
Nurse must be aware of personal style
How we communicate non-verbally:
physical appearance, posture/gait, facial
expressions, gestures, touch (tactile defensiveness)
Types of Communication
Nonverbal communication: body
language
– Expressions, posture, movements, gestures,
physical appearance
– Clues to the truth of the spoken message
– Indicators of patient discomfort
– Physical appearance is a part of nonverbal
communication
22
Communication Techniques
Nonverbal Therapeutic Communication
– Listening
Most effective methods but also most difficult
Conveys interest and caring
Active listening
– Requires the nurse’s full attention
Passive listening
– Nurse attends nonverbally to what the patient is saying through
eye contact and nodding, or verbally through encouraging
phrases such as “uh-huh” or “I see”
Communication Techniques
Nonverbal Therapeutic Communication
– Silence
Most underused
Requires skill and timing
Can convey respect, understanding, caring, support; often
used with touch
Gives you time to look at nonverbal responses
Communication Techniques
Nonverbal Therapeutic Communication
– Touch
Must be used with great discretion to fit into sociocultural
norms and guidelines
Can convey warmth, caring, support, and understanding
Nature of the touch must be sincere and genuine
If the nurse is hesitant or reluctant to touch, it may be
interpreted as rejection
Types of Communication
Affective communication: feeling tone
– Tone of communication
– Emission of energy
26
Communication Techniques
Nonverbal Therapeutic Communication
– Conveying acceptance
Patient may be reluctant to share information because
he or she feels the nurse may disapprove of the
patient’s values, beliefs, or practices or may even fear
rejection
Acceptance is the willingness to listen and respond to
what a patient is saying without passing judgment
The nurse must be careful not to nonverbally
communicate disapproval through gestures or facial
expressions
Relationship between verbal and non-
verbal communication
Congruency: are verbal and non-verbal
messages consistent?
Nurse states observations and validates with
patient
Nurse to crying patient: "You seem upset
today."
Patient: "I'm fine thanks."
Styles of Communication
Manner in which a message is communicated will
greatly affect the mood and the overall outcome of
an interaction
Assertive Communication
– Interaction that takes into account the feelings
and needs of the patient, yet honors the nurse’s
rights as an individual
Aggressive Communication
– Interacting with another in an overpowering and
forceful manner to meet one’s own needs at the
expense of others
Styles of Communication
Unassertive Communication
– Sacrifices the nurse’s legitimate personal rights to
meet the needs of the patient at the expense of
feeling resentful
Factors that affect communication
Nurse needs to assess and consider when
communicating with patient:
culture, developmental level, physical &
psychological barriers, personal space
(proxemics), territoriality, roles and
relationships, environment, attitudes and
values, level of self esteem
Communication Strategies
Active Listening
Most important part of any therapeutic
communication
Key factors include purpose, disciplined
attention, and focus
A common mistake is to listen to the words,
but not really hear the words
32
Communication Strategies
Active Listening Behaviors
Restating
Clarification
Reflection
Paraphrasing
Minimal encouraging
Silence
Summarizing
33 Validation
Communication Techniques
Verbal Therapeutic Communication
– Closed questioning
Focuses and seeks a particular answer
– Open-ended question
Does not require a specific response and allows the
patient to elaborate freely
– Restating
Nurse repeats to the patient what the nurse understands
to be the main point
Communication Techniques
Verbal Therapeutic Communication
– Paraphrasing
Restating the patient’s message in the nurse’s own
words to verify that the nurse’s interpretation is correct
– Clarifying
Restating the patient’s message in a manner that asks
the patient to verify that the message received is
accurate
– Focusing
Used when more specific information is needed to
accurately understand the patient’s message
Communication Techniques
Verbal Therapeutic Communication
– Reflecting
Assists the patient to “reflect” on inner feelings and
thoughts
– Stating observation
Validates the accuracy of observation
– Offering information
Nurse should make this interaction two-way
– Summarizing
Review of the main points covered in an interaction
Communication Strategies
Types of Questions
Open-ended questions
– Permit variety of responses
– Often begin with what, where, when, how, or why
“What happened to your leg?”
Closed-ended questions
– Require a specific answer
“When did you first notice the pain?”
Focused questions
– Provide more definitive information
“On a scale of 1 to 10, with 10 as the worst possible pain, how
37 would you rate your pain right now?”
Use of Humor
“Laughter is the best medicine”
Laughter is a psychological and physical release
It can enhance feelings of well-being, reduce
anxiety, and increase pain threshold
The use of humor can be effective and helpful, but it
must be used with caution and discretion
Never appropriate to laugh at—only with—a person
Factors Affecting Communication
Posturing and Positioning
– Where and how the nurse sits or stands conveys
a message to the patient
– The most therapeutic posture and positioning is
for the nurse to assume the same position and
level as the patient
Factors Affecting Communication
Space and Territoriality
– Comfort zone
Distance between two or more individuals that must be
maintained to guard against personal threat or
intimidation
– Four personal space zones
Intimate zone: 0 to 18 inches
Personal zone: 18 inches to 4 feet
Social zone: 4 to 12 feet
Public zone: 12 feet or more
Factors Affecting Communication
Environment
– Should provide a calm, relaxed atmosphere
Level of Trust
– Trusting relationship essential for effective nurse-
patient interaction
Language Barriers
– Interpreter if available; messages must be kept simple
Culture
– Significant component of a patient’s psychosocial well-
being
Factors Affecting Communication
Age and Gender
– A significant age difference between the nurse
and the patient may be a barrier to
communication.
– Male and female patterns of communication are
often related to cultural, familial, and lifestyle
patterns.
Factors Affecting Communication
Physiologic Factors
– Patients may experience physiologic factors that
can interfere with effective communication.
Pain
Altered cognition
Impaired hearing
Psychosocial Factors
– Stress
– Grieving
– Fear/anxiety
Communication Strategies:
Active Listening is most critical strategy
Strategies that encourage Conversation and Elaboration:
broad opening statements, general leads, reflecting, open-
ended and directing questions
Strategies that help patient express thoughts and feelings:
stating observations, acknowledging feelings, reflecting, using
silence
Strategies that insure mutual understanding:
clarifying, validating, verbalizing implied thoughts and feelings,
focusing, using closed questions and summary statements
Blocks/Barriers to Communication
Behaviors or comments of the nurse that have a
negative effect:
Not Listening is most harmful behavior!
reassuring clichés, giving advice, expressing
approval/disapproval, requesting an explanation
(asking why?), defending, belittling feelings,
stereotyped comments, changing the subject
Blocks to Communication
Nursing Process
– Phases of the nursing process
– Nursing diagnosis “Impaired verbal
communication”
Describes “decreased, delayed, or absent ability to
receive, process, transmit, and use a system of
symbols” (Ackley & Ladwig, 2008).
Communication in Special
Situations
Ventilator-Dependent Patients
– Assess the patient’s ability to use a particular
alternative method of communication
Communication board
“Signal system”
Aphasic Patients
– Expressive aphasia
The patient cannot send the desired message
– Receptive aphasia
The patient cannot recognize or interpret the message
being received
Communication in Special
Situations
Alternative Methods of Communication
– Lip reading
– Sign language
– Paper and pencil/magic slate
– Word or picture cards
– Magnetic boards with plastic letters
– Eye blinks
– Computer-assisted communication
– Clock face communicator
Communication in Special Situations
Unresponsive Patients
– Anyone interacting with the unresponsive patient
should assume that all sound and verbal stimuli may
be heard
– Speak to the patient as if he or she were awake
– Always explain to the patient any procedure or activity
that is to take place involving the patient
Male/Female Differences
Most males and females follow certain
patterns with regard to:
– Conversation
– Head movements
– Smiling
– Posture
Differences in patient communication have
important nursing implications
50
Cultural Differences
Understanding cultural differences will help
nurses respond respectfully and
therapeutically
Differences apply generally to groups as a
whole
Individual patient differences should still be
identified
51
Role Changes for the Patient
Dependent position
Set tone by providing respect and
information; do not use first name unless
specifically requested by patient
Avoid medical jargon
Ask if patient has questions
Be sensitive to personal or environmental
factors that may cause anxiety
52
Life Span Communication
Each age group has different
communication needs
– Infants
Cries have different meanings
Influenced by the sound of the voice
Respond to calm, low tones
– Preschool
Cannot verbally express frustration, leading to tantrums
Communicate by pointing
Can help if coached
53
Life Span Communication
– School-age
Can be part of many discussions
Can use drawings or pictures to explain an illness
– Teenage
Extend same courtesy as to adults
Encourage expression of feelings
54
Life Span Communication
– Adult
Collect data at all three communication levels
Limit questions to medical areas
– Elderly
Check which side is best for hearing
Read directions aloud
55
Conflict Resolution
Accept conflict as a natural part of life
Shift your own attitude and behavior
Take time to think critically before reacting
Treat conflict as an opportunity to voice your own opinion
and listen to the other side of the story
Choose your approach
Listen and learn
Discover what is important
Respect each other
Find common ground, generally the patient’s highest
56 good
Electronic Communication
Fax machines
Computer patient charting
E-mail
– Keep sentences and paragraphs short; check
spelling, punctuation
– Skip a line to separate topics
– Send message to the right person
– Write “subject” line carefully
– Be specific
– Be cautious with humor
57
– Avoid all CAPS
Electronic Communication
Cell Phones and Text Messaging
Shut off cell and text messaging phones
during class and clinical
Avoid behaving in ways disruptive to the
instructor and other students
Identify yourself
58
